Daily time spent on screens and psychological well-being: Cross-sectional association within the SUN cohort.

BACKGROUND: The impact of various lifestyles on psychological well-being (PWB) remains under-studied. We aimed to explore the cross-sectional association between daily screen use (television, tablet and mobile phone) and PWB within the SUN cohort. METHODS: PWB was assessed using the 29-item Ryff scale (ranging from 29 to 174), and participants with scores >75th percentile were considered as having optimal PWB. Participants were categorized based on their self-reported weekly screen usage hours. Postestimation logistic regression models assessing the prevalence likelihood of not achieving optimal PWB were adjusted for sociodemographic, psychological, personality and lifestyles factors. Isotemporal substitution models explored the potential impact on PWB resulting from replacing 1 h/day of screen time with 1 h/day of exercise. RESULTS: The study included 3051 participants (55.8% women, mean age 57.3 ± 11.1 years, mean Ryff's score: 139.1 ± 17.4 points). Daily screen use for ≥2 h was associated with a higher prevalence likelihood of not achieving an optimal PWB (Prevalence Ratio [PR]:1.09; 95% CI:1.01-1.18). Among PWB dimensions, screen use ≥2 h/day was linked to an increased likelihood of not achieving optimal scores in environmental mastery (PR:1.11; 95% CI:1.02-1.20), life purpose (PR:1.10; 95% CI:1.02-1.18), and personal growth (PR:1.09; 95% CI:1.01-1.18). Replacing 1 h of daily screens time with 1 h of exercise may lead to potential improvements in environmental mastery (Odds Ratio [OR]:0.87; 95% CI:0.76-0.99), purpose in life (OR:0.86; 95% CI: 0.76-0.98), personal growth (OR:0.84; 95% CI:0.73-0.96) and positive interpersonal relationships (OR:0.86; 95% CI:0.75-0.99). CONCLUSIONS: These findings highlight the importance of reducing screen use activities and increasing physical exercise for achieving optimal PWB.

Association between the consumption of ultra-processed foods and the incidence of peptic ulcer disease in the SUN project: a Spanish prospective cohort study.

PURPOSE: Consumption of ultra-processed foods (UPF) has increased despite potential adverse health effects. Recent studies showed an association between UPF consumption and some gastrointestinal disorders. We evaluated the association between UPF consumption and peptic ulcer disease (PUD) in a large Spanish cohort. METHODS: We conducted a prospective analysis of 18,066 participants in the SUN cohort, followed every two years. UPF was assessed at baseline and 10 years after. Cases of PUD were identified among participants reporting a physician-made diagnosis of PUD during follow-ups. Cases were only partially validated against medical records. Cox regression was used to assess the association between baseline UPF consumption and PUD risk. Based on previous findings and biological plausibility, socio-demographic and lifestyle variables, BMI, energy intake, Helicobacter pylori infection, gastrointestinal disorders, aspirin and analgesic use, and alcohol and coffee consumption were included as confounders.We fitted GEE with repeated dietary measurements at baseline and after 10 years of follow-up. Vanderweele's proposed E value was calculated to assess the sensitivity of observed associations to uncontrolled confounding. RESULTS: During a median follow-up of 12.2 years, we recorded 322 new PUD cases (1.56 cases/1000 person-years). Participants in the highest baseline tertile of UPF consumption had an increased PUD risk compared to participants in the lowest tertile (HR = 1.52, 95% CI: 1.15, 2.00, Ptrend=0.002). The E-values for the point estimate supported the observed association. The OR using repeated measurements of UPF intake was 1.39 (95% CI: 1.03, 1.87) when comparing extreme tertiles. CONCLUSION: The consumption of UPF is associated with an increased PUD risk.

Tobacco and alcohol co-use: Lifestyle and sociodemographic factors, and personality aspects as potential predictors in the "Seguimiento Universidad de Navarra" cohort.

Tobacco and alcohol co-use are two major lifestyle modifiable risk factors. Understanding the determinants of both behaviors helps to develop interventions to prevent these exposures. However, previous studies have focused on predictors of individual tobacco or alcohol use. This study aims to explore the potential predictors of tobacco and alcohol co-use among Spanish university graduates from the "Seguimiento Universidad de Navarra" (SUN) cohort study. A total of 7175 participants who were co-users of tobacco and alcohol were selected for this cross-sectional analysis. Their mean age was 39.1 years (12.04 SD) and 57.3% were women. Univariate regression models were used to select the potential predictors of tobacco and alcohol co-use, and the areas under the ROC curves (AUC) were calculated. Multivariable logistic regression models were used to create a predictive model. Baseline potential predictors included sociodemographic factors, lifestyle habits, and perceived personality aspects. In the multivariable model, the main significant potential predictors of tobacco and alcohol co-use were driving under the influence of alcohol (odds ratio [OR] = 1.65 [1.43-1.90]), drinking 1-2 cups of coffee daily (OR = 1.50 [1.24-1.84]), drinking three or more cups of coffee daily (OR = 1.61 [1.35-1.91]), and doing more physical activity than recommended (OR = 1.18 [1.02-1.34]) when compared with the reference group. Conversely, those who were married (OR = 0.87 [0.75-0.99], ate at home 7 days a week (OR = 0.69 [0.60-0.80]), or had a high perceived level of competitiveness (OR = 0.83 [0.72-0.95]) had a lower risk of co-use (AUC 0.61 [confidence interval 95% 0.59-0.63]), compared to the reference group. These results could be used by healthcare professionals, especially nurses, to effectively assess patients at higher risk of tobacco and alcohol co-use. [Correction added on 16 February 2024, after first online publication: The abstract section has been revised to provide more clarity in this version.].

Vitamin D and the Risk of Developing Hypertension in the SUN Project: A Prospective Cohort Study.

Vitamin D deficiency has been associated with a higher risk of multiple diseases, including cardiovascular disorders. The purpose of this study was to examine the potential association between predicted levels of serum 25(OH)D and the risk of new-onset hypertension in a large Mediterranean cohort. A validated 136-item food frequency questionnaire was used as the dietary assessment tool. 25(OH)D serum levels were predicted using a previously validated equation. We performed Cox regression models to analyze the association between predicted serum 25(OH)D and the risk of hypertension, according to quartiles of forecasted vitamin D at baseline, after adjusting for multiple potential confounders. Over a median follow-up of 12.3 years, 2338 new cases of hypertension were identified. The analyses revealed a significant inverse association between predicted serum levels of 25(OH)D at baseline and the risk of hypertension. Individuals in the highest quartile showed a 30% relatively lower risk of hypertension compared to the lowest quartile (hazard ratio (HR): 0.70; 95% confidence interval (CI): 0.60-0.80, p-trend < 0.001). The outcomes remained significant after performing sensitivity analyses. The findings suggested that higher levels of forecasted vitamin D are inversely and independently associated with the risk of incident hypertension, implying that vitamin D may offer protective benefits against the disease.

Is Ultra-Processed Food Intake Associated with a Higher Risk of Glaucoma? A Prospective Cohort Study including 19,255 Participants from the SUN Project.

OBJECTIVE: The aim of this study was to examine the relationship of ultra-processed food (UPF) intake with the incidence of glaucoma in a large sample of Spanish university graduates followed prospectively. METHODS: Prospective cohort study using data from the SUN Project. A final sample of 19,225 participants (60.1% women) was included in this study, with a mean age of 38.2 years (standard deviation (SD) = 12.4). Participants were followed-up for a mean time of 12.9 years (SD = 5.4). Dietary intake was measured using a 136-item semiquantitative food-frequency questionnaire. UPFs were defined based on the NOVA classification system. Glaucoma diagnosis was determined by asking the participants if they had ever been diagnosed with glaucoma by an ophthalmologist. This self-reported diagnosis of glaucoma has been previously validated. RESULTS: After adjusting for several covariates, participants with the highest UPF consumption were at higher risk of glaucoma (hazard ratio (HR) = 1.83; 95% confidence interval (CI) 1.06 to 3.17) when compared to participants in the lowest category of UPF consumption. Regarding subgroup analyses, a significant multiplicative interaction was found for age (p = 0.004) and omega 3:6 ratio (p = 0.040). However, an association between UPF consumption and glaucoma was only found in older participants (aged ≥ 55 years), in men, in the most physically active group, in the group of non- or former smokers, in those with a lower omega 3:6 ratio, and in those with a lower energy intake. Regarding the contribution of each type of UPF group, UPF coming from sweets showed a significant risky effect (HR = 1.51; CI 95% 1.07 to 2.12). CONCLUSIONS: This prospective cohort study shows that participants with a greater UPF consumption have a higher risk of developing glaucoma when compared to participants with a lower consumption. Our findings emphasize the relevance of monitoring and limiting the consumption of UPFs as a means of preventing glaucoma incidence.

Association between overall quality of macronutrients and incidence of overweight and obesity in the SUN (Seguimiento Universidad de Navarra) cohort.

INTRODUCTION: no previous large prospective studies have assessed the global quality of macronutrients in association with the risk of overweight/obesity. OBJECTIVE: to prospectively assess the association of an overall macronutrient quality index (MQI) with weight change and the incidence of overweight/obesity in the Seguimiento Universidad de Navarra (SUN) cohort. METHODS: the diet of 9,344 Spanish university graduates (mean age: 36.5 [SD, 11.1]) was assessed through a validated 136-item food frequency questionnaire. The MQI was calculated as the sum of the Carbohydrate Quality Index, the Fat Quality Index, and the Healthy Plate Protein Quality Index. Participants were classified into groups according to MQI. Incident overweight/obesity was defined if follow-up questionnaires indicated BMI was ≥ 25 kg/m2. Multiple linear regression models and Cox proportional hazard models were used to assess the average yearly weight change and the risk of overweight/obesity over follow-up time. RESULTS: 2,465 cases of incident overweight/obesity were identified (median follow-up: 10.7 years). Increasing MQI was significantly associated with lower annual weight gain (g): ß coefficient: -99.0, (95 % CI: -173.6 to -24.5) in the Q4 vs Q1, p for trend = 0.007. In the fully adjusted model the incidences of overweight/obesity in Q4 and Q1 were 21.7 % (431 cases) and 29.3 % (954 cases), respectively. The adjusted HR was 0.87 (95 % CI, 0.77-0.98, p for trend = 0.036). When we used repeated analyses updating the MQI after 10 years of follow-up, results remained similar. CONCLUSIONS: a significant inverse association between a multidimensional MQI and the risk of overweight/obesity was found in this Mediterranean cohort of adults.

Development of the VEGANScreener, a Tool for a Quick Diet Quality Assessment among Vegans in Europe.

BACKGROUND: Plant-based diets are not inherently healthy. Similar to omnivorous diets, they may contain excessive amounts of sugar, sodium, and saturated fats, or lack diversity. Moreover, vegans might be at risk of inadequate intake of certain vitamins and minerals commonly found in foods that they avoid. We developed the VEGANScreener, a tool designed to assess the diet quality of vegans in Europe. METHODS: Our approach combined best practices in developing diet quality metrics with scale development approaches and involved the following: (a) narrative literature synthesis, (b) evidence evaluation by an international panel of experts, and (c) translation of evidence into a diet screener. We employed a modified Delphi technique to gather opinions from an international expert panel. RESULTS: Twenty-five experts in the fields of nutrition, epidemiology, preventive medicine, and diet assessment participated in the first round, and nineteen participated in the subsequent round. Initially, these experts provided feedback on a pool of 38 proposed items from the literature review. Consequently, 35 revised items, with 17 having multiple versions, were suggested for further consideration. In the second round, 29 items were retained, and any residual issues were addressed in the final consensus meeting. The ultimate screener draft encompassed 29 questions, with 17 focusing on foods and nutrients to promote, and 12 addressing foods and nutrients to limit. The screener contained 24 food-based and 5 nutrient-based questions. CONCLUSIONS: We elucidated the development process of the VEGANScreener, a novel diet quality screener for vegans. Future endeavors involve contrasting the VEGANScreener against benchmark diet assessment methodologies and nutritional biomarkers and testing its acceptance. Once validated, this instrument holds potential for deployment as a self-assessment application for vegans and as a preliminary dietary screening and counseling tool in healthcare settings.

Effect of a nutritional intervention based on an energy-reduced Mediterranean diet on environmental impact.

OBJECTIVE: To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up. METHODS: Baseline and 1-year follow-up data were used for 5800 participants aged 55-75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact. RESULTS: We observed a significant reduction in the intervention group compared to the control group in acidification levels (-13.3 vs. -9.9 g SO2-eq), eutrophication (-5.4 vs. -4.0 g PO4-eq) and land use (-2.7 vs. -1.8 m2). Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %. CONCLUSIONS: A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters.

Meat consumption and incident type 2 diabetes: an individual-participant federated meta-analysis of 1·97 million adults with 100 000 incident cases from 31 cohorts in 20 countries.

BACKGROUND: Meat consumption could increase the risk of type 2 diabetes. However, evidence is largely based on studies of European and North American populations, with heterogeneous analysis strategies and a greater focus on red meat than on poultry. We aimed to investigate the associations of unprocessed red meat, processed meat, and poultry consumption with type 2 diabetes using data from worldwide cohorts and harmonised analytical approaches. METHODS: This individual-participant federated meta-analysis involved data from 31 cohorts participating in the InterConnect project. Cohorts were from the region of the Americas (n=12) and the Eastern Mediterranean (n=2), European (n=9), South-East Asia (n=1), and Western Pacific (n=7) regions. Access to individual-participant data was provided by each cohort; participants were eligible for inclusion if they were aged 18 years or older and had available data on dietary consumption and incident type 2 diabetes and were excluded if they had a diagnosis of any type of diabetes at baseline or missing data. Cohort-specific hazard ratios (HRs) and 95% CIs were estimated for each meat type, adjusted for potential confounders (including BMI), and pooled using a random-effects meta-analysis, with meta-regression to investigate potential sources of heterogeneity. FINDINGS: Among 1 966 444 adults eligible for participation, 107 271 incident cases of type 2 diabetes were identified during a median follow-up of 10 (IQR 7-15) years. Median meat consumption across cohorts was 0-110 g/day for unprocessed red meat, 0-49 g/day for processed meat, and 0-72 g/day for poultry. Greater consumption of each of the three types of meat was associated with increased incidence of type 2 diabetes, with HRs of 1·10 (95% CI 1·06-1·15) per 100 g/day of unprocessed red meat (I2=61%), 1·15 (1·11-1·20) per 50 g/day of processed meat (I2=59%), and 1·08 (1·02-1·14) per 100 g/day of poultry (I2=68%). Positive associations between meat consumption and type 2 diabetes were observed in North America and in the European and Western Pacific regions; the CIs were wide in other regions. We found no evidence that the heterogeneity was explained by age, sex, or BMI. The findings for poultry consumption were weaker under alternative modelling assumptions. Replacing processed meat with unprocessed red meat or poultry was associated with a lower incidence of type 2 diabetes. INTERPRETATION: The consumption of meat, particularly processed meat and unprocessed red meat, is a risk factor for developing type 2 diabetes across populations. These findings highlight the importance of reducing meat consumption for public health and should inform dietary guidelines. FUNDING: The EU, the Medical Research Council, and the National Institute of Health Research Cambridge Biomedical Research Centre.

Dietas basadas en plantas y factores de riesgo cardio-metabólicos. ¿Qué dice la evidencia?

RESUMEN Las dietas basadas en plantas (DBP) se caracterizan por una alta ingesta de alimentos de origen vegetal y evitan parcial o totalmente los productos animales. El objetivo de esta revisión fue recopilar evidencia sobre DBP, sus tipos y su efecto en principales factores de riesgo cardio-metabólicos (FRCM) modificables. Se encontró que existen DBP saludables y no saludables. Algunas DBP saludables son: vegetariana, mediterránea y DASH (sigla en inglés de la dieta Enfoques Alimenticios para Detener la Hipertensión). Estas promueven la ingesta de alimentos de origen vegetal "saludables" (frutas, verduras, legumbres, semillas, frutos secos, cereales integrales, palta, aceite de oliva y/o canola) y, una reducción gradual de todos los alimentos de origen animal, especialmente carnes rojas y procesadas; evitando alimentos de origen vegetal "menos saludables" (cereales refinados, fritos, productos de pastelería, alimentos con azúcar añadido). Las DBP no saludables, se caracterizan por una alta ingesta de estos alimentos "menos saludables", y se asocian con mayor riesgo cardiovascular, por el bajo aporte de antioxidantes, micronutrientes, fibra dietética y grasas insaturadas. DBP saludables pueden disminuir el riesgo de diabetes tipo 2, hipertensión arterial, sobrepeso y obesidad. Han mostrado mayores beneficios cardiovasculares en comparación con dietas tradicionales, reduciendo significativamente: HbA1c y glicemia en ayunas en diabéticos; presión arterial sistólica y diastólica en hipertensos y prehipertensos; índice de masa corporal en sujetos con sobrepeso/obesidad y mejorando el perfil lipídico en sujetos con dislipidemia. Patrones de DBP saludables, como el tipo vegetariano, mediterráneo y DASH son recomendadas para prevenir y tratar los FRCM.

ABSTRACT Plant-based diets (PBD) are characterized by a high intake of foods of plant origin and the partial or total avoidance of animal products. The objective of the current study was to compile the evidence on types of PBD and its effect on the main modifiable cardio-metabolic risk factors (CMRF). Healthy and unhealthy PBD were found to exist. Some healthy PBDs were: vegetarian, mediterranean and DASH (Dietary Approaches to Stop Hypertension). These promote the intake of "healthy" plant-based foods (fruits, vegetables, legumes, seeds, nuts, whole grains, avocado, olive oil and / or canola) and a gradual reduction of all foods of animal origin, especially red and processed meats; avoiding "less healthy" plant-based foods (refined, fried cereals, pastry products, foods with added sugar). Unhealthy PBDs were characterized by a high intake of these "less healthy" foods, and are associated with greater cardiovascular risk, due to the low contribution of antioxidants, micronutrients, dietary fiber and unsaturated fats. Healthy PBDs can lower the risk of type 2 diabetes, high blood pressure, being overweight, and obesity. They have shown greater cardiovascular benefits compared to traditional diets, significantly reducing: HbA1c and fasting glycemia in diabetics; systolic and diastolic blood pressure in hypertensive and prehypertensive patients; body mass index in overweight / obese subjects and improves lipid profile in subjects with dyslipidemia. Healthy PBD patterns, such as vegetarian, Mediterranean, and DASH are recommended to prevent and treat CMRF.

Reducción de carnes rojas y procesadas en la población española: ¿cuál es su impacto sobre la mortalidad cardiovascular? / Reduction of red and processed meats in the Spanish population: What is its impact on total and cardiovascular mortality?

OBJETIVO: Cuantificar el impacto de reducir el consumo de carnes rojas y procesadas sobre la mortalidad cardiovascular y la mortalidad total de la población adulta española, basado en 5 revisiones publicadas. Participantes y mediciones principales: Se define la exposición como el consumo de ≥ 3 raciones/semana de carnes rojas o procesadas, y se consideran cuatro escenarios de población expuesta (30-60%). Con datos del Instituto Nacional de Estadística, se calcula la mortalidad ponderada en población española de 40-80 años y, utilizando los riesgos relativos (RR) y los intervalos de confianza (IC) al 95% publicados en 5 revisiones (RR = 0,88; IC95%: 0,84-0,93 para mortalidad por todas las causas y RR = 0,92; IC95%: 0,90-0,93 para la mortalidad cardiovascular), se calculó la tasa de mortalidad en expuestos y no expuestos. Multiplicando esas tasas por el número de expuestos, se obtuvo el número de muertes atribuibles. RESULTADOS: Asumiendo un 60% de población española de 40-80años expuesta, el número de muertes anuales de causa cardiovascular que se podrían evitar consumiendo < 3 raciones/semana de carnes rojas o procesadas con un IC95% está entre 2.112 y 3.055. Si la población expuesta fuese un 30% se podrían evitar entre 1.079 y 1.577 muertes. CONCLUSIONES: Incluso bajo el supuesto más conservador, el beneficio poblacional de reducir el consumo de carnes rojas o procesadas sobre la mortalidad cardiovascular y total sería muy importante. Las conclusiones de las revisiones mencionadas contradicen sus propios resultados y contribuyen a un estado de confusión que representa un daño a la salud pública

OBJECTIVE: Quantify the impact of reducing the consumption of red/processed meats on cardiovascular mortality and all-cause mortality of the Spanish adult population based in 5 revisions published. Participants and main measurements: We defined exposure as consumption of ≥ 3 servings/week of red or processed meats and considered four possible scenarios of exposed population (30%-60%). Based on data from the Spanish National Statistics Institute, we calculated the weighted mortality between 40 and 80years. Using the relative risks (RR) and 95% confidence intervals (CI) published by the referred revisions (RR = 0.88; IC95%: 0.84-0.93 for all-cause mortality and RR = 0.92; IC95%: 0.90-0.93 for cardiovascular mortality), we calculated the expected mortality rate in both exposed and unexposed categories. By multiplying these rates by the number of exposed individuals, we estimated the attributable number of yearly deaths. RESULTS: If 60% of the population was exposed, with a 95% CI, the number of cardiovascular deaths that could be averted each year if population consumed < 3 servings/week of red or processed meats was between 2.112 and 3.055. If was exposed that 30%, the difference in the yearly number of potentially averted deaths was between 1.079 and 1.577. CONCLUSIONS: Even under the most conservative assumption, the benefit, at the population level, of reducing red or processed meats consumption < 3 servings/week on cardiovascular mortality is important. The conclusions of the recently published reviews contradicted their own results and contributed to a state of confusion that can create substantial harm for public health

Conflictos de interés: Poderoso caballero es Don Dinero / Conflicts of interests: Money Talks

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Nutrición y gastronomía en la Comunidad Foral de Navarra / Nutrition and gastronomy in the Community of Navarra

Introducción: Navarra es una comunidad que presenta gran variedad geográfica y climática, lo que da lugar a una amplia oferta alimentaria. Objetivos: revisar la gastronomía típica de Navarra, así como la evidencia disponible sobre el patrón de consumo de alimentos, el perfil nutricional y los indicadores sanitarios de la población navarra. Resultados: Navarra cuenta con 7 denominaciones de origen protegidas y 6 indicaciones geográficas protegidas. Su identidad gastronómica se asocia fundamentalmente con las verduras y las hortalizas, el cordero, la ternera y los embutidos autóctonos, lo que se refleja en el patrón de consumo. Comparativamente, los navarros consumen más hortalizas y frutas frescas, pero también presentan una ingesta frecuente y excesiva de carnes (especialmente rojas) y embutidos. Los estudios disponibles sobre el perfil nutricional muestran ingestas elevadas de proteínas y grasas en la población adulta, e inadecuación en algunos micronutrientes en la población infantil. En el contexto nacional, Navarra presenta menores tasas tanto de sobrepeso y obesidad como de sedentarismo en población adulta y se observa una tendencia a la baja en prevalencia de obesidad infantil. Conclusiones: la oferta alimentaria y gastronómica de Navarra es variada y con un gran protagonismo de las verduras y hortalizas, aunque el patrón de consumo de alimentos es mejorable. Para lograr una alimentación saludable y sostenible, es fundamental inculcar conocimientos gastronómicos y habilidades culinarias desde edades tempranas

Introduction: Navarra is a Community that presents a great geographical and climatic variety, which results in a wide food supply. Objectives: to review the typical gastronomy of Navarra, as well as the available evidence on dietary patterns, nutritional profile and health indicators of Navarra population. Results: Navarra has 7 Protected Designations of Origin and 6 Protected Geographical Indications. Its gastronomic identity is mainly associated with vegetables, lamb, veal and local sausages, which is reflected in dietary patterns. Comparatively, Navarra population consumes more vegetables and fresh fruits, but also has a frequent and excessive intake of meat (especially red) and sausages. The studies available on nutritional profile show high intakes of proteins and fats in the adult population, and inadequacy in some micronutrients in children. In the national context, Navarra has lower rates of overweight, obesity and sedentariness in the adult population, and there is a downward trend in the prevalence of childhood obesity. Conclusions: the food and gastronomic offer of Navarra is varied and with a great prominence of vegetables, although dietary patterns can be improved. To achieve a healthy and sustainable diet, it is essential to promote culinary knowledge and skills from an early age

Políticas alimentarias para prevenir la obesidad y las principales enfermedades no transmisibles en España: querer es poder / Food policies to prevent obesity and the main non-transmissible diseases in Spain: where there's a will there's a way

Introducción: En España, un tercio de los menores y dos tercios de los adultos padecen exceso de peso, una condición que genera un sobrecoste médico directo de 2000 millones de euros. El entorno alimentario obesogénico causa obesidad al promover el consumo de bebidas azucaradas y de alimentos ultraprocesados. Por ello, proponemos cinco políticas prioritarias con el PODER de revertir la epidemia de obesidad y de enfermedades no transmisibles asociadas a ella, mediante la creación de entornos alimentarios saludables. El PODER de las políticas alimentarias: P (Publicidad): regulación de la publicidad de alimentos y bebidas no saludables dirigida a menores por todos los medios y prohibición de patrocinios de congresos o eventos deportivos y avales de asociaciones científicas o profesionales de la salud. O (Oferta): promoción de una oferta 100% saludable en máquinas expendedoras de centros educativos, sanitarios y deportivos. D (Demanda): implantación de un impuesto, al menos del 20%, a las bebidas azucaradas, acompañado de subvenciones o bajadas de impuestos a alimentos saludables y disponibilidad de agua potable a coste cero en todos los centros y espacios públicos. E (Etiquetado): aplicación efectiva del Nutri-Score mediante el uso de incentivos, regulación y mecanismos de contratación pública. R (Reformulación): reformular los acuerdos de reformulación con la industria con objetivos más ambiciosos y de obligado cumplimiento. Reflexión final: Las cinco intervenciones propuestas, aplicadas con éxito en otros países, contribuirán a concienciar a la población y tendrán un impacto positivo en la salud y en la economía, por una reducción de los costes sanitarios de la obesidad y un aumento de la productividad laboral. Estas medidas deberían formar parte de una gran transformación del sistema alimentario, con políticas agroalimentarias que fomenten una producción sostenible de alimentos saludables

Introduction: In Spain, one third of all children and two-thirds of adults suffer from excess weight, a condition that generates a direct excess medical cost of 2000 million Euros. Obesogenic food environments cause obesity by promoting the consumption of sugar-sweetened beverages and ultra-processed foods. Accordingly, we propose five priority policies capable of reversing the epidemic of obesity and related non-communicable diseases through the creation of healthy food environments. The power (PODER in Spanish) of food policies: Advertising (Publicidad): regulation of unhealthy food and drink advertisements carried by all media and targeted at children, and prohibition of sponsorships of congresses, conferences or sports events and endorsements by scientific associations or health professionals. Supply (Oferta): promotion of a 100% healthy supply of goods on sale in vending machines sited at educational, health and sports centres. Demand (Demanda): levying a tax of at least 20% on sugar-sweetened beverages, accompanied by subsidies or reduced taxes on healthy foods and availability of drinking water free of charge at all public venues and areas. Labelling (Etiquetado): effective application of the Nutri-Score through the use of incentives, regulation and public-tender mechanisms. Reformulation (Reformulación): revising and redrawing reformulation agreements with the industry, setting more ambitious goals and mandatory compliance. A final thought: These five proposed interventions, all of which have been successfully applied in other countries, will serve to raise population awareness and have a positive impact on health and the economy, through reducing the health care costs of obesity and enhancing work productivity. These measures should form part of a wide-ranging transformation of the food system, with agri-food policies that foster the sustainable production of healthy foods

Egg consumption and dyslipidemia in a Mediterranean cohort / Consumo de huevo y dislipidemia en una cohorte mediterránea

Introduction and objectives: Our aim was to prospectively evaluate the association between egg consumption and dyslipidemia in a Mediterranean cohort. Methods: We followed-up 13,104 Spanish university graduates for a mean period of 8 years. Dietary habits at baseline were assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Self-reported blood concentrations of total cholesterol, high-density lipoproteins cholesterol (HDL-c) and triglycerides were evaluated according to categories of egg consumption after 6 and 8 years of follow-up. We also assessed the association between baseline egg consumption and the incidence of hypercholesterolemia, low HDL-c concentrations and hypertriglyceridemia during follow-up. Results: We observed a significant inverse association for intermediate levels of egg consumption (2 to 4 eggs/week vs. less than 1 egg/week) and hypertriglyceridemia with OR = 0.71 (95% confidence interval [CI]: 0.54 to 0.93, p < 0.05) in the multivariable-adjusted model. Using HDL-c values after 8-year follow-up, we found an association between higher egg consumption and lower HDL-c levels (p for trend = 0.02) with an adjusted difference of -4.01 mg/dl (-7.42 to -0.61) for > 4 vs. < 1 egg/week. Lower means of triglycerides were found in each of the three upper categories of egg consumption compared to the lowest category (< 1 egg/week) with significant results for some of these categories both after 6 and 8 year follow-up. Conclusions: Our data do not support that higher egg consumption was associated with abnormal blood levels of total cholesterol or triglycerides; an inverse association with HDL-c as a quantitative variable was found only in one of our analyses (AU)

Introducción y objetivos: evaluar prospectivamente la asociación entre el consumo de huevo y el riesgo de dislipidemia en una cohorte mediterránea. Métodos: se siguieron 13.104 graduados universitarios españoles durante un periodo medio de 8 años. La dieta se evaluó al inicio utilizando un cuestionario semicuantitativo de frecuencia de consumo de alimentos repetidamente validado. Las concentraciones sanguíneas de colesterol total, lipoproteínas de alta densidad (HDL-c) y trigliceridos autorreferidas fueron evaluadas según categorías de consumo de huevo tras 6 y 8 años de seguimiento. También se evaluó la asociación entre el consumo basal de huevo y la incidencia de hipercolesterolemia, concentraciones bajas de HDL-c e hipertrigliceridemia durante el seguimiento. Resultados: se observó una asociación entre los niveles intermedios de consumo de huevo (2-4 unidades/semana frente a < 1 unidad/semana) y menor riesgo de hipertrigliceridemia con OR = 0,71 (intervalo de confianza del 95% [IC]: 0,54 a 0,93, p < 0,05) en el modelo más ajustado. Tras 8 años de seguimiento, encontramos una asociación entre un mayor consumo de huevo y menores niveles de HDL-c (p tendencia lineal = 0,02) con una diferencia ajustada de -4,01 mg/dl (-7,42 a -0,61) para > 4 vs. < 1 unidad/semana. Se encontraron menores concentraciones de triglicéridos en las tres categorías superiores de consumo de huevo en comparación con la inferior con resultados significativos para algunas de estas categorías después de 6 y 8 años de seguimiento. Conclusiones: un mayor consumo de huevo no se asoció con niveles anormales de colesterol total o triglicéridos; se encontró una asociación inversa con HDL-c como variable cuantitativa solo en uno de nuestros análisis (AU)

Cured ham consumption and incidence of hypertension: The "Seguimiento Universidad de Navarra" (SUN) cohort / Consumo de jamón serrano e incidencia de hipertensión: cohorte "Seguimiento Universidad de Navarra" (SUN)

BACKGROUND AND OBJECTIVES: Cured ham is one of the most characteristic foods in the Spanish diet. Because it is a red processed meat and due to its nutritional composition, including high sodium content, a potential association between cured ham consumption and a higher risk of hypertension could be expected. However, epidemiological studies evaluating this association are scarce. We prospectively assessed the association between cured ham consumption and the incidence of hypertension. METHODS: The "Seguimiento Universidad de Navarra" (SUN) study is a cohort of Spanish middle-aged adult university graduates (average age: 38 (SD: 12) years, 60% women). We included 13,900 participants of the SUN cohort free of hypertension at baseline. One serving of cured ham is 50g. They were classified into 4 categories of cured ham consumption: <1; 1; 2-4 and ≥5servs/week. Multivariable-adjusted Cox regression models were fitted to assess the association between cured ham consumption and subsequent hypertension risk using the category of lowest consumption as the reference. RESULTS: After a median follow-up of 10.9 years, 1465 incident self-reported cases of hypertension were identified. After adjusting for potential confounders, including dietary confounders, a high consumption of cured ham (≥5servs/week vs. <1serv/week) was not significantly associated with hypertension risk in this prospective cohort (HR=0.88, 95% CI: 0.70-1.10, p linear trend=0.40). CONCLUSIONS: Our results showed that cured ham consumption was not associated with a significantly higher or lower risk of hypertension in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal and experimental studies are needed to disentangle the association between cured ham consumption and the risk of hypertension

INTRODUCCIÓN Y OBJETIVO: El jamón serrano es uno de los alimentos más característicos de la dieta española. Debido a que es una carne procesada y a su alto contenido en sodio, podría esperarse un mayor riesgo de hipertensión arterial (HTA). Sin embargo, los estudios epidemiológicos que evalúan esta asociación son escasos. Se evaluó prospectivamente la asociación entre el consumo de jamón serrano y la incidencia de HTA. MÉTODOS: El estudio Seguimiento Universidad de Navarra (SUN) es una cohorte de graduados universitarios españoles (edad promedio: 38 (DE:12) años, 60% mujeres). Incluimos a 13.900 participantes sin hipertensión prevalente. Una ración de jamón serrano equivale a 50g. Se clasificaron en 4 categorías de consumo: <1; 1; 2-4 y ≥5 raciones/semana. Se utilizaron modelos de regresión de Cox para evaluar la asociación entre el consumo de jamón serrano y el riesgo de HTA, utilizando la categoría de menor consumo como referencia. RESULTADOS: Después de una mediana de seguimiento de 10,9 años, se identificaron 1.465 casos auto-referidos incidentes de HTA. Tras ajustar por potenciales factores de confusión, se observó que un alto consumo de jamón serrano (≥5 raciones/semana frente a <1 ración/semana) no se asoció significativamente al riesgo de HTA (HR: 0,88; IC 95%: 0,70-1,10; p tendencia lineal=0,40). CONCLUSIONES: Nuestros resultados muestran que el consumo de jamón serrano no se asoció a un riesgo significativamente mayor o menor de HTA en una cohorte prospectiva de graduados universitarios españoles. Se necesitan más estudios longitudinales y de intervención para evaluar la asociación entre el consumo de jamón serrano y el riesgo de HTA

Frecuencia de comidas fuera de casa y calidad de hidratos de carbono y de grasas en el Proyecto SUN / Frequency of eating away from home and quality of dietary carbohydrate and fat intake in the SUN Project

Objetivo: Investigar la asociación entre la frecuencia de comidas fuera de casa (CFC) con a) la calidad de hidratos de carbono y b) la calidad de grasas. Materiales y métodos: Se evaluaron 19.371 participantes de la cohorte SUN que completaron un cuestionario basal de frecuencia de consumo de alimentos previamente validado. Se utilizaron los índices de calidad de hidratos de carbono (ICHC) en una escala de 4 a 20 y de grasas (ICG) en una escala de 0,62 a 5,92. En ambos casos, a mayor puntuación mayor calidad. Se utilizó la regresión lineal múltiple para determinar la asociación entre la frecuencia de CFC (4 categorías) y la puntuación de ambos índices, y la regresión logística para medir la asociación entre la frecuencia de CFC y un bajo ICHC o ICG (< percentil 25). Resultados: Los participantes mostraron una media de ICHC e ICG de 11,3 (DE 3,2) y 1,7 (DE 0,5), respectivamente. Una mayor frecuencia de CFC (≥ 2 veces / semana) se asoció con un menor ICHC (ß: -0,29, IC 95%: -0,41 a -0,17, p <0,001), y con un menor ICG (ß: -0,02, IC 95%: -0,03 a -0,001, p <0,03). Los participantes con CFC ≥ 2 veces/semana tuvieron mayor riesgo de peor ICHC (OR: 1,31, IC 95%: 1,17-1,46, p <0,001), pero no de peor ICG (OR: 0,93 IC 95%: 0,83-1,03, p 0,194). Conclusiones: Hacer con mayor frecuencia CFC se asoció con una peor calidad de grasas en la dieta y especialmente con peor calidad de hidratos de carbono. Estos resultados destacan la importancia de la educación nutricional dirigida a los consumidores de CFC (AU)

Objective: To investigate the association between eating- away-from-home (EAFH) and a) the quality of dietary carbohydrate intake and b) the quality of fat intake. Material and methods: We assessed 19,371 participants in the SUN cohort who completed a validated baseline food frequency questionnaire. Quality indices of carbohydrate (CQI) and fat (FQI) were used. Multiple regression models were fitted to determine the association between the frequency of EAFH (4 categories) and both indices. Logistic regression analysis was used to assess the association between the frequency of EAFH and low CQI or FQI (<25th percentile). Results: Participants showed an average CQI and FQI of 11,3 (SD 3,2) and 1,7 (SD 0,5), respectively. A higher frequency of EAFH (≥ 2 times/week) was associated with a poorer CQI and a poorer FQI. For CQI, the adjusted mean difference was -0,29, 95%CI: -0,41, -0,17 (p for trend <0,001), and for FQI it was -0,02, 95%CI: -0,03, -0,001 (p for trend 0,03). Participants with a highest frequency (≥ 2 times/week) of EAFH had higher adjusted risk of a poorer CQI, (adjusted OR 1,31, 95%CI 1,17, 1,46, p for trend <0,001), but this habit (EAFH) was unrelated to FQI (adjusted OR 0,93, 95%CI: 0,83, 1,03, p for trend 0,194). Key findings: A higher frequency of EAFH was associated with a poorer quality of dietary fat, and particularly, dietary carbohohydrate. These findings highlight the importance of nutritional education addressed to consumers who frequently do out-of-home meals (AU)

Trends of obesity prevalence among Spanish adults with diabetes, 1987-2012 / Tendencia de la prevalencia de obesidad en adultos españoles con diabetes, 1987-2012

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

Introducción y objetivo: Nuestro objetivo fue conocer la tendencia de la prevalencia de obesidad entre adultos españoles con diabetes. Material y métodos: Se utilizaron 8 (1987-2012) Encuestas Nacionales de Salud (ENS). Las ENS son estudios transversales realizados en muestras representativas de la población adulta española. Se analizaron datos de 7.378 adultos (≥16 años) que refirieron un diagnóstico de diabetes. El índice de masa corporal (IMC) se calculó a partir de los datos auto-referidos de peso y talla validados previamente. Se definió obesidad como un IMC≥30kg/m2. Se calculó para cada encuesta la prevalencia de obesidad ajustada por edad con el método directo de estandarización. Resultados: Desde 1987 a 2012 la prevalencia de obesidad ajustada aumentó en adultos con diabetes del 18,2% (intervalo de confianza [IC] 95%: 14,2-22,2%) al 39,8% (IC 95%: 36,8-42,8%). La prevalencia ajustada de obesidad en varones con diabetes aumentó del 13,2% (IC 95%: 7,3-19,1%) al 38,0% (IC 95%: 33,8-42,1%); en mujeres con diabetes aumentó del 23,0% (IC 95%: 17,6-28,4%) al 42,3% (IC 95%: 38,0-46,6%). Conclusiones: Entre 1987 y 2012 la prevalencia de obesidad aumentó notablemente en adultos españoles con diabetes

Evaluación de una intervención nutricional en personas mayores: el proyecto Edumay / Evaluation of a nutritional intervention among elderly people: the edumay project

Introducción: La adhesión a un patrón de Dieta Mediterránea está asociado a una reducción de la morbi-mortalidad, y a una mejora de la calidad de vida. Objetivos: Evaluar una intervención nutricional en personas mayores independientes a través de un programa de educación que favorezca el conocimiento de los alimentos y la confección de dietas adecuadas, promocionando un patrón de dieta saludable. Métodos: Estudio cuasi-experimental realizado en un colectivo de personas mayores que residen en apartamentos tutelados del Ayuntamiento de Pamplona (n = 41). La intervención consistió en seis sesiones de educación grupal y una entrevista motivacional individual en un periodo de tres meses. Se evaluó la adhesión a la Dieta Mediterránea a través de un cuestionario de 14 puntos previamente validado. Resultados: El 80,5% de los participantes fueron mujeres, con una mediana de edad de 79 años, en gran proporción viudas (48,8%) y con estudios primarios (58,5%). Tras la intervención nutricional el porcentaje de participantes que consumió dos o más raciones de verduras u hortalizas aumentó significativamente con respecto al grupo control (p = 0,042). De forma similar en comparación con el grupo control hubo un mayor incremento en el porcentaje de individuos que consumían 3 raciones de legumbres a la semana (p = 0,042), 3 o más veces por semana frutos secos (p = 0,003) y que tomaban preferentemente carne de pollo, pavo o conejo en vez de ternera, cerdo, hamburguesas o salchichas (p = 0,011). Discusión: Una intervención basada en educación nutricional individual y grupal consiguió una mejora significativa en diversos parámetros de adhesión a un patrón de Dieta Mediterránea (AU)

Background: The adherence to a Mediterranean Dietary Pattern is associated with a morbi-mortality reduction, and with a better quality of life. Objectives: To evaluate a nutritional intervention among independent elderly people enrolled in an educational program to increase the knowledge of the food and daily diets, promoting a healthy dietary pattern. Methods: Quasi-experimental design conducted in elderly participants who lived in foster home apartments owned by the City Council of Pamplona (n = 41). The intervention was based on six group sessions and an individual motivational session in a period of three months. Adherence to Mediterranean diet was evaluated through a 14-point scale previously validated. Results: Eighty point five per cent of participants were women, with a median age of 79 years, the majority of them widowed (48.8%) and with primary education (58.5%). After the nutritional intervention the percentage of participants who consumed two or more servings of vegetables increased significantly versus the control group (p = 0.042). Similarly, in comparison with the control group, there was an increase in the percentage of participants who consumed three servings per week of legumes (p = 0.042), three or more servings per week of nuts (p = 0.003), and those who consumed preferably meat from chicken, turkey, or rabbit instead of veal, pork, hamburgers, or sausages (p = 0.011). Discussion: An intervention based on individual and group sessions improved significantly several parameters of a Mediterranean dietary pattern (AU)