Valores de referencia y puntos de corte de leptina para identificar anormalidad cardiometabólica en la población española / Leptin reference values and cutoffs for identifying cardiometabolic abnormalities in the spanish population

Introducción y objetivos. Estimar los valores de referencia de leptina y calcular los puntos de corte de leptinemia que identifiquen anormalidad cardiometabólica en España. Métodos. Estudio transversal realizado de 2008 a 2010 sobre 11.540 individuos representativos de la población española de edad ≥ 18 años. La información se obtuvo mediante examen físico estandarizado y las analíticas se realizaron en un laboratorio central. La leptinemia se midió por enzimoinmunoanálisis. Se definió anormalidad cardiometabólica como la presencia de al menos dos de las siguientes: presión arterial elevada, triglicéridos elevados, colesterol unido a lipoproteínas de alta densidad bajo, valores altos de resistencia a insulina y proteína C reactiva y glucosa elevadas. Resultados. Los valores de leptina fueron mayores en mujeres que en varones (media geométrica, 21,9 y 6,6 ng/ml; p < 0,001). En mujeres la mediana [intervalo intercuartílico] fue 24,5 [14,1-37,0] ng/ml y en varones, 7,2 [3,3-14,3] ng/ml. En el análisis multivariable, la leptina estuvo significativamente asociada con las medidas antropométricas, la insulinemia y la proteína C reactiva y en relación inversa con la edad, el tabaquismo y la actividad física en mujeres (r2 = 0,53; p < 0,001) y en varones (r2 = 0,61; p < 0,001). Los valores de leptinemia que identificaron anormalidad cardiometabólica fueron 23,75 ng/ml en mujeres (área bajo la curva, 0,722; sensibilidad, 72,3%; especificidad, 58,7%) y 6,45 ng/ml en varones (área bajo la curva, 0,716; sensibilidad, 71,4%; especificidad, 60,2%). Conclusiones. Estos resultados facilitan la interpretación de los valores de leptinemia en estudios clínicos y poblacionales. La leptina tiene sensibilidad y especificidad moderadas para identificar anormalidad cardiometabólica (AU)

Introduction and objectives. Estimate leptin reference values and calculate leptinemia cutoff values for identifying cardiometabolic abnormalities in Spain. Methods. Cross-sectional study carried out between 2008 and 2010 in 11 540 individuals representing the Spanish population aged ≥ 18 years. Data were obtained by standardized physical examination and analyses were performed at a central laboratory. Leptinemia was measured using ELISA. Cardiometabolic abnormality was defined as the presence of at least two of the following: high blood pressure, high triglycerides, reduced high density lipoprotein cholesterol, high insulin resistance values, and elevated C-reactive protein and glucose. Results. Leptin values were higher in women than men (geometric mean, 21.9 and 6.6 ng/mL; P < .001). The median [interquartile range] was 24.5 [14.1-37.0] ng/mL in women, and 7.2 [3.3-14.3] ng/mL in men. In the multivariate analysis, leptin was significantly associated with anthropometric measures, insulin, and C-reactive protein, and inversely associated with age, smoking, and physical activity in women (r2 = 0.53; P < .001) and in men (r2 = 0.61; P < .001). The leptin values that identified cardiometabolic abnormality were 23.75 ng/mL in women (area under the curve, 0.722; sensitivity, 72.3%; specificity, 58.7%) and 6.45 ng/mL in men (area under the curve, 0.716; sensitivity, 71.4%; specificity, 60.2%). Conclusions. These results facilitate the interpretation of leptin values in clinical and population studies. Leptin has moderate sensitivity and specificity for identifying cardiometabolic abnormalities (AU)

Leptin Reference Values and Cutoffs for Identifying Cardiometabolic Abnormalities in the Spanish Population.

INTRODUCTION AND OBJECTIVES: Estimate leptin reference values and calculate leptinemia cutoff values for identifying cardiometabolic abnormalities in Spain. METHODS: Cross-sectional study carried out between 2008 and 2010 in 11 540 individuals representing the Spanish population aged ≥ 18 years. Data were obtained by standardized physical examination and analyses were performed at a central laboratory. Leptinemia was measured using ELISA. Cardiometabolic abnormality was defined as the presence of at least two of the following: high blood pressure, high triglycerides, reduced high density lipoprotein cholesterol, high insulin resistance values, and elevated C-reactive protein and glucose. RESULTS: Leptin values were higher in women than men (geometric mean, 21.9 and 6.6 ng/mL; P<.001). The median [interquartile range] was 24.5 [14.1-37.0] ng/mL in women, and 7.2 [3.3-14.3] ng/mL in men. In the multivariate analysis, leptin was significantly associated with anthropometric measures, insulin, and C-reactive protein, and inversely associated with age, smoking, and physical activity in women (r(2)=0.53; P<.001) and in men (r(2)=0.61; P<.001). The leptin values that identified cardiometabolic abnormality were 23.75 ng/mL in women (area under the curve, 0.722; sensitivity, 72.3%; specificity, 58.7%) and 6.45 ng/mL in men (area under the curve, 0.716; sensitivity, 71.4%; specificity, 60.2%). CONCLUSIONS: These results facilitate the interpretation of leptin values in clinical and population studies. Leptin has moderate sensitivity and specificity for identifying cardiometabolic abnormalities.

Magnitud y manejo del síndrome metabólico en España en 2008-2010: Estudio ENRICA / Magnitude and Management of Metabolic Syndrome in Spain in 2008-2010: The ENRICA Study

Introducción y objetivos Pocos estudios en España han descrito la distribución del síndrome metabólico según la definición armonizada, y del síndrome metabólico premórbido, que es el síndrome metabólico sin diabetes mellitus o enfermedad cardiovascular. Además, se desconoce la distribución por comunidades autónomas y su manejo clínico. Este trabajo examina la distribución y el manejo clínico de ambos síndromes en España. Métodos Estudio transversal realizado de 2008 a 2010 sobre 11.149 personas representativas de la población española de 18 o más años. La información se obtuvo mediante examen físico estandarizado y las determinaciones analíticas se hicieron en un laboratorio central. Resultados La prevalencia (intervalo de confianza del 95%) de síndrome metabólico fue del 22,7% (21,7-23,7) y la del premórbido, el 16,9% (16,0-17,8). La frecuencia de ambos síndromes aumentó con la edad y fue mayor en varones que en mujeres hasta los 65 años; a partir de esa edad, fue mayor entre las mujeres. Las comunidades del sur de España y las insulares fueron las de mayor prevalencia de ambos síndromes, y en algún caso resultó el doble que la de la comunidad de menor prevalencia. Aproximadamente un tercio de los pacientes con síndrome metabólico premórbido declararon no recibir consejo sanitario para mejorar sus estilos de vida; entre los que recibieron consejo, el seguimiento fue bajo, especialmente para perder peso (31,9%) y reducir la sal (38,3%).Conclusiones La prevalencia de síndrome metabólico es elevada en España. Hay importantes diferencias geográficas en su distribución y sustanciales oportunidades de mejora del manejo clínico del síndrome metabólico premórbido(AU)

Introduction and objectives Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized definition and that of premorbid metabolic syndrome, which consists of metabolic syndrome without diabetes mellitus or cardiovascular disease. Moreover, their regional distributions and clinical management are unknown. The present study examined the distributions and clinical management of both syndromes in Spain. Methods This cross-sectional study was performed from 2008 to 2010 in 11 149 representative individuals of the Spanish population aged 18 years or older. Data were obtained through standardized physical examination, and analytical measurements were done in a central laboratory. Results The prevalences (95% confidence interval) of metabolic syndrome and premorbid metabolic syndrome were 22.7% (21.7%-23.7%) and 16.9% (16.0%-17.8%), respectively. The frequency of both syndromes increased with age and was higher in men than in women up to 65 years; above this age, the frequency was higher in women. The communities of the south of Spain and the Balearic and Canary islands had the highest prevalence of both syndromes, in some regions reaching double that of the community with the lowest prevalence. About one third of patients with premorbid metabolic syndrome reported that they had not received health recommendations to improve their lifestyles; of those that did receive advice, adherence was low, particularly for reducing weight (31.9%) and salt intake (38.3%). Conclusions The prevalence of metabolic syndrome is high in Spain and considerable geographical differences exist in its distribution. There is substantial room for improvement in the clinical management of premorbid metabolic syndrome (AU)

Magnitude and management of metabolic syndrome in Spain in 2008-2010: the ENRICA study.

INTRODUCTION AND OBJECTIVES: Few studies in Spain have reported the distribution of metabolic syndrome using the harmonized definition and that of premorbid metabolic syndrome, which consists of metabolic syndrome without diabetes mellitus or cardiovascular disease. Moreover, their regional distributions and clinical management are unknown. The present study examined the distributions and clinical management of both syndromes in Spain. METHODS: This cross-sectional study was performed from 2008 to 2010 in 11 149 representative individuals of the Spanish population aged 18 years or older. Data were obtained through standardized physical examination, and analytical measurements were done in a central laboratory. RESULTS: The prevalences (95% confidence interval) of metabolic syndrome and premorbid metabolic syndrome were 22.7% (21.7%-23.7%) and 16.9% (16.0%-17.8%), respectively. The frequency of both syndromes increased with age and was higher in men than in women up to 65 years; above this age, the frequency was higher in women. The communities of the south of Spain and the Balearic and Canary islands had the highest prevalence of both syndromes, in some regions reaching double that of the community with the lowest prevalence. About one third of patients with premorbid metabolic syndrome reported that they had not received health recommendations to improve their lifestyles; of those that did receive advice, adherence was low, particularly for reducing weight (31.9%) and salt intake (38.3%). CONCLUSIONS: The prevalence of metabolic syndrome is high in Spain and considerable geographical differences exist in its distribution. There is substantial room for improvement in the clinical management of premorbid metabolic syndrome.

Reach and equity of primary care-based counseling to promote walking among the adult population of Spain.

OBJECTIVES: Some controlled trials have shown that brief counseling in primary care settings can increase walking. We examined the prevalence of primary care-based counseling to promote walking and assessed its reach and equity in Spain. DESIGN: Data were taken from a cross-sectional study conducted in 2008-2010 among 11,951 individuals representative of the non-institutionalized population aged 18-years and older in Spain. METHODS: Information on whether advice was received, adherence to advice, and time spent walking was self-reported. Analyses were adjusted for proxies of the need for physical activity (age, subjective health, and classic cardiovascular risk factors, including physical activity other than walking and body mass index), equity (sex and educational level), and factors enabling counseling (use of primary care services). RESULTS: Overall, 46.2% (95% confidence interval [CI] 45.0-47.4) of adults in Spain received counseling to promote walking. Older adults, those with worse subjective health, lower physical activity, with overweight or obesity, and higher use of primary care services were more likely to be counseled. For equal need, counseling was less frequent in men and those with lower socioeconomic position. A total of 69.2% (95% CI 67.8-70.6) of adults who received counseling reported following it. There was no difference in the time spent walking between those who received and did not receive counseling (+0.4 min/day; 95% CI -0.1 to 0.9). CONCLUSIONS: A substantial proportion of Spanish adults has been encouraged to walk by primary care physician and nurses, but counseling did not translate into longer walking time.

Adherence to the Mediterranean diet pattern has declined in Spanish adults.

This work examined the Spanish population's degree of accordance with the Mediterranean diet (MD). This was a cross-sectional study conducted in 2008-2010 among 11,742 individuals representative of the Spanish population aged ≥ 18 y. Habitual food consumption was assessed with a computerized diet history. Accordance of food consumption with the MD was assessed with the MD Adherence Screener (MEDAS) score using the cutoffs ≥ 9 to define strict accordance and ≥ 7 (mid-range value) for modest accordance. Accordance of nutrient intake with the MD was defined as ≥ 4.5 points (mid-range value) on the high-unsaturated fat OmniHeart diet score. The diet of 12% (95% CI: 11.3-12.7%) of the Spanish population reached MEDAS-based strict accordance with the MD and 46% (95% CI: 44.7-47.7) attained modest accordance. Moreover, 39.0% (95%: 37.8-40.1%) of the population achieved OnmiHeart-based MD accordance. Factor analysis identified 2 main dietary patterns. The first one was called "Westernized" and was rich in red and processed meat, French fries, refined cereals, and sweetened beverages and poor in fresh fruit; the second pattern was named "Mediterranean" and was rich in olive oil and plant-based foods. Regardless of how it was defined, MD accordance was less frequent and the Westernized pattern was more frequent among the younger, the less educated, current smokers, and those less physically active and more sedentary. In conclusion, the Spanish population is drifting away from the MD to adopt a less healthy diet, typical of Western countries. The departure from the MD mostly affects the socially disadvantaged and clusters with other unhealthy lifestyles, which may have synergistic undesirable effects on health.

Justificación y métodos del estudio sobre nutrición y riesgo cardiovascular en España (ENRICA) / Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA)

Introducción y objetivos. El estudio ENRICA pretende medir la frecuencia y la distribución de los principales componentes de la historia natural de la enfermedad cardiovascular en España, incluyendo el consumo alimentario y otros factores de riesgo conductuales, factores de riesgo biológicos, daño precoz en órganos diana y morbilidad diagnosticada. Métodos. Estudio transversal realizado de junio de 2008 a octubre de 2010 sobre 11.991 personas representativas de la población no institucionalizada de 18 y más años de edad en España. La recogida de datos se hizo en tres etapas secuenciales: a) entrevista telefónica asistida por ordenador sobre estilos de vida, conocimiento y actitudes sobre factores de riesgo de enfermedad cardiovascular y sobre signos y síntomas de alerta de ataque al corazón e ictus, salud subjetiva y morbilidad; b) primera visita al domicilio, para obtener muestras de sangre y orina que se envían a un laboratorio central para las determinaciones analíticas, y c) segunda visita al domicilio, para realizar antropometría, medir presión arterial y completar historia dietética electrónica. De las personas de 65 y más años, se obtuvo información sobre limitaciones funcionales. Discusión. El estudio ENRICA ha mostrado en España la factibilidad de un gran estudio con entrevista y examen físico en los domicilios. Este estudio proporcionará información valiosa para orientar y evaluar las estrategias nacionales contra la enfermedad cardiovascular y otras enfermedades crónicas. Además, está previsto que en el segundo semestre de 2011 comience el seguimiento durante 3 años de los participantes en el estudio. Con ello se actualizará la información de estilos de vida y sobre variables biológicas obtenidas en un nuevo examen físico (ClinicalTrials.gov number, NCT01133093) (AU)

Introduction and objectives. The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity. Methods. A cross-sectional survey of 11 991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first homevisit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older. Discussion. The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093) (AU)

[Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA)]. / Justificación y métodos del estudio sobre nutrición y riesgo cardiovascular en España (ENRICA).

INTRODUCTION AND OBJECTIVES: The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity. METHODS: A cross-sectional survey of 11,991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first home visit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older. DISCUSSION: The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093).