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Álvarez OS, Ruíz-Cantero MT, Argüelles MV, Margolles M, Cofiño R, Álvarez-Dardet C. Activos de salud, calidad de vida y morbimortalidad de la población en Asturias. Glob Health Promot 2022; 29:207-217. [PMID: 35343291 DOI: 10.1177/17579759211073177] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCCIÓN n promoción de la salud se ha detectado en los últimos años un incremento de investigaciones con enfoques teóricos basados en activos de salud. Pese a los estudios identificados, no se dispone de suficiente evidencia sobre los efectos que diferentes tipos de activos pueden tener en la calidad de vida y en la morbimortalidad de la población. OBJETIVO analizar la relación entre los activos de salud disponibles con indicadores de morbilidad, mortalidad y calidad de vida de la población asturiana en el año 2018. METODOLOGÍA diseño ecológico a partir de datos agregados municipales procedentes de los 78 municipios de Asturias (1.034.960 habitantes). Tras aplicar la definición de activos de salud como aquellas variables que pudieran redundar en una mejora de la salud y del bienestar de los individuos y de las comunidades, se seleccionaron 19 variables de activos agrupados en cuatro categorías: individuales, socioeconómicas, comunitarias e infraestructura. Una vez controladas las variables relacionadas con las características demográficas de la población, se analizó la asociación de los activos con las tasas de morbimortalidad y de calidad de vida. Se desarrollaron 5 modelos predictivos a partir de modelos de regresión lineal múltiple para las variables dependientes: calidad de vida, enfermedades crónicas, mortalidad por todas las causas, mortalidad por enfermedades cardiovasculares (ECV) y por cáncer. RESULTADOS la disponibilidad de recursos sanitarios (beta = 0.474), coberturas sociales (beta = 0.305) y redes de apoyo social (beta = 0.225) constituyen los activos de salud con mayor peso explicativo en los resultados de salud de la población asturiana. Las variables incluidas en los modelos predictivos de calidad de vida (R2 = 0.650) y de mortalidad por ECV (R2 = 0.544) son las que mostraron una mayor capacidad explicativa. CONCLUSIONES la inversión en recursos sociosanitarios y la mejora de redes de apoyo social impulsados desde el ámbito de la salud pública pueden producir importantes mejoras en la salud de la población asturiana.
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Affiliation(s)
- O Suárez Álvarez
- Programa de Doctorado en Ciencias de la Salud, Universidad de Alicante, España.,Dirección de Salud Pública, Asturias Regional Ministry of Health, Oviedo, España
| | - M T Ruíz-Cantero
- Grupo de Investigación Salud Pública, Universidad de Alicante, CIBERESP, Alicante, España
| | - M V Argüelles
- Dirección de Salud Pública, Asturias Regional Ministry of Health, Oviedo, España
| | - M Margolles
- Dirección de Salud Pública, Asturias Regional Ministry of Health, Oviedo, España
| | - R Cofiño
- Dirección de Salud Pública, Asturias Regional Ministry of Health, Oviedo, España
| | - C Álvarez-Dardet
- Grupo de Investigación Salud Pública, Universidad de Alicante, CIBERESP, Alicante, España
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Steins Bisschop CN, van Gils CH, Emaus MJ, Bueno-de-Mesquita HB, Monninkhof EM, Boeing H, Aleksandrova K, Jenab M, Norat T, Riboli E, Boutron-Rualt MC, Fagherazzi G, Racine A, Palli D, Krogh V, Tumino R, Naccarati A, Mattiello A, Argüelles MV, Sanchez MJ, Tormo MJ, Ardanaz E, Dorronsoro M, Bonet C, Khaw KT, Key T, Trichopoulou A, Orfanos P, Naska A, Kaaks RR, Lukanova A, Pischon T, Ljuslinder I, Jirström K, Ohlsson B, Overvad K, Landsvig Berentzen T, Halkjaer J, Tjonneland A, Weiderpass E, Skeie G, Braaten T, Siersema PD, Freisling H, Ferrari P, Peeters PHM, May AM. Weight change later in life and colon and rectal cancer risk in participants in the EPIC-PANACEA study. Am J Clin Nutr 2014; 99:139-47. [PMID: 24225355 DOI: 10.3945/ajcn.113.066530] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND A moderate association exists between body mass index (BMI) and colorectal cancer. Less is known about the effect of weight change. OBJECTIVE We investigated the relation between BMI and weight change and subsequent colon and rectal cancer risk. DESIGN This was studied among 328,781 participants in the prospective European Prospective Investigation into Cancer-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating study (mean age: 50 y). Body weight was assessed at recruitment and on average 5 y later. Self-reported weight change (kg/y) was categorized in sex-specific quintiles, with quintiles 2 and 3 combined as the reference category (men: -0.6 to 0.3 kg/y; women: -0.4 to 0.4 kg/y). In the subsequent years, participants were followed for the occurrence of colon and rectal cancer (median period: 6.8 y). Multivariable Cox proportional hazards regression analyses were used to study the association. RESULTS A total of 1261 incident colon cancer and 747 rectal cancer cases were identified. BMI at recruitment was statistically significantly associated with colon cancer risk in men (HR: 1.04; 95% CI: 1.02, 1.07). Moderate weight gain (quintile 4) in men increased risk further (HR: 1.32; 95% CI: 1.04, 1.68), but this relation did not show a clear trend. In women, BMI or weight gain was not related to subsequent risk of colon cancer. No statistically significant associations for weight loss and colon cancer or for BMI and weight changes and rectal cancer were found. CONCLUSIONS BMI attained at adulthood was associated with colon cancer risk. Subsequent weight gain or loss was not related to colon or rectal cancer risk in men or women.
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Affiliation(s)
- Charlotte N Steins Bisschop
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands (CNSB, CHvG, EMM, PHMP, and AMM); the National Institute for Public Health and the Environment, Bilthoven, Netherlands (HBB-d-M); the Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands (HBB-d-M); the Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany (HB and KA); the International Agency for Research on Cancer, WHO, Lyon, France (MJ, HF, and PF); the Division of Epidemiology, Public Health and Primary Care, Imperial College, London, United Kingdom (HBB-d-M, TN, ER, and PHMP); INSERM, Centre for Research in Epidemiology and Population Health, Nutrition, Hormones and Women's Health Team, Villejuif, France (MB-R, GF, and AR); University of Paris, Sud, Villejuif, France (MB-R, GF, and AR); IGR, Villejuif, France (MB-R, GF, and AR); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy (DP); the Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (VK); the Cancer Registry and Histopathology Unit, "Civile M.P. Arezzo" Hospital, ASP Ragusa, Italy (RT); HuGeF-Human Genetics Foundation-Torino, Molecular and Genetic Epidemiology Unit, Torino, Italy (A Naccarati); Dipartimento di Medicina Clinica e Chirugia, FEDERICO II University, Naples, Italy (AM); Public Health Directorate, Asturias, Spain (MVA); the Andalusian School of Public Health, Granada, Spain (MS and MJT); CIBER de Epidemiología y Salud Pública, Spain (MS, MJT, and EA); the Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain (MJT); the Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain (MJT); the Navarre Public Health Institute, Pamplona, Spain (EA); Subdirección de Salud Pública de Gipuzkoa, Gobierno Vasco, San Sebastian, Spain (MD); the Department of Epidemiology, Catalan I
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Vermeulen E, Zamora-Ros R, Duell EJ, Luján-Barroso L, Boeing H, Aleksandrova K, Bueno-de-Mesquita HB, Scalbert A, Romieu I, Fedirko V, Touillaud M, Fagherazzi G, Perquier F, Molina-Montes E, Chirlaque MD, Vicente Argüelles M, Amiano P, Barricarte A, Pala V, Mattiello A, Saieva C, Tumino R, Ricceri F, Trichopoulou A, Vasilopoulou E, Ziara G, Crowe FL, Khaw KT, Wareham NJ, Lukanova A, Grote VA, Tjønneland A, Halkjær J, Bredsdorff L, Overvad K, Siersema PD, Peeters PHM, May AM, Weiderpass E, Skeie G, Hjartåker A, Landberg R, Johansson I, Sonestedt E, Ericson U, Riboli E, González CA. Dietary flavonoid intake and esophageal cancer risk in the European prospective investigation into cancer and nutrition cohort. Am J Epidemiol 2013; 178:570-81. [PMID: 23652166 DOI: 10.1093/aje/kwt026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We prospectively investigated dietary flavonoid intake and esophageal cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,312 adult subjects from 10 European countries. At baseline, country-specific validated dietary questionnaires were used. During a mean follow-up of 11 years (1992-2010), there were 341 incident esophageal cancer cases, of which 142 were esophageal adenocarcinoma (EAC), 176 were esophageal squamous cell carcinoma (ESCC), and 23 were other types of esophageal cancer. In crude models, a doubling in total dietary flavonoid intake was inversely associated with esophageal cancer risk (hazard ratio (HR) (log₂) = 0.87, 95% confidence interval (CI): 0.78, 0.98) but not in multivariable models (HR (log₂) = 0.97, 95% CI: 0.86, 1.10). After covariate adjustment, no statistically significant association was found between any flavonoid subclass and esophageal cancer, EAC, or ESCC. However, among current smokers, flavonols were statistically significantly associated with a reduced esophageal cancer risk (HR (log₂) = 0.72, 95% CI: 0.56, 0.94), whereas total flavonoids, flavanols, and flavan-3-ol monomers tended to be inversely associated with esophageal cancer risk. No associations were found in either never or former smokers. These findings suggest that dietary flavonoid intake was not associated with overall esophageal cancer, EAC, or ESCC risk, although total flavonoids and some flavonoid subclasses, particularly flavonols, may reduce the esophageal cancer risk among current smokers.
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Affiliation(s)
- Esther Vermeulen
- Unit of Nutrition, Environment, and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Zamora-Ros R, Fedirko V, Trichopoulou A, González CA, Bamia C, Trepo E, Nöthlings U, Duarte-Salles T, Serafini M, Bredsdorff L, Overvad K, Tjønneland A, Halkjaer J, Fagherazzi G, Perquier F, Boutron-Ruault MC, Katzke V, Lukanova A, Floegel A, Boeing H, Lagiou P, Trichopoulos D, Saieva C, Agnoli C, Mattiello A, Tumino R, Sacerdote C, Bueno-de-Mesquita HB, Peeters PHM, Weiderpass E, Engeset D, Skeie G, Argüelles MV, Molina-Montes E, Dorronsoro M, Tormo MJ, Ardanaz E, Ericson U, Sonestedt E, Sund M, Landberg R, Khaw KT, Wareham NJ, Crowe FL, Riboli E, Jenab M. Dietary flavonoid, lignan and antioxidant capacity and risk of hepatocellular carcinoma in the European prospective investigation into cancer and nutrition study. Int J Cancer 2013; 133:2429-43. [PMID: 23649669 DOI: 10.1002/ijc.28257] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/16/2013] [Indexed: 12/15/2022]
Abstract
Limited epidemiological evidence suggests a protective role for plant foods rich in flavonoids and antioxidants in hepatocellular cancer (HCC) etiology. Our aim was to prospectively investigate the association between dietary intake of flavonoids, lignans and nonenzymatic antioxidant capacity (NEAC) and HCC risk. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 477,206 subjects (29.8% male) recruited from ten Western European countries, was analyzed. Flavonoid, lignan and NEAC intakes were calculated using a compilation of existing food composition databases linked to dietary information from validated dietary questionnaires. Dietary NEAC was based on ferric reducing antioxidant capacity (FRAP) and total radical-trapping antioxidant parameter (TRAP). Hepatitis B/C status was measured in a nested case-control subset. During a mean follow-up of 11-years, 191 incident HCC cases (66.5% men) were identified. Using Cox regression, multivariable adjusted models showed a borderline nonsignificant association of HCC with total flavonoid intake (highest versus lowest tertile, HR = 0.65, 95% CI: 0.40-1.04; p(trend) = 0.065), but not with lignans. Among flavonoid subclasses, flavanols were inversely associated with HCC risk (HR = 0.62, 95% CI: 0.39-0.99; p(trend) = 0.06). Dietary NEAC was inversely associated with HCC (FRAP: HR 0.50, 95% CI: 0.31-0.81; p(trend) = 0.001; TRAP: HR 0.49, 95% CI: 0.31-0.79; p(trend) = 0.002), but statistical significance was lost after exclusion of the first 2 years of follow-up. This study suggests that higher intake of dietary flavanols and antioxidants may be associated with a reduced HCC risk.
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Affiliation(s)
- Raul Zamora-Ros
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
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Zamora-Ros R, Knaze V, Romieu I, Scalbert A, Slimani N, Clavel-Chapelon F, Touillaud M, Perquier F, Skeie G, Engeset D, Weiderpass E, Johansson I, Landberg R, Bueno-de-Mesquita HB, Sieri S, Masala G, Peeters PHM, Grote V, Huerta JM, Barricarte A, Amiano P, Crowe FL, Molina-Montes E, Khaw KT, Argüelles MV, Tjønneland A, Halkjær J, de Magistris MS, Ricceri F, Tumino R, Wirfält E, Ericson U, Overvad K, Trichopoulou A, Dilis V, Vidalis P, Boeing H, Förster J, Riboli E, González CA. Impact of thearubigins on the estimation of total dietary flavonoids in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Eur J Clin Nutr 2013; 67:779-82. [PMID: 23612513 DOI: 10.1038/ejcn.2013.89] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/18/2013] [Accepted: 03/29/2013] [Indexed: 11/09/2022]
Abstract
Thearubigins (TR) are polymeric flavanol-derived compounds formed during the fermentation of tea leaves. Comprising ∼70% of total polyphenols in black tea, TR may contribute majorly to its beneficial effects on health. To date, there is no appropriate food composition data on TR, although several studies have used data from the US Department of Agriculture (USDA) database to estimate TR intakes. We aimed to estimate dietary TR in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort and assess the impact of including TR or not in the calculation of the total dietary flavonoid intake. Dietary data were collected using a single standardized 24-h dietary recall interviewer-administered to 36 037 subjects aged 35-74 years. TR intakes were calculated using the USDA database. TR intakes ranged from 0.9 mg/day in men from Navarra and San Sebastian in Spain to 532.5 mg/day in men from UK general population. TR contributed <5% to the total flavonoid intake in Greece, Spain and Italy, whereas in the UK general population, TR comprised 48% of the total flavonoids. High heterogeneity in TR intake across the EPIC countries was observed. This study shows that total flavonoid intake may be greatly influenced by TR, particularly in high black tea-consuming countries. Further research on identification and quantification of TR is needed to get more accurate dietary TR estimations.
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Affiliation(s)
- R Zamora-Ros
- Catalan Institute of Oncology, Barcelona, Spain.
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