Open Access
Breakfast energy intake and dietary quality and trajectories of cardiometabolic risk factors in older adults
(Elsevier, 2024-11-05) Pérez-Vega, Karla-Alejandra; Lassale, Camille; Zomeño, María Dolores; Castañer, Olga; Salas-Salvadó, Jordi; Basterra Gortari, Francisco Javier; Corella, Dolores; Estruch, Ramón; Ros, Emilio; Tinahones, Francisco J.; Blanchart, Gemma; Malcampo, Mireia; Muñoz-Aguayo, Daniel; Schröder, Helmut; Fitó, Montserrat; Hernáez, Álvaro; Ciencias de la Salud; Osasun Zientziak
Objectives: Not skipping breakfast is associated with a better overall diet quality and lower cardiometabolic risk. However, the impact of calorie intake and dietary quality of breakfast on cardiovascular health remains unexplored. We aimed to study the associations between breakfast energy intake and quality and time trajectories of cardiometabolic traits in high cardiovascular risk participants. Design: Prospective observational exploratory study with repeated measurements. Setting: Spanish older adults. Participants: 383 participants aged 55-75 with metabolic syndrome from PREDIMED-Plus, a clinical trial involving a weight-loss lifestyle intervention based on the Mediterranean diet. Measurements: Participants were followed for 36 months. Longitudinal averages of breakfast energy intake and quality were calculated. Three categories were defined for energy intake: 20-30% (reference), <20% (low), and >30% (high). Quality was estimated using the Meal Balance Index; categories were above (reference) or below the median score (low). Natural cubic spline mixed effects regressions described trajectories of cardiometabolic indicators (anthropometry, blood pressure, lipids, glucose, glycated hemoglobin, and kidney function) in breakfast groups. Inter-group differences in predicted values were estimated by linear regressions. Analyses were adjusted for age, sex, PREDIMED-Plus intervention group, education, smoking, physical activity, and total daily kilocalorie intake. Lipid profile analyses were further adjusted for baseline hypercholesterolemia, blood pressure analyses for baseline hypertension, and glucose/glycated hemoglobin analyses for baseline diabetes. Breakfast energy intake analyses were adjusted for breakfast quality, and vice versa. Results: At 36 months, compared to the reference, low- or high-energy breakfasts were associated with differences in body mass index (low: 0.61 kg/m² [95% confidence interval: 0.19; 1.02]; high: 1.18 kg/m² [0.71; 1.65]), waist circumference (low: 2.22 cm [0.96; 3.48]; high: 4.57 cm [3.13; 6.01]), triglycerides (low: 13.8 mg/dL [10.8; 16.8]; high: 28.1 cm [24.7; 31.6]), and HDL cholesterol (low: -2.13 mg/dL [-3.41; -0.85]; high: -4.56 mg/dL [-6.04; -3.09]). At 36 months, low-quality breakfast was associated with higher waist circumference (1.50 cm [0.53; 2.46]), and triglycerides (5.81 mg/dL [3.50; 8.12]) and less HDL cholesterol (-1.66 mg/dL [-2.63; -0.69]) and estimated glomerular filtration rate (-1.22 mL/min/1.73m2 [-2.02; -0.41]). Conclusions: Low- or high-energy and low-quality breakfasts were associated with higher adiposity and triglycerides, and lower HDL cholesterol in high-risk older adults. Low-quality breakfasts were also linked to poorer kidney function.
Open Access
Higher versus lower nut consumption and changes in cognitive performance over two years in a population at risk of cognitive decline: a cohort study
(Elsevier, 2023) Ni, Jiaqi; Nishi, Stephanie K.; Babio, Nancy; Ros, Emilio; Basterra Gortari, Francisco Javier; Corella, Dolores; Castañer, Olga; Martínez, J. Alfredo; Alonso Gómez, Ángel M.; Wärnberg, Julia; Vioque, Jesús; Romaguera, Dora; López Miranda, José; Estruch, Ramón; Tinahones, Francisco J.; Santos Lozano, José Manuel; Serra-Majem, Lluis; Cano Ibáñez, Noemí; Tur, Josep A.; Fernández-García, José Manuel; Pintó, Xavier; Delgado Rodríguez, Miguel; Matía-Martín, Pilar; Vidal, Josep; Vázquez, Clotilde; Daimiel, Lidia; Fernández-Aranda, Fernando; Ruiz Canela, Miguel; Mestres Solà, Cristina; Portolés, Olga; Sala Vila, Aleix; García-Rios, Antonio; Compañ-Gabucio, Laura María; Gómez-Gracia, Enrique; Zulet, María Ángeles; Chaplin, Alice; Casas, Rosa; Martínez Diz, Silvia; Tojal-Sierra, Lucas; Gómez Pérez, Ana María; Toledo, Estefanía; Ríos, Santiago; Ortega Azorín, Carolina; Torre, Rafael de la; Peña-Orihuela, Patricia J.; García de la Hera, Manuela; Sayón-Orea, Carmen; Malcampo, Mireia; Salas-Salvadó, Jordi; Ciencias de la Salud; Osasun Zientziak
Background: Tree nuts and peanuts (henceforth, nuts) are nutrient-dense foods rich in neuroprotective components; thus, their consumption could benefit cognitive health. However, evidence to date is limited and inconsistent regarding the potential benefits of nuts for cognitive function. Objective: To prospectively evaluate the association between nut consumption and 2-y changes in cognitive performance in older adults at cognitive decline risk. Methods: A total of 6,630 participants aged 55 to 75 y (mean age 65.04.9 y, 48.4% women) with overweight/obesity and metabolic syndrome completed a validated semi-quantitative food frequency questionnaire and a comprehensive battery of neuropsychological tests at baseline and a 2-y follow-up. Composite cognitive scores were used to assess global, general, attention, and executive function domains. Nut consumption was categorized as <1, 1 to <3, 3 to <7, and 7 servings/wk (1 serving¼30 g). Multivariable-adjusted linear regression models were fitted to assess associations between baseline nut consumption and 2-y cognitive changes. Results: Nut consumption was positively associated with 2-y changes in general cognitive function (P-trend <0.001). Compared with participants consuming <1 serving/wk of nuts, those categorized as consuming 3 to <7 and 7 servings/wk showed more favorable changes in general cognitive performance (β z-score [95% CI] ¼ 0.06 [0.00,0.12] and 0.13 [0.06,0.20], respectively). No significant changes were observed in the multivariableadjusted models for other cognitive domains assessed. Conclusion: Frequent nut consumption was associated with a smaller decline in general cognitive performance over 2 y in older adults at risk of cognitive decline. Randomized clinical trials to verify our findings are warranted.
Open Access
Vitamin D and risk of developing type 2 diabetes in the SUN project: a prospective cohort study
(Springer, 2024) Valer-Martínez, Ana; Sayón-Orea, Carmen; Martínez, J. Alfredo; Basterra Gortari, Francisco Javier; Martínez González, Miguel Ángel; Bes-Rastrollo, Maira; Ciencias de la Salud; Osasun Zientziak
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.
Open Access
Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult mediterranean population
(Springer, 2024) Baenas, I.; Camacho-Barcia, L.; Granero, R.; Razquin, Cristina; Corella, Dolores; Gómez-Martínez, Carlos; Castañer, Olga; Martínez, J. Alfredo; Alonso Gómez, Ángel M.; Wärnberg, Julia; Vioque, Jesús; Romaguera, Dora; López Miranda, José; Estruch, Ramón; Tinahones, Francisco J.; Lapetra, José; Serra-Majem, Lluis; Cano Ibáñez, Noemí; Tur, Josep A.; Martín-Sánchez, Vicente; Pintó, Xavier; Gaforio, José J.; Matía-Martín, Pilar; Vidal, Josep; Vázquez, Clotilde; Daimiel, Lidia; Ros, Emilio; Jiménez-Murcia, S.; Dalsgaard, S.; García-Arellano, Ana; Babio, Nancy; Sorli, Jose V.; Lassale, Camille; García de la Hera, Manuela; Gómez-Gracia, Enrique; Zulet, María Ángeles; Konieczna, J.; Martín Peláez, Sandra; Tojal-Sierra, Lucas; Basterra Gortari, Francisco Javier; Las Heras-Delgado, Sara de; Portolés, Olga; Muñoz-Pérez, M. Á.; Arenas-Larriva, A. P.; Compañ-Gabucio, Laura María; Eguaras, S.; Shyam, S.; Fitó, Montserrat; Baños, R. M.; Salas-Salvadó, Jordi; Fernández-Aranda, Fernando; Ciencias de la Salud; Osasun Zientziak
Objectives: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. Methods: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. Results: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. Conclusions: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short–medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.
Open Access
Pre-pregnancy provegetarian food pattern and the risk of developing gestational diabetes mellitus: the Seguimiento Universidad de Navarra (SUN) cohort study
(MDPI, 2024-11-16) Bullón-Vela, Vanessa; Martínez Tabar, Ainara; Etxezarreta-Uranga, Maddi; Martínez González, Miguel Ángel; Basterra Gortari, Francisco Javier; Bes-Rastrollo, Maira; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Background and Objectives: Gestational diabetes mellitus (GDM) is one of the most common medical conditions in pregnancy, with adverse effects on maternal and neonatal outcomes. Evidence suggests a beneficial effect of plant-based dietary patterns, rich in foods derived from plant sources and low in animal foods, on type 2 diabetes; however, their effects on GDM remain unclear. We aimed to investigate the association between pre-pregnancy provegetarian food patterns and the incidence of GDM in a Spanish cohort. Materials and Methods: This subsample of the Seguimiento Universidad de Navarra (SUN) cohort analyzed 3589 Spanish university graduate pregnant women with a mean (standard deviation) age of 28 (±4.3) who were initially free of pre-existing diabetes at baseline. Dietary food consumption was evaluated through a validated, 136-item semi-quantitative food frequency questionnaire. The pre-pregnancy provegetarian food pattern was obtained by assigning positive scores to plant-based food groups and reverse scores to animal food groups. Energy-adjusted quintiles were applied to allocate points to construct the provegetarian food pattern, ranging from 12 to 60 points. Logistic regression models were performed to estimate the odds ratios (OR) of GDM across quintiles of a pre-pregnancy provegetarian food pattern, using the lowest quintile as the reference category. Results: We identified 178 incidence cases of GDM. Women in the highest quintile (Q5) of provegetarian food pattern before pregnancy exhibited a 42% relative reduction in the odds of GDM [adjusted OR (95% CI) Q5 vs. Q1: 0.58 (0.35, 0.97); p-trend = 0.109]. Higher consumption of meat and dairy before pregnancy was associated with a significantly increased risk of GDM [adjusted OR (95% CI) Q5 vs. Q1: 1.94 (1.19, 3.16); p-trend = 0.005] and [adjusted OR (95% CI) Q5 vs. Q1: 1.77 (1.07, 2.94); p-trend = 0.082], respectively. Conclusions: Higher pre-pregnancy consumption of a provegetarian food pattern was associated with a lower risk of developing GDM in Spanish women. Further studies are needed to confirm these findings.
Open Access
Interobserver variability in thyroid ultrasound
(Springer, 2024) Carlos Artajo, Joaquín de; Basterra Gortari, Francisco Javier; Pineda Arribas, Javier; Ollero García-Agulló, María Dolores; Toni García, Marta; Munarriz, Patricia; Anda Apiñániz, Emma; Ciencias de la Salud; Osasun Zientziak
Purpose: Ultrasound evaluation of thyroid nodules is the preferred technique, but it is dependent on operator interpretation, leading to inter-observer variability. The current study aimed to determine the inter-physician consensus on nodular characteristics, risk categorization in the classification systems, and the need for fine needle aspiration puncture. Methods: Four endocrinologists from the same center blindly evaluated 100 ultrasound images of thyroid nodules from 100 different patients. The following ultrasound features were evaluated: composition, echogenicity, margins, calcifications, and microcalcifications. Nodules were also classified according to ATA, EU-TIRADS, K-TIRADS, and ACR-TIRADS classifications. Krippendorff¿s alpha test was used to assess interobserver agreement. Results: The interobserver agreement for ultrasound features was: Krippendorff's coefficient 0.80 (0.71-0.89) for composition, 0.59 (0.47-0.72) for echogenicity, 0.73 (0.57-0.88) for margins, 0.55 (0.40-0.69) for calcifications, and 0.50 (0.34-0.67) for microcalcifications. The concordance for the classification systems was 0.7 (0.61-0.80) for ATA, 0.63 (0.54-0.73) for EU-TIRADS, 0.64 (0.55-0.73) for K-TIRADS, and 0.68 (0.60-0.77) for K-TIRADS. The concordance in the indication of fine needle aspiration puncture (FNA) was 0.86 (0.71-1), 0.80 (0.71-0.88), 0.77 0.67-0.87), and 0.73 (0.64-0.83) for systems previously described respectively. Conclusions: Interobserver agreement was acceptable for the identification of nodules requiring cytologic study using various classification systems. However, limited concordance was observed in risk stratification and many ultrasonographic characteristics of the nodules.