Hershey-de-la-Cruz, M.S. (María Soledad)
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- Mediterranean lifestyle index and 24-h systolic blood pressure and heart rate in community-dwelling older adults(Springer, 2024) Cruz-Troca, J.J. (Juan J.) de la; Ruiz-Canela, M. (Miguel); Sotos-Prieto, M. (Mercedes); Rodríguez-Artalejo, F. (Fernando); Talavera-Rodríguez, I. (Irene); Ortolá, R. (Rosario); Martinez-Gomez, D. (David); Banegas, J.R. (José R.); Hershey-de-la-Cruz, M.S. (María Soledad)Specific foods, nutrients, dietary patterns, and physical activity are associated with lower blood pressure (BP) and heart rate (HR), but little is known about the joint effect of lifestyle factors captured in a multidimensional score. We assessed the association of a validated Mediterranean-lifestyle (MEDLIFE) index with 24-h-ambulatory BP and HR in everyday life among community-living older adults. Data were taken from 2,184 individuals (51% females, mean age: 71.4 years) from the Seniors-ENRICA-2 cohort. The MEDLIFE index consisted of 29 items arranged in three blocks: 1) Food consumption; 2) Dietary habits; and 3) Physical activity, rest, and conviviality. A higher MEDLIFE score (0-29 points) represented a better Mediterranean lifestyle adherence. 24-h-ambulatory BP and HR were obtained with validated oscillometric devices. Analyses were performed with linear regression adjusted for the main confounders. The MEDLIFE-highest quintile (vs Q1) was associated with lower nighttime systolic BP (SBP) (-3.17 mmHg [95% CI: -5.25, -1.08]; p-trend = 0.011), greater nocturnal-SBP fall (1.67% [0.51, 2.83]; p-trend = 0.052), and lower HR (-2.04 bpm [daytime], -2.33 bpm [nighttime], and -1.93 bpm [24-h]; all p-trend < 0.001). Results were similar for each of the three blocks of MEDLIFE and by hypertension status (yes/no). Among older adults, higher adherence to MEDLIFE was associated with lower nighttime SBP, greater nocturnal-SBP fall, and lower HR in their everyday life. These results suggest a synergistic BP-related protection from the components of the Mediterranean lifestyle. Future studies should determine whether these results replicate in older adults from other Mediterranean and non-Mediterranean countries.
- Association of the modified mediterranean diet score (mMDS) with anthropometric and biochemical indices in US career firefighters(MDPI, 2020) Tripsianis, G. (Grigorios); Kales, S.N. (Stefanos N.); Christophi, C. (Costas); Romanidou, M. (Maria); Sotos-Prieto, M. (Mercedes); Moffatt, S. (Steven); Hershey-de-la-Cruz, M.S. (María Soledad); Constantinidis, T.C. (Theodoros C.)The Mediterranean diet is associated with multiple health benefits, and the modified Mediterranean Diet Score (mMDS) has been previously validated as a measure of Mediterranean diet adherence. The aim of this study was to examine associations between the mMDS and anthropometric indices, blood pressure, and biochemical parameters in a sample of career firefighters. The participants were from Indiana Fire Departments, taking part in the “Feeding America’s Bravest” study, a cluster-randomized controlled trial that aimed to assess the efficacy of a Mediterranean diet intervention. We measured Mediterranean diet adherence using the mMDS. Anthropometric, blood pressure, and biochemical measurements were also collected. Univariate and multivariate linear regression models were used. In unadjusted analyses, many expected favorable associations between the mMDS and cardiovascular disease risk factors were found among the 460 firefighters. After adjustment for age, gender, ethnicity, physical activity, and smoking, a unitary increase in the mMDS remained associated with a decrease of the total cholesterol/HDL ratio (β-coefficient −0.028, p = 0.002) and an increase of HDL-cholesterol (β-coefficient 0.254, p = 0.004). In conclusion, greater adherence to the Mediterranean diet was associated with markers of decreased cardiometabolic risk. The mMDS score is a valid instrument for measuring adherence to the Mediterranean diet and may have additional utility in research and clinical practice.
- The Mediterranean diet and physical activity: interaction analysis and assessment of a mediterranean lifestyle score for the prevention of chronic diseases and premature(Universidad de Navarra, 2022-04-13) Hershey-de-la-Cruz, M.S. (María Soledad); Martinez-Gonzalez, M.A. (Miguel Ángel); Ruiz-Canela, M. (Miguel)Epidemiology is the science that studies disease occurrence and health states in human populations.1 Epidemiology represents a multifaceted and interdisciplinary field of medicine which assesses the effect of exposures, including causal inference, on any health-related outcome that impacts the overall health of a given population.1–3 In recent decades, epidemiological studies have sought to better understand the causality of some detrimental exposures (i.e. poor nutrition, lack of exercise, pollution, inadequate sleep, smoking) and have proposed public health strategies for mitigating the world’s current non-communicable or chronic disease (NCDs) epidemic.1,4 A variety of highly prevalent NCDs are largely responsible for both morbidity and mortality worldwide. Whereas morbidity is the state of being symptomatic or unhealthy for a disease or condition, mortality is related to the number of deaths caused by the health outcome, presented either as an absolute number or “per 1000” rate of the given population.4 Additionally, in public health it is important to capture fatal outcomes in a summary measure of average levels of population health, such as life expectancy.5 At the population-level, in addition to the attributable mortality, mortality rates, and life expectancy, other health metrics estimate the population impact of disease and disease risk factors, not only fatalities. These metrics include years of life lost due to premature mortality (YLLs), years of healthy life lost due to disability (YLDs), and disability-adjusted life-years (DALYs).6 These measures help understand the burden that a health outcome may place on a population and offer stakeholders some direction as to how health outcomes can be more effectively prioritized to design and proactively implement prevention strategies, and properly allocate the pertinent resources to each alternative strategy.4 Furthermore, the population impact of morbidity and cause-specific mortality have been recently evidenced using these estimated measures within The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD).7
- Joint association of the Mediterranean diet and smoking with all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort(2022) Martinez-Gonzalez, M.A. (Miguel Ángel); Toledo, E. (Estefanía); Pardavila-Belio, M.I. (Miren Idoia); Ruiz-Canela, M. (Miguel); Barbería-Latasa, M. (María); De-la-O-Pascual, V. (Víctor); Hershey-de-la-Cruz, M.S. (María Soledad); Martin-Moreno, J.M. (J.M.)Objectives: Although low-quality diets and smoking are independently associated with higher mortality risk, a joint analysis of both risk factors in relation to mortality has not been sufficiently studied. The aim of this study was to explore the effect modification between level of adherence to a Mediterranean dietary pattern (MedDiet) and smoking status on all-cause, cancer, and cardiovascular mortality.Methods: We conducted a prospective analysis to assess the association between diet and smoking status in the SUN (Seguimiento Universidad de Navarra) cohort study. Deaths were confirmed by review of the National Death Index. Participants were classified into six categories according to the MedDiet (adherence/non-adherence) and their exposure to smoking (never/former/current smoker). Multivariate-adjusted Cox regression models were fitted to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for mortality. During a mean follow-up of 11.5 y (SD 4.5), we observed 18 948 participants (mean age 38.4 y; SD 12.4) and 431 deaths (51.3% cancer deaths). Results: A higher risk for death was found among smokers with a low adherence to the MedDiet (HR, 2.20; 95% CI, 1.45-3.34) compared with never smokers with high adherence to the MedDiet. The P value for supra-multiplicative effect modification was not statistically significant, meaning that the effect of both factors is multiplicative. A higher risk for premature death from cancer was found in smokers and in those nonadherent with the MedDiet.Conclusion: Smoking and poor adherence to the MedDiet exerted a multiplicative effect in increasing allcause mortality and cancer-related mortality in a Spanish population of university graduates.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
- Correction: Martínez-González, M.A. et al. Transferability of the Mediterranean Diet to Non-Mediterranean Countries. What Is and What Is Not the Mediterranean Diet. Nutrients 2017, 9, 1226(MDPI, 2018) Martinez-Gonzalez, M.A. (Miguel Ángel); Zazpe, I. (Itziar); Trichopoulou, A. (Antonia); Hershey-de-la-Cruz, M.S. (María Soledad)The authors have requested that the following changes be made to their paper [1].
- A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: a Pilot Study Protocol(2023) Moreno-Galarraga, L. (Laura); García-Hermoso, A. (Antonio); López-Gil, J.F. (José Francisco); Eumann-Mesas, A. (Arthur); Brazo-Sayavera, J. (Javier); Panisello-Royo, J.M. (Josefa María); Smith, L. (Lee); Ezzatvar, Y. (Yasmin); Kales, S.N. (Stefanos N.); Alcaraz, P.E. (Pedro Emilio); Gallego, A. (Alejandra); Fernandez-Montero, A. (Alejandro); Gutiérrez-Espinoza, H. (Héctor); López-Benavente, A. (Alba); Tarraga-López, P.J. (Pedro J.); Victoria-Montesinos, D. (Desirée); Jiménez-López, E. (Estela); Chen, S. (Sitong); Sánchez-Miguel, P.A. (Pedro Antonio); Hershey-de-la-Cruz, M.S. (María Soledad)Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's halo effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.
- ACE-Vitamin Index and Risk of Glaucoma: the SUN Project(2022) Moreno-Galarraga, L. (Laura); Martinez-Gonzalez, M.A. (Miguel Ángel); López-Gil, J.F. (José Francisco); Moreno-Montañes, J. (Javier); Kales, S.N. (Stefanos N.); Bes-Rastrollo, M. (Maira); Fernandez-Montero, A. (Alejandro); Gándara-Rodríguez-de-Campoamor, E. (Elsa); Hershey-de-la-Cruz, M.S. (María Soledad)Background: Previous studies regarding antioxidant consumption and glaucoma have shown contradictory results. The aim of this study was to analyze the combined effect of the consumption of three vitamins (A, C and E) on the incidence of glaucoma in the SUN Project. Methods: For this study, 18,669 participants were included. The mean follow-up was 11.5 years. An index including vitamins A, C and E (ACE-Vitamin Index) was calculated. Vitamin intake was extracted from participants' dietary data and vitamin supplements, if taken. Information on glaucoma incidence was collected by previously validated self-reported questionnaires. The association between glaucoma and vitamin intake was assessed by repeated-measures Cox regression using multi-adjusted hazard ratios. Results: A total of 251 (1.3%) cases of glaucoma were detected. Participants with a higher ACE-Vitamin Index presented a reduced risk of glaucoma compared to participants with lower consumption (adjusted HR = 0.73; 95% CI, (0.55-0.98)). When each vitamin was analyzed individually, none of them had a significant protective effect. The protective effect of the ACE-Vitamin Index was higher in men and older participants (>= 55 year). Conclusions: The consumption of vitamins A, C and E considered separately do not seem to exert a protective effect against glaucoma, but when these vitamins are considered together, they are associated with a lower risk of glaucoma.
- Anthocyanin Intake and physical activity: associations with the lipid profile of a US working population(MDPI, 2020) Martinez-Gonzalez, M.A. (Miguel Ángel); Kales, S.N. (Stefanos N.); Ruiz-Canela, M. (Miguel); Cassidy, A. (A.); Sotos-Prieto, M. (Mercedes); Moffatt, S. (Steven); Hershey-de-la-Cruz, M.S. (María Soledad)While growing evidence exists on the independent associations between anthocyanins and physical activity on cardiovascular disease (CVD) risk determinants, the possible interaction between these exposures has not yet been studied. We aimed to study the potential synergism between anthocyanin intake and physical activity on lipid profile measures. This cross-sectional study was conducted among 249 US career firefighters participating in the Feeding America's Bravest trial. Anthocyanin intake was calculated using a validated food frequency questionnaire (FFQ) and physical activity level by a validated questionnaire. Multivariable linear regression models determined the extent to which anthocyanin intake and physical activity predicted lipid parameters. Generalized linear models were used for joint effect and interaction analyses on the multiplicative and additive scales. Both anthocyanins and physical activity were independently inversely associated with total cholesterol:high density lipoprotein (HDL) cholesterol. Only physical activity was inversely associated with triglycerides, low density lipoprotein (LDL) cholesterol:HDL, and triglycerides (TG):HDL. Although the combined exposure of low anthocyanin intake and low physical activity was associated with lower (RR is 2.83; 95/100 CI: 1.42 to 5.67) HDL cholesterol 40 mg/dL, neither multiplicative (p is 0.72) nor additive interactions were detected (relative excess risk due to interaction (RERI): 0.02; 95/100 CI: -1.63 to 1.66; p is 0.98). Our findings provide insight on the potential synergism between anthocyanin intake and physical activity on the lipid profile.
- 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.
- Effect of a nutrition intervention on Mediterranean diet adherence among firefighters a cluster randomized clinical trial(2023) Chang, C.R. (Chia-Rui); Kales, S.N. (Stefanos N.); Folta, S. (Sara); Christophi, C. (Costas); Fernandez-Montero, A. (Alejandro); Cash, S.B. (Sean B.); Mozaffarian, D. (Dariush); Muegge, C. (Carolyn); Sotos-Prieto, M. (Mercedes); Kleinschmidt, V. (Vanessa); Moffatt, S. (Steven); Hershey-de-la-Cruz, M.S. (María Soledad)Importance: US firefighters are a working population at risk of chronic diseases, including obesity, cardiovascular disease, and cancer. This risk may be mitigated by a healthy diet. Objective: To evaluate the effect of a Mediterranean nutrition intervention using a behavioral/environmental approach (firefighter/fire station/home) at the individual participant level. Design, setting, and participants: This 12-month cluster randomized clinical trial included US career firefighters from fire stations and homes within 2 Indiana fire departments. Participants were randomized by fire station to either Mediterranean diet or control (usual care). The study was conducted from October 2016 to December 2019, and data were analyzed in November 2022. Intervention: For the first 12 months of the study, firefighters located at fire stations randomized to the intervention group were provided with access to supermarket discounts and free samples of Mediterranean diet foods, online nutrition education platforms, email announcements and reminders, family and peer education and support, and chef demonstrations. Firefighters in fire stations allocated to the control group received no intervention and were instructed to follow their usual diet. Main outcomes and measures: Change in dietary habits at 12 months as measured by a modified Mediterranean diet score (range, 0 to 51 points) at baseline and 6-month and 12-month follow-up. Cardiometabolic parameters were secondary outcomes. Results: Of 485 included firefighters, 458 (94.4%) were male, and the mean (SD) age was 47 (7.5) years. A total of 241 firefighters (27 fire stations) were randomized to the Mediterranean nutrition intervention, and 244 (25 fire stations) were randomized to usual diet. Outcomes were analyzed using generalized linear mixed models for modified Mediterranean diet score at 6 months (n = 336) and 12 months (n = 260), adjusting for baseline age, sex, race and ethnicity, fire department, physical activity, and waist circumference. In the intervention group compared with the control group, the modified Mediterranean diet score significantly increased by 2.01 points (95% CI, 0.62-3.40; P = .005) at 6 months and by 2.67 points (95% CI, 1.14-4.20; P = .001) at 12 months. Among secondary outcomes, changes in cardiometabolic risk factors were not statistically significant at 1 year. Results from analyses with multilevel multiple imputation for missingness were similar. Conclusions and relevance: In this Mediterranean nutrition intervention of multicomponent behavioral/environmental changes, career firefighters had increased adherence to a Mediterranean diet. Trial registration: ClinicalTrials.gov Identifier: NCT02941757.