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- Predicted vitamin D levels and risk of depression in the SUN Project: A prospective cohort study(Elsevier, 2024) Martinez-Gonzalez, M.A. (Miguel Ángel); Pons-Izquierdo, J.J. (Juan José); Bes-Rastrollo, M. (Maira); Silva-Sabiao, T. (Thaís) da; Cardoso-Carraro, J.C. (Julia Cristina); Sanchez-Villegas, A. (Almudena); Valer-Martínez, A. (Ana); Sayon-Orea, C. (Carmen)The current study aimed to investigate the association between predicted vitamin D status and depression in a prospective Spanish cohort of university graduates. The SUN Project is a dynamic cohort study designed to investigate multiple aspects of health and lifestyle. Participants were asked to complete a comprehensive questionnaire consisting of 556 items, that included a validated food-frequency questionnaire. Participants initially free of depression were classified as incident cases if they reported a medical diagnosis of depression during follow-up. Serum vitamin D levels were predicted by a previously validated equation. Vitamin D deficiency was defined as vitamin D levels below 20 ng/mL. Cox models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). We included 15,175 Spanish university graduates [mean (SD) age: 36.9 year (11.5)] followed-up for a median of 12.7 years. Among 192,976 person-years of follow-up, we identified 753 incident cases of depression. Participants with vitamin D deficiency had a 27% higher risk of depression as compared to those with vitamin D sufficiency (HR: 1.27, 95% CI: 1.09–1.48; p = 0.002) after adjusting for potential confounders. Furthermore, a significant effect modification by female sex was observed with higher depression risks associated with vitamin D deficiency in women than in men (p for interaction = 0.034). In educated middle-aged Spanish adults, we observed a direct association between vitamin D deficiency and the risk of depression, that was stronger among women.
- Macronutrient quality and its association with micronutrient adequacy in children(Elsevier, 2024) Martinez-Gonzalez, M.A. (Miguel Ángel); García-Blanco, L. (Lorena); Zazpe, I. (Itziar); Martín‐Calvo, N. (Nerea); De-la-O-Pascual, V. (Víctor); Fabios, E. (Elise)Background & aims: The double burden of malnutrition compels us to reconsider macronutrients from a diet quality perspective. The Macronutrient Quality Index (MQI) has been designed to reflect overall macronutrient quality and is based on three sub-indexes: the carbohydrate quality index (CQI), the healthy plate protein quality index (HPPQI) and the fat quality index (FQI). Nutritional adequacy is an essential aspect of diet quality that should be captured by reliable dietary indexes. Methods: We analyzed the association between the Macronutrient Quality Index (MQI) and micronutrient adequacy. Participants were children aged 4 and 5 years, recruited in the SENDO cohort. Baseline information was collected through a self-administered online questionnaire, which included information on sociodemographic, dietary, and lifestyle variables. Dietary information was obtained using a 147-item validated semi-quantitative food frequency questionnaire. Participants were categorized into tertiles based on their MQI score. We evaluated the intake of 20 micronutrients and assessed the probability of micronutrient adequacy using the Estimated Average Requirement cut-off point. Results: Children in the highest tertile of MQI had 0.33-fold lower odds (95%CI 0.17e0.66) of having 3 inadequate micronutrient intakes than their peers in the lowest tertile, after adjusting for potential confounders. The adjusted proportions of children with inadequate intake of 3 micronutrients were 18%, 14% and 11% in the first, second, and third tertiles of MQI respectively. The MQI appears to be capable of capturing nutrient adequacy in children, although our results suggest that a modified MQI, with eggs and dairy products weighted positively, might be more adequate for the pediatric population.
- Association between pre-conceptional carbohydrate quality index and the incidence of gestational diabetes: the SUN cohort study(Cambridge University Press on behalf of The Nutrition Society, 2023) Martinez-Gonzalez, M.A. (Miguel Ángel); Bes-Rastrollo, M. (Maira); Santiago, S. (Susana); Fernández-González, E. (Elena); Suescun-Elizalde, D. (David); Gea, A. (Alfredo); Basterra-Gortari, F.J. (Francisco Javier)The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of gestational diabetes mellitus (GDM). Data from the ‘Seguimiento Universidad de Navarra’ (SUN) cohort were used, which includes 3827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semicuantitative 136-item FFQ to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalised estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: OR the highest v. the lowest CQI category: 0·67, 95 % CI (0·40, 1·10), Pfor trend = 0·10. Participants at the highest CQI category and with daily carbohydrate amounts ≥50 % of total energy intake had the lowest incidence of GDM (OR = 0·29 (95 % CI (0·09, 0·89)) compared with those with the lowest quality (lowest CQI) and quantity (≤40 %). Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.
- Vitamin D and risk of developing type 2 diabetes in the SUN project: a prospective cohort study(Springer Nature, 2024) Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Bes-Rastrollo, M. (Maira); Valer-Martínez, A. (Ana); Basterra-Gortari, F.J. (Francisco Javier); Sayon-Orea, C. (Carmen)Purpose: Vitamin D deficiency has been associated with multiple chronic diseases, including metabolic disorders such as insulin resistance and type 2 diabetes (T2D). The aim of the study was to analyze the association between validated predicted serum vitamin D status and the risk of developing T2D in a large prospective cohort based on a Mediterranean population. Methods: The SUN project is a prospective and dynamic Spanish cohort that gathers university graduates who have answered lifestyle questionnaires, including a validated Food Frequency Questionnaire. The association between predicted serum vitamin D and the risk of T2D was assessed through Cox regression models according to quartiles (Q) of predicted vitamin D at baseline. The models were adjusted for potential confounders and sensitivity analyses were performed to ensure the robustness of our findings. Results: Our study included a total of 18,594 participants and after a total follow-up of 238,078 person-years (median follow-up of 13.5 years), 209 individuals were diagnosed with incident T2D. We found a significant inverse association between predicted levels of serum vitamin D and the risk of developing T2D, after adjusting for potential confounders and performing different sensitivity analyses (hazard ratio Q4 vs. Q1: 0.48, 95% CI 0.26-0.88; p for trend = 0.032). Conclusion: The outcomes suggest that higher levels of vitamin D at baseline may be associated with a reduced risk of developing T2D.
- Association of monetary diet cost of foods and diet quality in Spanish older adults(Frontiers, 2023) Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Riquelme-Gallego, B. (Blanca); Pastor, R. (Rosario); Tinahones, F.J. (Francisco J.); Vioque, J. (Jesús); Bes-Rastrollo, M. (Maira); Romaguera, D. (Dora); Romero-Secin, A. (Anny); Lapetra, J. (José); Bouzas, C. (Cristina); Schröder, H. (Helmut); López-Miranda, J. (José); Ruiz-Canela, M. (Miguel); Alonso-Gomez, A. (Ángel); Wärnberg, J. (Julia); Estruch, R. (Ramón); Serra-Majem, L. (Luis); Corella, D. (Dolores); Abete, I. (Itziar); Salas-Salvado, J. (Jordi); Monserrat-Mesquida, M. (Margalida); Garcia, S. (Silvia); Garcia-Arellano, A. (Ana)Background: A major barrier to a healthy diet may be the higher price of healthy foods compared to low-quality foods. Objectives: This study aimed to assess the association between the monetary cost of food and diet quality in Spanish older adults at high risk of cardiovascular disease. Methods: Cross-sectional analysis was carried out in Spanish older adults (n = 6,838; 48.6% female). A validated food frequency questionnaire was used to assess dietary intake. Metabolic syndrome severity, adherence to the Mediterranean diet (MedDiet), adherence to a provegetarian dietary pattern, and dietary inflammatory index were assessed. The economic cost of the foods was obtained from the Spanish Ministry of Agriculture Fisheries and Food database (2015–2017, the period of time when the participants were recruited). The total cost of diet adjusted per 1,000 kcal was computed. Results: The healthier dietary pattern was associated with a higher cost of the diet. Higher adherence to the MedDiet, anti-inflammatory diet, and the healthy version of the provegetarian dietary pattern were related to higher costs of the diet. Conclusion: Higher diet quality was associated with a higher dietary cost of the diet per 1,000 kcal/day. Food prices can be an important component of interventions and policies aimed at improving people's diets and preventing diet-related chronic diseases.
- Daily time spent on screens and psychological well-being: Cross-sectional association within the SUN cohort(Elsevier, 2024) Martinez-Gonzalez, M.A. (Miguel Ángel); Fuente-Arrillaga, C. (Carmen) de la; Bes-Rastrollo, M. (Maira); Basterra-Gortari, V. (Virginia); Lahortiga, F. (Francisca); Sayon-Orea, C. (Carmen); Gil-Conesa, M. (Mario)Background: The impact of various lifestyles on psychological well-being (PWB) remains under-studied. We aimed to explore the cross-sectional association between daily screen use (television, tablet and mobile phone) and PWB within the SUN cohort. Methods: PWB was assessed using the 29-item Ryff scale (ranging from 29 to 174), and participants with scores >75th percentile were considered as having optimal PWB. Participants were categorized based on their self-reported weekly screen usage hours. Postestimation logistic regression models assessing the prevalence likelihood of not achieving optimal PWB were adjusted for sociodemographic, psychological, personality and lifestyles factors. Isotemporal substitution models explored the potential impact on PWB resulting from replacing 1 h/day of screen time with 1 h/day of exercise. Results: The study included 3051 participants (55.8% women, mean age 57.3 ± 11.1 years, mean Ryff's score: 139.1 ± 17.4 points). Daily screen use for ≥2 h was associated with a higher prevalence likelihood of not achieving an optimal PWB (Prevalence Ratio [PR]:1.09; 95% CI:1.01-1.18). Among PWB dimensions, screen use ≥2 h/day was linked to an increased likelihood of not achieving optimal scores in environmental mastery (PR:1.11; 95% CI:1.02-1.20), life purpose (PR:1.10; 95% CI:1.02-1.18), and personal growth (PR:1.09; 95% CI:1.01-1.18). Replacing 1 h of daily screens time with 1 h of exercise may lead to potential improvements in environmental mastery (Odds Ratio [OR]:0.87; 95% CI:0.76-0.99), purpose in life (OR:0.86; 95% CI: 0.76-0.98), personal growth (OR:0.84; 95% CI:0.73-0.96) and positive interpersonal relationships (OR:0.86; 95% CI:0.75-0.99). Conclusions: These findings highlight the importance of reducing screen use activities and increasing physical exercise for achieving optimal PWB.
- Relationship of visceral adipose tissue with surrogate insulin resistance and liver markers in individuals with metabolic syndrome chronic complications(Sage journals, 2020) Martinez, J.A. (José Alfredo); Corbella, E. (Emili); Martinez-Gonzalez, M.A. (Miguel Ángel); Fito, M. (Montserrat); Konieczna, J. (Jadwiga); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Zulet, M.A. (María Ángeles); Tur, J.A. (Josep A.); Toledo, E. (Estefanía); Romaguera, D. (Dora); Macías-González, M. (Manuel); Ros, E. (Emilio); Estruch, R. (Ramón); Corella, D. (Dolores); Abete, I. (Itziar); Mascaró, C.M. (Catalina M.); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Sayon-Orea, C. (Carmen); Bullón-Vela, M. V. (María Vanessa)Background: Visceral adipose tissue (VAT) has a hazardous influence on systemic inflammation, insulin resistance and an adverse metabolic profile, which increases the risk of developing non-alcoholic fatty liver disease (NAFLD) and chronic complications of diabetes. In our study we aimed to evaluate the association of VAT and the triglyceride glucose (TyG) as a proxy of insulin resistance surrogated with metabolic and liver risk factors among subjects diagnosed with metabolic syndrome (MetS). Methods: A cross-sectional study was performed including 326 participants with MetS (55– 75years) from the PREDIMED-Plus study. Liver-status markers, VAT and TyG were assessed. Participants were stratified by tertiles according to VAT (n=254) and TyG (n=326). A receiver operating characteristic curve was used to analyse the efficiency of TyG for VAT. Results: Subjects with greater visceral fat depots showed worse lipid profile, higher homeostatic model assessment for insulin resistance (HOMA-IR), TyG, alanine transaminase (ALT), fibroblast growth factor-21 (FGF-21), fatty liver index (FLI) and hepatic steatosis index (HSI) compared with participants in the first tertile. The multi-adjusted linear-regression analyses indicated that individuals in the third tertile of TyG (>9.1−10.7) had a positive association with HOMA-IR [β=3.07 (95% confidence interval (CI) 2.28−3.86; p trend<0.001)], ALT [β=7.43 (95% CI 2.23−12.63; p trend=0.005)], gamma glutamyl transferase (GGT) [β=14.12 (95% CI 3.64−24.61; p trend=0.008)], FGF-21 [β=190.69 (95% CI 93.13−288.25; p trend<0.001)], FLI [β=18.65 (95% CI 14.97−22.23; p trend<0.001)] and HSI [β=3.46 (95% CI, 2.23−4.68; p trend<0.001)] versus participants from the first tertile. Interestingly, the TyG showed the largest area under the receiver operating curve (AUC) for women (AUC=0.713; 95% CI 0.62−0.79) compared with men (AUC=0.570; 95% CI 0.48−0.66). Conclusions: A disrupted VAT enlargement and impairment of TyG are strongly associated with liver status and cardiometabolic risk factors linked with NAFLD in individuals diagnosed with MetS. Moreover, the TyG could be used as a suitable and reliable marker estimator of VAT.
- Urinary resveratrol metabolites output: Differential associations with cardiometabolic markers and liver enzymes in house-dwelling subjects featuring metabolic syndrome(MDPI AG, 2020) Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Rodriguez-Mateos, A. (Ana); Fito, M. (Montserrat); Sánchez, V.M. (Vicente Martín); Konieczna, J. (Jadwiga); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Zulet, M.A. (María Ángeles); Tur, J.A. (Josep A.); Toledo, E. (Estefanía); Romaguera, D. (Dora); Xu, Y. (Yifan); Ruiz-Canela, M. (Miguel); Estruch, R. (Ramón); Diaz-Lopez, A. (Andres); Lamuela-Raventos, R.M. (Rosa Maria); Almanza-Aguilera, E. (Enrique); Abete, I. (Itziar); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Sayon-Orea, C. (Carmen); Bullón-Vela, M. V. (María Vanessa)Metabolic syndrome (MetS) components are strongly associated with increased risk of non-alcoholic fatty liver disease (NAFLD) development. Several studies have supported that resveratrol is associated with anti-inflammatory and antioxidant effects on health status. The main objective of this study was to assess the putative associations between some urinary resveratrol phase II metabolites, cardiometabolic, and liver markers in individuals diagnosed with MetS. In this cross-sectional study, 266 participants from PREDIMED Plus study (PREvención con DIeta MEDiterránea) were divided into tertiles of total urinary resveratrol phase II metabolites (sum of five resveratrol conjugation metabolites). Urinary resveratrol metabolites were analyzed by ultraperformance liquid chromatography coupled to triple quadrupole mass spectrometry (UPLC-Q-q-Q MS), followed by micro-solid phase extraction (µ-SPE) method. Liver function markers were assessed using serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Moreover, lipid profile was measured by triglycerides, very-low-density lipoprotein cholesterol (VLDL-c), and total cholesterol/high-density lipoprotein ratio (total cholesterol/HDL). Linear regression adjusted models showed that participants with higher total urine resveratrol concentrations exhibited improved lipid and liver markers compared to the lowest tertile. For lipid determinations: log triglycerides (βT3 = −0.15, 95% CI; −0.28, −0.02, p-trend = 0.030), VLDL-c, (βT3 = −4.21, 95% CI; −7.97, −0.46, p-trend = 0.039), total cholesterol/HDL ratio Moreover, (βT3 = −0.35, 95% CI; −0.66, −0.03, p-trend = 0.241). For liver enzymes: log AST (βT3 = −0.12, 95% CI; −0.22, −0.02, p-trend = 0.011, and log GGT (βT3 = −0.24, 95% CI; −0.42, −0.06, p-trend = 0.002). However, there is no difference found on glucose variables between groups. To investigate the risk of elevated serum liver markers, flexible regression models indicated that total urine resveratrol metabolites were associated with a lower risk of higher ALT (169.2 to 1314.3 nmol/g creatinine), AST (599.9 to 893.8 nmol/g creatinine), and GGT levels (169.2 to 893.8 nmol/g creatinine). These results suggested that higher urinary concentrations of some resveratrol metabolites might be associated with better lipid profile and hepatic serum enzymes. Moreover, urinary resveratrol excreted showed a reduced odds ratio for higher liver enzymes, which are linked to NAFLD.
- The effect of physical activity and high body mass index on health-related quality of life in individuals with metabolic syndrome(MDPI AG, 2020) Babio, N. (Nancy); Castañer, O. (Olga); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Sorto-Sánchez, C. (Carolina); Galilea-Zabalza, I. (Iñigo); Garcia-Rios, A. (Antonio); Marcos-Delgado, A. (Alba); Gimenez-Alba, I.M. (Ignacio Manuel); Palau-Galindo, A. (Antoni); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Vaquero-Luna, J. (Jessica); Vioque, J. (Jesús); Ortega-Azorin, C. (Carolina); Zulet, M.A. (María Ángeles); Becerra-Tomas, N. (Nerea); Pastor-Morel, A. (Ana); Tur, J.A. (Josep A.); Toledo, E. (Estefanía); Romaguera, D. (Dora); Vázquez, C. (Clotilde); Fernández-Villa, T. (Tania); Paz, J.A. (José Antonio) de; Muñoz-Martínez, J. (Júlia); Lapetra, J. (José); Zomeño, M.D. (María Dolores); Matía-Martín, P. (Pilar); Delgado-Rodriguez, M. (Miguel); López-Miranda, J. (José); Galmes-Panades, A.M. (Aina M.); Ros, E. (Emilio); Perez-Vega, K.A. (Karla Alejandra); Casas, R. (Rosa); Alonso-Gomez, A. (Ángel); Wärnberg, J. (Julia); García-Molina, L. (Laura); Estruch, R. (Ramón); Vazquez-Ruiz, Z. (Zenaida); Santos-Lozano, J.M. (José M.); Pérez-Lopez, J. (Jessica); Serra-Majem, L. (Luis); Corella, D. (Dolores); Abete, I. (Itziar); Vidal, J. (Josep); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Martin, V. (Vicente); Bernal-López, M.R. (María Rosa)The main objective of this study was to examine the relationship between the level of physical activity (PA) and the degree of obesity with health-related quality of life (HRQoL) in individuals with metabolic syndrome (MetS) who participated in the Predimed-Plus study. A total of 6875 subjects between 55 and 75 years of age with MetS were selected and randomized in 23 Spanish centers. Subjects were classified according to categories of body mass index (BMI). PA was measured with the validated Registre Gironí del Cor (REGICOR) questionnaire and subjects were classified according to their PA level (light, moderate, vigorous) and the HRQoL was measured with the validated short-form 36 (SF-36) questionnaire. By using the ANOVA model, we found a positive and statistically significant association between the level of PA and the HRQoL (aggregated physical and mental dimensions p < 0.001), but a negative association with higher BMI in aggregated physical dimensions p < 0.001. Furthermore, women obtained lower scores compared with men, more five points in all fields of SF-36. Therefore, it is essential to promote PA and body weight control from primary care consultations to improve HRQoL, paying special attention to the differences that sex incurs.
- Physical fitness and physical activity association with cognitive function and quality of life: baseline cross-sectional analysis of the PREDIMED-Plus trial(Springer Nature, 2020) Buil-Cosiales, P. (Pilar); Colmenarejo, G. (Gonzalo); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Micó-Pérez, R.M. (Rafael Manuel); Galilea-Zabalza, I. (Iñigo); Garcia-Rios, A. (Antonio); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Vioque, J. (Jesús); Torre, R. (Rafael) de la; Zulet, M.A. (María Ángeles); Tur, J.A. (Josep A.); Romaguera, D. (Dora); Lapetra, J. (José); Paz-Graniel, I. (Indira); Schröder, H. (Helmut); López-Miranda, J. (José); Galdon, A. (Alba); Galmes-Panades, A.M. (Aina M.); Matia, P. (Pilar); Ros, E. (Emilio); Ordovas, J.M. (Jose Manuel); Micó, V. (Victor); Alonso-Gomez, A. (Ángel); Wärnberg, J. (Julia); Estruch, R. (Ramón); Vazquez-Ruiz, Z. (Zenaida); Diaz-Lopez, A. (Andres); Gaforio, J.J. (José Juan); Serra-Majem, L. (Luis); Corella, D. (Dolores); Vidal, J. (Josep); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Cano-Ibañez, N. (Naomi); Sorli, J.V. (Jose V.); Cuenca-Royo, A. (Aida); Gisbert-Sellés, C. (Cristina)Physical activity (PA) has been hypothesized to be effective to maintaining cognitive function and delay cognitive decline in the elderly, but physical fitness (PF) could be a better predictor of cognitive function. We aimed to study the association between PA and PF with cognitive function and quality of life using cross-sectional data from 6874 participants of the PREDIMED-Plus trial (64.9 ± 4.9 years, 48.5% female). PF and PA were measured with a Chair Stand Test, the REGICOR and Rapid Assessment Physical Activity questionnaires. Cognitive function was measured with Mini-mental State Examination, Control Oral Word Association Test, Trail Making Test and Digit Span tests; whereas health-related quality of life was assessed with the SF36-HRQL test. Cognitive and quality of life scores were compared among PF quartiles and PA levels (low, moderate and high) with ANCOVA and with Chair Stand repetitions and energy expenditure from total PA with multivariable linear regression adjusted for confounding factors. PF associated with higher scores in phonemic and semantic verbal fluency tests and with lower TMT A time. However, PA was not associated with the neurocognitive parameters evaluated. Both PF and PA levels were strongly associated with a better quality of life. We concluded that PF, but not PA, is associated with a better cognitive function. This trial was retrospectively registered at the International Standard Randomized Controlled Trial (ISRCTN89898870, https://www.isrctn.com/ISRCTN89898870?q=ISRCTN89898870&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search) on 07/24/2014.