Mediterranean alcohol-drinking pattern and mortality in the SUN (Seguimiento Universidad de Navarra) Project: a prospective cohort study.

Moderate alcohol intake has been related to lower mortality. However, alcohol use includes other dimensions beyond the amount of alcohol consumed. These aspects have not been sufficiently studied as a comprehensive entity. We aimed to test the relationship between an overall alcohol-drinking pattern and all-cause mortality. In a Mediterranean cohort study, we followed 18 394 Spanish participants up to 12 years. A validated 136-item FFQ was used to assess baseline alcohol intake. We developed a score assessing simultaneously seven aspects of alcohol consumption to capture the conformity to a traditional Mediterranean alcohol-drinking pattern (MADP). It positively scored moderate alcohol intake, alcohol intake spread out over the week, low spirit consumption, wine preference, red wine consumption, wine consumed during meals and avoidance of binge drinking. During the follow-up, 206 deaths were identified. For each 2-point increment in a 0-9 score of adherence to the MADP, we observed a 25% relative risk reduction in mortality (95% CI 11, 38%). Within each category of alcohol intake, a higher adherence to the MADP was associated with lower mortality. Abstainers (excluded from the calculations of the MADP) exhibited higher mortality (hazard ratio 1·82, 95% CI 1·14, 2·90) than participants highly adherent to the MADP. In conclusion, better adherence to an overall healthy alcohol-drinking pattern was associated with reduced mortality when compared with abstention or departure from this pattern. This reduction goes beyond the inverse association usually observed for moderate alcohol drinking. Even moderate drinkers can benefit from the advice to follow a traditional MADP.

Alcohol intake, wine consumption and the development of depression: the PREDIMED study.

BACKGROUND: Alcoholic beverages are widely consumed. Depression, the most prevalent mental disorder worldwide, has been related to alcohol intake. We aimed to prospectively assess the association between alcohol intake and incident depression using repeated measurements of alcohol intake. METHODS: We followed-up 5,505 high-risk men and women (55 to 80 y) of the PREDIMED Trial for up to seven years. Participants were initially free of depression or a history of depression, and did not have any history of alcohol-related problems. A 137-item validated food frequency questionnaire administered by a dietician was repeated annually to assess alcohol intake. Participants were classified as incident cases of depression when they reported a new clinical diagnosis of depression, and/or initiated the use of antidepressant drugs. Cox regression analyses were fitted over 23,655 person-years. RESULTS: Moderate alcohol intake within the range of 5 to 15 g/day was significantly associated with lower risk of incident depression (hazard ratio (HR) and 95% confidence interval (95% CI) = 0.72 (0.53 to 0.98) versus abstainers). Specifically, wine consumption in the range of two to seven drinks/week was significantly associated with lower rates of depression (HR (95% CI) = 0.68 (0.47 to 0.98)). CONCLUSIONS: Moderate consumption of wine may reduce the incidence of depression, while heavy drinkers seem to be at higher risk.

Prospective study of changes in sugar-sweetened beverage consumption and the incidence of the metabolic syndrome and its components: the SUN cohort.

The incidence of the metabolic syndrome (MetS) is increasing and lifestyle behaviours may play a role. The aim of the present study was to prospectively assess the association between changes in the consumption of sugar-sweetened beverages (SSB) and the incidence of the MetS and its components in a Spanish cohort of university graduates. We included 8157 participants initially free of the MetS and followed up during at least 6 years. SSB consumption was collected by a FFQ previously validated in Spain. The change in SSB consumption was calculated as the difference between SSB consumption at a 6-year follow-up and baseline consumption. The MetS was defined according to the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute's new definition of the MetS that had harmonised previous definitions. The associations between changes in SSB intake and the MetS were examined using multiple logistic regression. We observed 361 incident cases of the MetS. Participants who increased their consumption of SSB (upper v. lower quintile) had a significantly higher risk of developing the MetS (adjusted OR 2·2, 95 % CI 1·4, 3·5; P for trend = 0·003). Similarly, they presented a significantly higher risk of developing high blood pressure (adjusted OR 1·6, 95 % CI 1·3, 2·1), central obesity (adjusted OR 2·3, 95 % CI 1·9, 2·7), hypertriacylglycerolaemia (adjusted OR 1·7, 95 % CI 1·1, 2·6) or impaired fasting glucose (adjusted OR 1·6, 95 % CI 1·1, 2·2). In conclusion, an increase in SSB consumption was associated with a higher risk of developing the MetS and other metabolic disorders after 6 years of follow-up in a Mediterranean cohort of university graduates.

Nut consumption and incidence of metabolic syndrome after 6-year follow-up: the SUN (Seguimiento Universidad de Navarra, University of Navarra Follow-up) cohort.

OBJECTIVE: To assess the long-term relationship between tree nut consumption and the risk of developing metabolic syndrome (MetS). DESIGN: Nut consumption was collected using a validated 136-item FFQ. The MetS was defined according to the International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute harmonizing definition. The association between nut consumption and MetS was assessed with logistic regression models adjusting for potential confounders. We compared the incidence of MetS between extreme categories of nut intake (> or = 2 servings/week v. never/almost never) after 6 years of follow-up. SETTING: The SUN Project (Seguimiento Universidad de Navarra, University of Navarra Follow-up) is a prospective cohort study, formed of Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. Nut consumption and MetS information was collected by self-reported data. SUBJECTS: Participants (n 9887) initially free of MetS or diabetes and followed up for a minimum of 6 years were included. RESULTS: We observed 567 new cases of MetS during follow-up. Participants who consumed nuts > or = 2 servings/week presented a 32% lower risk of developing MetS than those who never/almost never consumed (adjusted OR = 0.68, 95% CI 0.50, 0.92). The inverse association was stronger among participants who were health professionals. CONCLUSIONS: Nut consumption was significantly associated with lower risk of developing MetS after a 6-year follow-up period in a cohort of Spanish graduates.

Magnesium intake is not related to depression risk in Spanish university graduates.

Magnesium is the second most predominant intracellular cation and it is an important cofactor in over 300 enzymatic reactions. It is a calcium antagonist and a voltage-dependent blocker of the N-methyl-D-aspartate channel, which plays a role in the entrance of calcium into the neuron. Other mechanisms also add biological plausibility to neuro-protective properties for magnesium, including an inverse association with major depression. A higher magnesium intake has been related to lower depressive symptoms. However, epidemiological evidence on this issue is scarce. Our aim was to prospectively evaluate the association between dietary magnesium intake and depression incidence in a cohort of 12,939 Spanish university graduates initially free of depression (Seguimiento Universidad de Navarra Cohort Study). Total magnesium intake was assessed with a validated, semiquantitative FFQ and incident depression was ascertained through self-reports of a new clinical diagnosis of depression done by a medical doctor and/or the habitual use of antidepressive drugs. The self-report was validated against the Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria in a subsample of the cohort. Cox regression models were used to obtain HR of incident depression during follow-up according to baseline quintiles of magnesium intake using the lowest quintile as the reference category. After a median follow-up of 6.3 y, 737 new cases of depression were identified. No association between magnesium intake and depression was found, with multivariate-adjusted HR = 1 (reference), 1.00 (95% CI: 0.78-1.27), 1.00 (0.76-1.31), 0.95 (0.70-1.30), and 1.11 (0.77-1.59) for increasing categories (quintiles 1-5) of total magnesium intake. No dose-response relationship was found (P-trend = 0.59). Results were robust through different sensitivity analyses, including nutrient density or residual models. In conclusion, our findings do not suggest an inverse association between magnesium intake and depressive disorder.

The Mediterranean diet is associated with a reduction in premature mortality among middle-aged adults.

The available large prospective studies supporting an inverse association between better adherence to the Mediterranean diet and lower mortality have mainly included older adults. It is not clear whether this inverse association is also present among younger individuals at lower mortality risk. Our aim was to assess the association between adherence to the Mediterranean diet and total mortality in middle-aged adults from the Seguimiento Universidad de Navarra (SUN) Project. We followed 15,535 Spanish university graduates for a mean of 6.8 y. Their mean age was 38 ± 12 y, 59.6% were females, and all were initially free of cardiovascular disease, cancer, and diabetes. A validated FFQ was used to assess dietary habits. Adherence to the Mediterranean diet was categorized into 3 groups according to the Mediterranean Diet Score (low, 0-2 points; moderate, 3-5 points; and high, 6-9 points). The outcome variable was total mortality. Cox proportional hazards models were used to estimate HR and 95% CI. We adjusted the estimates for sex, age, years of university education, BMI, smoking, physical activity, television watching, history of depression and baseline hypertension, and hypercholesterolemia. We observed 125 deaths during 105,980 person-years of follow-up. The fully adjusted HR for moderate and high adherence were 0.58 (95% CI: 0.34, 0.99; P = 0.05) and 0.38 (95% CI: 0.21, 0.70; P = 0.002), respectively. For each 2-point increment in the Mediterranean Diet Score, the HR of death was 0.72 (95% CI: 0.58, 0.91; P = 0.006). Among highly educated, middle-aged adults, adherence to the traditional Mediterranean diet was associated with reduced risk of death.

A longitudinal assessment of alcohol intake and incident depression: the SUN project.

BACKGROUND: Longitudinal studies assessing the long-term association between alcohol intake and depression are scarce. The type of beverage may also be important. Therefore we aimed to prospectively evaluate the influence of alcohol intake on incident depression in a Mediterranean cohort. METHODS: We assessed 13,619 university graduates (mean age: 38 years, 42% men) participating in a Spanish prospective epidemiological cohort (the SUN Project), initially free of depression. They were recruited between 1999-2008 and biennially followed-up during 2001-2010. At baseline, a 136-item validated food-frequency questionnaire was used to assess alcohol intake. Wine was the preferred beverage. Participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and/or initiated the use of antidepressant drugs. Cox regression and restricted cubic splines analyses were performed over 82,926 person-years. RESULTS: Only among women, an U-shaped relationship between total alcohol intake and depression risk was found (P=0.01). Moderate alcohol intake (5-15 g/day) was associated with lower risk (Hazard Ratio: 0.62; 95% Confidence Interval: 0.43-0.89). No association was apparent for higher intakes of alcohol or for any specific type of alcoholic beverage. CONCLUSIONS: Moderate alcohol intake might protect against depression among women. Further confirmatory studies are needed.

Work hours and incidence of hypertension among Spanish university graduates: the Seguimiento Universidad de Navarra prospective cohort.

OBJECTIVE: The aim of this study was to assess the association between work hours and incidence of hypertension in 8779 participants of a Spanish dynamic prospective cohort of university graduates. METHODS: The baseline questionnaire included information about the weekly number of hours the participants devoted to work and to home chores. The work hours were grouped into four categories: 39 or less, 40-49, 50-59, and at least 60 for men; 29 or less, 30-39, 40-49, and at least 50 for women. We added up the number of hours working and spent in home chores in what we called 'total activity hours' that was categorized in quartiles, specific by sex. A participant was classified as an incident case of hypertension if he/she was initially free of hypertension at baseline and reported a physician-made diagnosis of hypertension in at least one of the follow-up questionnaires. The associations between work hours or 'total activity hours' and incidence of hypertension were estimated by calculating the multivariable-adjusted odds ratio and its 95% confidence interval, using logistic regression models. RESULTS: The cumulative incidence of hypertension during 4.2 years median follow-up was 5.8%. No association was found between work hours or 'total activity hours' and incidence of hypertension in either sex. CONCLUSION: The results of our study do not support any association between work hours and incidence of hypertension. Further longitudinal studies in the general population should be conducted to test this relationship.

Annual motor vehicle travel distance and incident obesity: a prospective cohort study.

BACKGROUND: Obesity has become a major health and economic problem with increasing prevalence. Unfortunately, no country can act as public health exemplar for reduction of obesity. The finding of associations between sedentary behaviors and obesity, independent of the level of physical activity, may offer new insights to prevent this burdensome problem. PURPOSE: To evaluate prospectively the relationship between annual distance traveled by motor vehicles and subsequent incidence of overweight or obesity in a Mediterranean cohort. METHODS: Data from a prospective cohort study (Seguimiento Universidad de Navarra Project, 1999-2011) with a permanently open recruitment were analyzed. Self-administered questionnaires are mailed every 2 years, collecting information on dietary habits, lifestyle, risk factors, and medical conditions. Annual kilometers traveled by motor vehicles were grouped into three categories (≤10,000; >10,000 to ≤20,000; and >20,000). Multivariate Cox regression analyses were used to assess the risk of overweight or obesity across categories of distance traveled annually. RESULTS: In all, 9160 participants (58% female, average age=37 years) were followed up for a median of 6.4 years. During 39,175 person-years of follow-up, 1044 (15.3%) normal-weight participants at baseline became overweight or obese. Among participants who did not change their category of annual kilometers traveled during follow-up, an increased risk of overweight or obesity in the highest category of annual kilometers traveled was observed, compared with the lowest one (hazard ratio=1.4, 95% CI=1.1, 1.7). CONCLUSIONS: This study suggests a potential pernicious effect of the use of motor vehicles on the risk of overweight or obesity.

Type of alcoholic beverage and incidence of overweight/obesity in a Mediterranean cohort: the SUN project.

OBJECTIVE: The effects of alcohol on body weight might be modulated by the total amount of alcohol intake and type of alcoholic beverage. However, available results are contradictory. There is a scarcity of studies on this topic in Mediterranean areas where wine consumption is high. We prospectively evaluated the association between the type of alcoholic beverage intake and weight change in a Mediterranean cohort. METHODS: We followed for an average of 6.1 y 9318 adults without previous chronic disease at baseline. Validated data on diet including alcohol consumption were collected at baseline. Weight was recorded at baseline and updated every 2 y during follow-up. The outcomes were average weight gained every year and incidence of overweight/obesity after a 6-y follow-up. RESULTS: During follow-up, 1006 incident cases of overweight/obesity were identified in participants with normal weight at baseline. Beer and spirits consumption (≥7 drinks/wk) was associated with a +119 g/y (95% confidence interval +27 to +212) higher average yearly weight gain after adjusting for relevant confounders. It was also associated with a higher risk of developing overweight/obesity compared with non-drinkers. No association between wine consumption and yearly weight change or the risk of developing overweight/obesity was apparent. CONCLUSION: The type of alcoholic beverage can modulate the effect of alcohol intake on the risk of developing overweight/obesity.

[Validity of self-reported metabolic syndrome components in a cohort study]. / Validación de los componentes del síndrome metabólico autodeclarados en un estudio de cohortes.

OBJECTIVES: To assess the accuracy of self-reported data needed to constitute the metabolic syndrome in the University of Navarra Follow-Up [Seguimiento Universidad de Navarra (SUN)] cohort. METHODS: The SUN project is a multi-purpose prospective cohort, formed by more than 20,000 university graduates, followed-up using surface mail questionnaires every 2 years. In a sample of 287 cohort participants, self-reported data on the criteria needed to define the metabolic syndrome (waist circumference, blood pressure, triglycerides, high-density lipoprotein-cholesterol and glucose) were compared with the same biometric data obtained by blood tests or measured by trained medical staff. Intra-class correlation coefficients with 95% confidence intervals (95% CI), relative mean error and agreement limits according to the method proposed by Bland and Altman were calculated for each variable studied. RESULTS: High intraclass correlations were found for the values of waist circumference (r=0.86, 95% CI: 0.80-0.90) and triglycerides (r=0.71, 95%CI: 0.61-0.79). Moderate intraclass correlations were found (between 0.46 and 0.63) for the other factors. Relative mean errors were always<2.5%, and >91% of values were within the limits of agreement for all variables. CONCLUSIONS: The results suggest that self-declared data on the criteria of metabolic syndrome obtained in the SUN cohort, though with some caution, are sufficiently accurate to be used in epidemiological studies.

Childhood and young adult overweight/obesity and incidence of depression in the SUN project.

This study included 11,825 participants of a Spanish dynamic prospective cohort based on former students from University of Navarra, registered professionals from some Spanish provinces, and university graduates from other associations, followed-up for 6.1 years. We aimed to assess the association between childhood or young adult overweight/obesity and the risk of depression. Participants were asked to select which of nine figures most closely represented their body shape at ages 5 and 20 years. Childhood and young adult overweight/obesity was defined as those cases in which participants reported body shape corresponding to the figures 6-9 (more obese categories) at age 5 or 20, respectively. A subject was classified as incident case of depression if he/she was initially free of depression and reported physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of biannual follow-up questionnaires. The association between childhood and young adult overweight/obesity and incidence of depression was estimated by multiple-adjusted hazard ratio (HR) and its 95% confidence interval (95% CI). Overweight/obesity at age 5 years predicted an increased risk for adult depression (HR = 1.50, 95% CI = 1.06-2.12), and a stronger association was observed at age 20 years ((HR = 2.22, 95% CI = 1.22-4.08), (subjects younger than 30 years at recruitment were excluded from this last analysis)). Childhood or young adult overweight/obesity was associated with elevated risk of adult depression. These results, if causal and confirmed in other prospective studies, support treating childhood and young adult overweight/obesity as part of comprehensive adult depression prevention efforts.

Alcohol consumption and the incidence of hypertension in a Mediterranean cohort: the SUN study.

INTRODUCTION AND OBJECTIVES: To assess prospectively the association between alcohol consumption, including alcoholic beverage preference and days of consumption per week, and the risk of hypertension in a Mediterranean cohort. METHODS: We prospectively followed 9,963 Spanish men and women initially without hypertension. Self-reported and validated data on diet and hypertension diagnoses were collected. RESULTS: During follow-up (median [interquartile range], 4.2 [2.5-6.1] years), 554 incident cases of hypertension were identified over a total of 43,562 person-years. The hazard ratio for hypertension among those who consumed alcohol on >or=5 days per week was 1.28 (95% confidence interval, 0.97-1.7) compared to abstainers. Among those who drank alcohol >or=5 days per week, the hazard ratio for hypertension associated with consuming >or=1 drink per day was 1.45 (95% confidence interval, 1.06-2) compared with abstainers. The consumption of beer or spirits, but not wine, was associated with an increased risk of hypertension. The hazard ratio associated with consuming >0.5 drinks of beer or spirits per day was 1.53 (95% confidence interval, 1.18-1.99) compared with abstainers. In contrast, there was a nonsignificant inverse association between red wine intake and the risk of hypertension. CONCLUSIONS: In this Mediterranean population, the consumption of beer or spirits, but not wine, was associated with a higher risk of developing hypertension. However, the weekly pattern of alcohol consumption did not have a significant impact on the risk of hypertension.

[Incidence of hypertension in a cohort of Spanish university graduates: the SUN study]. / Incidencia de hipertensión arterial en una cohorte de graduados universitarios españoles: el estudio SUN.

Hypertension is a major public health problem. However, no estimates of age- and sex-specific incidences are available for the Spanish population. Our objective was to estimate the incidence of hypertension in a cohort of university graduates in Spain. We followed up 5648 individuals aged 25-65 years who were initially free of hypertension, diabetes, and cardiovascular disease for a median of 30 months. New diagnoses of hypertension were identified using mailed questionnaires. We verified all self-reported diagnoses of hypertension. In 18 250 person-years of follow-up, we identified 248 new cases of hypertension. The unadjusted incidences of hypertension in women and men were 8.2 per 1000 person-years (95% CI, 6.7-10.1) and 21.8 per 1000 person-years (95% CI, 18.6-25.4), respectively. The cumulative probability of receiving a medical diagnosis of hypertension by the age of 65 years was 50% among women and 72% among men. In conclusion, we have provided new evidence confirming that hypertension is one of the most important public health problems in Spain.