Álvarez-Álvarez, I. (Ismael)
- Publications
- item.page.relationships.isContributorAdvisorOfPublication
- item.page.relationships.isContributorOfPublication
6 results
Search Results
Now showing 1 - 6 of 6
- The Mediterranean diet and physical activity: better together than apart for the prevention of premature mortality(2022) Martinez-Gonzalez, M.A. (Miguel Ángel); Martínez-Hernández, J.A. (J. Alfredo); Ruiz-Canela, M. (Miguel); Hershey-de-la-Cruz, M.S. (María Soledad); Álvarez-Álvarez, I. (Ismael)Diet and physical activity (PA) have been studied extensively in epidemiology as single or combined lifestyle factors; however, their interaction has not been studied thoroughly. Studying potential synergisms between lifestyle components with a comprehensive interaction analysis, including additive measures of interaction, provides key insights into the nature of their joint effect and helps target interventions more effectively. First, a comprehensive review was conducted to assess the potential research gap regarding reported interaction analyses conducted in studies assessing the Mediterranean diet (MedDiet) in combination with PA on all-cause mortality. Thereafter, we prospectively assessed the joint association of the MedDiet with PA on all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort, followed by both multiplicative and additive interaction analyses. The conjoint effect of low adherence to the MedDiet and low PA observed an increased risk greater than the individual risk factors, suggesting a potential additive interaction or synergism between both exposures, with relative risk due to interaction (RERI) and (95 % confidence interval (95 % CI)) = 0.46 (-0.83 to 1.75) and attributable proportion (95 % CI) due to interaction of 36 % (-0.62, 1.34). No multiplicative interaction was detected. Studying interactions between lifestyle factors, such as the MedDiet and PA, is particularly relevant given the current research gaps in studying the complexities of combined aspects of lifestyle in comparison with isolated behaviours. Our findings underline the important public health message of adhering to both the MedDiet and PA for the prevention of premature mortality.
- Strong inverse associations of Mediterranean diet, physical activity and their combination with cardiovascular disease: The Seguimiento Universidad de Navarra (SUN) cohort(Oxford academic, 2018) Martinez-Gonzalez, M.A. (Miguel Ángel); Zazpe, I. (Itziar); Bes-Rastrollo, M. (Maira); Fernandez-Montero, A. (Alejandro); Ruiz-Canela, M. (Miguel); Pérez-de-Rojas, J. (Javier); Hidalgo-Santamaría, M. (María); Álvarez-Álvarez, I. (Ismael)Background: Inverse associations of the Mediterranean diet (MedDiet) and physical activity with cardiovascular disease have been previously reported. We investigated the individual and combined contributions of both to this inverse association in a Mediterranean cohort. Design: We used data from 19,536 participants from a prospective cohort of Spanish university graduates, the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, followed up between December 1999 and December 2016. Methods: Adherence to the MedDiet was obtained from a 136-item validated food-frequency questionnaire and categorized in tertiles using four previously reported dietary scores. A validated questionnaire assessed the physical activity levels according to volume, intensity and frequency. Results: Participants were followed up during a median time of 10.4 years. Compared with the lowest category of adherence to the MedDiet (3 in the Mediterranean Diet Score), higher adherence (6–9 points) was strongly inversely associated with cardiovascular disease (multivariable adjusted hazard ratio ¼ 0.33; 95% confidence interval (CI) 0.20– 0.55). Also, engaging in an active lifestyle (6–8 points in an eight-item score) compared with low activity (<2 points) was associated with a reduced risk of incident cardiovascular disease (hazard ratio ¼ 0.43; 95% CI 0.20–0.90). Greater adherence to the MedDiet and engaging in high levels of active lifestyle showed a 75% relatively reduced risk of cardiovascular disease (hazard ratio ¼ 0.25; 95% CI 0.13–0.48). Conclusions: The combined effect of adherence to the MedDiet and adopting an active lifestyle showed a synergistic inverse association with cardiovascular disease risk.
- Leisure-time physical activity, sedentary behavior, and risk of breast cancer: Results from the SUN (‘Seguimiento Universidad De Navarra’) project(Elsevier, 2021) Gardeazabal, I. (Itziar); Martinez-Gonzalez, M.A. (Miguel Ángel); Romanos-Nanclares, A. (Andrea); Sanchez-Bayona, R. (Rodrigo); Toledo, E. (Estefanía); Santisteban, M. (Marta); Ruiz-Canela, M. (Miguel); Fernández-Lázaro, C.I. (César I.); Gea, A. (Alfredo); Álvarez-Álvarez, I. (Ismael)Evidence is still limited on the influence of sedentary lifestyles on breast cancer (BC) risk. Also, prospective information on the combined effects of both sedentariness and leisure-time physical activity (LTPA) is scarce. We aimed to assess the association of higher sedentary behavior and LTPA (separately and in combination) with the risk of BC in a middle-aged cohort of university graduates. The SUN Project is a follow-up study initiated in 1999 with recruitment permanently open. Baseline assessments included a validated questionnaire on LTPA and sedentary habits. Subsequently, participants completed biennial follow-up questionnaires. Multivariable adjusted Cox models were used to estimate the hazard ratios (HR) for incident BC according to LTPA, TV-watching, the joint classification of both, and a combined 8-item multidimensional active lifestyle score. We included 10,812 women, with 11.8 years of median follow-up of. Among 115,802 women-years of follow-up, we confirmed 101 incident cases of BC. Women in the highest category of LTPA (>16.5 MET-h/week) showed a significantly lower risk of BC (HR = 0.55; 95% CI: 0.34–0.90) compared to women in the lowest category (≤6 MET/h-week). Women watching >2 h/d of TV sh owed a higher risk (HR = 1.67; 95% CI:1.03–2.72) than those who watched TV <1 h/d. Women in the highest category (6–8 points) of the multidimensional combined 8-item score showed a lower BC risk (HR = 0.35; 95% CI: 0.15–0.79) than those in the lowest category (<2 points) group. There was no significant supra-multiplicative interaction between TV-watching and LTPA. Both low LTPA and TV-watching >2 h/d may substantially increase BC risk, independently of each other.
- Infant mortality in the European Union: A time trend analysis of the 1994---2015 period(Elsevier BV, 2019) Guillen-Grima, F. (Francisco); Arnedo-Pena, A. (Alberto); Niu, H. (Hao); Aguinaga-Ontoso, I. (Inés); San-Martín-Rodríguez, L. (Leticia); Álvarez-Álvarez, I. (Ismael); Onambele, L. (Luc)Background: Infant mortality is an indicator of child health, and an explanatory variable to reflect the socioeconomic development of a country. We aimed to examine the changes and trends of infant mortality in the European Union (EU) and its 28 member states in the 1994-2015 period. Methods: We extracted data of deaths in children aged less than one year between 1994 and 2015 from the Eurostat database. We analysed secular variation in the EU overall, by country and by geographical region using joinpoint regression analysis. We conducted additional analyses to examine neonatal and early neonatal mortality trends. Results: Infant mortality in the EU has declined significantly from 8,3 to 3,6 per 1,000 live births (annual percent change=-3,8%; 95% confidence interval, -4,1 to -3,6). Among EU countries, we found the highest mortality rates throughout the study period in Romania and Bulgaria, and the lowest rates in Scandinavian countries (Finland, Sweden). There were significant decreasing trends in every country of the EU, which were most pronounced in former Soviet Baltic states and Eastern European countries, and least pronounced in Western European countries. Mortality rates have increased significantly in Greece in the last years, and plateaued in the United Kingdom and Ireland. Conclusions: Our findings, which are based on official data, provide consistent evidence that infant mortality has declined steadily in the EU and its member states in the past decades, most markedly in Eastern European countries and former Soviet Baltic states. However, rates have risen or levelled off in some western countries in the past few years.
- Mediterranean diet, physical activity and their combined effect on all-cause mortality: The Seguimiento Universidad de Navarra (SUN) cohort(Elsevier, 2018) Martinez-Gonzalez, M.A. (Miguel Ángel); Zazpe, I. (Itziar); Bes-Rastrollo, M. (Maira); Fernandez-Montero, A. (Alejandro); Ruiz-Canela, M. (Miguel); Pérez-de-Rojas, J. (Javier); Hidalgo-Santamaría, M. (María); Álvarez-Álvarez, I. (Ismael)The health benefits of the Mediterranean diet (MedDiet) and of physical activity (PA) have been widely documented. However, no longitudinal studies have investigated their combined effect on mortality. We assessed the individual and combined effects of adherence to the MedDiet and PA on all-cause mortality. We used data from 19,467 participants from a prospective cohort of Spanish university graduates, the SUN cohort, followed-up between December 1999 and February 2016. Adherence to the MedDiet was assessed using four different dietary scores, categorizing the quantitative scores into tertiles of adherence. To assess multiple dimensions of PA, an 8-item score was built. Multivariable Cox regression models were used to study the individual and combined relationship of adherence to the MedDiet and PA with all-cause mortality. During a median follow-up of 10.3 years, we registered 305 deaths. Compared with the lowest adherence to the MedDiet (< 20 in the modified Mediterranean diet score), better adherence (23–30 points) was associated with lower mortality (multivariable-adjusted hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.46–0.96). Engaging in moderate or high levels of PA (versus lower levels) was associated with 44% and 52% relative reductions in mortality, respectively. High adherence to the MedDiet combined with engaging in higher amounts of PA showed a HR = 0.36 (95% CI: 0.19–0.67). We documented that the combined effect of better adherence to the MedDiet and increased PA had multiplicative effects on mortality risk reduction.
- Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study(BMJ, 2019) Martinez-Gonzalez, M.A. (Miguel Ángel); Raquel; Fuente-Arrillaga, C. (Carmen) de la; Bes-Rastrollo, M. (Maira); Rico-Campà, A. (Anais); Gómez-Donoso, C. (Clara); Álvarez-Álvarez, I. (Ismael)OBJECTIVE To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN Prospective cohort study. SETTING Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS 19899 participants (12113 women and 7786 men) aged 20-91 years followed-up every two years between December 1999 and February 2014 for food and drink consumption, classified according to the degree of processing by the NOVA classification, and evaluated through a validated 136 item food frequency questionnaire. MAIN OUTCOME MEASURE Association between consumption of energy adjusted ultra-processed foods categorised into quarters (low, low-medium, medium-high, and high consumption) and all cause mortality, using multivariable Cox proportional hazard models. RESULTS 335 deaths occurred during 200432 persons years of follow-up. Participants in the highest quarter (high consumption) of ultra-processed foods consumption had a higher hazard for all cause mortality compared with those in the lowest quarter (multivariable adjusted hazard ratio 1.62, 95% confidence interval 1.13 to 2.33) with a significant dose-response relation (P for linear trend=0.005). For each additional serving of ultra-processed foods, all cause mortality relatively increased by 18% (adjusted hazard ratio 1.18, 95% confidence interval 1.05 to 1.33). CONCLUSIONS A higher consumption of ultra-processed foods (>4 servings daily) was independently associated with a 62% relatively increased hazard for all cause mortality. For each additional serving of ultraprocessed food, all cause mortality increased by 18%.