Associations between ultra-processed food consumption and kidney function in an older adult population with metabolic syndrome.

BACKGROUND & AIMS: Ultra-processed food (UPF) consumption has increased dramatically over the last decades worldwide. Although it has been linked to some cardiometabolic comorbidities, there is limited evidence regarding kidney function. This study aimed to cross-sectionally and longitudinally assess the association between UPF consumption and estimated-glomerular filtration rate (eGFR) based on Cystatin C (CysC). METHODS: Older adults (mean age 65 ± 5.0 years, 46% women) with overweight/obesity and metabolic syndrome (MetS) who had available data of CysC at baseline (n = 1909), at one-year and at 3-years of follow-up (n = 1700) were analyzed. Food consumption was assessed using a validated 143-item semi-quantitative food frequency questionnaire and UPF consumption (% of g/d) at baseline and changes after one-year of follow-up were estimated according to NOVA classification system. Multivariable-adjusted linear and logistic regression models were performed to evaluate the cross-sectional associations between UPF consumption with eGFR levels and decreased kidney function (eGFR <60 ml/min/1.73 m2) at baseline. Multivariable-adjusted mixed-effects linear regression models were fitted to investigate the associations between one-year changes in UPF and eGFR over 3-years of follow-up. RESULTS: Individuals with the highest baseline UPF consumption showed lower eGFR (ß: -3.39 ml/min/1.73 m2; 95% CI: -5.59 to -1.20) and higher odds of decreased kidney function (OR: 1.64; 95% CI: 1.21 to 2.22) at baseline, compared to individuals in the lowest tertile. Participants in the highest tertile of one-year changes in UPF consumption presented a significant decrease in eGFR after one-year of follow-up (ß: -1.45 ml/min/1.73 m2; 95% CI: -2.90 to -0.01) as well as after 3-years of follow-up (ß: -2.18 ml/min/1.73 m2; 95% CI: -3.71 to -0.65) compared to those in the reference category. CONCLUSIONS: In a Mediterranean population of older adults with overweight/obesity and MetS, higher UPF consumption at baseline and one-year changes towards higher consumption of UPF were associated with worse kidney function at baseline and over 3-years of follow-up, respectively. CLINICAL TRIAL REGISTRY NUMBER: ISRCTN89898870.

Two-Year Changes in Physical Activity and Concurrent Changes in Cognitive Function in a Cohort of Adults with Metabolic Syndrome.

BACKGROUND: It has been proposed that physical activity (PA) could prevent cognitive decline. OBJECTIVE: To evaluate the association between changes in PA and changes in cognitive function in a cohort of adults with metabolic syndrome. METHODS: Longitudinal observational study including 5,500 adults (mean age 65 years, SD = 5; women = 49.3% ) with metabolic syndrome. Participants underwent physical activity measurements and cognitive evaluation at baseline and at two-years of follow-up. PA was quantified using the Minnesota questionnaire-shortened version. Cognitive function was evaluated using a battery of tests: Mini-Mental Test Examination, Clock Drawing Test, Trail Making Test A and B, Verbal Fluency Test, and Digit Span. The primary outcome was two-year change in cognition, measured through the Global Composite Score (GCS) of all neuropsychological tests. Multivariable-adjusted linear regression models were fitted with baseline PA and their changes as the main exposures and changes in cognitive function as the outcome. RESULTS: No significant association was found between PA levels (or their changes) in the GCS of cognitive function. A greater increase in PA levels was associated with a more favorable two-year change in the Trail Making Test A (Q4 versus Q1: b = - 2.24s, 95% CI -4.36 to -0.12s; p-trend = 0.020). No significant association was found for other neuropsychological test. CONCLUSION: Our results do not support an association between increases in PA and the evolution of the global cognitive function at two-year in an intervention trial which included PA promotion in one of its two randomized arms, but they suggested a possible beneficial effect of PA on attentional function in older adults.

[Vision of the management of frailty in Primary Health Care.] / Visión del manejo de la fragilidad en Atención Primaria.

Primary Care (PC) and community are the priority health sites for the detection and management of frailty. There are good guidelines (Strategy and consensus of the National Health Service, ADVANTAGE European Joint Action, recommendations of the Program of Prevention and Health Promotion Activities of the Spanish Society of Family and Community Medicine PAPPS-semFYC, Fisterra guideline); however, its implementation is not taking place with the expected magnitude or speed, also considering the influence of the COVID-19 pandemic. The detection and management of frailty requires multidisciplinary work by professionals who usually carry out their activity at the first level of care (physicians, nurses, social workers), with others whose integration is advisable (nutritionists, physiotherapists, etc.); and counting on others of reference (geriatricians). On the other hand, it is necessary to work with comprehensive approaches based on good coordination between PC and the Community, with various experiences in this regard. The support by the Information and Communication Technologies (ICT) can be very interesting, with tools for both users and careers (e.g., VIVIFRAIL), as well as for social and health professionals (e.g., VALINTAN or WHO ICOPE-Handbook App). Strategies to intervene in fragility in a more effective and systematic way must be consolidated: with an adequate professional training, establishment of campaigns and dissemination ways for visualizing its relevance and extend their intervention, prioritization of the most effective programmed assistance activities (highlighting fragility), multidisciplinary work with coordination and participation of the different healthcare and community levels and of the patients themselves, and providing the PC with adequate resources.

La Atención Primaria (AP) y la comunidad constituyen el medio asistencial primordial para el manejo de la fragilidad. Se cuenta con buenas directrices (Estrategia y Consenso del Sistema Nacional de Salud, Acción Conjunta Europea ADVANTAGE, recomendaciones del Programa de Actividades de Prevención y de Promoción de la Salud de la Sociedad Española de Medicina familiar y Comunitaria: PAPPS-semFYC, guía Fisterra...); no obstante, su implantación no se está dando con la magnitud ni rapidez esperada, considerando también la influencia de la pandemia por la COVID-19. La detección y manejo de la fragilidad exige un trabajo multidisciplinar de profesionales que habitualmente desarrollan su actividad en el primer nivel asistencial (profesionales de medicina, enfermería y trabajo social), junto con otros cuya integración es aconsejable (nutricionistas, fisioterapeutas, etc...) y contando con otros profesionales de referencia (geriatras). Por otro lado, es necesario trabajar con enfoques integrales basados en una buena coordinación entre AP y la Comunidad, existiendo diversas experiencias en este sentido. El apoyo de las Tecnologías de la Información y Comunicación (TIC) puede ser muy interesante, existiendo herramientas tanto para usuarios y personas cuidadoras (por ej. VIVIFRAIL), como para profesionales sociosanitarios (por ej. VALINTAN o WHO ICOPE-Handbook App). Deben consolidarse las estrategias para intervenir en fragilidad de una manera más efectiva y sistemática: con la formación adecuada de los profesionales, establecimiento de campañas y difusión que hagan visualizar la relevancia y extender su intervención, priorizando las actividades asistenciales programadas más efectivas (destacando la fragilidad), a través del trabajo multidisciplinar con coordinación y participación de los diferentes niveles asistenciales y comunitarios y de los propios pacientes, y dotando de medios y recursos a la AP.

[ASSOCIATION BETWEEN DIETARY GLYCEMIC INDEX AND GLYCEMIC LOAD AND INTIMA MEDIA THICKNESS IN A POPULATION AT HIGH CARDIOVASCULAR RISK: A SUBGROUP ANALYSIS IN THE PREDIMED TRIAL]. / ASOCIACIÓN ENTRE EL ÍNDICE GLUCÉMICO O LA CARGA GLUCÉMICA Y EL GROSOR DE LA ÍNTIMA MEDIA EN PACIENTES CON ALTO RIESGO CARDIOVASCULAR: ANÁLISIS DE UNA SUBMUESTRA DEL ENSAYO PREDIMED.

BACKGROUND: increased carotid íntima-media thickness (IMT) is a marker of atherosclerosis and a predictor of future cardiovascular events. Although a beneficial effect of Mediterranean diets, in particular, enhanced with virgin olive oil and nuts, on longitudinal changes in IMT has been reported, the association between carbohydrates and the development of atherosclerosis is still unclear. OBJECTIVE: to assess the association between glycemic index (IG) and glycemic load (CG) of the diet and intima media thickness (GIMC) in a population at high cardiovascular risk with no clinical symptoms. METHODS: one hundred eighty seven participants of the PREDIMED-NAVARRA center (PREDIMED means in Spanish "PREvención con DIeta MEDiterránea") were randomly selected to undergo baseline and 1-year measurement of GIMC. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire. Participants were categorized into four groups of energy-adjusted IG and CG intake. Multivariate analysis models (ANCOVA) were used to study the association between dietary IG and CG and GIMC and its changes. RESULTS: in our study we found no significant association between IG or CG and GIMC at baseline or after one year.

Introducción: el grosor de la íntima media carotídea (GIMC) es un conocido marcador de arteriosclerosis precoz y un buen predictor de eventos cardiovasculares futuros. Aunque se ha demostrado que la adhesión a la dieta mediterránea, especialmente si está enriquecida con aceite de oliva virgen extra o frutos secos, tiene efectos beneficiosos sobre los cambios en el GIMC, el papel de los carbohidratos en el desarrollo de la arterioesclerosis sigue siendo controvertido. Objetivo: valorar la relación entre el índice glucémico (IG) o la carga glucémica (CG) de la dieta y el GIMC en una población asintomática con alto riesgo cardiovascular. Métodos: en el marco del estudio PREDIMED (PREvención con Dieta MEDiterránea), se seleccionaron de manera aleatorizada 187 sujetos del centro PREDIMED- NAVARRA. A estos pacientes asintomáticos, pero con alto riesgo cardiovascular, se les realizó una ecografía carotídea basal para determinar su GIMC, y tras un año en el estudio se les repitió la misma medición. Se usó un cuestionario validado de frecuencia de consumo de alimentos (137 ítems) tanto basal como anualmente para obtener el IG y la CG, que fueron categorizados en cuartiles, tras ser ajustados por energía. Mediante modelos multivariables (ANCOVA) se estudió la posible asociación entre el IG o la CG de la dieta y el GIMC o su cambio al año. Resultados: en la población estudiada no se observó una asociación estadísticamente significativa entre el IG o la CG y el GIMC, ni al inicio ni tras un año de seguimiento.