Depósito Académico
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- Do healthy doctors deliver better messages of health promotion to their patients?: Data from the SUN cohort study(2020) Martinez-Gonzalez, M.A. (Miguel Ángel); Carlos-Chillerón, S. (Silvia); Fuente-Arrillaga, C. (Carmen) de la; Rico-Campà, A. (Anais); Fernandez-Montero, A. (Alejandro); Echavarri, M. (María); Gea, A. (Alfredo); Salazar, C. (Camino)Background Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors. Methods We assessed 890 doctors aged ≤65 years participating in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits. Results Among doctors, 31% reported <10 min per visit; 73% counseled 60–100% of their patients on smoking cessation, 58% on physical activity, 54% on weight control, 51% on healthy nutrition, 44% on alcohol avoidance/reduction and 28% recommended alcohol moderate consumption. The percentage of doctors that counseled 100% of their patients about lifestyle was 43% for smoking cessation, 15% for exercise and 13% for weight control and nutrition. Better doctor’s adherence to the Mediterranean dietary pattern was associated with more frequent and longer nutrition counseling. Higher practice of physical activity was associated with longer time on counseling about exercise to their patients. Among doctors both current and former smoking were inversely associated with the frequency and duration of their smoking cessation/avoidance counseling practices. Conclusions Personal behavioral changes among doctors and better training of medical doctors on a personal healthy diet and lifestyle are likely to contribute to improve the behavioral counseling given to patients.
- Dietary Inflammatory Index and liver status in subjects with different adiposity levels within the PREDIMED trial(2018) Babio, N. (Nancy); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Fito, M. (Montserrat); Zulet, M.A. (María Ángeles); Shivappa, N. (Nitin); Tur, J.A. (Josep A.); Gomez-Gracia, E. (Enrique); Ruiz-Canela, M. (Miguel); Portillo, M.P. (María P.); Wärnberg, J. (Julia); Estruch, R. (Ramón); Corella, D. (Dolores); Abete, I. (Itziar); Pinto, X. (Xavier); Cantero-González, I. (Irene); Salas-Salvado, J. (Jordi); Hebert, J.R. (James R.); Aros, F. (Fernando)Background & aims: To assess the possible association between a validated Dietary Inflammatory Index (DII) and specific dietary components with suitable non-invasive markers of liver status in overweight and obese subjects within the PREDIMED study. Methods: A cross-sectional study encompassing 794 randomized overweight and obese participants (mean ± SD age: 67.0 ± 5.0 y, 55% females) from the PREDIMED (PREvencion con DIeta MEDiterr anea) trial was conducted. DII is a validated tool evaluating the effect of diet on six inflammatory biomarkers (IL-1b, IL-4, IL-6, IL-10, TNF-a and C-reactive protein). Furthermore, a validated 137-item food-frequencyquestionnaire was used to obtain the information about the food intake. In addition, anthropometric measurements and several non-invasive markers of liver status were assessed and the Fatty Liver Index (FLI) score was calculated. Results: A higher DII and lower adherence to Mediterranean diet (MeDiet) were associated with a higher degree of liver damage (FLI > 60) in obese as compared to overweight participants. Furthermore, the DII score was positively associated with relevant non-invasive liver markers (ALT, AST, GGT and FLI) and directly affected FLI values. Interestingly, a positive correlation was observed between liver damage (>50th percentile FLI) and nutrients and foods linked to a pro-inflammatory dietary pattern. Conclusions: This study reinforced the concept that obesity is associated with liver damage and revealed that the consumption of a pro-inflammatory dietary pattern might contribute to obesity and fatty liver disease features. These data suggest that a well-designed precision diet including putative antiinflammatory components could specifically prevent and ameliorate non-alcoholic fatty liver manifestations in addition to obesity.
- Association between an oxidative balance score and mortality: a prospective analysis in the SUN cohort(Springer, 2023) Martinez-Gonzalez, M.A. (Miguel Ángel); Fuente-Arrillaga, C. (Carmen) de la; Hernández-Ruiz, Á; Galarregui-Miquelarena, C. (Cristina); Ruiz-Canela, M. (Miguel); Fernández-Lázaro, C.I. (César I.); Sotos-Prieto, M. (Mercedes); Talavera-Rodríguez, I. (Irene); Hershey-de-la-Cruz, M.S. (María Soledad)Purpose We aimed to prospectively investigate the association of an overall oxidative balance score (OBS) with all-cause death and cause-specifc mortality among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of Spanish graduates. Methods Using baseline information on 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures—vitamins C and E, β-carotenes, selenium, zinc, heme iron, polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity—we constructed an equally weighted OBS categorized into quartiles, with higher scores representing greater antioxidant balance. Cox proportional hazards models were ftted to evaluate the association between the OBS and mortality. Results A total of 18,561 participants (mean [SD] age, 38.5 [12.4] years; 40.8% males) were included in the analysis. During a median follow-up of 12.2 years (interquartile range 8.3–14.9), 421 deaths were identifed, including 80 deaths from cardiovascular disease (CVD), 215 from cancer, and 126 from other causes. After adjustment for potential confounders, the hazard ratios and 95% confdence interval (CIs) between the highest quartile (predominance of antioxidants) vs. the lowest quartile (reference category) were 0.35 (95% CI 0.22–0.54, P-trend<0.001) for all-cause mortality, 0.18 (95% CI 0.06–0.51, P-trend=0.001) for CVD mortality, 0.35 (95% CI 0.19–0.65, P-trend=0.002) for cancer mortality, and 0.45 (95% CI 0.20–1.02, P-trend=0.054) for other-cause mortality. Conclusion Our fndings suggest a strong inverse association between the OBS and all-cause, CVD, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk.
- Ultra-processed foods consumption as a promoting factor of greenhouse gas emissions, water, energy, and land use: A longitudinal assessment(2023) Buil-Cosiales, P. (Pilar); Castañer, O. (Olga); Martinez-Gonzalez, M.A. (Miguel Ángel); González-Palacios, S. (Sandra); Fito, M. (Montserrat); Pastor, R. (Rosario); Alvarez-Alvarez, L. (Laura); Tojal-Sierra, L. (Lucas); Martín-Sánchez, V. (Vicente); Gonzalez, J.I. (José I.); Martínez-Hernández, J.A. (J. Alfredo); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Vioque, J. (Jesús); Tur, J.A. (Josep A.); Shyam, S. (Sangeetha); Toledo, E. (Estefanía); Bes-Rastrollo, M. (Maira); Romaguera, D. (Dora); Vázquez, C. (Clotilde); Matía-Martín, P. (Pilar); Bouzas, C. (Cristina); Rubín-García, M. (María); Delgado-Rodriguez, M. (Miguel); López-Miranda, J. (José); Coltell, O. (Oscar); Khoury, N. (Nadine); Perez, K.A. (Karla Alejandra); Ros, E. (Emili); Wärnberg, J. (Julia); Estruch, R. (Ramón); Santos-Lozano, J.M. (José M.); Barcelo, C.; Bernal-Lopez, M. R; Casas, R.; Garcia-Rios, A.; Goicolea-Guemez, L.; Gomez-Gracia, E.; Konieczna, J.; Masso-Guijarro, P.; Zulet-Alzórriz, M. (María de los Ángeles); Serra-Majem, L. (Luis); Corella, D. (Dolores); Zomeño-Fajardo, M.D. (Maria Dolores); Martinez-Rodriguez, M.A. (Maria Angeles); Vidal, J. (Josep); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Pena-Orihuela, P.J. (Patricia J.); Cano-Ibañez, N. (Naomi); Monserrat-Mesquida, M. (Margalida); Garcia, S. (Silvia)Background: Dietary patterns can produce an environmental impact. Changes in people's diet, such as the increased consumption of ultra-processed food (UPF) can not only influence human health but also environment sustainability. Objectives: Assessment of the impact of 2-year changes in UPF consumption on greenhouse gas emissions and water, energy and land use. Design: A 2-year longitudinal study after a dietary intervention including 5879 participants from a Southern European population between the ages of 55-75 years with metabolic syndrome. Methods: Food intake was assessed using a validated 143-item food frequency questionnaire, which allowed classifying foods according to the NOVA system. In addition, sociodemographic data, Mediterranean diet adherence, and physical activity were obtained from validated questionnaires. Greenhouse gas emissions, water, energy and land use were cal-culated by means of the Agribalyse & REG; 3.0.1 database of environmental impact indicators for food items. Changes in UPF consumption during a 2-year period were analyzed. Statistical analyses were conducted using computed General Lin-ear Models. Results: Participants with major reductions in their UPF consumption reduced their impact by -0.6 kg of CO2eq and -5.3 MJ of energy. Water use was the only factor that increased as the percentage of UPF was reduced. Conclusions: Low consumption of ultra-processed foods may contribute to environmental sustainability. The processing level of the consumed food should be considered not only for nutritional advice on health but also for environmental protection. Trial registration: ISRCTN, ISRCTN89898870. Registered 05 September 2013, http://www.isrctn.com/ ISRCTN89898870.
- Effect of dietary phenolic compounds on incidence of type 2 diabetes in the "Seguimiento Universidad de Navarra" (SUN) cohort(2023) Martinez-Gonzalez, M.A. (Miguel Ángel); Toledo, E. (Estefanía); Bes-Rastrollo, M. (Maira); Vitelli-Storelli, F. (Facundo); Vazquez-Ruiz, Z. (Zenaida); Basterra-Gortari, F.J. (Francisco Javier)The global incidence of type 2 diabetes (T2D) has been steadily increasing in recent decades. The Mediterranean dietary pattern has shown a preventive effect on the risk of T2D. Evaluating the association between bioactive compounds such as phenolic compounds (PC) in a Mediterranean cohort could help to better understand the mechanisms implicated in this protection. We evaluated the association between dietary intake of PC and the risk of T2D in a relatively young cohort of 17,821 Spanish participants initially free of T2D, through the University of Navarra Follow-up Project (Seguimiento Universidad de Navarra or SUN cohort) after 10 years of median follow-up using time-dependent Cox models. Intake of PC was estimated at baseline and repeatedly at 10-year follow-up using a 136-item validated food frequency and the Phenol-Explorer database. The incidence of T2D was identified by a biennial follow-up, and only medically confirmed cases were included. During 224,751 person-years of follow-up, 186 cases of T2D were confirmed. A suboptimal intake of stilbenes was independently associated with a higher risk of T2D in subjects over 50 years (HR: 1.75, 95% CI: 1.06-2.90, p value < 0.05) after adjusting for potential confounders. Our results suggest that a moderate-high intake of stilbenes can decrease the risk of developing T2D in subjects over 50 years in our cohort.
- Dietary inflammatory index and prevalence of overweight and obesity in Brazilian graduates from the Cohort of Universities of Minas Gerais (CUME project)(Elsevier, 2020) Martinez-Gonzalez, M.A. (Miguel Ángel); Hermsdorff, H.H. (H. H.); Shivappa, N. (Nitin); Bressan, J. (J.); Moreira-Silva, T. (Thatianne); Hebert, J.R. (James R.); Marcal-Pimenta, A. (Adriano)Objectives: The aim of this study was to evaluate the independent association of the dietary inflammatory index (DII ) score with overweight and obesity in Brazilian participants of the Cohort of Universities of Minas Gerais (CUME project). Methods: This was a cross-sectional study consisting of 3,151 graduates and postgraduates (2197 women) with a mean (SD) age of 36.3 y (§9.4 y). Sociodemographic characteristics, lifestyle, and anthropometric data were assessed via online self-reported questionnaire. Additionally, a validated food frequency questionnaire with 144 food items was used to generate energy-adjusted DII (E-DIITM) scores, which evaluated the inflammatory potential of the diet. Results: The prevalence of overweight and obesity were 28.2% and 11%, respectively. Participants in the highest E-DII quartile (most proinflammatory diet) were more likely to be smokers/former smokers; sedentary; and consumers of red and ultra-processed meats, fats and oils (excluding olive oil), bottled fruit juices and soft drinks, sugars, sweets, and higher overall caloric intake, compared with the first quartile of E-DII. Both men and women in the fourth E-DII quartile had the highest prevalence of overweight and obesity (prevalence ratio [PR], 1.35; 95% confidence interval [CI], 1.14 1.59 and PR, 1.97; 95% CI, 1.20 3.22, respectively, in men; PR, 1.38; 95% CI, 1.17 to 1.65 and PR, 1.95; 95% CI, 1.31 2.90, respectively, in women). Conclusion: The most proinflammatory dietary pattern was associated with a higher prevalence of overweight and obesity and other unhealthy lifestyles including being sedentary, smoking, and consuming a obesogenic diet.
- Low dietary magnesium and overweight/obesity in a Mediterranean population: a detrimental synergy for the development of hypertension. The SUN Project(2021) Martinez-Gonzalez, M.A. (Miguel Ángel); Fresan, U. (Ujue); Dominguez, L.J. (Ligia J.); Barbagallo, M. (Mario); Ruiz-Canela, M. (Miguel); Gea, A. (Alfredo); Ruiz-Estigarribia, L. (Liz); Sayon-Orea, C. (Carmen)Hypertension is the strongest independent modifiable risk factor for cardiovascular disease. We aimed to investigate the association of magnesium intake with incident hypertension in a Mediterranean population, and the potential modification of this association by body mass index (BMI). We assessed 14,057 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (67.0% women) initially free of hypertension. At baseline, a validated 136-item food frequency questionnaire was administered. We used Cox models adjusted for multiple socio-demographic, anthropometric, and lifestyle factors, and prevalent conditions present at baseline. Among a mean 9.6 years of follow-up we observed 1406 incident cases of medically diagnosed hypertension. An inverse association in multivariable-adjusted models was observed for progressively higher magnesium intake up to 500 mg/d vs. intake < 200 mg/d, which was greater among those with a BMI > 27 kg/m(2). Lean participants with magnesium intake < 200 mg/d vs. >200 mg/d also had a higher risk of incident hypertension. Adherence to the Mediterranean diet did not modify these associations. In conclusion, dietary magnesium intake < 200 mg/d was independently associated with a higher risk of developing hypertension in a Mediterranean cohort, stronger for overweight/obese participants. Our results emphasize the importance of encouraging the consumption of magnesium-rich foods (vegetables, nuts, whole cereals, legumes) in order to prevent hypertension.
- Metabolites of glutamate metabolism are associated with incident cardiovascular events in the PREDIMED PREvención con DIeta MEDiterránea (PREDIMED) trial(American Heart Association, 2016) Martinez-Gonzalez, M.A. (Miguel Ángel); Fiol, M. (Miquel); Clish, C.B. (Clary B.); Fito, M. (Montserrat); Hu, F.B. (Frank B.); Hruby, A. (Adela); Gomez-Gracia, E. (Enrique); Toledo, E. (Estefanía); Lapetra, J. (José); Zheng, Y. (Yan); Liang, L. (Liming); Ros, E. (Emilio); Ruiz-Canela, M. (Miguel); Dennis, C. (Courtney); Estruch, R. (Ramón); Serra-Majem, L. (Luis); Corella, D. (Dolores); Salas-Salvado, J. (Jordi); Aros, F. (Fernando)Glutamate metabolism may play a role in the pathophysiology of cardiometabolic disorders. However, there is limited evidence of an association between glutamate-related metabolites and, moreover, changes in these metabolites, and risk of cardiovascular disease (CVD). Methods and Results-—Plasma levels of glutamate and glutamine were measured at baseline and 1-year follow-up in a case-cohort study including 980 participants (mean age 68 years; 46% male) from the PREvenci on con DIeta MEDiterr anea (PREDIMED) randomized trial, which assessed a Mediterranean diet intervention in the primary prevention of CVD. During median 4.8 years of follow-up, there were 229 incident CVD events (nonfatal stroke, nonfatal myocardial infarction, or CVD death). In fully adjusted models, per 1-SD, baseline glutamate was associated with 43% (95% CI: 16% to 76%) and 81% (39% to 137%) increased risk of composite CVD and stroke alone, respectively, and baseline glutamine-to-glutamate ratio with 25% (6% to 40%) and 44% (25% to 58%) decreased risk of composite CVD and stroke alone, respectively. Associations appeared linear for stroke (both Plinear trend≤0.005). Among participants with high baseline glutamate, the interventions lowered CVD risk by 37% compared to the control diet; the intervention effects were not significant when baseline glutamate was low (Pinteraction=0.02). No significant effect of the intervention on year-1 changes in metabolites was observed, and no effect of changes themselves on CVD risk was apparent. Conclusions-—Baseline glutamate was associated with increased CVD risk, particularly stroke, and glutamine-to-glutamate ratio was associated with decreased risk. Participants with high glutamate levels may obtain greater benefits from the Mediterranean diet than those with low levels.
- Adherence to Mediterranean diet is associated with methylation changes in inflammation-related genes in peripheral blood cells(Springer, 2017-02-08) Martinez, J.A. (José Alfredo); Riezu-Boj, J.I. (José Ignacio); Martinez-Gonzalez, M.A. (Miguel Ángel); Fito, M. (Montserrat); Milagro-Yoldi, F.I. (Fermín Ignacio); Arpon, A. (Ana); Razquin, C. (Cristina); Ros, E. (Emilio); Casas, R. (Rosa); Estruch, R. (Ramón); Corella, D. (Dolores); Salas-Salvado, J. (Jordi)Epigenetic processes, including DNA methylation, might be modulated by environmental factors such as the diet, which in turn have been associated with the onset of several diseases such as obesity or cardiovascular events. Meanwhile, Mediterranean diet (MedDiet) has demonstrated favourable effects on cardiovascular risk, blood pressure, inflammation and other complications related to excessive adiposity. Some of these effects could be mediated by epigenetic modifications. Therefore, the objective of this study was to investigate whether the adherence to MedDiet is associated with changes in the methylation status from peripheral blood cells. A subset of 36 individuals was selected within the Prevención con Dieta Mediterránea (PREDIMED)-Navarra study, a randomised, controlled, parallel trial with three groups of intervention in high cardiovascular risk volunteers, two with a MedDiet and one low-fat control group. Changes in methylation between baseline and 5 years were studied. DNA methylation arrays were analysed by several robust statistical tests and functional classifications. Eight genes related to inflammation and immunocompetence (EEF2, COL18A1, IL4I1, LEPR, PLAGL1, IFRD1, MAPKAPK2, PPARGC1B) were finally selected as changes in their methylation levels correlated with adherence to MedDiet and because they presented sensitivity related to a high variability in methylation changes. Additionally, EEF2 methylation levels positively correlated with concentrations of TNF-α and CRP. This report is apparently the first showing that adherence to MedDiet is associated with the methylation of the reported genes related to inflammation with a potential regulatory impact.
- A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN project(BioMed Central, 2015) Martinez-Gonzalez, M.A. (Miguel Ángel); Toledo, E. (Estefanía); Lahortiga, F. (Francisca); Ruiz-Canela, M. (Miguel); Henriquez-Sanchez, P. (Patricia); Sanchez-Villegas, A. (Almudena); Molero, P. (Patricio)Background: Some studies have pointed out that several dietary patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations. The objective of the study was to compare and to establish the type of relationship between three diet quality scores and depression in the SUN (Seguimiento Universidad de Navarra) Cohort study. Methods: We performed a dynamic cohort study based on Spanish university graduates free of depression at baseline. Dietary intake was repeatedly assessed at baseline and after 10 years of follow-up with a validated semi-quantitative foodfrequency questionnaire. Three previously described diet quality scores: Mediterranean Diet Score (MDS), Pro-vegetarian Dietary Pattern (PDP) and Alternative Healthy Eating Index-2010 (AHEI-2010) were built. Participants were classified as having depression if they reported a new clinical diagnosis of depression by a physician or initiated the use of an antidepressant drug during follow-up. Time-dependent Cox regression models with cumulative averages of diet and restricted cubic splines were used to estimate hazard ratios of depression according to quintiles of adherence to the MDS, PDP and AHEI-2010. Results: One thousand and fifty one incident cases of depression were observed among 15,093 participants from the SUN Cohort after a median follow-up of 8.5 years. Inverse and significant associations were observed between the three diet quality scores and depression risk. The hazard ratios and 95 % confidence intervals for extreme quintiles (fifth versus first) of updated adherence to MDS, PDP and AHEI-2010 were 0.84 (0.69–1.02), 0.74 (0.61–0.89) and 0.60 (0.49–0.72), respectively. The dose–response analyses showed non-linear associations, suggesting that suboptimal adherence to these dietary patterns may partially be responsible for increased depression risk. Conclusions: Better adherence to the MDS, PDP and AHEI-2010 was associated with a reduced risk of depression among Spanish adults. However, our data suggested a threshold effect so that although the risk of depression was reduced when comparing moderate versus lower adherence, there was not much extra benefit for the comparison between moderate and high or very high adherence.