Bes-Rastrollo, M. (Maira)

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    Predictors of total mortality and their differential association on premature or late mortality in the SUN cohort
    (2023) Martinez-Gonzalez, M.A. (Miguel Ángel); Carlos-Chillerón, S. (Silvia); Fuente-Arrillaga, C. (Carmen) de la; Bes-Rastrollo, M. (Maira); Barbería-Latasa, M. (María); Gea, A. (Alfredo)
    Several studies have tried to analyse the association between all-cause mortality and different risk factors, (especially those which are modifiable, such as smoking, diet or exercise), to develop public health preventive strategies. However, a specific analysis of predictors of premature and late mortality is needed to give more precise recommendations. Considering that there are risk factors which exert an influence on some diseases and not on others, we expect that, similarly, they may have a different impact depending on the timing of mortality, separating premature (<65 years) from late mortality (>65 years). Thus, we prospectively followed-up during a median of 12 years a cohort of 20,272 university graduates comprising an ample range of ages at inception. Time-dependent, covariate-adjusted Cox models were used to estimate adjusted hazard ratios (HR) and their 95 % confidence intervals (CI) for each predictor. The strongest independent predictor of mortality at any age was physical activity which was associated with reduced risk of total, premature and late mortality (range of HRs when comparing the highest vs. the lowest level: 0.24 to 0.48). Specific strong predictors for premature mortality were smoking, HR: 4.22 (95 % CI: 2.42-7.38), and the concurrence of >2 metabolic conditions at baseline, HR: 1.97 (1.10-3.51). The habit of sleeping a long nap (>30 min/d), with HR: 2.53 (1.30-4.91), and poor adherence to the Mediterranean Diet (<3 points in a 0 to 8 score vs. >6 points), with HR: 2.27 (1.08-4.76), were the strongest specific predictors for late mortality. Smoking, diet quality or lifestyles, probably should be differen-tially assessed as specific predictors for early and late mortality. In the era of precision medicine, this approach will allow tailored recommendations appropriate to each person's age and baseline condition.
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    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.
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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.
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    May the Mediterranean diet attenuate the risk of type 2 diabetes associated with obesity: the Seguimiento Universidad de Navarra (SUN) cohort
    (Cambridge University Press, 2017-06-19) Martinez-Gonzalez, M.A. (Miguel Ángel); Eguaras, S. (Sonia); Carlos-Chillerón, S. (Silvia); Bes-Rastrollo, M. (Maira); Ruiz-Canela, M. (Miguel)
    It is likely that the Mediterranean diet (MedDiet) may mitigate the adverse effects of obesity on the incidence of type 2 diabetes mellitus (T2DM). We assessed this hypothesis in a cohort of 18 225 participants initially free of diabetes (mean age: 38 years, 61 % women). A validated semi-quantitative 136-item FFQ was used to assess dietary intake and to build a 0-9 score of adherence to MedDiet. After a median of 9·5-year follow-up, 136 incident cases of T2DM were confirmed during 173 591 person-years follow-up. When MedDiet adherence was low (≤4 points), the multivariable-adjusted hazard ratios (HR) were 4·07 (95 % CI 1·58, 10·50) for participants with BMI 25-29·99 kg/m2 and 17·70 (95 % CI 6·29, 49·78) kg/m2 for participants with BMI≥30 kg/m2, (v.4 points), these multivariable-adjusted HR were 3·13 (95 % CI 1·63, 6·01) and 10·70 (95 % CI 4·98, 22·99) for BMI 25-30 and ≥30 kg/m2, respectively. The P value for the interaction was statistically significant (P=0·002). When we assessed both variables (BMI and MedDiet) as continuous, the P value for their interaction product-term was marginally significant (P=0·051) in fully adjusted models. This effect modification was not explained by weight changes during follow-up. Our results suggest that the MedDiet may attenuate the adverse effects of obesity on the risk of T2DM.
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    Determinants of self-rated health perception in a sample of a physically active population: PLENUFAR VI study
    (2018) Martinez, J.A. (José Alfredo); Martinez-Gonzalez, M.A. (Miguel Ángel); Moreno-Aliaga, M. J. (María Jesús); Tur, J.A. (Josep A.); Pastor, M.R. (María R.); Bes-Rastrollo, M. (Maira); Santiago, S. (Susana); García, A. (Aquilino); Sayon-Orea, C. (Carmen)
    The aim of this study was to investigate determinants of self-rated health (SRH) perception in Spanish adults. This cross-sectional study including data from 11,342 participants from the Spanish PLENUFAR VI study. SRH status was grouped in two categories ('good'/'poor') and the associations of socio-demographic characteristics, lifestyles, diet adequacy and chronic disease with SRH were assessed. After adjusting for relevant confounders, the risk ratios (RR) and (95% confidence intervals) for poor SRH were 1.05 (1.03-1.07) for each hour of increment of sitting, 1.56 (1.30-1.88) for short (>= 5 h vs. 7-8 h) sleep duration, 0.63 (0.55-0.72) for vigorous (vs. light) physical activity, 0.61 (0.50-0.74) for adequate (vs. non-adequate) diet. Activities like jogging [RR for each unit of increment in the METs-h/day = 0.87 (0.82-0.92)], gymnastics [0.87 (0.81-0.93)], biking [0.91 (0.85-0.98)], and track and field [0.94 (0.89-0.98)], were associated with better health perception. Normally weight participants with any chronic disease had lower probability to report poor SRH than overweight/obese participants with any chronic disease. Frequent consumption of bread (>2 servings/day) was associated with a lower adjusted mean of health perception scale, while higher consumption of vegetables and fruit or fish were associated with higher values, concerning good SRH. We can conclude that normal-weight participants even suffering a chronic disease had lower probability to report poor health perception than participants with overweight/obesity and a chronic disease especially for hypertension and diabetes. Activities like jogging, gymnastics, biking, and track and field, and a higher consumption of fruits, vegetables and fish, were associated with better health rated perception.
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    Catering services and HACCP: temperature assessment and surface hygiene control before and after audits and a specific training session
    (Elsevier, 2014) Díez-Leturia, M. (María); Garayoa, M.R. (Mª Roncesvalles); Bes-Rastrollo, M. (Maira); Vitas, A.I. (Ana Isabel); Garcia-Jalon, I. (Isabel)
    Proper application of HACCP in catering services involves monitoring decisive critical points. The purpose of this study was to assess food temperatures and surface hygiene control in two catering services in Navarra (Spain) at two different time periods: the first one after implementation of the HACCP system and the second period, after the initial supervision through audits and a specific training session regarding temperatures of products and hygienic conditions of surfaces and equipment because the majority of detected nonconformities were related to these parameters. The recorded temperatures of 650 cooked food products within the first period showed that only 65.1% of the hot dishes had a temperature higher than 65 °C, in accordance with Spanish legislation, and 12.9% of them showed a risky holding temperature (<55 °C). However, the percentage of noncomplying dishes was reduced by a half after the training session (p < 0.001). Since the significant differences observed in recorded temperatures were related to the type of meal (with or without sauces) and the type of cooking procedure, a lower safe criterion for the retention of hot dishes was suggested if the temperature is continuously maintained over 55 °C until serving. With regard to cleaning and disinfection, 18.3% of the 600 analyzed surfaces did not meet the established cleaning criterion (≤100 CFU/25 cm2) in the first period, while in the second period this percentage was reduced to 13.6% in both catering businesses (p = 0.021). The dirtiest surfaces were equipment such as cutting boards and meat slicing machines (>26%) compared to utensils for distribution (12.0%). As the impact of dirty surfaces on the hygienic quality of a finished product will depend on which step was being taken during dish elaboration when equipment or utensil was used, it is suggested that more restrictive limits be established regarding utensils and equipment that are in direct contact with the finished product (≤1 CFU/cm2). Results of the study demonstrate that a specific training session on these items has improved the temperature control of prepared meals and the effectiveness of cleaning and disinfection, essentials for guaranteeing the hygienic quality of prepared foods.
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    Egg consumption and risk of cardiovascular disease in the sun project
    (Nature Publishing Group, 2011) Martinez-Gonzalez, M.A. (Miguel Ángel); Fuente-Arrillaga, C. (Carmen) de la; Zazpe, I. (Itziar); Bes-Rastrollo, M. (Maira); Benito-Corchon, S. (Silvia); Beunza, J.J. (Juan José); Wärnberg, J. (Julia); Vazquez-Ruiz, Z. (Zenaida)
    Background/Objective: Egg consumption has been associated with the risk of cardiovascular diseases (CVD), but evidence is scarce and inconsistent. Our aim was to examine the association between egg consumption and incidence of CVD in a prospective dynamic Mediterranean cohort of 14 185 university graduates. Subjects/Methods: Egg intake was assessed using a 136-item validated food frequency questionnaire. The baseline consumption was categorized into no consumption or <1/week, 1/week, 2-4/week, and >4/week. The presence of cardiovascular risk factors was assessed by questionnaire at baseline and the incidence of CVD was assessed using biennial assessments. The median follow-up was 6.1 years. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios (HR) for CVD (myocardial infarction, revascularization procedures or stroke). Outcomes were confirmed by review of medical records. Results: During a median follow-up of 6.1 years, 91 new confirmed cases of CVD were observed. No association was found between egg consumption and the incidence of CVD (HR=1.10, 95% CI: 0.46-2.63) for the highest vs. the lowest category of egg consumption) after adjusting for age, sex, total energy intake, adherence to the Mediterranean food pattern and other cardiovascular risk factors. Results were robust to different analytical scenarios Conclusions: No association between egg consumption and the incidence of CVD was found in this Mediterranean cohort.
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    Long-Term Coffee Consumption Is Associated with Decreased Incidence of New-Onset Hypertension: A Dose–Response Meta-Analysis
    (2017) Martinez-Gonzalez, M.A. (Miguel Ángel); Godos, J. (Justyna); Pajak, A. (Andrzej); Sciacca, S. (Salvatore); Bes-Rastrollo, M. (Maira); Grosso, G. (Giuseppe); Galvano, F. (Fabio); Micek, A. (Agnieszka)
    Objective: To perform a dose–response meta-analysis of prospective cohort studies investigating the association between long-term coffee intake and risk of hypertension. Methods: An online systematic search of studies published up to November 2016 was performed. Linear and non-linear dose–response meta-analyses were conducted; potential evidence of heterogeneity, publication bias, and confounding effect of selected variables were investigated through sensitivity and meta-regression analyses. Results: Seven cohorts including 205,349 individuals and 44,120 cases of hypertension were included. In the non-linear analysis, there was a 9% significant decreased risk of hypertension per seven cups of coffee a day, while, in the linear dose–response association, there was a 1% decreased risk of hypertension for each additional cup of coffee per day. Among subgroups, there were significant inverse associations for females, caffeinated coffee, and studies conducted in the US with longer follow-up. Analysis of potential confounders revealed that smoking-related variables weakened the strength of association between coffee consumption and risk of hypertension. Conclusions: Increased coffee consumption is associated with a modest decrease in risk of hypertension in prospective cohort studies. Smoking status is a potential effect modifier on the association between coffee consumption and risk of hypertension.
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    Mediterranean alcohol-drinking patterns and all-cause mortality in women more than 55 years old and men more than 50 years old in the "Seguimiento Universidad de Navarra" (SUN) Cohort
    (2022) Martinez-Gonzalez, M.A. (Miguel Ángel); Bes-Rastrollo, M. (Maira); Pérez-Araluce, R.M. (Rafael María); Barbería-Latasa, M. (María); Gea, A. (Alfredo)
    Background: Most of the available epidemiological evidence on alcohol and chronic disease agrees on recommending alcohol abstention to young people, but some controversy exists about the most appropriate recommendation for alcohol abstention for people of older ages. A growing body of evidence suggests that the pattern of alcohol consumption is likely to be a strong effect modifier. The Mediterranean Alcohol Drinking Pattern (MADP) represents a score integrating several dimensions of drinking patterns (moderation, preference for red wine, drinking with meals, and avoiding binge drinking). Our aim was to clarify this issue and provide more precise recommendations on alcohol consumption. Methods: We prospectively followed-up 2226 participants (men older than 50 years and women older than 55 years at baseline) in the Seguimiento Universidad de Navarra (SUN) cohort. We classified participants into three categories of adherence to the MADP score (low, moderate, and high), and we added a fourth category for abstainers. Cox regression models estimated multivariable-adjusted hazard ratios (HR) of all-cause death and 95% confidence intervals (CI) using low MADP adherence as the reference category. Results: The strongest reduction in risk of mortality was observed for those with high adherence to the MADP, with an HR of 0.54 (95% CI: 0.37-0.80). The moderate adherence group (HR = 0.65, 95% CI: 0.44-0.96) and the abstention group (HR = 0.60, 95% CI: 0.36-0.98) also exhibited lower risks of mortality than the low MADP adherence group. Conclusions: based on the available evidence, a public health message can be provided to people older than 50 years as follows: among those who drink alcohol, high adherence to the MADP score could substantially reduce their risk of all-cause mortality.
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    Karnofsky performance score in acute renal failure as a predictor of short-term survival
    (Wiley-Blackwell, 2007) Perez-Valdivieso, J.R. (José Ramón); Lavilla, F.J. (Francisco Javier); Bes-Rastrollo, M. (Maira); Monedero, P. (Pablo); Irala, J. (Jokin) de
    Karnofsky Performance Scale Index (KPS) is a measure of functional status that allows patients to be classified according to their functional impairment. We aim to assess if the prior KPS may predict the risk of death among patients with acute renal failure (ARF). METHODS: A cohort of 668 consecutive patients who had been admitted in an university-affiliated hospital between June 2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred and eighty-six patients with ARF who matched at least one of the RIFLE (Risk, Injury, Failure, Loss and End stage) criteria on increased serum creatinine were included for subsequent analysis. The group was divided into four categories, according to different Karnofsky scores measured by a nephrologist (>or=80, 70, 60 and or=80 Karnofsky group. Adjusted odds ratios were 8.87 (95% confidence interval (CI) 3.03-25.99), 6.78 (95% CI 2.61-17.58) and 2.83 (95% CI 1.04-7.68), for Karnofsky groups of