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Castro-Espin C, Bonet C, Crous-Bou M, Nadal-Zaragoza N, Tjønneland A, Mellemkjær L, Hajji-Louati M, Truong T, Katzke V, Le Cornet C, Schulze MB, Jannasch F, Masala G, Sieri S, Panico S, Di Girolamo C, Skeie G, Borch KB, Olsen KS, Sánchez MJ, Amiano P, Chirlaque MD, Guevara M, Sund M, Bodén S, Gunter MJ, Gonzalez-Gil EM, Weiderpass E, Aguilera-Buenosvinos I, Tsilidis KK, Heath AK, Aune D, Dossus L, Agudo A. Association of Mediterranean diet with survival after breast cancer diagnosis in women from nine European countries: results from the EPIC cohort study. BMC Med 2023; 21:225. [PMID: 37365585 PMCID: PMC10294413 DOI: 10.1186/s12916-023-02934-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The Mediterranean diet has been associated with lower risk of breast cancer (BC) but evidence from prospective studies on the role of Mediterranean diet on BC survival remains sparse and conflicting. We aimed to investigate whether adherence to Mediterranean diet prior to diagnosis is associated with overall and BC-specific mortality. METHODS A total of 13,270 incident breast cancer cases were identified from an initial sample of 318,686 women in 9 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Adherence to Mediterranean diet was estimated through the adapted relative Mediterranean diet (arMED), a 16-point score that includes 8 key components of the Mediterranean diet and excludes alcohol. The degree of adherence to arMED was classified as low (score 0-5), medium (score 6-8), and high (score 9-16). Multivariable Cox proportional hazards models were used to analyze the association between the arMED score and overall mortality, and Fine-Gray competing risks models were applied for BC-specific mortality. RESULTS After a mean follow-up of 8.6 years from diagnosis, 2340 women died, including 1475 from breast cancer. Among all BC survivors, low compared to medium adherence to arMED score was associated with a 13% higher risk of all-cause mortality (HR 1.13, 95%CI 1.01-1.26). High compared to medium adherence to arMED showed a non-statistically significant association (HR 0.94; 95% CI 0.84-1.05). With no statistically significant departures from linearity, on a continuous scale, a 3-unit increase in the arMED score was associated with an 8% reduced risk of overall mortality (HR3-unit 0.92, 95% CI: 0.87-0.97). This result sustained when restricted to postmenopausal women and was stronger among metastatic BC cases (HR3-unit 0.81, 95% CI: 0.72-0.91). CONCLUSIONS Consuming a Mediterranean diet before BC diagnosis may improve long-term prognosis, particularly after menopause and in cases of metastatic breast cancer. Well-designed dietary interventions are needed to confirm these findings and define specific dietary recommendations.
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Affiliation(s)
- Carlota Castro-Espin
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Crous-Bou
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Núria Nadal-Zaragoza
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anne Tjønneland
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Lene Mellemkjær
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mariem Hajji-Louati
- Université Paris-Saclay, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Franziska Jannasch
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Via Venezian, 1. 20133, Milan, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Chiara Di Girolamo
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano (TO), Italy
| | - Guri Skeie
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Karina Standahl Olsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, 18011, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastian, Spain
| | - María-Dolores Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marcela Guevara
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, 31003, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, 31008, Spain
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
- Department of Surgery, University of Helsinki & Helsinki University Hospital, Helsinki, Finland
| | - Stina Bodén
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Marc J Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Esther M Gonzalez-Gil
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Inmaculada Aguilera-Buenosvinos
- Navarra Institute for Health Research (IdiSNA), Pamplona, 31008, Spain
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Kostas K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Laure Dossus
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Aguilera-Buenosvinos I, Martínez-González MÁ, Zazpe I, Romanos-Nanclares A, Sánchez-Bayona R, Toledo E. Associations between overall, healthful, and unhealthful low-fat dietary patterns and breast cancer risk in a Mediterranean cohort: The SUN project. Nutrition 2023; 109:111967. [PMID: 36738657 DOI: 10.1016/j.nut.2022.111967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/25/2022] [Accepted: 12/31/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Dietary patterns may have a greater influence on human health than individual foods or nutrients, and they are also of substantial interest in the field of breast cancer prevention. Beyond the adequate balance of macronutrients, evidence indicates that the quality of macronutrient sources may play an important role in health outcomes. We sought to examine the relationship between healthful and unhealthful low-fat dietary patterns in relation to breast cancer. METHODS We used observational data from a Mediterranean cohort study (the Seguimiento Universidad de Navarra project). We prospectively followed 10 930 middle-aged women initially free of breast cancer during a median follow-up of 12.1 y. We calculated an overall, an unhealthful, and a healthful low-fat diet score, based on a previously validated 136-item food frequency questionnaire and grouped participants into tertiles. Incident breast cancer-overall and stratified by menopausal status-was the primary outcome. It was self-reported by participants and confirmed based on medical reports or consultation of the National Death Index. We used multivariable Cox regression models adjusted for potential confounders. RESULTS During 123 297 person-years of follow-up, 150 cases of incident breast cancer were confirmed. No significant associations were observed for overall or premenopausal breast cancer. For postmenopausal women, we observed a significant association for moderate adherence to the unhealthful low-fat dietary score and postmenopausal breast cancer (comparing tertile 2 to tertile 1; hazard ratio = 2.18; 95% confidence interval, 1.15-4.13). CONCLUSIONS In conclusion, no clear associations were observed, although more research is needed to address the association between an unhealthful dietary pattern and postmenopausal breast cancer risk.
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Affiliation(s)
- Inmaculada Aguilera-Buenosvinos
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain
| | - Miguel Ángel Martínez-González
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain; Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA USA
| | - Itziar Zazpe
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Department of Nutrition and Food Sciences and Physiology, University of Navarra, Irunlarrea, Spain
| | - Andrea Romanos-Nanclares
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Estefanía Toledo
- University of Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Navarra Institute for Health Research, IdiSNA, Pamplona, Spain; Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.
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Fernandez-Lazaro CI, Martínez-González MÁ, Aguilera-Buenosvinos I, Gea A, Ruiz-Canela M, Romanos-Nanclares A, Toledo E. Dietary Antioxidant Vitamins and Minerals and Breast Cancer Risk: Prospective Results from the SUN Cohort. Antioxidants (Basel) 2021; 10:antiox10030340. [PMID: 33668391 PMCID: PMC7996327 DOI: 10.3390/antiox10030340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023] Open
Abstract
There is growing interest in natural antioxidants and their potential effects on breast cancer (BC). Epidemiological evidence, however, is inconsistent. We prospectively evaluated the association between dietary intake of vitamins A, C, and E, selenium, and zinc and BC among 9983 female participants from the SUN Project, a Mediterranean cohort of university graduates. Participants completed a food frequency questionnaire at baseline, and biennial follow-up information about incident BC diagnosis was collected. Cases were ascertained through revision of medical charts and consultation of the National Death Index. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CI). During an average follow-up of 11.3 years, 107 incident BC cases were confirmed. The multivariable HRs (95% CI) for BC comparing extreme tertiles of energy-adjusted dietary intakes were 1.07 (0.64–1.77; Ptrend = 0.673) for vitamin A, 1.00 (0.58–1.71; Ptrend = 0.846) for vitamin C, 0.92 (0.55–1.54; Ptrend = 0.728) for vitamin E, 1.37 (0.85–2.20; Ptrend = 0.135) for selenium, and 1.01 (0.61–1.69; Ptrend = 0.939) for zinc. Stratified analyses showed an inverse association between vitamin E intake and postmenopausal BC (HRT3 vs. T1 = 0.35; 95% CI, 0.14–0.86; Ptrend = 0.027). Our results did not suggest significant protective associations between dietary vitamins A, C, and E, selenium, or zinc and BC risk.
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Affiliation(s)
- Cesar I. Fernandez-Lazaro
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Miguel Ángel Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Inmaculada Aguilera-Buenosvinos
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
| | - Miguel Ruiz-Canela
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
| | - Andrea Romanos-Nanclares
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, University of Navarra, 31008 Pamplona, Spain; (C.I.F.-L.); (M.Á.M.-G.); (I.A.-B.); (A.G.); (M.R.-C.); (A.R.-N.)
- IdisNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIBERobn Physiopathology of Obesity and Nutrition, Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948-425-600 (ext. 806224)
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Aguilera-Buenosvinos I, Fernandez-Lazaro CI, Romanos-Nanclares A, Gea A, Sánchez-Bayona R, Martín-Moreno JM, Martínez-González MÁ, Toledo E. Dairy Consumption and Incidence of Breast Cancer in the 'Seguimiento Universidad de Navarra' (SUN) Project. Nutrients 2021; 13:nu13020687. [PMID: 33669972 PMCID: PMC7924827 DOI: 10.3390/nu13020687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/21/2023] Open
Abstract
Dairy products might influence breast cancer (BC) risk. However, evidence is inconsistent. We sought to examine the association between dairy product consumption-and their subtypes-and incident BC in a Mediterranean cohort. The SUN ("Seguimiento Universidad de Navarra") Project is a Spanish dynamic ongoing cohort of university graduates. Dairy product consumption was estimated through a previously validated 136-item food frequency questionnaire (FFQ). Incident BC was reported in biennial follow-up questionnaires and confirmed with revision of medical records and consultation of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression models. Among 123,297 women-years of follow-up (10,930 women, median follow-up 12.1 years), we confirmed 119 incident BC cases. We found a nonlinear association between total dairy product consumption and BC incidence (pnonlinear = 0.048) and a significant inverse association for women with moderate total dairy product consumption (HRQ2vs.Q1 = 0.49 (95% CI 0.28-0.84); HRQ3vs.Q1 = 0.49 (95% CI 0.29-0.84) ptrend = 0.623) and with moderate low-fat dairy product consumption (HRQ2vs.Q1 = 0.58 (95% CI 0.35-0.97); HRQ3vs.Q1 = 0.55 (95% CI 0.32-0.92), ptrend = 0.136). In stratified analyses, we found a significant inverse association between intermediate low-fat dairy product consumption and premenopausal BC and between medium total dairy product consumption and postmenopausal BC. Thus, dairy products, especially low-fat dairy products, may be considered within overall prudent dietary patterns.
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Affiliation(s)
- Inmaculada Aguilera-Buenosvinos
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
| | - Cesar Ignacio Fernandez-Lazaro
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Andrea Romanos-Nanclares
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Alfredo Gea
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
| | - Rodrigo Sánchez-Bayona
- Department of Clinical Oncology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jose M. Martín-Moreno
- Department of Preventive Medicine and Public Health, Medical School & INCLIVA, University of Valencia, 46010 Valencia, Spain;
| | - Miguel Ángel Martínez-González
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Estefanía Toledo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Navarra, 31008 Pamplona, Spain; (I.A.-B.); (C.I.F.-L.); (A.R.-N.); (A.G.); (M.Á.M.-G.)
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- Centro de Investigación Biomédica en Red Área de Fisiología de la Obesidad y la Nutrición (CIBEROBN), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948425600 (ext. 806224)
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