Evaluation of the mediterranean diet cost in Extremadura: adherence and relationship with available income

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute - Spain

Background

Cardiovascular diseases are the leading cause of death in developed countries. In this context, the Mediterranean diet (MD) is widely recognized as cardioprotective, although its implementation cost has been little studied and rarely employed as an argument for debate.

Although previous Spanish studies have corroborated a higher monetary cost associated with increased adherence to the MD, there exist large disparities among studies, and none of them has related the cost of MD to available income, which is highly relevant for assessing the degree of affordability by families.

Purpose

The aim of this study is twofold. First, to estimate the cost and degree of adherence of the MD in a population of Extremadura. Second, to provide evidence on the cost of the MD in relation to available incomes.

Methods

A population study including 2.833 subjects between 25 and 79 years old (54% women), randomly selected from Don Benito-Villanueva de la Serena (Badajoz, Spain). Diet questionnaire contained 175 food items and 7 items related to alcoholic beverages. Consumption frequencies were translated in terms of grams or millilitres. Price for each item was obtained using price supermarket comparators from the same geographical area. Total monthly cost was obtained using monthly quantities consumed and the price of each category.  Final cost was related to Panagiotakos adherence degree and to available income. Data of available income was obtained from the Income Tax Statistics by municipality.

Results

Median monthly cost was EUR 203.63 (IQR 154.04-265.37): 216.91 for men and 191.22 for women. Median monthly cost per age cohort showed an inverted U-shape, with a maximum in the 45-54 years-old cohort (EUR 212.1; IQR 155.47-274.63) and a minimum for the 75-79 years-old cohort (EUR 179; IQR 130.21-224.99). Median monthly cost was very similar for primary, secondary and higher educational levels (208.18, 206.57 and 205.70, respectively), but 14% lower for those without primary studies. MD cost was lower in rural compared with urban areas (188 versus 223 euros, respectively)

The percentage of population showing a high MD adherence was 59% whereas the percentage with a low adherence was 12%. The cost associated with a high MD adherence was EUR 228.38.

The average cost represents 14% of the available income, ranging from 10.5% for the group with low MD adherence, to 15.72% for the group with a high adherence.

Conclusions

Higher adherence to the MD can reach almost 20% of the available income. This can lead to low-income families opting for cheaper, energy-dense, and consequently, less healthy dietary patterns. Emphasis should be placed on education strategies to recreate the MD at an affordable price or to introduce changes to consumer taxes (VAT) that favor DM pattern.

P1638Predictors of in-hospital and late mortality in acutely decompensated chronic heart failure

Background

Heart failure (HF) is a global pandemic, and the cause of the greater health expenditure on hospitalization.

Purpose

To determine, in patients admitted due to decompensated heart failure (dHF), the predictors of in-hospital and late all-cause mortality.

Methods

Retrospective and longitudinal observational study of consecutive patients admitted with a diagnosis of dHF in a General Hospital between 2000–2015. Primary objective was in-hospital and late mortality.

Results

A total of 3705 patients were included (76.9 + 10.1 years, 54.1% women). Diabetes was present in 1611 (43.5%) patients, hypertension in 3210 (86.6%), active smoking in 221 (6%), COPD in 989 (26.7%), neoplasms in 415 (11.2%), chronic renal failure (CRF) in 628 (17%), previous myocardial infarction (pMI) in 449 (12.1%), stroke in 416 (11.2%), previous heart failure (pHF) in 1015 (27.4%), atrial fibrillation in 1672 (45.1%). A total of 239 (6.5%) lived in a nursing home (NH). The rate of 6-months readmission due to heart failure was 473 (12.8%). The in-hospital all-cause mortality rate was 9.3% (345). During a median follow-up of 930 days (RI 230–2611), 2165 (58.4%) patients died.

The following variables were independent predictors of in-hospital mortality (Odds ratio, 95% CI): age 1.03 (1.02–1.05), basal creatinine 1.18 (1.01–1.39) and urea 1.014 (1.011–1.018) (model AUC 0.78 (0.75–0.81)). We identified the following predictors of late mortality (Hazard ratio, 95% CI): age 1,029 (1,022–1,035), diabetes mellitus 1,13 (1,02–1,25), COPD 1,15 (1,03–1,28), neoplasms 1,17 (1,008–1,361), pMI 1.19 (1.02–1.38), pHF 1.25 (1.12–1.39), NH 1.24 (1.03–1.49), readmission 1.73 (1.51–1.97), urea 1.003 (1.001–1.005) (model AUC 0.73 (0.71–0.75)).

Conclusions

In-hospital mortality was significantly associated with age and markers of renal function, while for late mortality the predictors were comorbidities, hospital readmissions and living in a nursing home.

Non-proteinuric diabetic nephropathy is the main cause of chronic kidney disease: Results of a general population survey in Spain

BACKGROUND

Diabetic nephropathy traditionally produces significant proteinuria prior to the development of renal impairment. However, this clinical paradigm has recently been questioned. The current study evaluated the impact of diabetes mellitus on the prevalence of renal disease in general population.

METHODOLOGY

Data from of the HERMEX survey, an observational, cross sectional, population based study were used. The final sample included 2813 subjects (mean age 51.2 years, 53.5% female). Four hundred patients have diabetes. Urinary albumin excretion (UAE) rate was analyzed and glomerular filtration rate (GFR) was estimated using the CKD-EPI formula.

RESULTS

Among participants without diabetes, 2.9%(2.2-3.6) had a GFR < 60 ml/min. Prevalence of abnormal UAE in population without diabetes was 3.3% (2.6-4.0). The global prevalence of renal disease was 5.6%(4.8-6.6). Prevalence of GFR <60 ml/min in subjects with diabetes was 8.8%(6.4-11.9)(p<0.001,Chi-square test). Prevalence of abnormal UAE in population with diabetes was 14.1%(7.7-19.8)(p< 0.001,Chi-square test). CKD prevalence was 20.3%(16.6-24.6)(p<0.001,Chi-square test). The logistic regression analysis showed a positive independent association of CKD with age, high blood pressure and albuminuria. No significant relationship was found with diabetes mellitus CONCLUSIONS: CKD is more prevalent in population with diabetes. Nevertheless, most of patients with diabetes and CKD have no albuminuria. An increased cardiovascular burden seems to produce this clinical presentation.

The H.U.G.E. Formula (Hematocrit, Urea, Sex) for Screening Chronic Kidney Disease (CKD) in an Age-Stratified General Population

OBJECTIVES

AIM

To evaluate the screening power of the HUGE formula for the detection of chronic kidney disease (CKD) in a Spanish population sample obtained from the HERMEX study, a survey of cardiovascular risk factors carried out in the region of Extremadura, stratified by age.

DESIGN AND METHODS

This was an observational, cross-sectional, population-based study. The final sample included 2,813 subjects selected from Health Care System records. Anthropometric data and cardiovascular risk factors were recorded. Hematocrit, urea, creatinine and microalbuminuria were analyzed, after which the HUGE formula was applied. Renal function, assessed as eGFR based on serum creatinine, was estimated following the MDRD-4 formula.

RESULTS

Using the HUGE formula, the estimated prevalence of CKD was 2.2% (men 2.2%, women 2.1%). The prevalence of CKD increased with age (5.0% in persons aged 60- 70 years and 9.6% in individuals over 70 years of age, p < 0.001) whereas with the MDRD formula the prevalence values were 9.8% and 15.5% respectively. The HUGE formula was seen to be highly specific (0.99). CKD was more common in persons >70 years, obese subjects, hypertensive patients, dyslipidemic subjects and those with microalbuminuria. Multivariate analysis revealed an independent negative association of CKD as the dependent variable with SBP, serum triglyceride levels and microalbuminuria.

CONCLUSIONS

The HUGE formula allows the prediction of CKD in the general population to be honed without relying on serum creatinine levels. This method was found to have a higher specificity than the MDRD-4 formula. Moreover, it could reduce the excessively extensive diagnostic suspicion of CKD in women.

The HUGE formula (hematocrit, urea and gender): association with cardiovascular risk

OBJECTIVES

To evaluate the relationship between chronic renal failure (CFR) defined through HUGE (hematocrit, urea and gender) formula score and the patient's cardiovascular risk measured through cardiovascular disease antecedents such as ischemic cardiopathy, cerebrovascular disease and peripheral arterial disease.

DESIGN AND METHODS

The sample consisted of 2,831 subjects. Mean age was 51.2±14.7 years and 53.5% were female. Serum creatinine, urea, hematocrit and 24h proteinuria were analyzed. HUGE score was calculated from gender, urea and hematocrit. GFR was estimated from uncalibrated serum creatinine using the abbreviated Modification of Diet in Renal Disease equation (MDRD-4). UAE was measured in first morning urine sample.

RESULTS

Using HUGE formula 2.2% (n = 61) of subjects had CRF. Of them, 12 (19.7%) had cardiovascular disease history. Among patients without CRF (n = 2770), 194 subjects had history of previous cardiovascular diseases (0.07%; p < 0.001 Square Chi test). Using the MDRD-4 formula 4.0% of subjects (n = 113) had a GFR < 60 ml/min. Of them, 18 (15.9%) had cardiovascular disease history. Among patients without CRF (n = 2718), 188 subjects had history of previous cardiovascular diseases (0.07%; p < 0.001 Square Chi test). Odd's ratio for cardiovascular diseases using HUGE definition of CRF was 3.25 (p = 0.001, Mantel-Haenszel test). CFR was associated to higher pulse pressure (PP) and increased urinary albumin excretion.

CONCLUSIONS

A significant cardiovascular risk was associated to the diagnosis of CRF through HUGE formula. This relation was closer than the obtained using MDRD estimated GFR in spite of a bigger sample. HUGE formula seems to be a useful tool for diagnosing CRF and evaluate the cardiovascular risk of these patients.