Effectiveness of a Two-Year Multicomponent Intervention for the Treatment of Overweight and Obesity in Older People.

This study aimed to assess the effectiveness of a two-year intervention based on the Mediterranean diet for the treatment of overweight and obesity in a sample of 51 older people from the Mediterranean city of Alicante (Spain). We also examined the effects of the intervention on psychological well-being. The participants were randomly assigned to the experimental and control groups. The experimental group received group nutritional education sessions, an individualized dietary-nutritional treatment based on a Mediterranean diet, and a physical activity program; the control group received Mediterranean nutritional education in a written format. The experimental group showed a greater loss in weight (p = 0.017) and percentage of fat mass (p = 0.049), and a greater reduction in body mass index (BMI) (p = 0.014) and waist circumference (p = 0.010). Both groups improved their depression scores using the PHQ-9; however, no significant improvement was seen in adherence to the Mediterranean diet (PREDIMED) and anxiety level (GAD-7). These results suggest that a two-year intervention based on the Mediterranean diet allows an older population with overweight or obesity to achieve greater weight loss and a greater decrease in BMI, waist circumference, and fat mass percentage. In relation to psychological well-being, depression levels improved at the end of said intervention.

Effects of the Mediterranean Lifestyle During the COVID-19 Lockdown in Spain: Preliminary Study.

We aim to assess the beneficial effects of the Mediterranean style-diet before and after the period of confinement due to COVID-19 in a sample of 51 older patients who were part of a clinical trial of the Instituto de Investigación sanitaria y Biomédica de Alicante (ISABIAL, CEIM). Participants were randomly assigned to two conditions: experimental vs. a control group. A pre-test survey assessment was conducted before confinement, while a post-test survey was conducted after the confinement period. Adherence to Mediterranean Diet and nutritional status were evaluated through self-reported questionnaires. Individuals who initiated the Mediterranean Diet intervention program before confinement increased 3.5% their level of adherence to the Mediterranean Diet and maintained their nutritional status after the confinement. In the case of BMI, there no were statistically significant differences between groups before and after confinement. These results suggest that adherence to the Mediterranean Diet may play an important role in the establishment of appropriate dietary guidelines in confinement situations such as the COVID-19.

Cross-Cultural Adaptation, Validity, and Reproducibility of the Mediterranean Islands Study Food Frequency Questionnaire in the Elderly Population Living in the Spanish Mediterranean.

The objective of this study was to perform cross-cultural adaptation of the Mediterranean Islands Study Food Frequency Questionnaire (MEDIS-FFQ) and to evaluate its reproducibility and validity in a population over 60 years of age in the Spanish Mediterranean. Three hundred forty-one people completed the food frequency questionnaire (FFQ), which was administered twice (FFQ1 and FFQ2) with nine 24-h dietary recalls (24-HDRs) over a nine-month period to assess its reproducibility and validity. Cross-cultural translation and adaptation were performed according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines and included direct translation, back-translation, and a pilot comprehension test. Reproducibility was evaluated with Pearson's and interclass correlation coefficients. Validity was estimated using correlations between the FFQ food groups and the 24-HDR mean. The levels of agreement and misclassification were expressed as the proportions of individuals classified by comparing the estimated information from the FFQ2 and the 24-HDR. Reproducibility correlation coefficients ranged from r = 0.44 to r = 0.90. Validity indices ranged from 0.71 to 0.99. More than 80% of the subjects were classified in the same quartile on both instruments. The kappa statistic showed a moderate to high level of agreement (0.70⁻0.95) between the two instruments. In conclusion, the MEDIS-FFQ showed good reproducibility and validity in estimating the nutrient intake of the elderly population in the Spanish Mediterranean.

Eat or Skip Breakfast? The Important Role of Breakfast Quality for Health-Related Quality of Life, Stress and Depression in Spanish Adolescents.

This study examined the associations between eating or skipping breakfast and the quality of breakfast eaten on health-related quality of life (HRQOL), perceived stress and depression in 527 Spanish adolescents. Results showed differences in stress and two domains of HRQOL; Moods and Emotions and Parent Relations and Home Life between adolescent breakfast skippers and eaters, those having breakfast showing higher levels of stress and poor HRQOL. When breakfast quality was analyzed in breakfast eaters, adolescents who ate a good quality breakfast showed better HRQOL and lower levels of stress and depression than those who ate a poor or very poor quality breakfast. Further, breakfast skippers showed better HRQOL and lower levels of stress and depression than breakfast eaters who ate a poor or very poor quality breakfast. These findings indicate the importance of eating a good quality breakfast, rather than just having or not having breakfast. The conclusions of the present study are especially relevant for clinicians and nutritional educators, given the significant impact of breakfast quality on health-related quality of life, stress and depression observed in the adolescents studied.

Low Adherence to the Mediterranean Diet in Isolated Adolescents: The Mediation Effects of Stress.

Loneliness perception during adolescence has been increased dramatically in recent years. Changes in lifestyle and difficulties in social interaction could explain this increased phenomenon. As described in previous research, this fact has been associated with the development of high stress levels and dysfunctional lifestyles, in which eating habits play a main role. In this regard, loneliness has been classically associated with poor eating habits, fundamentally the consumption of processed food with little nutritional value. However, the relationship between loneliness and healthy eating patterns, such as the Mediterranean Diet (MD), has not been previously analyzed. The main aim of the present study was to identify the relationship between perceived loneliness, stress, dietary habits, and adherence to the MD in a sample of 527 Spanish adolescents. The obtained results show a significant association between high perceived loneliness and high stress levels with lower MD adherence. Hence, adolescents with high perceived loneliness exhibit poor dietary habits in comparison to those counterparts with low perceived loneliness. Mediation analyses demonstrated an indirect effect of the loneliness on adherence to the MD through the mediation effect of stress. These findings point out a possible mechanism that underlies the classic association between loneliness and health deterioration, based on a poor adherence to a healthy dietary pattern, such as the MD.

[Adherence to the Mediterranean diet and its relation to nutritional status in older people]. / Adherencia a la dieta mediterránea y su relación con el estado nutricional en personas mayores.

INTRODUCTION: the Mediterranean diet (MD) and model quality diet is associated with a reduction in mortality and an improvement in quality of life in elderly. OBJECTIVE: To evaluate the relationship between nutritional status and lifestyles with the degree of adherence to the DM in elderly Methods: Sample consists of 60 subjects who attended the nursing consultation of a scepter health of Alicante with an index greater than 24.9 body mass. The frequency questionnaire food consumption MEDIS-FFQ questionnaire PREDIMED adherence to the Mediterranean diet and anthropometric assessment was used. RESULTS: 83.3% of the population were overweight compared to 16.7% obesity, no significant differences between sexes. The percentage of body fat was 40.3% in women and 29.5% in men (p = 0.001). 65.2% of the women had cardiovascular risk compared with 81.8% of men (p = 0.001). It was observed under compliance with dietary recommendations in whole grains, fruits and nuts. Subjects with low adherence to the DM had higher rates of obesity (OR = 1.46; 95% CI, 0.89-2.40), increased consumption of snuff (OR = 1.65; 95% CI, 1.05-2.60) and alcohol (OR = 1.53; 95% CI, 0.91-2.55), increased waist-hip ratio (OR = 2.57; 95% CI, 1.3-4.9) and higher percentage of body fat (OR = 5.3; 95% CI, 1.02-6.48). CONCLUSION: Subjects with good adherence (DM) had a lower waist-hip ratio and a lower percentage of body fat.

Introducción: la Dieta Mediterránea (DM) como modelo de dieta de calidad se asocia con una reducción de la mortalidad y con una mejora en la calidad de vida en personas mayores. Objetivo: evaluar la relación entre el estado nutricional y los estilos de vida con el grado de adherencia a la DM en personas mayores Métodos: Muestra compuesta por 60 sujetos que acudían a la consulta de enfermería de un cetro de salud de Alicante con un Índice de Masa Corporal mayor a 24.9. Se utilizó el cuestionario de frecuencia de consumo de alimentos MEDIS-FFQ, el cuestionario de adherencia a la Dieta Mediterránea PREDIMED y la valoración antropométrica. Resultados: El 83.3% de la población presentó sobrepeso frente a un 16.7% de obesidad, sin diferencias significativas entre sexos. El porcentaje de grasa corporal fue del 40.3% en las mujeres y 29.5% en los hombres (p=0.001). El 65.2% de la mujeres presentó riesgo cardiovascular frente al 81.8% de los hombres (p=0.001). Se observó bajo cumplimento de las recomendaciones alimentarias en los cereales integrales, fruta y frutos secos. Los sujetos con baja adherencia a la DM presentaron mayores índices de obesidad (OR= 1.46; IC 95%, 0.89-2.40), un mayor consumo de tabaco (OR= 1.65; IC 95%, 1.05-2.60) y de alcohol (OR=1.53; IC 95%, 0.91-2.55), un mayor índice cintura-cadera (OR= 2.57; IC 95%, 1.3-4.9) y mayor porcentaje de grasa corporal (OR= 5.3; IC 95%, 1.02-6.48). Conclusión: Los sujetos con una buena adherencia a la (DM) presentaron un menor índice cintura-cadera y un menor porcentaje de grasa corporal.

Clinical pathway intervention compliance and effectiveness when used in the treatment of patients with severe sepsis and septic shock at an Intensive Care Unit in Spain.

The purpose of this quasi-experimental study was to assess levels of compliance with the intervention bundles contained in a clinical pathway used in the treatment of patients with severe sepsis and septic shock, and to analyze the pathway's impact on survival and duration of hospital stays. We used data on 125 patients in an Intensive Care Unit, divided into a control group (N=84) and an intervention group (N=41). Levels of compliance increased from 13.1% to 29.3% in 5 resuscitation bundle interventions and from 14.3% to 22% in 3 monitoring bundle interventions. In-hospital mortality at 28 days decreased by 11.2% and the duration of hospital stay was reduced by 5 days. Although compliance was low, the intervention enhanced adherence to the instructions given in the clinical pathway and we observed a decline in mortality at 28 days and shorter hospital stays.

Clinical pathway intervention compliance and effectiveness when used in the treatment of patients with severe sepsis and septic shock at an Intensive Care Unit in Spain / Observância e efetividade das intervenções de um protocolo clínico utilizado para pacientes com sepse grave e choque séptico de uma Unidade de Cuidados Intensivos da Espanha / Cumplimiento y efectividad de las intervenciones de un protocolo clínico utilizado en pacientes con sepsis grave y shock séptico en una Unidad de Cuidados Intensivos en España

The purpose of this quasi-experimental study was to assess levels of compliance with the intervention bundles contained in a clinical pathway used in the treatment of patients with severe sepsis and septic shock, and to analyze the pathway's impact on survival and duration of hospital stays. We used data on 125 patients in an Intensive Care Unit, divided into a control group (N=84) and an intervention group (N=41). Levels of compliance increased from 13.1% to 29.3% in 5 resuscitation bundle interventions and from 14.3% to 22% in 3 monitoring bundle interventions. In-hospital mortality at 28 days decreased by 11.2% and the duration of hospital stay was reduced by 5 days. Although compliance was low, the intervention enhanced adherence to the instructions given in the clinical pathway and we observed a decline in mortality at 28 days and shorter hospital stays.

O objetivo deste estudo quase-experimental foi avaliar o grau de cumprimento das intervenções de um pacote de medidas, em um protocolo clínico proposto para pacientes com sepse grave e choque séptico, e analisar o seu impacto na sobrevivência e duração das permanências hospitalares. Foram incluídos 125 pacientes, alocados no grupo controle (n=84) e intervenção (n=41) de uma Unidade de Cuidados Intensivos, na Espanha. O nível de adesão aumentou em pelo menos 5 intervenções do pacote de reanimação (de 13,1 para 29,3%) e em pelo menos 3 intervenções do pacote de acompanhamento (de 14,3 para 22%). A mortalidade hospitalar aos 28 dias diminuiu em 11,2% e a duração da permanência hospitalar foi reduzida em 5 dias. Embora o cumprimento tenha sido baixo, a intervenção aumentou a adesão às indicações do protocolo clínico e foram observadas queda da mortalidade aos 28 dias e menor duração da permanência hospitalar.

El objetivo de este estudio cuasiexperimental fue valorar el nivel de cumplimiento de las intervenciones de los paquetes de medidas de un protocolo clínico para pacientes con sepsis grave y shock séptico y analizar su impacto sobre la supervivencia y la duración de estancias hospitalarias. Se incluyeron los datos de 125 pacientes divididos en grupo control (N=84) e intervención (N=41) de una Unidad de Cuidados Intensivos. El nivel de cumplimiento aumentó de 13,1% a 29,3% en 5 intervenciones del paquete de reanimación y de 14,3% a 22% en 3 intervenciones del paquete de seguimiento. La mortalidad hospitalaria a los 28 días disminuyó un 11,2% y la duración de la estancia hospitalaria se redujo en 5 días. Aunque el cumplimiento fue bajo, la intervención aumentó la adhesión a las indicaciones del protocolo clínico y se observó un descenso de la mortalidad a los 28 días y menor duración de estancias hospitalarias.