Association between pre-conceptional carbohydrate quality index and the incidence of gestational diabetes: the SUN cohort study.

The aim of the study was to investigate the association between pre-gestational carbohydrate quality index (CQI) and the incidence of gestational diabetes mellitus (GDM). Data from the 'Seguimiento Universidad de Navarra' (SUN) cohort were used, which includes 3827 women who notified at least one pregnancy between December 1999 and December 2019. We used a validated semi-quantitative 136-item FFQ to evaluate dietary exposures at baseline and at 10-year follow-up. The CQI was defined by four criteria: glycaemic index, whole-grain/total-grain carbohydrate, dietary fibre intake and solid/total carbohydrate ratio. We fitted generalised estimating equations with repeated measurements of the CQI to assess its relationship with incident GDM. A total of 6869 pregnancies and 202 new cases of incident GDM were identified. The inverse association between the global quality of carbohydrate and the development of GDM was not statistically significant: OR the highest v. the lowest CQI category: 0·67, 95 % CI (0·40, 1·10), Pfor trend = 0·10. Participants at the highest CQI category and with daily carbohydrate amounts ≥50 % of total energy intake had the lowest incidence of GDM (OR = 0·29 (95 % CI (0·09, 0·89)) compared with those with the lowest quality (lowest CQI) and quantity (≤40 %). Further studies are needed to overcome the limitations of our study. Those studies should jointly consider the quality and the quantity of dietary carbohydrates, as the quality might be of importance, especially in women with a higher intake of carbohydrates.

Psychological and metabolic risk factors in older adults with a previous history of eating disorder: A cross-sectional study from the Predimed-Plus study.

GOALS: To explore affective and cognitive status, later in life, in individuals with and without previous history of eating disorder (ED), and also its association with higher risk for metabolic syndrome (MetS) symptomatology. METHODS: A cross-sectional analysis of 6756 adults, aged 55-75 years with overweight/obesity and MetS participating in the Predimed-Plus study was conducted. Participants completed self-reported questionnaires to examine lifetime history of ED, according to DSM-5 criteria, and other psychopathological and neurocognitive factors. Anthropometric and metabolic measurements were also collected. RESULTS: Of the whole sample, 24 individuals (0.35%) reported a previous history of ED. In this subsample, there were more women and singles compared to their counterparts, but they also presented higher levels of depressive symptoms and higher cognitive impairment, but also higher body mass index (BMI) and severe obesity, than those without lifetime ED. CONCLUSIONS: This is one of the first studies to analyse the cognitive and metabolic impact of a previous history of ED. The results showed that previous ED was associated with greater affective and cognitive impairment, but also with higher BMI, later in life. No other MetS risk factors were found, after controlling for relevant variables.

Association between dietary fibre intake and fruit, vegetable or whole-grain consumption and the risk of CVD: results from the PREvención con DIeta MEDiterránea (PREDIMED) trial.

Prospective studies assessing the association between fibre intake or fibre-rich food consumption and the risk of CVD have often been limited by baseline assessment of diet. Thus far, no study has used yearly repeated measurements of dietary changes during follow-up. Moreover, previous studies included healthy and selected participants who did not represent subjects at high cardiovascular risk. We used yearly repeated measurements of diet to investigate the association between fibre intake and CVD in a Mediterranean cohort of elderly adults at high cardiovascular risk. We followed-up 7216 men (55-80 years) and women (60-80 years) initially free of CVD for up to 7 years in the PREvención con DIeta MEDiterránea study (registered as ISRCTN35739639). A 137-item validated FFQ was repeated yearly to assess diet. The primary end point, confirmed by a blinded ad hoc Event Adjudication Committee, was a composite of cardiovascular death, myocardial infarction and stroke. Time-dependent Cox's regression models were used to estimate the risk of CVD according to baseline dietary exposures and to their yearly updated changes. We found a significant inverse association for fibre (P for trend=0·020) and fruits (P for trend=0·024) in age-sex adjusted models, but the statistical significance was lost in fully adjusted models. However, we found a significant inverse association with CVD incidence for the sum of fruit and vegetable consumption. Participants who consumed in total nine or more servings/d of fruits plus vegetables had a hazard ratio 0·60 (95 % CI 0·40, 0·96) of CVD in comparison with those consuming <5 servings/d.

Survey of Spanish hospitals on diabetes care resources.

INTRODUCTION: The quality of diabetes care varies from region to region. The objective of this study is to analyze the characteristics of care in different hospitals in Spain through a specific survey assessing different aspects of care for both children and adults. MATERIALS AND METHODS: Cross-sectional observational voluntary survey study, sent to the heads of the Endocrinology and Pediatric Endocrinology Departments or Units in public hospitals with more than 150 beds, during the first semester of 2021. A total of 105 responses were obtained, 55.5% of the 189 requested, which corresponded to a population served of 31,782,409 people, representing almost 80% of the total population served. RESULTS: Patients with diabetes under 15 years of age are cared for by Pediatric Departments, but only 58% of them have a specific Diabetes Education Unit for children, and in 72% of the cases, there is one single nurse dedicated to these tasks, and not always full-time. Those over 15 years of age are attended by specialists in Endocrinology and Nutrition in 94.3 % of hospitals. There are Therapeutic Education Units in Diabetes in practically all hospitals (94.3%). However, Diabetes Day Hospitals exist in only 32 centres and cover 40.3% of the population, since in 22 provinces there are none. Virtual and telematic consultations, as well as retinography, are available in more than 70% of cases, but access to a Diabetic Foot Unit only in 54% of centres. Monographic technological consultations on diabetes have become widespread, but access to mental health specialists with diabetes training remains limited (24% of centres), and interdisciplinary (32%) or interlevel (12%) committees are very scarce. CONCLUSION: Diabetes care in Spain shows great variability from one region to another, and some deficiencies have been detected that affect a large part of the population, such as access to Diabetic Foot Units, as well as mental health specialists with specific training. The presence of multidisciplinary and mixed committees between levels of care remains scarce.

Effect of Dietary Phenolic Compounds on Incidence of Type 2 Diabetes in the "Seguimiento Universidad de Navarra" (SUN) Cohort.

The global incidence of type 2 diabetes (T2D) has been steadily increasing in recent decades. The Mediterranean dietary pattern has shown a preventive effect on the risk of T2D. Evaluating the association between bioactive compounds such as phenolic compounds (PC) in a Mediterranean cohort could help to better understand the mechanisms implicated in this protection. We evaluated the association between dietary intake of PC and the risk of T2D in a relatively young cohort of 17,821 Spanish participants initially free of T2D, through the University of Navarra Follow-up Project ("Seguimiento Universidad de Navarra" or SUN cohort) after 10 years of median follow-up using time-dependent Cox models. Intake of PC was estimated at baseline and repeatedly at 10-year follow-up using a 136-item validated food frequency and the Phenol-Explorer database. The incidence of T2D was identified by a biennial follow-up, and only medically confirmed cases were included. During 224,751 person-years of follow-up, 186 cases of T2D were confirmed. A suboptimal intake of stilbenes was independently associated with a higher risk of T2D in subjects over 50 years (HR: 1.75, 95% CI: 1.06-2.90, p value < 0.05) after adjusting for potential confounders. Our results suggest that a moderate-high intake of stilbenes can decrease the risk of developing T2D in subjects over 50 years in our cohort.

One-Year Changes in Urinary Microbial Phenolic Metabolites and the Risk of Type 2 Diabetes-A Case-Control Study.

The intake of polyphenols has been associated with a risk reduction of type 2 diabetes. Nevertheless, to the best of our knowledge, the molecules that might be metabolically active after ingestion are only starting to be investigated regarding this metabolic disease. To investigate the association between one-year changes in urinary microbial phenolic metabolites (MPM) and the incidence of type 2 diabetes, we performed a case-control study using data and samples of the PREDIMED trial including 46 incident type 2 diabetes cases of 172 randomly selected participants. Eight urinary MPMs were quantified in urine by liquid chromatography coupled to mass spectrometry and used to assess their associations with type 2 diabetes risk by multivariable logistic regression models. Compared to participants in the lowest tertile of one-year changes in hydroxybenzoic acid glucuronide, those in the highest tertile had a significantly lowered probability of developing type 2 diabetes (OR [95% CI], 0.39 [0.23−0.64]; p < 0.001 for trend). However, when additionally adjusting for fasting plasma glucose, the statistical significance was lost. Changes in the dietary pattern can increase the concentrations of this compound, derived from many (poly)phenol-rich foods, and might be changing the gut microbial population as well, promoting the production of the metabolite.

Physical Activity Intensity and Type 2 Diabetes: Isotemporal Substitution Models in the "Seguimiento Universidad de Navarra" (SUN) Cohort.

Which intensity of physical activity (PA) is associated with type 2 diabetes (T2D) prevention remains unclear. Isotemporal substitution models assess the relationship of replacing the amount of time spent in one activity for another. We aimed to assess T2D incidence associated with light-to-moderate physical activity (LMPA) and vigorous physical activity (VPA) using isotemporal substitution models of one hour (1 h) sitting by 1 h of LMPA or VPA. Furthermore, we evaluated the effect on T2D of an isotemporal substitution of 1 h sitting by 1 h of slow (light physical activity) or brisk-very brisk walking (moderate physical activity). In total, 20,060 participants (both sexes) of the SUN cohort (Spain) initially free of T2D followed-up during a median of 12 years were included. Cox regression models were fitted to assess the association between the substitution of 1 h LMPA, VPA, slow and brisk-very brisk pace by 1 h sitting and T2D. The replacement of 1 h sitting time by 1 h of VPA was associated with an adjusted HR of 0.52 (95% CI: 0.34-0.80), not observed for the substitution by 1 h of LMPA (HR 0.93; 95% CI: 0.73-1.20). An apparent inverse association was observed for the replacement of 1 h sitting time by 1 h of brisk/very brisk walking (HR: 0.69; 95% CI: 0.46-1.04), not observed by 1 h of slow pace. From equal conditions of duration and frequency of PA, the higher the intensity of PA, the greater the T2D prevention.

Ultra-processed foods and type-2 diabetes risk in the SUN project: A prospective cohort study.

BACKGROUND & AIM: The association between ultra-processed foods (UPF) consumption and the risk of type 2 diabetes (T2D) has not been much explored. We aimed to evaluate the association between consumption of UPF and the incidence of T2D. METHODS: We assessed 20,060 participants (61.5% women) from the SUN project (Seguimiento Universidad de Navarra) followed-up every two years (median follow-up 12 years). Food and drink consumption were evaluated through a validated 136-item food frequency questionnaire and grouped according to their degree of processing by the NOVA classification. Participants were categorized into tertiles of UPF consumption adjusted for total energy intake. We fitted Cox proportional hazard models with repeated dietary measurements at baseline and updating information on food consumption after 10 years of follow-up to minimise the potential effect of diet variation. RESULTS: During 215,149 person-years of follow-up, 175 new-onset T2D cases were confirmed. Participants in the highest baseline tertile (high consumption) of UPF consumption had a higher risk of T2D as compared to those in the lowest tertile (multivariable adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.06 to 2.22) with a significant dose-response relationship (p for linear trend = 0.024). The multivariable adjusted HR using repeated measurements of UPF intake was 1.65 (95% CI 1.14-2.38) when comparing extreme tertiles. CONCLUSIONS: In a highly-educated Mediterranean cohort with a low absolute risk, a higher intake of UPF was independently associated with a higher risk for T2D. These results provide more evidence to encourage the limitation of UPF consumption to reduce the population burden of T2D.

A prospective study of eating away-from-home meals and weight gain in a Mediterranean population: the SUN (Seguimiento Universidad de Navarra) cohort.

OBJECTIVE: The traditional Mediterranean food pattern is more easily preserved when meals are eaten at home; however, as a result of recent socio-economic changes, away-from-home meal consumption has increased rapidly in Mediterranean countries. Little research has been conducted so far to investigate the long-term health effects of these changes in the Mediterranean area. DESIGN: In a prospective Spanish dynamic cohort of 9182 university graduates (the SUN Study; Seguimiento Universidad de Navarra, University of Navarra Follow-up) with a mean age of 37 years, followed up for an average of 4.4 years, we assessed the association between the frequency of eating out of home and weight gain or incident overweight/obesity. Dietary habits were assessed with an FFQ previously validated in Spain. RESULTS: During follow-up, eating-out consumers (two times or more per week) had higher average adjusted weight gain (+129 g/year, P < 0.001) and higher adjusted risk of gaining 2 kg or more per year (OR = 1.36; 95 % CI 1.13, 1.63) than non-eating-out consumers. Among participants with baseline BMI < 25 kg/m2, we observed 855 new cases of overweight/obesity. Eating away-from-home meals was significantly associated with a higher risk of becoming overweight/obese (hazard ratio = 1.33; 95 % CI 1.13, 1.57). CONCLUSIONS: A higher frequency of meals eaten out of home may play a role in the current obesity epidemic observed in some Mediterranean countries.

Mediterranean Diet Decreases the Initiation of Use of Vitamin K Epoxide Reductase Inhibitors and Their Associated Cardiovascular Risk: A Randomized Controlled Trial.

Our aim is to assess whether following a Mediterranean Diet (MedDiet) decreases the risk of initiating antithrombotic therapies and the cardiovascular risk associated with its use in older individuals at high cardiovascular risk. We evaluate whether participants of the PREvención con DIeta MEDiterránea (PREDIMED) study allocated to a MedDiet enriched in extra-virgin olive oil or nuts (versus a low-fat control intervention) disclose differences in the risk of initiation of: (1) vitamin K epoxide reductase inhibitors (acenocumarol/warfarin; n = 6772); (2) acetylsalicylic acid as antiplatelet agent (n = 5662); and (3) other antiplatelet drugs (cilostazol/clopidogrel/dipyridamole/ditazol/ticlopidine/triflusal; n = 6768). We also assess whether MedDiet modifies the association between the antithrombotic drug baseline use and incident cardiovascular events. The MedDiet intervention enriched with extra-virgin olive oil decreased the risk of initiating the use of vitamin K epoxide reductase inhibitors relative to control diet (HR: 0.68 [0.46-0.998]). Their use was also more strongly associated with an increased risk of cardiovascular disease in participants not allocated to MedDiet interventions (HRcontrol diet: 4.22 [1.92-9.30], HRMedDiets: 1.71 [0.83-3.52], p-interaction = 0.052). In conclusion, in an older population at high cardiovascular risk, following a MedDiet decreases the initiation of antithrombotic therapies and the risk of suffering major cardiovascular events among users of vitamin K epoxide reductase inhibitors.

Metabolic risk factors in a cohort of young adults and their association with a body-mass index between 22 and 25 kg/m2.

BACKGROUND AND OBJECTIVES: Although health risks associated to excessive body fat increase with small increases in body weight, measurement of body fat is usually grouped in very few categories. The aim of our study was to assess whether the risk for a combined end-point including the incidence of either hypertension and/or type 2 diabetes mellitus and/or the metabolic syndrome was elevated even within the "normal" limits of body-mass index (BMI). MATERIAL AND METHODS: We followed up 10,639 initially healthy university graduates participating in the SUN dynamic cohort for a variable period ranging 2 to 6 years. Baseline BMI and physical activity were the major exposures. The combined end-point was defined by the incidence of either hypertension and/or type 2 diabetes and/or the metabolic syndrome during the follow-up period. We fitted non-conditional logistic regression models and nonparametric regression models (restricted cubic splines). RESULTS: We observed 768 incident cases of the combined outcome (incidence of 16/1000 person-years) and found a monotonic linear association between BMI and the combined end-point. The multivariate-adjusted odds ratios for the combined end-point were 1.4 (95% CI: 1.1-1.7) for BMI 22-24.9 kg/m2, 2.7 (2.1-3.5) for 25-29.9 kg/m2 and 4.0 (2.8-5.6) for 30 kg/m2. We observed a threshold effect in the association between physical activity and the combined end-point multivariate-adjusted odds ratio=0.8 (0.7-0.9) for >15 METs-h/week. CONCLUSIONS: Our findings suggest that the incidence of metabolic risk factors (hypertension, diabetes mellitus and/or metabolic syndrome) is already increased at a BMI of 22 kg/m2 in young adults. These results deserve consideration for judging whether the cut-off point for "normal" weight should be lowered.

Trends of obesity prevalence among Spanish adults with diabetes, 1987-2012.

INTRODUCTION AND OBJECTIVE: Our aim was to examine the secular trends in obesity prevalence among Spanish adults with diabetes. MATERIAL AND METHODS: Data were collected from 8 waves (from 1987 to 2012) of the National Health Surveys (NHS). NHS are cross-sectional studies conducted in representative samples of the Spanish adult population. Data of 7378 adults (≥16 years) who reported having been diagnosed of diabetes were analyzed. Previously validated self-reported weight and height were used to estimate body mass index (BMI). Obesity was defined as a BMI of 30kg/m2 or greater. Age-adjusted obesity prevalence for each wave was calculated by the direct standardization method. RESULTS: From 1987 to 2012 age-adjusted prevalence of obesity among persons with diabetes increased from 18.2% (95% confidence interval [CI]: 14.2-22.2%) to 39.8% (95% CI: 36.8-42.8%). Age-adjusted prevalence of obesity in males with diabetes increased from 13.2% (95% CI: 7.3-19.1%) to 38.0% (95% CI: 33.8-42.1%) and in females from 23.0% (95% CI: 17.6-28.4%) to 42.3% (95% CI: 38.0-46.6%). CONCLUSIONS: Between 1987 and 2012 the prevalence of obesity markedly increased in Spain among adults with diabetes.

Associations between Dietary Polyphenols and Type 2 Diabetes in a Cross-Sectional Analysis of the PREDIMED-Plus Trial: Role of Body Mass Index and Sex.

Overweight and obesity are important risk factors for type 2 diabetes (T2D). Moving towards healthier diets, namely, diets rich in bioactive compounds, could decrease the odds of suffering T2D. However, those individuals with high body mass index (BMI) may have altered absorption or metabolism of some nutrients and dietary components, including polyphenols. Therefore, we aimed to assess whether high intakes of some classes of polyphenols are associated with T2D in a population with metabolic syndrome and how these associations depend on BMI and sex. This baseline cross-sectional analysis includes 6633 participants from the PREDIMED-Plus trial. Polyphenol intakes were calculated from food frequency questionnaires (FFQ). Cox regression models with constant time at risk and robust variance estimators were used to estimate the prevalence ratios (PRs) for polyphenol intake and T2D prevalence using the lowest quartile as the reference group. Analyses were stratified by sex and BMI groups (overweight and obese) to evaluate potential effect modification. Catechins, proanthocyanidins, hydroxybenzoic acids, and lignans were inversely associated with T2D. Hydroxycinnamic acids were directly related in men. These associations were different depending on sex and BMI, that is, women and overweight obtained stronger inverse associations.

Should we recommend reductions in saturated fat intake or in red/processed meat consumption? The SUN prospective cohort study.

BACKGROUND & AIMS: While most studies have shown increased mortality associated with excessive red/processed meat consumption, the association of saturated fatty acids (SFA) intake with mortality is less homogeneous. We aimed to prospectively assess the association of both, meat consumption (red, processed, red + processed, and total) and SFA intake, with the risk of all-cause death. METHODS: We assessed 18,540 participants of the SUN (Seguimiento Universidad de Navarra) cohort, followed-up for a mean of 9.5 years. A validated 136-item FFQ was administered at baseline. We used Cox models adjusted for potential confounders. RESULTS: We observed 255 deaths during 176,916 person-years of follow-up. Age modified the association between meat consumption and all-cause mortality (p for interaction = 0.027, 0.075, and 0.013, for red, total, and processed meat, respectively). Among participants aged >45 years the fully-adjusted HRs (95% CIs) for one additional serving/d of red, total, and red + processed meat consumption were 1.47 (1.06, 2.04), 1.23 (1.05, 1.45), and 1.32 (1.05, 1.65), respectively, with significant linear trends (P for trend 0.022, 0.012, and 0.018, respectively). In these participants, SFA intake was non-significantly associated with mortality. However, isocaloric replacement of monounsaturated fat or carbohydrates by SFA resulted in significantly higher mortality risk. Likewise, replacing 100 g of vegetables, fruits & nuts or cereals by 100 g of red meat resulted in higher mortality risk. No association of meat consumption or SFA with all-cause mortality was observed in participants younger than 46 years. CONCLUSIONS: Among highly educated persons, aged >45 years, a high consumption of red, total, and red + processed meat was related to increased all-cause mortality, compared with those with low consumption, whereas no significant associations were found for SFA intake. Dietary guidelines should specifically limit meat consumption and not relying only in limiting SFA intake.

Prevalence of obesity and diabetes in Spanish adults 1987-2012. / Prevalencia de obesidad y diabetes en adultos españoles, 1987-2012.

BACKGROUND AND OBJECTIVE: The prevalence of obesity and diabetes mellitus (DM) has increased worldwide. Our objective was to examine trends in the prevalence of overweight, obesity, morbid obesity and DM in Spain from 1987 to 2012. PARTICIPANTS AND METHODS: Data were obtained from 8 waves of the national health surveys which are cross-sectional studies conducted in representative samples of the Spanish adult population. Self-reported data of 156,440 adults (≥16 years) from 1987 to 2012 were used. Body mass index (BMI) was calculated from self-reported weight and height. Overweight was defined as a BMI of 25.0 to 29.9kg/m2, obesity as a BMI≥30kg/m2 and morbid obesity as a BMI≥40kg/m2. DM was considered present if the participant reported having been diagnosed. Age-adjusted prevalence was adjusted by the direct standardisation method to the 2003 survey population. RESULTS: From 1987 to 2012 age-adjusted prevalence of overweight increased from 34.0% (95% confidence interval [95% CI] 33.2-34.8) to 35.8% (95% CI 35.0-36.6), prevalence of obesity from 8.0% (95% CI 7.5-8.5) to 16.5% (95% CI 15.7-17.1%) and DM prevalence from 4.2% (95% CI 3.9-4.5) to 7.1% (95% CI 6.7-7.4%). Morbid obesity increased from 0.20% (95% CI 0.13-0.27) in 1993 to 0.88% (95% CI 0.70-1.05) in 2012. The growth rate was greater among males. CONCLUSIONS: An increasing trend of the prevalence of overweight, obesity, morbid obesity and DM was found in Spain from 1987 to 2012, particularly in males.

Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS).

BACKGROUND: Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM). Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS), which integrates optimal food patterns, with the risk of developing T2DM in the SUN ("Seguimiento Universidad de Navarra") longitudinal study. METHODS: We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points) were used to build the DDS (maximum: 60 points). Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR) of T2DM. RESULTS: We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25-39 points) vs. low (11-24) category 0.43 [95% confidence interval (CI) 0.21, 0.89]; and for high (40-60) vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019). CONCLUSIONS: The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve dietary habits of subjects at high risk of T2DM and also as an educational tool for laypeople to help them in self-assessing their future risk for developing diabetes.

Fast food consumption and gestational diabetes incidence in the SUN project.

BACKGROUND: Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. METHODS: The prospective dynamic "Seguimiento Universidad de Navarra" (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0-3 servings/month), intermediate (>3 servings/month and ≤2 servings/week) and high (>2 servings/week). Non-conditional logistic regression models were used to adjust for potential confounders. RESULTS: We identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81-2.13) and 1.86 (95% CI: 1.13-3.06) for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007). CONCLUSION: Our results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes.

Television viewing, computer use, time driving and all-cause mortality: the SUN cohort.

BACKGROUND: Sedentary behaviors have been directly associated with all-cause mortality. However, little is known about different types of sedentary behaviors in relation to overall mortality. Our objective was to assess the association between different sedentary behaviors and all-cause mortality. METHODS AND RESULTS: In this prospective, dynamic cohort study (the SUN Project) 13 284 Spanish university graduates with a mean age of 37 years were followed-up for a median of 8.2 years. Television, computer, and driving time were assessed at baseline. Poisson regression models were fitted to examine the association between each sedentary behavior and total mortality. All-cause mortality incidence rate ratios (IRRs) per 2 hours per day were 1.40 (95% confidence interval (CI): 1.06 to 1.84) for television viewing, 0.96 (95% CI: 0.79 to 1.18) for computer use, and 1.14 (95% CI: 0.90 to 1.44) for driving, after adjustment for age, sex, smoking status, total energy intake, Mediterranean diet adherence, body mass index, and physical activity. The risk of mortality was twofold higher for participants reporting ≥ 3 h/day of television viewing than for those reporting <1 h/d (IRR: 2.04 [95% CI 1.16 to 3.57]). CONCLUSIONS: Television viewing was directly associated with all-cause mortality. However, computer use and time spent driving were not significantly associated with higher mortality. Further cohort studies and trials designed to assess whether reductions in television viewing are able to reduce mortality are warranted. The lack of association between computer use or time spent driving and mortality needs further confirmation.

Egg consumption and risk of type 2 diabetes in a Mediterranean cohort; the sun project.

INTRODUCTION AND AIM: The prevalence of diabetes is increasing at an alarming rate in nearly all countries. Some studies from non-Mediterranean populations suggest that higher egg consumption is associated with an increased risk of diabetes. The aim of our study was to prospectively assess the association between egg consumption and the incidence of type 2 diabetes in a large cohort of Spanish university graduates. METHODS: In this prospective cohort including 15,956 participants (mean age: 38.5 years) during 6.6 years (median), free of diabetes mellitus at baseline. Egg consumption was assessed at baseline through a semiquantitative food-frequency questionnaire repeatedly validated in Spain. Incident diabetes mellitus diagnosed by a doctor was assessed through biennial follow-up questionnaires and confirmed subsequently by medical reports or records, according to the American Diabetes Association criteria. Analyses were performed through multivariable non-conditional logistic regression. RESULTS: After adjustment for confounders, egg consumption was not associated with the development of diabetes mellitus, comparing the highest versus the lowest quartile of egg consumption (<4 eggs/week vs >1 egg/week): odds ratio = 0.7; 95% CI 0.3-1.7. CONCLUSION: Egg consumption was not associated with the development of diabetes mellitus in this Mediterranean cohort.

Introducción y Objetivo: La prevalencia de la diabetes está aumentando a un ritmo alarmante en casi todos los países. Algunos estudios en poblaciones no mediterráneas sugieren que un mayor consumo de huevo se asocia con un mayor riesgo de diabetes. El objetivo de nuestro estudio fue evaluar prospectivamente la asociación entre el consumo de huevo y la incidencia de diabetes tipo 2 en una gran cohorte de graduados universitarios esp2013les. Métodos: Un total de 15.956 participantes (edad media: 38,5 2013s) seguidos durante 6,6 2013s (mediana), y libres de la diabetes mellitus al inicio del estudio fueron incluidos en este estudio. El consumo de huevos se evaluó al inicio del estudio a través de un cuestionario semicuantitativo de frecuencia de alimentos repetidamente validado en España. Los casos de diabetes mellitas incidente fueron diagnosticados por un médico a través de cuestionarios de seguimiento bianuales y posteriormente confirmados por los informes médicos o registros, de acuerdo con los criterios de la American Diabetes Association. Los análisis se realizaron a través de modelos de regresión logística no condicional multivariable. Resultados: Después de ajustar por los factores de confusión, el consumo de huevo no se asoció con el desarrollo de diabetes mellitus. Odds Ratio de aquellos participantes con mayores consumos frente a los del cuartel más bajo de consumo de huevos (< 4 huevos/semana frente a >1 huevo/semana) fue 0,7, IC del 95% CI 0.3-1.7. Conclusión: El consumo de huevos no se asoció con el desarrollo de diabetes mellitus en esta cohorte mediterránea.