Muñoz, M.A. (Miguel Angel)
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- Impact of psychosocial factors on cardiovascular morbimortality: a prospective cohort study(BioMed Central, 2014) Castañer, O. (Olga); Martinez-Gonzalez, M.A. (Miguel Ángel); Fiol, M. (Miquel); Mejia-Lancheros, C. (Cilia); Diez-Espino, J. (Javier); Gomez-Gracia, E. (Enrique); Lapetra, J. (José); Muñoz, M.A. (Miguel Angel); Basora, J. (Josep); Ruiz-Gutierrez, V. (Valentina); Ros, E. (Emilio); Estruch, R. (Ramón); Lamuela-Raventos, R.M. (Rosa Maria); Serra-Majem, L. (Luis); Corella, D. (Dolores); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Sorli, J.V. (Jose V.); Aros, F. (Fernando)Background: Whilst it is well known that psychosocial determinants may contribute to cardiovascular diseases (CVD), data from specific groups are scarce. The present study aims to determine the contribution of psychosocial determinants in increasing the risk of cardiovascular events (myocardial infarction and stroke), and death from CVD, in a high risk adult population. Methods: Longitudinal prospective study of 7263 patients (57.5% women), mean age 67.0 (SD 6.2) free from CVD but at high risk, with a median follow-up of 4.8 years (from October 2003 to December 2010). The Hazard Ratios (HRs) of cardiovascular events (myocardial infarction, stroke, and death from cardiovascular causes) related to educational attainment, diagnosed depression (based on medical records), and low social support (number of people living in the household) were estimated by multivariate Cox regression models. Results: Stroke incidence was associated with low educational level in the whole population (HR: 1.83, 95% CI: 1.09–3.09), and especially in men (HR: 2.11, 95% CI 1.09–4.06). Myocardial infarction and CVD mortality were not associated with any of the psychosocial factors considered. Conclusion: Adults with low educational level had a higher risk of stroke. Depression and low social support were not associated with CVD incidence. Trial registration: Clinical trial registration information unique identifier: ISRCTN35739639.
- Mercury exposure and risk of cardiovascular disease: a nested casecontrol study in the PREDIMED (PREvention with MEDiterranean Diet) study(Bio Med Central, 2017) Martinez-Gonzalez, M.A. (Miguel Ángel); Fiol, M. (Miquel); Fito, M. (Montserrat); Garcia-Rodriguez, A. (Antonio); Gomez-Gracia, E. (Enrique); Lapetra, J. (José); Muñoz, M.A. (Miguel Angel); Ros, E. (Emilio); Ruiz-Canela, M. (Miguel); Downer, M.K. (Mary Kathryn); Gutierrez-Bedmar, M. (Mario); Bullo, M. (Monica); Stampfer, M. (Meir); Wärnberg, J. (Julia); Estruch, R. (Ramón); Gea, A. (Alfredo); Serra-Majem, L. (Luis); Corella, D. (Dolores); Salas-Salvado, J. (Jordi); Sorli, J.V. (Jose V.); Aros, F. (Fernando)Background: Substantial evidence suggests that consuming 1–2 servings of fish per week, particularly oily fish (e.g., salmon, herring, sardines) is beneficial for cardiovascular health due to its high n-3 polyunsaturated fatty acid content. However, there is some concern that the mercury content in fish may increase cardiovascular disease risk, but this relationship remains unclear. Methods: The PREDIMED trial included 7477 participants who were at high risk for cardiovascular disease at baseline. In this study, we evaluated associations between mercury exposure, fish consumption and cardiovascular disease. We randomly selected 147 of the 288 cases diagnosed with cardiovascular disease during follow-up and matched them on age and sex to 267 controls. Instrumental neutron activation analysis was used to assess toenail mercury concentration. In-person interviews, medical record reviews and validated questionnaires were used to assess fish consumption and other covariates. Information was collected at baseline and updated yearly during follow-up. We used conditional logistic regression to evaluate associations in the total nested case-control study, and unconditional logistic regression for population subsets. Results: Mean (±SD) toenail mercury concentrations (μg per gram) did not significantly differ between cases (0.63 (±0.53)) and controls (0.67 (±0.49)). Mercury concentration was not associated with cardiovascular disease in any analysis, and neither was fish consumption or n-3 fatty acids. The fully-adjusted relative risks for the highest versus lowest quartile of mercury concentration were 0.71 (95% Confidence Interval [CI], 0.34, 1.14; ptrend = 0.37) for the nested case-control study, 0.74 (95% CI, 0.32, 1.76; ptrend = 0.43) within the Mediterranean diet intervention group, and 0.50 (95% CI, 0.13, 1.96; ptrend = 0.41) within the control arm of the trial. Associations remained null when mercury was jointly assessed with fish consumption at baseline and during follow-up. Results were similar in different sensitivity analyses.Conclusions: We found no evidence that mercury exposure from regular fish consumption increases cardiovascular disease risk in a population of Spanish adults with high cardiovascular disease risk and high fish consumption. This implies that the mercury content in fish does not detract from the already established cardiovascular benefits of fish consumption.
- Mediterranean diet and quality of life: baseline cross-sectional analysis of the PREDIMED-PLUS trial(PLOS, 2018) Babio, N. (Nancy); Buil, P. (Pilar); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Galilea-Zabalza, I. (Iñigo); González-Palacios, S. (Sandra); Garcia-Rios, A. (Antonio); Delgado, A. (Alba); Fito, M. (Montserrat); Pérez-Farinós, N. (Napoleón); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Vioque, J. (Jesús); Ortega-Azorin, C. (Carolina); Tur, J.A. (Josep A.); Diez-Espino, J. (Javier); Toledo, E. (Estefanía); Romaguera, D. (Dora); Vázquez, C. (Clotilde); Zomeño, M.D. (María Dolores); Bueno-Cavanillas, A. (Aurora); Muñoz, M.A. (Miguel Angel); Delgado-Rodriguez, M. (Miguel); López-Miranda, J. (José); Matia, P. (Pilar); Ros, E. (Emilio); Ortega-Calvo, M. (Manuel); Estruch, R. (Ramón); Vazquez-Ruiz, Z. (Zenaida); Diaz-Lopez, A. (Andres); Serra-Majem, L. (Luis); Corella, D. (Dolores); Abete, I. (Itziar); Vidal, J. (Josep); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Aros, F. (Fernando)We assessed if a 17-item score capturing adherence to a traditional Mediterranean diet (MedDiet) was associated with better health-related quality of life among older Spanish men and women with overweight or obesity harboring the metabolic syndrome. We analyzed baseline data from 6430 men and women (age 55–70 years) participating in the PREDIMED-Plus study. PREDIMED-Plus is a multi-centre randomized trial testing an energyrestricted MedDiet combined with promotion of physical activity and behavioral therapy for primary cardiovascular prevention compared to a MedDiet alone. Participants answered a 36-item questionnaire about health-related quality of life (HRQoL) and a 17-item questionnaire that assessed adherence to an MedDiet. We used ANCOVA and multivariableadjusted linear regression models to compare baseline adjusted means of the quality of life scales according to categories of adherence to the MedDiet. Higher adherence to the MedDiet was independently associated with significantly better scores in the eight dimensions of HRQoL. Adjusted differences of > = 3 points between the highest and the lowest dietary adherence groups to the MedDiet were observed for vitality, emotional role, and mental health and of > = 2 points for the other dimensions. In conclusion, this study shows a positive association between adherence to a MedDiet and several dimensions of quality of life.
- Dietary diversity and nutritional adequacy among an older Spanish population with Metabolic Syndrome in the PREDIMED-Plus study: a cross-sectional analysis(MDPI, 2019) Buil, P. (Pilar); Portoles, O. (Olga); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Muñoz-Garach, A. (Araceli); Riquelme-Gallego, B. (Blanca); Garcia-Rios, A. (Antonio); Fernandez-Carrion, R. (Rebeca); Gallardo-Alfaro, L. (Laura); Fito, M. (Montserrat); Konieczna, J. (Jadwiga); Palau-Galindo, A. (Antoni); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Vioque, J. (Jesús); Moñino, M. (Manuel); Tur, J.A. (Josep A.); Romaguera, D. (Dora); Vázquez, C. (Clotilde); Lapetra, J. (José); Zomeño, M.D. (María Dolores); Bueno-Cavanillas, A. (Aurora); Muñoz, M.A. (Miguel Angel); Basora, J. (Josep); Delgado-Rodriguez, M. (Miguel); Miralles-Gisbert, S. (Salvador); Contreras-Fernandez, E. (Eugenio); Matia, P. (Pilar); Ros, E. (Emilio); Ruiz-Canela, M. (Miguel); Notario-Barandiaran, L. (Leyre); Perez-Vega, K.A. (Karla Alejandra); Casas, R. (Rosa); Alonso-Gomez, A. (Ángel); Wärnberg, J. (Julia); Estruch, R. (Ramón); Diaz-Lopez, A. (Andres); Santos-Lozano, J.M. (José M.); Gea, A. (Alfredo); Sanchez-Villegas, A. (Almudena); Serra-Majem, L. (Luis); Corella, D. (Dolores); Abete, I. (Itziar); Vidal, J. (Josep); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Martin, V. (Vicente); Cano-Ibañez, N. (Naomi); Aros, F. (Fernando); Moreno-Rodríguez, A. (Anai)Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55–75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80–39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55–18.65), fruits OR = 11.62 (95% CI 6.81–19.81), dairy products OR = 6.54 (95% CI 4.64–9.22) and protein foods OR = 6.60 (95% CI 1.96–22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s. View Full-Text
- Associations of the FTO rs9939609 and the MC4R rs17782313 polymorphisms with type 2 diabetes are modulated by diet, being higher when adherence to the mediterranean diet pattern is low(BioMed Central, 2012) Martinez-Gonzalez, M.A. (Miguel Ángel); Fiol, M. (Miquel); Saez-Tormo, G. (Guillermo); Ortega-Azorin, C. (Carolina); Gomez-Gracia, E. (Enrique); Ordovas, J.M. (Jose Maria); Lapetra, J. (José); Muñoz, M.A. (Miguel Angel); Coltell, O. (Oscar); Covas, M.I. (María Isabel); Ros, E. (Emilio); Estruch, R. (Ramón); Asensio, E.M. (Eva M.); Serra-Majem, L. (Luis); Corella, D. (Dolores); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Sorli, J.V. (Jose V.); Aros, F. (Fernando)BACKGROUND: Although the fat mass and obesity (FTO) and melanocortin-4 receptor (MC4R) genes have been consistently associated with obesity risk, the association between the obesity-risk alleles with type 2 diabetes is still controversial. In some recent meta-analyses in which significant results have been reported, the associations disappeared after adjustment for body mass index (BMI). However gene-diet interactions with dietary patterns have not been investigated. Our main aim was to analyze whether these associations are modulated by the level of adherence to the Mediterranean Diet (MedDiet). METHODS: Case-control study in 7,052 high cardiovascular risk subjects (3,430 type 2 diabetes cases and 3,622 non-diabetic subjects) with no differences in BMI. Diet was assessed by validated questionnaires. FTO-rs9939609 and MC4R-rs17782313 were determined. An aggregate genetic score was calculated to test additive effects. Gene-diet interactions were analyzed. RESULTS: Neither of the polymorphisms was associated with type 2 diabetes in the whole population. However, we found consistent gene-diet interactions with adherence to the MedDiet both for the FTO-rs9939609 (P-interaction=0.039), the MC4R-rs17782313 (P-interaction=0.009) and for their aggregate score (P-interaction=0.006). When adherence to the MedDiet was low, carriers of the variant alleles had higher type 2 diabetes risk (OR=1.21, 95%CI: 1.03-1.40; P=0.019 for FTO-rs9939609 and OR=1.17, 95%CI:1.01-1.36; P=0.035 for MC4R-rs17782313) than wild-type subjects. However, when adherence to the MedDiet was high, these associations disappeared (OR=0.97, 95%CI: 0.85-1.16; P=0.673 for FTO-rs9939609 and OR=0.89, 95%CI:0.78-1.02; P=0.097 for MC4R-rs17782313). These gene-diet interactions remained significant even after adjustment for BMI. As MedDiet is rich in folate, we also specifically examined folate intake and detected statistically significant interaction effects on fasting plasma glucose concentrations in non-diabetic subjects. However these findings should be interpreted with caution because folate intake may simply reflect a healthy dietary pattern. CONCLUSIONS: These novel results suggest that the association of the FTO-rs9939609 and the MC4R-rs17782313 polymorphisms with type 2 diabetes depends on diet and that a high adherence to the MedDiet counteracts the genetic predisposition.
- Empirically derived food patterns and the risk of total mortality and cardiovascular events in the predimed study(Elsevier, 2014) Buil, P. (Pilar); Martinez-Gonzalez, M.A. (Miguel Ángel); Fiol, M. (Miquel); Recondo, J. (Javier); Sanchez-Tainta, A. (Ana); Tur, J.A. (Josep A.); Zazpe, I. (Itziar); Gomez-Gracia, E. (Enrique); Toledo, E. (Estefanía); Lapetra, J. (José); Muñoz, M.A. (Miguel Angel); Schröder, H. (Helmut); Razquin, C. (Cristina); Ros, E. (Emilio); Estruch, R. (Ramón); Lamuela-Raventos, R.M. (Rosa Maria); Serra-Majem, L. (Luis); Corella, D. (Dolores); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Sorli, J.V. (Jose V.)BACKGROUND & AIMS: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). DESIGN: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial. RESULTS: We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a "Mediterranean-type" dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098). CONCLUSIONS: Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events.
- Primary prevention of cardiovascular disease with a Mediterranean diet(Massachusetts Medical Society, 2013) Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Fiol, M. (Miquel); Gomez-Gracia, E. (Enrique); Lapetra, J. (José); Muñoz, M.A. (Miguel Angel); Basora, J. (Josep); Ruiz-Gutierrez, V. (Valentina); Covas, M.I. (María Isabel); Ros, E. (Emilio); Estruch, R. (Ramón); Lamuela-Raventos, R.M. (Rosa Maria); Serra-Majem, L. (Luis); Corella, D. (Dolores); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Sorli, J.V. (Jose V.); Aros, F. (Fernando)BACKGROUND: Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. METHODS: In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. RESULTS: A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. CONCLUSIONS: Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.
- Seafood Consumption, Omega-3 Fatty Acids Intake, and Life-Time Prevalence of Depression in the PREDIMED-Plus Trial(MDPI, 2018-12-18) Babio, N. (Nancy); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Izquierdo, M. (Marisol); Garcia-Rios, A. (Antonio); Fito, M. (Montserrat); Daimiel, L. (Lidia); Tinahones, F.J. (Francisco J.); Vioque, J. (Jesús); Ortega-Azorin, C. (Carolina); García Hera, M (Manoli) de la; Tur, J.A. (Josep A.); Toledo, E. (Estefanía); Romaguera, D. (Dora); Lecea, O. (Oscar); Vázquez, C. (Clotilde); Zomeño, M.D. (María Dolores); Bueno-Cavanillas, A. (Aurora); Muñoz, M.A. (Miguel Angel); Delgado-Rodriguez, M. (Miguel); López-Miranda, J. (José); Matia, P. (Pilar); Ros, E. (Emilio); Ruiz-Canela, M. (Miguel); Alvarez Perez, J. (Jacqueline); Ortega-Calvo, M. (Manuel); Estruch, R. (Ramón); Diaz-Lopez, A. (Andres); Pérez-Lopez, J. (Jessica); Sanchez-Villegas, A. (Almudena); Serra-Majem, L. (Luis); Corella, D. (Dolores); Abete, I. (Itziar); Vidal, J. (Josep); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Martin, V. (Vicente); Aros, F. (Fernando)Background: The aim of this analysis was to ascertain the type of relationship between fish and seafood consumption, omega-3 polyunsaturated fatty acids (ω-3 PUFA) intake, and depression prevalence. Methods: Cross-sectional analyses of the PREDIMED-Plus trial. Fish and seafood consumption and ω-3 PUFA intake were assessed through a validated food-frequency questionnaire. Self-reported life-time medical diagnosis of depression or use of antidepressants was considered as outcome. Depressive symptoms were collected by the Beck Depression Inventory-II. Logistic regression models were used to estimate the association between seafood products and ω-3 PUFA consumption and depression. Multiple linear regression models were fitted to assess the association between fish and long-chain (LC) ω-3 PUFA intake and depressive symptoms. Results: Out of 6587 participants, there were 1367 cases of depression. Total seafood consumption was not associated with depression. The odds ratios (ORs) (95% confidence intervals (CIs)) for the 2nd, 3rd, and 4th quintiles of consumption of fatty fish were 0.77 (0.63–0.94), 0.71 (0.58–0.87), and 0.78 (0.64–0.96), respectively, and p for trend = 0.759. Moderate intake of total LC ω-3 PUFA (approximately 0.5–1 g/day) was significantly associated with a lower prevalence of depression. Conclusion: In our study, moderate fish and LC ω-3 PUFA intake, but not high intake, was associated with lower odds of depression suggesting a U-shaped relationship.
- Polyphenol intake and mortality risk: a re-analysis of the PREDIMED trial(BioMed Central, 2014) Martinez-Gonzalez, M.A. (Miguel Ángel); Medina-Remon, A. (Alexander); Fiol, M. (Miquel); Lopez-Sabater, M.C. (M. Carmen); Gomez-Gracia, E. (Enrique); Tresserra-Rimbau, A. (Anna); Lapetra, J. (José); Muñoz, M.A. (Miguel Angel); Ruiz-Gutierrez, V. (Valentina); Covas, M.I. (María Isabel); Ros, E. (Emilio); Rimm, E.B. (Eric B.); Estruch, R. (Ramón); Lamuela-Raventos, R.M. (Rosa Maria); Gea, A. (Alfredo); Serra-Majem, L. (Luis); Corella, D. (Dolores); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Aros, F. (Fernando)Background: Polyphenols may lower the risk of cardiovascular disease (CVD) and other chronic diseases due to their antioxidant and anti-inflammatory properties, as well as their beneficial effects on blood pressure, lipids and insulin resistance. However, no previous epidemiological studies have evaluated the relationship between the intake of total polyphenols intake and polyphenol subclasses with overall mortality. Our aim was to evaluate whether polyphenol intake is associated with all-cause mortality in subjects at high cardiovascular risk. Methods: We used data from the PREDIMED study, a 7,447-participant, parallel-group, randomized, multicenter, controlled five-year feeding trial aimed at assessing the effects of the Mediterranean Diet in primary prevention of cardiovascular disease. Polyphenol intake was calculated by matching food consumption data from repeated food frequency questionnaires (FFQ) with the Phenol-Explorer database on the polyphenol content of each reported food. Hazard ratios (HR) and 95% confidence intervals (CI) between polyphenol intake and mortality were estimated using time-dependent Cox proportional hazard models. Results: Over an average of 4.8 years of follow-up, we observed 327 deaths. After multivariate adjustment, we found a 37% relative reduction in all-cause mortality comparing the highest versus the lowest quintiles of total polyphenol intake (hazard ratio (HR) = 0.63; 95% CI 0.41 to 0.97; P for trend = 0.12). Among the polyphenol subclasses, stilbenes and lignans were significantly associated with reduced all-cause mortality (HR =0.48; 95% CI 0.25 to 0.91; P for trend = 0.04 and HR = 0.60; 95% CI 0.37 to 0.97; P for trend = 0.03, respectively), with no significant associations apparent in the rest (flavonoids or phenolic acids). Conclusions: Among high-risk subjects, those who reported a high polyphenol intake, especially of stilbenes and lignans, showed a reduced risk of overall mortality compared to those with lower intakes. These results may be useful to determine optimal polyphenol intake or specific food sources of polyphenols that may reduce the risk of all-cause mortality. Clinical trial registration: ISRCTN35739639.
- Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study(Biomed Central, 2014) Buil, P. (Pilar); Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Fiol, M. (Miquel); Fito, M. (Montserrat); Hu, F.B. (Frank B.); Recondo, J. (Javier); Gomez-Gracia, E. (Enrique); Lapetra, J. (José); Guasch-Ferre, M. (Marta); Muñoz, M.A. (Miguel Angel); Basora, J. (Josep); Ruiz-Gutierrez, V. (Valentina); Ros, E. (Emilio); Bullo, M. (Monica); Estruch, R. (Ramón); Lamuela-Raventos, R.M. (Rosa Maria); Serra-Majem, L. (Luis); Corella, D. (Dolores); Pinto, X. (Xavier); Salas-Salvado, J. (Jordi); Sorli, J.V. (Jose V.)Background: It is unknown whether individuals at high cardiovascular risk sustain a benefit in cardiovascular disease from increased olive oil consumption. The aim was to assess the association between total olive oil intake, its varieties (extra virgin and common olive oil) and the risk of cardiovascular disease and mortality in a Mediterranean population at high cardiovascular risk. Methods: We included 7,216 men and women at high cardiovascular risk, aged 55 to 80 years, from the PREvención con DIeta MEDiterránea (PREDIMED) study, a multicenter, randomized, controlled, clinical trial. Participants were randomized to one of three interventions: Mediterranean Diets supplemented with nuts or extra-virgin olive oil, or a control low-fat diet. The present analysis was conducted as an observational prospective cohort study. The median follow-up was 4.8 years. Cardiovascular disease (stroke, myocardial infarction and cardiovascular death) and mortality were ascertained by medical records and National Death Index. Olive oil consumption was evaluated with validated food frequency questionnaires. Multivariate Cox proportional hazards and generalized estimating equations were used to assess the association between baseline and yearly repeated measurements of olive oil intake, cardiovascular disease and mortality. Results: During follow-up, 277 cardiovascular events and 323 deaths occurred. Participants in the highest energy-adjusted tertile of baseline total olive oil and extra-virgin olive oil consumption had 35% (HR: 0.65; 95% CI: 0.47 to 0.89) and 39% (HR: 0.61; 95% CI: 0.44 to 0.85) cardiovascular disease risk reduction, respectively, compared to the reference. Higher baseline total olive oil consumption was associated with 48% (HR: 0.52; 95% CI: 0.29 to 0.93) reduced risk of cardiovascular mortality. For each 10 g/d increase in extra-virgin olive oil consumption, cardiovascular disease and mortality risk decreased by 10% and 7%, respectively. No significant associations were found for cancer and all-cause mortality. The associations between cardiovascular events and extra virgin olive oil intake were significant in the Mediterranean diet intervention groups and not in the control group. Conclusions: Olive oil consumption, specifically the extra-virgin variety, is associated with reduced risks of cardiovascular disease and mortality in individuals at high cardiovascular risk.