Obstetric factors associated with postpartum post-traumatic stress disorder after spontaneous vaginal birth.

BACKGROUND: This study aimed to determine whether there is an association between clinical practices carried out during spontaneous vaginal birth (SVB), or clinical situations that arise during vaginal birth, and the incidence of post-traumatic stress disorder (PTSD). METHODS: A cross-sectional study with 839 puerperal women in Spain was conducted. The Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) was administered online. The relationship between the risk of postpartum PTSD and various intrapartum complications was studied in addition to practices or procedures performed during the intrapartum period. RESULTS: PTSD (PPQ scores ≥19) was identified in 8.1% (68) of the women who participated. Among the risk factors for PTSD was a concerning intrapartum FHR tracing (adjusted OR: 2.24, 95% CI: 1.07-4.66). Other intrapartum practices also put women at risk of PTSD, including the administration of an enema (aOR: 7.01, 95% CI: 2.14-23.01), being required to stay lying down throughout the labor and birth (aOR: 5.75, 95% CI: 3.25-10.19), artificial amniorrhexis without consent (aOR: 2.28, 95% CI: 1.31-3.97), administration of synthetic oxytocin without consent (aOR: 2.18, 95% CI: 1.26-3.77), fundal pressure during pushing (aOR: 3.14, 95% CI: 1.72-5.73), repeated vaginal examinations performed by different people (aOR: 4.84, 95% CI: 2.77-8.47), and manual removal of the placenta without anesthesia (aOR: 3.45, 95% CI: 1.81-6.58). CONCLUSIONS: Various intrapartum clinical practices, all related to dehumanized treatment, and intrapartum complications, were associated with an increased risk of PTSD. There is a need to eradicate obstetric mistreatment and to increase access to evidence-informed, respectful care in Spain. Care practitioners need to better appreciate their roles in preventing PTSD.

Consumption of caffeinated beverages and kidney function decline in an elderly Mediterranean population with metabolic syndrome.

It remains unclear whether caffeinated beverages could have deleterious renal effects in elderly population with underlying comorbid conditions. We investigated the associations between coffee, tea, or caffeine intake and 1-year changes in glomerular filtration rate (eGFR) in a large Spanish cohort of overweight/obese elderly with metabolic syndrome (MetS). This prospective analysis includes 5851 overweight/obese adults (55-75 years) with MetS from the PREDIMED-Plus study. We assessed coffee, tea, and caffeine consumption from a validated food-frequency questionnaire and creatinine-based eGFR using the Chronic Kidney Disease Epidemiology Collaboration equation. Multivariate-adjusted regression models were applied to test associations between baseline coffee, tea, or caffeine intake and 1-year eGFR changes. Caffeinated coffee (> 2 cups/day) and tea (at least 1 cup/day) drinkers had 0.88 and 0.93 mL/min/1.73 m2 greater eGFR decrease respectively, compared to those with less than 1 cup/day of coffee consumption or non-tea drinkers. Furthermore, caffeinated coffee consumption of > 2 cups/day was associated with 1.19-fold increased risk of rapid eGFR decline > 3 mL/min/1.73 m2 (95% CI 1.01-1.41). Similarly, individuals in the highest (median, 51.2 mg/day) tertile of caffeine intake had a 0.87 mL/min/1.73 m2 greater eGFR decrease. Decaffeinated coffee was not associated with eGFR changes. In conclusion, higher consumption of caffeinated coffee, tea, and caffeine was associated with a greater 1-year eGFR decline in overweight/obese adults with MetS.

Dietary Polyphenol Intake is Associated with HDL-Cholesterol and A Better Profile of other Components of the Metabolic Syndrome: A PREDIMED-Plus Sub-Study.

Dietary polyphenol intake is associated with improvement of metabolic disturbances. The aims of the present study are to describe dietary polyphenol intake in a population with metabolic syndrome (MetS) and to examine the association between polyphenol intake and the components of MetS. This cross-sectional analysis involved 6633 men and women included in the PREDIMED (PREvención con DIeta MEDiterranea-Plus) study. The polyphenol content of foods was estimated from the Phenol-Explorer 3.6 database. The mean of total polyphenol intake was 846 ± 318 mg/day. Except for stilbenes, women had higher polyphenol intake than men. Total polyphenol intake was higher in older participants (>70 years of age) compared to their younger counterparts. Participants with body mass index (BMI) >35 kg/m2 reported lower total polyphenol, flavonoid, and stilbene intake than those with lower BMI. Total polyphenol intake was not associated with a better profile concerning MetS components, except for high-density lipoprotein cholesterol (HDL-c), although stilbenes, lignans, and other polyphenols showed an inverse association with blood pressure, fasting plasma glucose, and triglycerides. A direct association with HDL-c was found for all subclasses except lignans and phenolic acids. To conclude, in participants with MetS, higher intake of several polyphenol subclasses was associated with a better profile of MetS components, especially HDL-c.

Maternal iron intake during pregnancy and the risk of small for gestational age.

Studies of iron and its association with the risk of small for gestational age (SGA) show inconsistent results. Consuming iron supplements during pregnancy is controversial because of possible risks. This study assessed the association between iron intake and the risk of having an SGA newborn and whether iron intake is associated with gestational diabetes. A case-control study of 518 pairs of Spanish women who were pregnant and attending five hospitals was conducted. Groups were matched 1:1 for age (±2 years) and hospital. Cases were women with an SGA newborn at delivery. Controls were women with normal-sized newborns at delivery. Data were gathered on demographic characteristics, socio-economic status, adverse habits (like smoking), and diet. A 137-item food frequency questionnaire was completed. Iron intakes were categorized in quintiles (Q1-Q5). Crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (CIs) were estimated by conditional logistic regression. No significant relationship was found between dietary iron intake and SGA. A protective association was found for women receiving iron supplementation >40 mg/day and SGA versus women not taking supplements (aOR = 0.64, 95% CI [0.42, 0.99]). This association was identified in mothers both with (aOR = 0.57, 95% CI [0.40, 0.81]) and without (aOR = 0.64, 95% CI [0.64, 0.97]) anaemia. In women in the control group without anaemia, iron supplementation >40 mg/day was positively associated with gestational diabetes (aOR = 6.32, 95% CI [1.97, 20.23]). Iron supplementation in pregnancy may prevent SGA independently of existing anaemia but may also increase the risk of gestational diabetes.

Naturally Lignan-Rich Foods: A Dietary Tool for Health Promotion?

Dietary guidelines universally advise adherence to plant-based diets. Plant-based foods confer considerable health benefits, partly attributable to their abundant micronutrient (e.g., polyphenol) content. Interest in polyphenols is largely focused on the contribution of their antioxidant activity to the prevention of various disorders, including cardiovascular disease and cancer. Polyphenols are classified into groups, such as stilbenes, flavonoids, phenolic acids, lignans and others. Lignans, which possess a steroid-like chemical structure and are defined as phytoestrogens, are of particular interest to researchers. Traditionally, health benefits attributed to lignans have included a lowered risk of heart disease, menopausal symptoms, osteoporosis and breast cancer. However, the intake of naturally lignan-rich foods varies with the type of diet. Consequently, based on the latest humans' findings and gathered information on lignan-rich foods collected from Phenol Explorer database this review focuses on the potential health benefits attributable to the consumption of different diets containing naturally lignan-rich foods. Current evidence highlight the bioactive properties of lignans as human health-promoting molecules. Thus, dietary intake of lignan-rich foods could be a useful way to bolster the prevention of chronic illness, such as certain types of cancers and cardiovascular disease.

Maternal dietary consumption of legumes, vegetables and fruit during pregnancy, does it protect against small for gestational age?

BACKGROUND: Different diets during pregnancy might have an impact on the health, reflected in the birthweight of newborns. The consumption of fruits and vegetables during pregnancy and the relationship with newborn health status have been studied by several authors. However, these studies have shown inconsistent results. PURPOSE: We assessed whether certain foods were related to the risk of small for gestational age (SGA). METHODS: A matched by age (± 2 years) and hospital 1:1 case-control study of 518 pairs of pregnant Spanish women in five hospitals was conducted. The cases were women with an SGA newborn at delivery (neonates weighting less than the 10th percentile, adjusted for gestational age at delivery and sex, were diagnosed as SGA). The control group comprised women giving birth to babies adequate for gestational age (AGA). Mothers who gave birth to babies large for gestational age (LGA) were excluded. Data were gathered concerning demographic characteristics, socioeconomic status, toxic habits and diet. A food frequency questionnaire (FFQ) comprising 137 items was completed by all participants. The intake of vegetables, legumes and fruits was categorized in quintiles (Q1-Q5). Crude values and and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. The variables for adjustment were as follows: preeclampsia, education, smoking, weight gain per week during pregnancy, fish intake and previous preterm/low birthweight newborns. RESULTS: Total pulse intake showed an inverse association with the risk of SGA (trend p = 0.02). Women with an intake of fruits above 420 g/day (Q5), compared with women in Q1 (≤ 121 g/day) showed a decreased risk of SGA (AOR = 0.63, 95% CI = 0.40-0.98). The total consumption of vegetables was not associated with the risk of SGA. The intake of selenium was assessed: a protective association was observed for Q3-5; a daily intake above 60 µg was associated with a lower risk of SGA (AOR = 0.39, 95% CI: 0.22-0.69). CONCLUSIONS: Fruits, pulses and selenium reduce the risk of SGA in Spanish women.

[Olive Oil and Body Weight. Systematic Review and Meta-Analysis of Randomized Controlled Trials]. / Aceite de oliva y peso corporal. Revisión sistemática y metaanálisis de ensayos controlados aleatorizados.

BACKGROUND: Olive oil, as fundamental fat in the Mediterranean diet, has contributed to a decrease in obesity in several epidemiological studies. It is unknown whether olive oil itself can decrease the weight independently of the diet used. The objective of this work was to determine the efficacy of olive oil in reducing weight. METHODS: Systematic review of meta-analysis of randomized controlled trials (RCTs) of at least 12 weeks of intervention on adults without previous cardiovascular events to estimate the effect of an olive-enriched diet on weight, waist and body mass index. The search was performed in PubMed, Embase, Cochrane plus, Web of Science, Ovid, Scopus, Virtual Health Library (BVS), Theses and Dissertations Online (TDX) until December 2016. No language, gender or underlying pathology was restricted. We used Stata14 SE for data synthesis. RESULTS: 490 studies were identified, of which only 11 studies met the inclusion criteria. A diet enriched in olive oil reduced weight more than control diet: -0.92 kg, 95% CI (-1.16, -0.67), p heterogeneity = 0.1; decreased waist circumference in -0.60 cm, 95% CI (-1.17, -0.04), p heterogeneity = 0.6; and diminished BMI in -0.90, 95% CI (-0.91, -0.88), p heterogeneity < 0.001. The benefits were seen when olive oil was supplemented in its natural state and not when capsules were given. CONCLUSIONS: A diet enriched with olive oil can be an important weight control strategy in people without previous cardiovascular events.

OBJETIVO: El aceite de oliva, grasa fundamental de la dieta mediterránea, ha contribuido a un descenso de la obesidad en diversos estudios epidemiológicos. Se desconoce si por sí mismo puede disminuir el peso con independencia de la dieta utilizada. El objetivo de este trabajo fue determinar la eficacia del aceite de oliva en la reducción ponderal. METODOS: Revisión sistemática con metaanálisis de ensayos controlados aleatorizados (ECA) de al menos 12 semanas de intervención sobre adultos sin eventos cardiovasculares previos, para estimar el efecto de una dieta enriquecida con aceite de oliva sobre el peso, cintura e índice de masa corporal. La búsqueda se realizó en PubMed, Embase, Cochrane plus, Web of Science, Ovid, Scopus, Biblioteca Virtual en Salud (BVS), Tesis Doctorales en Red (TDR), hasta diciembre de 2016. No se restringió idioma, sexo ni patología de base. Utilizamos Stata14 SE para la síntesis de datos. RESULTADOS: Se identificaron 490 estudios, de ellos sólo 11 estudios cumplieron los criterios de inclusión. Una dieta enriquecida con aceite de oliva redujo más el peso que una dieta control -0,92 kg, IC 95% (-1,16,-0,67), p heterogeneidad =0,1; disminuyó la cintura en -0,60 cm, IC 95% (-1,17,-0,04), p heterogeneidad = 0,6; y descendió el IMC en -0,90, IC 95% (-0,91, -0,88), p heterogeneidad < 0,001. El efecto favorable fue cuando el aceite se suplementó de forma líquida y no con cápsulas. CONCLUSIONES: Una dieta enriquecida con aceite de oliva puede ser una importante estrategia de control ponderal en personas sin eventos cardiovasculares previos.

Association between Vitamin Intake during Pregnancy and Risk of Small for Gestational Age.

Pregnancy increases the requirements of certain nutrients, such as vitamins, to provide nutrition for the newborn. The aim was to analyze the association between dietary intake of vitamins during pregnancy and risk of having a small for gestational age (SGA) newborn. A matched case-control study was conducted (518 cases and 518 controls of pregnant women) in Spain. Dietary vitamin intake during pregnancy was assessed using a validated food frequency questionnaire, categorized into quintiles. Odds ratios (ORs) and their 95% confidence intervals (CI) were estimated with conditional regression logistic models. A protective association was observed between maternal dietary intake of vitamins A and D and SGA. For vitamin B3 and B6, the observed protective effect was maintained after adjusting for potential confounding factors. For vitamin B9, we found only an effect in quintiles 3 and 4 (OR = 0.64; 95% CI, 0.41-1.00; OR = 0.58; 95% CI, 0.37-0.91). Protective effect for vitamin B12 was observed in 4th and 5th quintiles (OR = 0.61; 95% CI, 0.39-0.95; OR = 0.68; 95% CI, 0.43-1.04). No associations were detected between dietary intake of vitamins B2, E and C intake and SGA. Our results suggest a positive association between dietary vitamin intake during pregnancy and the weight of the newborn, although more studies are necessary and there could be a ceiling effect for higher intakes of some vitamins cannot be discarded.

Phytoestrogen (+)-pinoresinol exerts antitumor activity in breast cancer cells with different oestrogen receptor statuses.

BACKGROUND: Consumption of virgin olive oil (VOO) has been associated with a low breast cancer incidence. Pinoresinol is a phytoestrogen that is typically found in VOO. Considering the role of oestrogen in breast cancer development and progression, we investigated the potential antitumor activity of pinoresinol in breast cancer cells. METHODS: To address this question, we treated MDA-MB-231 (oestrogen receptor [ER] negative) and MCF7 (ER+) human breast tumour cells and MCF10A human mammary epithelial cells (ER-) with different concentrations of pinoresinol. The cytotoxic activity, cell proliferation, cell cycle profile, apoptosis induction, reactive oxygen species production and DNA damage were assessed. RESULTS: Pinoresinol showed cytotoxic, anti-proliferative and pro-oxidant activity in human breast tumour cells, independent of their oestrogen receptor status. In addition, pinoresinol exerted antioxidant activity and prevented DNA damage associated with oxidative stress in human mammary epithelial cells. CONCLUSIONS: Overall, the results suggest that pinoresinol may have antitumor activity in human breast cancer cells independently of oestrogen receptor status. Furthermore, the results show that the pinoresinol has the typical characteristics of a chemopreventive compound.

Olive oil consumption and risk of CHD and/or stroke: a meta-analysis of case-control, cohort and intervention studies.

Increasing evidence suggests that the Mediterranean diet can reduce the risk of CVD. Olive oil is the hallmark of this dietary pattern. We conducted a meta-analysis of case-control, prospective cohort studies and a randomised controlled trial investigating the specific association between olive oil consumption and the risk of CHD (101,460 participants) or stroke (38,673 participants). The results of all observational studies were adjusted for total energy intake. The random-effects model assessing CHD as an outcome showed a relative risk (RR) of 0.73 (95% CI 0.44, 1.21) in case-control studies and 0.96 (95% CI 0.78, 1.18) in cohort studies for a 25 g increase in olive oil consumption. In cohort studies, the random-effects model assessing stroke showed a RR of 0.74 (95% CI 0.60, 0.92). The random-effects model combining all cardiovascular events (CHD and stroke) showed a RR of 0.82 (95% CI 0.70, 0.96). Evidence of heterogeneity was apparent for CHD, but not for stroke. Both the Egger test (P= 0.06) and the funnel plot suggested small-study effects. Available studies support an inverse association of olive oil consumption with stroke (and with stroke and CHD combined), but no significant association with CHD. This finding is in agreement with the recent successful results of the PREDIMED randomised controlled trial.

Eficacia de un programa de entrenamiento intradiálisis de fuerza-resistencia en combinación con electroestimulación neuromuscular: mejora en la capacidad funcional, fuerza, y calidad de vida. “Premio de investigación en enfermería nefrológica Janssen-Cilag 2010” / Efficacy of an intradialysis strength-stamina training programme in combination with neuromuscular electrostimulation: improvement in functional capacity, strength, and quality of life

El propósito de este estudio fue determinar la eficacia de un programa de ejercicios de fuerza-resistencia durante la hemodiálisis, en la mejora de la fuerza muscular, calidad de vida y capacidad funcional para la realización de actividades de la vida diaria. Se realizó un estudio cuantitativo y experimental de tipo pretest y postest. Se aplicó un programa de ejercicios de fuerzaresistencia en combinación con electroestimulación neuromuscular a 10 pacientes sometidos a hemodiálisis. Fueron tres ejercicios de sencilla ejecución adaptados a la posición en la que se realizaba la hemodiálisis. Todos los pacientes mostraron una mejoría significativa en la fuerza, medida mediante test funcionales para la realización de las actividades de la vida diaria: caminar (6-MWT) y sentarse-levantarse (10-STS). Estos test fueron medidos antes y después del programa de entrenamiento. También mostraron mejoría en la dimensión física de la calidad de vida medida mediante el cuestionario específico para el enfermo renal, el KDQOL-SFTM (AU)

The purpose of this study was to determine the efficacy of a programme of strength-stamina exercises during haemodialysis, in improving muscular strength, quality of life and functional capacity to carry out everyday activities. A quantitative, experimental pre-test and post-test study was carried out. A programme of strength-stamina exercises in combination with neuromuscular electrostimulation was applied to 10 patients undergoing haemodialysis. These were three simple exercises adapted to the position in which haemodialysis was carried out. All the patients showed a significant improvement in strength, measured using functional tests to carry out everyday activities: walking (6-MWT) and sitto- stand tests (10-STS). These tests were measured before and after the training programme. They also showed an improvement in the physical dimension of the quality of life measured using the specific questionnaire for renal patients, KDQOL-SFTM (AU)