Circulating endogenous sex steroids and risk of differentiated thyroid carcinoma in men and women.

Thyroid cancer (TC) is substantially more common in women than in men, pointing to a possible role of sex steroid hormones. We investigated the association between circulating sex steroid hormones, sex hormone binding globulin (SHBG) and the risk of differentiated TC in men and women within the European Prospective Investigation into Cancer and nutrition (EPIC) cohort. During follow-up, we identified 333 first primary incident cases of differentiated TC (152 in pre/peri-menopausal women, 111 in post-menopausal women, and 70 in men) and 706 cancer-free controls. Women taking exogenous hormones at blood donation were excluded. Plasma concentrations of testosterone, androstenedione, dehydroepiandrosterone, estradiol, estrone and progesterone (in pre-menopausal women only) were performed using liquid chromatography/mass spectrometry method. SHBG concentrations were measured by immunoassay. Odds ratios (ORs) were estimated using conditional logistic regression models adjusted for possible confounders. No significant associations were observed in men and postmenopausal women, while a borderline significant increase in differentiated TC risk was observed with increasing testosterone (adjusted OR T3 vs T1: 1.68, 95% CI: 0.96-2.92, ptrend = .06) and androstenedione concentrations in pre/perimenopausal women (adjusted OR T3 vs T1: 1.78, 95% CI: 0.96-3.30, ptrend = .06, respectively). A borderline decrease in risk was observed for the highest progesterone/estradiol ratio (adjusted OR T3 vs T1: 0.54, 95% CI: 0.28-1.05, ptrend = .07). Overall, our results do not support a major role of circulating sex steroids in the etiology of differentiated TC in post-menopausal women and men but may suggest an involvement of altered sex steroid production in pre-menopausal women.

Molecular Mechanisms Linking Genes and Vitamins of the Complex B Related to One-Carbon Metabolism in Breast Cancer: An In Silico Functional Database Study.

Carcinogenesis is closely related to the expression, maintenance, and stability of DNA. These processes are regulated by one-carbon metabolism (1CM), which involves several vitamins of the complex B (folate, B2, B6, and B12), whereas alcohol disrupts the cycle due to the inhibition of folate activity. The relationship between nutrients related to 1CM (all aforementioned vitamins and alcohol) in breast cancer has been reviewed. The interplay of genes related to 1CM was also analyzed. Single nucleotide polymorphisms located in those genes were selected by considering the minor allele frequency in the Caucasian population and the linkage disequilibrium. These genes were used to perform several in silico functional analyses (considering corrected p-values < 0.05 as statistically significant) using various tools (FUMA, ShinyGO, and REVIGO) and databases such as the Kyoto Encyclopedia of Genes and Genomes (KEGG) and GeneOntology (GO). The results of this study showed that intake of 1CM-related B-complex vitamins is key to preventing breast cancer development and survival. Also, the genes involved in 1CM are overexpressed in mammary breast tissue and participate in a wide variety of biological phenomena related to cancer. Moreover, these genes are involved in alterations that give rise to several types of neoplasms, including breast cancer. Thus, this study supports the role of one-carbon metabolism B-complex vitamins and genes in breast cancer; the interaction between both should be addressed in future studies.

High adherence to Western dietary pattern increases breast cancer risk (an EPIC-Spain study).

OBJECTIVE: To explore the association between three previously identified and validated dietary patterns (Western, Prudent and Mediterranean) and breast cancer risk by tumour subtype and menopausal status. METHODS: Data from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study provided epidemiological information (including diet and cancer incidence) from 24,892 women (639 breast cancer cases) recruited between 1992 and 1996. The associations between adherence to the three dietary patterns and breast cancer risk (overall and by tumour subtype) were explored by fitting multivariate Cox proportional hazards regression models stratified by region, among other variables. A possible interaction with menopausal status (changing over time) was explored. RESULTS: No clear association of the Prudent and Mediterranean dietary patterns with breast cancer risk was found. When compared with women with a level of adherence to the Western diet in the first quartile, women with a level of adherence in the third (hazard ratio (95 % confidence interval) (HR(95%CI)):1.37 (1.07;1.77)) and fourth quartiles (1.37 (1.03;1.83)); p for curvature of splines = 0.016) showed a non-linear increased risk, especially postmenopausal women (HR (95 % CI) 1.30 (0.98;1.72) in the third and 1.42 (1.04;1.94) in the fourth quartiles; p for curvature of splines = 0.081) and for estrogen or progesterone receptor positive with human epidermal growth factor receptor 2 negative tumours (HR (95 % CI) 1.62 (1.10;2.38) and 1.71 (1.11;2.63) for the third and fourth quartiles respectively; p for curvature of splines = 0.013). CONCLUSIONS: Intake of foods such as high-fat dairy products, red and processed meats, refined grains, sweets, caloric drinks, convenience food and sauces might be associated with a higher risk of breast cancer.

Nitrosyl-Heme and Heme Iron Intake from Processed Meats in Subjects from the EPIC-Spain Cohort.

BACKGROUND: The consumption of processed meats (PMs) and red meats are linked to the likelihood of developing colorectal cancer. Various theories have been proposed to explain this connection, focusing on nitrosyl-heme and heme iron intake. We hypothesized that differences in nitrosyl-heme and heme iron intakes will be associated with various sociodemographic and lifestyle factors. METHODS: The study included 38,471 healthy volunteers (62% females) from five Spanish regions within the EPIC-Spain cohort. High-Performance Liquid Chromatography (HPLC) determined nitrosyl-heme and heme iron levels in the 39 most consumed PMs. Food intake was assessed using validated questionnaires in interviews. Nitrosyl-heme and heme iron intakes, adjusted for sex, age, body mass index (BMI), center, and energy intake, were expressed as geometric means due to their skewed distribution. Variance analysis identified foods explaining the variability of nitrosyl-heme and heme iron intakes. RESULTS: The estimated intakes were 528.6 µg/day for nitrosyl-heme and 1676.2 µg/day for heme iron. Significant differences in nitrosyl-heme intake were found by sex, center, energy, and education level. Heme iron intake varied significantly by sex, center, energy, and smoking status. "Jamón serrano" and "jamón cocido/jamón de York" had the highest intake values, while "morcilla asturiana" and "sangrecilla" were key sources of nitrosyl-heme and heme iron. CONCLUSIONS: This is the first study to estimate levels of nitrosyl-heme intake directly in PMs for a large sample, revealing variations based on sex, BMI, smoking, and activity. Its data aids future exposure estimations in diverse populations.

Relationship between exposure to parabens and benzophenones and prostate cancer risk in the EPIC-Spain cohort.

The etiology of prostate cancer is not fully elucidated. Among environmental risk factors, endocrine-disrupting chemicals (EDCs) deserve special mention, as they alter metabolic pathways involved in hormone-dependent cancers. Epidemiological evidence assessing the carcinogenicity of EDCs is scarce. The aim of this study was to analyze the relationship between exposure to parabens and benzophenones and prostate cancer risk. We conducted a case-cohort study nested within the EPIC-Spain prospective multi-center cohort. Study population comprised 1,838 sub-cohort participants and 467 non-sub-cohort prostate cancer cases. Serum concentrations of four parabens and two benzophenones were assessed at recruitment. Covariates included age, physical activity, tobacco smoking, alcohol consumption, body mass index, educational level and diabetes. Borgan II weighted Cox proportional hazard models stratified by study center were applied. Median follow-up time was 18.6 years (range = 1.0-21.7 years). Most sub-cohort participants reached primary education at most (65.5%), were overweight (57.7%) and had a low level of physical activity (51.3%). Detection percentages varied widely, being lowest for butyl-paraben (11.3%) and highest for methyl-paraben (80.7%), which also showed the highest geometric mean (0.95 ng/ml). Cases showed significantly higher concentrations of methyl-paraben (p = 0.041) and propyl-paraben (p < 0.001). In the multivariable analysis, methyl-paraben - log-transformed (HR = 1.07; 95%CI = 1.01-1.12) and categorized into tertiles (HR = 1.60 for T3; 95%CI = 1.16-2.20) -, butyl-paraben - linear (HR = 1.19; 95%CI = 1.14-1.23) and log-transformed (HR = 1.17; 95%CI = 1.01-1.35) - and total parabens - log-transformed (HR = 1.09; 95%CI = 1.02-1.17) and categorized into tertiles (HR = 1.62 for T3; 95%CI = 1.10-2.40) - were associated with an increased prostate cancer risk. In this study, higher concentrations of methyl-, butyl-, and total parabens were positively associated with prostate cancer risk. Further research is warranted to confirm these findings.

Dietary intakes of dioxins and polychlorobiphenyls (PCBs) and mortality: EPIC cohort study in 9 European countries.

Dioxins and polychlorinated biphenyls (PCBs) are toxic, endocrine disruptors and persistent chemicals for which the main exposure source is diet due to their bioaccumulation and biomagnification in food chains. Cohort studies in the general populations have reported inconsistent associations between these chemicals in serum/plasma and mortality. Our objective was to study the association between dietary intake of 17 dioxins and 35 PCBs and all-cause, cancer-specific and cardiovascular-specific mortalities were assessed in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Dietary intake of dioxins and PCBs was assessed combining EPIC food consumption data with European food contamination data provided by the European Food Safety Authority. We applied multivariable Cox regressions. The analysis included 451,390 adults (mean ± SD age:51.1 ± 9.7 years) with 46,627 deaths and a median follow-up of 17.4 years (IQR = 15.2-19.1). A U-shaped non-linear association with all-cause mortality for dietary intake of dioxins (Pnon-linearity<0.0001), DL-PCB (Pnon-linearity = 0.0001), and NDL-PCBs (Pnon-linearity<0.01) was observed. For example, the hazard ratios (95%Confidance interval) for all-cause mortality obtained with the spline model was equal to 1.03 (1.02-1.05) for low levels of intake to dioxins (7 pg TEQ/day), 0.93 (0.90-0.96) for moderate levels of intake (25 pg TEQ/day), while for high levels of intake (55 pg TEQ/day) it was 1.03 (0.97-1.09). Intake of dioxins, DL-PCBs and NDL-PCBs was not associated with cardiovascular mortality. There was no association between intakes of dioxins and cancer mortality, but a U-shaped association was observed for intake of DL-PCBs and intakes of NDL-PCBs and cancer mortality. The PCBs and dioxins are known to have endocrine disrupting properties which can lead to non-monotonic dose responses. These results need to be interpreted with caution and further studies are needed to better clarify the association between dietary intake of dioxins and PCB and mortality in the general population.

On the use of the healthy lifestyle index to investigate specific disease outcomes.

The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell's C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

La obesidad como factor de riesgo en personas con COVID-19: posibles mecanismos e implicaciones / Obesity as a risk factor in COVID-19: Possible mechanisms and implications

Varios artículos recientes sugieren que la obesidad es un factor de riesgo para una enfermedad más grave por coronavirus. En este artículo se resume la evidencia científica disponible sobre el papel de la obesidad en COVID-19, con especial atención en las personas más jóvenes y los mecanismos biológicos propuestos para explicar tanto el mayor riesgo observado como la posible mayor contagiosidad de esta población. Se consideran varias implicaciones de la pandemia sobre las personas con obesidad, en relación con las posibles dificultades en el manejo de los pacientes ingresados, las implicaciones del confinamiento sobre el control y tratamiento de la obesidad, y el estigma que sufren estas personas por su condición, y que puede verse aumentado si se confirma la relación de la obesidad con COVID-19. Comprender el papel de la obesidad en COVID-19 debería ser una prioridad de salud pública, dada la alta prevalencia de esta condición en nuestro país

Recent reports suggest that obesity is a risk factor for more severe coronavirus disease. This article summarizes the available scientific evidence on the role of obesity in COVID-19. We focus on implications for younger patients and the proposed biological mechanisms that could explain both the higher risk observed and the possible higher contagiousness of people with obesity. We consider implications of the pandemic for people with obesity in relation to: difficulties in managing hospitalized patients, implications of confinement for the control and treatment of obesity, and the stigma people with obesity suffer, that could increase should the relationship between obesity and COVID-19 be confirmed. Understanding the role of obesity in COVID-19 should be a public health priority, given the high prevalence of this condition in our country

Night-shift work and breast and prostate cancer risk: updating the evidence from epidemiological studies / Trabajo nocturno por turnos y el riesgo de cáncer de mama y próstata: actualizando la evidencia a partir de estudios epidemiológicos

It has been hypothesized that circadian disruption is related to higher cancer risk. Since the International Agency for Research on Cancer classified shift work involving circadian disruption as probably carcinogenic to humans (Group 2A), multiple studies have been conducted to test this hypothesis. The aim of this systematic review was to summarize the findings and evaluate the quality of existing epidemiological studies (case-control and cohort studies) on the relationship between night-shift work and breast and prostate cancer risk. Thirty-three epidemiological studies investigating the relationship between night-shift work and breast (n = 26) or prostate (n = 8) cancer risk were included (one paper included both sites). The Newcastle-Ottawa Scale for the quality of non-randomized studies was used to assess the risk of bias of the publications. The studies included were heterogeneous regarding population (general population, nurses working in rotating shifts, and other) and measurement of exposure to night-shift work (ever vs. never exposure, short vs. long-term, rotating vs. permanent) and, thus, a diversity of outcomes were observed even within the same type of cancer. In summary, 62.5% works found some type of association between night-shift work and increased risk of cancer, for both breast and prostate. The risk of bias scored an average of 7.5 over 9 stars. Due to the limitations inherent in these studies, the evidence of a possible association between night-shift work and breast or prostate cancer risk remains uncertain and more studies providing greater control of exposure and confounding factors are required. Despite the lack of conclusive evidence, application of the precautionary principle seems advisable

Se ha formulado la hipótesis de que la disrupción circadiana está relacionada con un mayor riesgo de cáncer. Desde que la Agencia Internacional de Investigación sobre el Cáncer clasificó la disrupción circadiana asociada al trabajo por turnos como "probablemente carcinógeno para los humanos" (Grupo 2A) se han llevado a cabo numerosos estudios para confirmar o rechazar esta hipótesis. Por esa razón, el objetivo de esta revisión sistemática fue analizar la posible asociación entre el trabajo nocturno por turnos y el riesgo de cáncer de mama o próstata. Se incluyeron treinta y tres estudios epidemiológicos sobre la relación entre el riesgo de padecer cáncer de mama (n = 26) o próstata (n = 8) y el trabajo nocturno; un estudio evaluó ambas localizaciones. El riesgo de sesgo de los artículos se evaluó mediante la escala Newcastle-Ottawa. Los estudios incluidos en esta revisión fueron heterogéneos respecto a población incluida (población general, enfermeras a turnos, y otros), medida de la exposición a trabajo nocturno (siempre vs nunca, a corto vs largo plazo, a turnos o fijo) y, por tanto, los hallazgos fueron variados incluso para el mismo tipo de cáncer. En resumen, un 62,5% de los estudios encontraron asociación entre el trabajo nocturno y el riesgo aumentado de padecer cáncer, tanto de mama como de próstata. El riesgo de sesgo medio fue de 7,5 estrellas sobre 9. Debido a las limitaciones inherentes a estos estudios, la evidencia de una posible asociación entre el trabajo nocturno y el riesgo de cáncer de mama o próstata sigue siendo incierta, por lo que se requieren más estudios epidemiológicos con mayor control de la exposición y de los factores de confusión. No obstante, parece aconsejable la aplicación del principio de precaución

Prevalence of intimate partner violence in Spain: a national cross-sectional survey in primary care / Prevalencia de la violencia de parejas en España: estudio transversal a través de cuestionario en la atención primaria

OBJECTIVES: (1) To analyze the prevalence of Intimate Partner Violence by types. (2) To examine the relationship between sociodemographic characteristics and Intimate Partner Violence. DESIGN: Cross-sectional study using a self-administered questionnaire. SETTING: Primary Healthcare centers in Spain. PARTICIPANTS: 10,322 women (18-70 years) attending Primary Healthcare centers. MAIN MEASUREMENTS: A compound index was calculated based on frequency, types, and duration of Intimate Partner Violence. Multivariable adjusted logistic regression models were used to identify the sociodemographic factors, which were independently associated with each Intimate Partner Violence category. RESULTS: The prevalence of Intimate Partner Violence was 24.8%. For the physical only category, no differences were observed regarding education or employment status, and women with the highest income have less risk. For the psychological only category, no differences were observed according to the income level. The risk increases as the education level decreases, and the greatest frequency of only psychological Intimate Partner Violence was observed in women who were unemployed or students. For both the physical and psychological category of Intimate Partner Violence, a clear risk increase is observed as income and education levels decrease. Retired women showed the highest frequency of this violence category. CONCLUSION: The results show that Intimate Partner Violence affects women of all social strata, but the frequency and Intimate Partner Violence category will vary according to the socio-economic

OBJETIVOS: 1) Analizar la prevalencia de Violencia de Pareja por tipos. 2) Examinar la relación entre las características sociodemográficas y la Violencia de Pareja. DISEÑO: Estudio transversal a través de cuestionario autoadministrado. EMPLAZAMIENTO: Centros de Atención Primaria en España. PARTICIPANTES: 10.322 mujeres (de 18 a 70 años) asistentes a Centros de Atención Primaria. MEDICIONES PRINCIPALES: Se ha calculado un índice compuesto en función de la frecuencia, el tipo y la duración de la Violencia de Pareja. Se ha llevado a cabo modelos ajustados de regresión logística multivariable para identificar los factores sociodemográficos que se asocian de forma independiente con cada categoría de Violencia de Pareja. RESULTADOS: La prevalencia total de Violencia de Pareja fue de 24.8%. Para la violencia física, no se observaron diferencias en cuanto a la educación y la situación laboral y las mujeres con mayores ingresos tienen menos riesgo de sufrir violencia física. Para violencia psicológica, no se observaron diferencias según el nivel de renta. El riesgo aumenta a medida que el nivel de educación disminuye, y en las mujeres desempleadas y las estudiantes. Para la categoría de violencia tanto física como psicológica, se observa un claro aumento del riesgo según disminuye el nivel de renta y el nivel educativo de las mujeres. Las mujeres jubiladas mostraron una mayor prevalencia de violencia en esta categoría. CONCLUSIONES: Los resultados muestran que la IPV afecta a mujeres de todos los estratos sociales pero que la frecuencia de las diferentes categorías de IPV varían de acuerdo con el nivel socioeconómico

Protocolo y metodología del estudio epidemiológico de la salud mental en Andalucía: PISMA-ep / Protocol and methodology of study epidemiological mental health in Andalusia: PISMA-ep

Introducción. El presente artículo describe la metodología general de un estudio transversal cuyo principal objetivo consiste en la detección de la prevalencia de los principales trastornos mentales en Andalucía, y el estudio de sus correlatos o posibles factores de riesgo mediante una amplia muestra representativa de adultos que vive en la comunidad. Materiales y métodos. Este es un estudio transversal en el que desarrollamos un muestreo de varias fases utilizando distintos niveles de estratificación habituales y en el que teníamos como objetivo entrevistar a 4.518 participantes seleccionados al azar y representativos de las 8 provincias de la comunidad andaluza, con un enfoque de «llamada a la puerta». Como principal herramienta diagnóstica se utilizó la versión española de la entrevista neuropsiquiátrica internacional MINI, un instrumento válido de detección para el establecimiento de diagnósticos de trastorno mental compatibles con los criterios CIE-10/DSM-IV. Asimismo, se empleó una amplia batería de instrumentos para explorar la funcionalidad global, la comorbilidad médica, las características de la personalidad, la función cognitiva y la exposición a posibles factores de riesgo psicosocial. También se obtuvo una muestra de saliva para extraer ADN para un estudio de asociación genética. Entrevistadores entrenados llevaron a cabo las entrevistas, a pesar de que la mayoría de las medidas son compatibles con entrevistadores legos. Resultados. De los 5.496 hogares seleccionados inicialmente, el 70,8% (3.892) tuvieron que sustituirse por falta de respuesta (37,7%) o por no incluir a ninguna persona que cumpliese las características requeridas (33%). Así, de las nuevas 5.496 personas, a las cuales finalmente se accedió, 4.507 (83,7%) consintieron participar, completaron la entrevista y se las incluyó finalmente en el estudio (n = 4.507), mientras que 4.286 (78%) también proporcionaron una muestra de saliva. Por su parte, 989 (16,3%) rechazaron participar. Discusión. Se trata del estudio de epidemiología de salud mental más amplio desarrollado en la comunidad autónoma más grande y poblada de España (Andalucía). Las tasas de respuesta y representatividad de la muestra son bastante altas. El método empleado es muy completo para este tipo de estudios e incluye tanto valoraciones de personalidad (rasgos y trastorno) como valoración cognitiva, así como un amplio abanico de medidas de riesgo biopsicosocial (AU)

Introduction. This is the general methods describing paper of a cross-sectional study that aims to detect the prevalence of major mental disorders in Andalusia (Southern Spain), and their correlates or potential risk factors, using a large representative sample of community-dwelling adults. Materials and methods. This is a cross-sectional study. We undertook a multistage sampling using different standard stratification levels and aimed to interview 4,518 randomly selected participants living in all 8 provinces of the Andalusian region utilizing a door-knocking approach. The Spanish version of the MINI International Neuropsychiatric Interview, a valid screening instrument ascertaining ICD-10/DSM-IV compatible mental disorder diagnoses was used as our main diagnostic tool. A large battery of other instruments was used to explore global functionality, medical comorbidity, personality traits, cognitive function and exposure to psychosocial potential risk factors. A saliva sample for DNA extraction was also obtained for a sub-genetic study. The interviews were administered and completed by fully trained interviewers, despite most tools used are compatible with lay interviewer use. Results. A total of 3,892 (70.8%) of 5,496 initially attempted households had to be substituted for equivalent ones due to either no response (37.7%) or not fulfilling the required participant quota (33%). Thence, out of 5,496 eligible participants finally approached, 4,507 (83.7%) agreed to take part in the study, completed the interview and were finally included in the study (n=4,507) and 4,286 (78%) participants also agreed and consented to provide a saliva sample for DNA study. On the other hand, 989 (16.3%) approached potential participants refused to take part in the study. Discussion. This is the largest mental health epidemiological study developed in the region of Spain (Andalusia). The response rates and representativeness of the sample obtained are fairly high. The method is particularly comprehensive for this sort of studies and includes both, personality and cognitive assessments, as well as a large array of bio-psycho-social risk measures (AU)

Polyphenol intake and differentiated thyroid cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Polyphenols are bioactive compounds with several anticarcinogenic activities; however, human data regarding associations with thyroid cancer (TC) is still negligible. Our aim was to evaluate the association between intakes of total, classes and subclasses of polyphenols and risk of differentiated TC and its main subtypes, papillary and follicular, in a European population. The European Prospective Investigation into Cancer and Nutrition cohort included 476,108 men and women from 10 European countries. During a mean follow-up of 14 years, there were 748 incident differentiated TC cases, including 601 papillary and 109 follicular tumors. Polyphenol intake was estimated at baseline using validated center/country-specific dietary questionnaires and the Phenol-Explorer database. In multivariable-adjusted Cox regression models, no association between total polyphenol and the risks of overall differentiated TC (HRQ4 vs. Q1 = 0.99, 95% confidence interval [CI] 0.77-1.29), papillary (HRQ4 vs. Q1 = 1.06, 95% CI 0.80-1.41) or follicular TC (HRQ4 vs. Q1 = 1.10, 95% CI 0.55-2.22) were found. No associations were observed either for flavonoids, phenolic acids or the rest of classes and subclasses of polyphenols. After stratification by body mass index (BMI), an inverse association between the intake of polyphenols (p-trend = 0.019) and phenolic acids (p-trend = 0.007) and differentiated TC risk in subjects with BMI ≥ 25 was observed. In conclusion, our study showed no associations between dietary polyphenol intake and differentiated TC risk; although further studies are warranted to investigate the potential protective associations in overweight and obese individuals(AU)

Correspondencias entre CIE-10 y CIE-9 para las listas de causas de muerte del Instituto Nacional de Estadística y de la región de Murcia / Correspondences from 10th to 9th revision of the International Classification of Diseases in the causes of death lists of the National Institute of Statistics and the regional health authority of Murcia in Spain

Fundamento: Diversos países han realizado estudios de comparabilidadentre las revisiones 10ª y 9ª de la Clasificación Internacionalde Enfermedades para listas agregadas de causas de muerte. EnEspaña el proyecto COMPARA pretende evaluar el impacto delcambio de revisión.Métodos: Estudio epidemiológico transversal descriptivo de88.048 defunciones inscritas en 1999 en España con la causa demuerte doblemente codificada en CIE-9 y 10. Se establecen lascorrespondencias teóricas entre CIE en las listas INE y Murcia. Secalculan las razones de comparabilidad e intervalos de confianza y elíndice kappa global.Resultados: Descienden las enfermedades infecciosas (-1,7%),las hepatitis víricas (-12,3%), mientras que aumenta el Sida (5,7%).Las neoplasias aumentan el 0,3% por la incorporación del síndromemielodisplásico (55,2%). Se incrementa la diabetes mellitus (2,1%).Se reducen los trastornos mentales al salir las demencias hacia laenfermedad de Alzheimer (28,6%). Las enfermedades cardiovascularesdescienden ligeramente (-1,4%), sin impacto sobre las cerebrovasculares,aunque el infarto agudo de miocardio decrece (-0,6%)con aumento de la enfermedad isquémica cardiaca (0,3%). La neumoníadecrece (-12,5%) y la cirrosis hepática se aumenta (4,3%).Las entidades mal definidas aumentan por la cesión de las insuficienciascardiorrespiratorias. Las causas externas no varían sin querecojan la precisión de la CIE-9. La lista INE - 102 grupos obtiene uníndice kappa del 95,4%, similar a las variantes de Murcia. Conclusiones: Aunque el impacto global de la CIE-10 es menor,se deberían tener en cuenta las razones de comparabilidad significativasde los grupos de causas de muerte con diferencias absolutasimportantes entre las revisiones

Background: Different countries have conducted comparabilitystudies between Revisions 10 and 9 of the International Classificationof Diseases for aggregate lists of causes of death. In Spain,the COMPARA project was aimed at evaluating the impact of therevision change.Methods: Descriptive cross-sectional epidemiological study of88,048 deaths recorded in Spain in 1999 with the underlying cause ofdeath doubled coded in ICD-9 and ICD-10. The theoretical correspondencesbetween the ICD on the lists of the National Institute ofStatistics and Murcia are established. The comparability rates andtheir confidence intervals, and the total kappa index were calculated.Results: A decline in infectious diseases (-1.7%) and viral hepatitis,(-12.3%) declined under Tenth revision, while AIDS showed anincrease (5.7%). Neoplasms increased a little (0.3%) with the inclusionof the Mielodisplasic Syndrome (55.2%). Diabetes mellitus isincreased (2.1%). Mental disorders declined on dementia being shiftedto Alzheimer's disease (28.6%). Cardiovascular diseases droppedslightly (-1.4%), without any impact on cerebrovascular diseases,although acute myocardial infarct decreased (-0.6%) while ischemicheart disease increased (0.3%). Pneumonia decreased (-12.5%) andhepatic cirrhosis grows (4.3%). Ill-defined conditions increased dueto cardiorespiratory insufficiencies. The external causes show nochange without including the accuracy of ICD-9. The National Instituteof Statistics 102 groups list obtained a total kappa index of95.4%, similar to the Murcia variants. Conclusions: Although ICD-10 has a lesser overall impact, thesignificant comparability rates of the causes of death groups betweenthe revisions with important absolute differences should be takeninto account