Caffeinated coffee consumption and risk of atrial fibrillation in two Spanish cohorts.

AIMS: The association between caffeinated coffee consumption and atrial fibrillation remains unclear. Recent studies suggest an inverse association only between a moderate caffeinated coffee consumption and atrial fibrillation, but others have reported no association. The aim of our study was to prospectively assess the association between caffeinated coffee consumption and atrial fibrillation in two Spanish cohorts, one of adults from a general population and another of elderly participants at high cardiovascular risk. METHODS AND RESULTS: We included 18,983 and 6479 participants from the 'Seguimiento Universidad de Navarra' (SUN) and 'Prevención con Dieta Mediterránea' (PREDIMED) cohorts, respectively. Participants were classified according to their caffeinated coffee consumption in three groups: ≤3 cups/month, 1-7 cups/week, and >1 cup/day. We identified 97 atrial fibrillation cases after a median follow-up of 10.3 years (interquartile range 6.5-13.5), in the SUN cohort and 250 cases after 4.4 years median follow-up (interquartile range 2.8-5.8) in the PREDIMED study. No significant associations were observed in the SUN cohort although a J-shaped association was suggested. A significant inverse association between the intermediate category of caffeinated coffee consumption (1-7 cups/week) and atrial fibrillation was observed in PREDIMED participants with a multivariable-adjusted hazard ratio = 0.53 (95% confidence interval 0.36-0.79) when compared with participants who did not consume caffeinated coffee or did it only occasionally. No association was found for higher levels of caffeinated coffee consumption (>1 cup per day), hazard ratio = 0.79 (95% confidence interval 0.49-1.28). In the meta-analysis of both PREDIMED and SUN studies, the hazard ratio for intermediate consumption of caffeinated coffee was 0.60 (95% confidence interval 0.44-0.82) without evidence of heterogeneity. Similar findings were found for the association between caffeine intake and atrial fibrillation risk. CONCLUSION: Intermediate levels of caffeinated coffee consumption (1-7 cups/week) were associated with a reduction in atrial fibrillation risk in two prospective Mediterranean cohorts.

Halo effect of a Mediterranean-lifestyle weight-loss intervention on untreated family members' weight and physical activity: a prospective study.

OBJECTIVES: Obesity is subject to strong family clustering. The relatives of participants in weight-loss interventions may also modify their lifestyle and lose weight. The aim of this study was to examine the presence and magnitude of a halo effect in untreated family members of participants enrolled in a randomized, multi-component, lifestyle intervention. METHODS: A total of 148 untreated adult family members of participants in an intensive weight-loss lifestyle intervention (the PREDIMED-Plus study) were included. Changes at 1 and 2 years in body weight, physical activity, and adherence to a traditional Mediterranean diet (MedDiet) were measured. Generalized linear mixed models were used to assess whether the change differed between family members of the intervention group compared to the control. RESULTS: Untreated family members from the intervention group displayed a greater weight loss than those from the control after 1 and 2 years: adjusted 2-year weight change difference between groups was -3.98 (SE 1.10) kg (p < 0.001). There was a halo effect with regard to adherence to the MedDiet at one year which was sustained at two years: 2-year adjusted difference in MedDiet score change +3.25 (SE 0.46) (p < 0.001). In contrast, no halo effect was observed with regard to physical activity, as the untreated family members did not substantially modify their physical activity levels in either group, and the adjusted difference at two years between the 2 groups was -272 (SE 624) METs.min/week (p = 0.665). CONCLUSIONS: In the first prospective study to assess the influence on untreated family members of a diet and physical activity weight-loss intervention, we found evidence of a halo effect in relatives on weight loss and improvement in adherence to a MedDiet, but not on physical activity. The expansion of MedDiet changes from individuals involved in a weight-loss intervention to their family members can be a facilitator for obesity prevention.

Health-related quality of life in individuals with metabolic syndrome: a cross-sectional study / Calidad de vida relacionada con la salud en individuos con síndrome metabólico: un estudio descriptivo

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected

INTRODUCCIÓN Y OBJETIVOS: El síndrome metabólico (SM) es la combinación de diversos factores de riesgo cardiovascular que pueden derivar en un mayor impacto en la morbimortalidad prematura. Sin embargo, el impacto del SM en la calidad de vida relacionada con la salud (CVRS) es desconocido. El objetivo de este estudio es evaluar la CVRS en la población adulta española de 55 años o más con SM. MÉTODOS: Se realizó un análisis transversal con los datos del ensayo PREDIMED-Plus. Seis mil cuatrocientos treinta varones y mujeres entre 55-75 años con sobrepeso/obesidad y SM. El instrumento de medida de la CVRS fue el cuestionario SF-36. Cada escala del SF-36 fue descrita y estratificada por sexo. RESULTADOS: Los participantes mostraron valores más altos en las escalas función social (media: 85,9; IC 95%: 85,4-86,4) y rol emocional (media: 86,8; IC 95%: 86,0-87,5). En los varones, la peor puntuación fue en la dimensión salud general (media: 65,6; IC 95%: 65,0-66,2) y en las mujeres el dolor corporal (media: 54,3; IC 95%: 53,4-55,2). Además, los varones obtuvieron puntuaciones más altas en todas las escalas. En la escala función física en varones se encontró una disminución significativa de la CVRS en los participantes entre 70 y 75 años en comparación con los más jóvenes. Las peores puntuaciones se obtuvieron en las dimensiones físicas agregadas. CONCLUSIONES: El SM afecta de manera negativa a la CVRS en las dimensiones agregadas físicas, haciendo especial hincapié en la esfera dolor corporal en mujeres y salud general en varones. Sin embargo, las esferas psicológicas se encuentran menos afectadas por el SM

Health-related quality of life in individuals with metabolic syndrome: A cross-sectional study.

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected.

Efecto de una intervención nutricional intensiva en pacientes refractarios a la pérdida de peso / Effect of intensive nutritional intervention in patients refractory to weight loss

OBJETIVO: Valorar el efecto de una intervención nutricional intensiva, basada en la aplicación de una dieta mediterránea hipocalórica personalizada, sobre el peso corporal y el perímetro de la cintura en adultos refractarios a la pérdida de peso. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo durante 6 meses en 100 participantes con edades comprendidas entre 55-75 años, índice de masa corporal ≥ 27 y < 40kg/m2, que cumplieran con 3 o más criterios de síndrome metabólico. La intervención consistió en la pauta de una dieta mediterránea hipocalórica, recomendaciones de ejercicio y entrevistas motivacionales. Se recogieron variables antropométricas una vez al mes durante toda la intervención. Para analizar los resultados se realizaron los test de la chi al cuadrado y t de Student, y se calculó mediante regresión logística no condicional los odds ratio con intervalos de confianza del 95% de las variables asociadas a la pérdida de peso. RESULTADOS: Tras la intervención de «rescate», los pacientes perdieron una media del 2,9% del peso corporal y del 2,1% del perímetro abdominal, alcanzando el 38% de la muestra una pérdida ≥ 3% del peso y el 26% de la muestra una reducción ≥ 3% de circunferencia de cintura. No se observaron diferencias estadísticamente significativas en la pérdida de peso y cintura en ninguna de las variables analizadas. CONCLUSIONES: Una intervención intensiva, basada en una dieta mediterránea hipocalórica, recomendación de actividad física y charlas motivacionales, consigue pérdidas moderadas de peso en pacientes refractarios a los tratamientos contra la obesidad

OBJECTIVE: To assess the effect of an intensive nutritional intervention on the body weight and waist circumference in adults refractory to weight loss, by applying a personalised low-calorie Mediterranean diet. MATERIAL AND METHODS: A prospective study was conducted for 6 months on 100 participants with an age range between 55 and 75 years, a BMI ≥ 27 and < 40 kg/my, and fulfilled 3 or more criteria of metabolic syndrome. The intervention consisted of prescribing a low-calorie Mediterranean diet, exercise recommendations, and motivational talks. Anthropometric variables were recorded 11a month during the entire intervention. An analysis was made of the results using the Chi-squared and Student-t tests. The Odds Ratio of the variables associated with weight loss and their 95% confidence intervals was calculated using a non-conditional logistic regression. RESULTS: After the "rescue" intervention, the patients lost an average of 2.9% of the body weight and 2.1% of waist circumference, the target of the loss ≥ 3% of the weight and 26% of the sample the target of reduction ≥ 3% of waist circumference being achieved 38% of the sample. No statistically significant differences were observed in weight and waist circumference loss in any of the variables analysed. CONCLUSIONS: Intensive intervention, based on a low-calorie Mediterranean diet, with recommendations of physical activity and motivational talks, achieved a moderate weight loss in patients refractory to treatments for obesity

[Effect of intensive nutritional intervention in patients refractory to weight loss]. / Efecto de una intervención nutricional intensiva en pacientes refractarios a la pérdida de peso.

OBJECTIVE: To assess the effect of an intensive nutritional intervention on the body weight and waist circumference in adults refractory to weight loss, by applying a personalised low-calorie Mediterranean diet. MATERIAL AND METHODS: A prospective study was conducted for 6 months on 100 participants with an age range between 55 and 75 years, a BMI ≥ 27 and < 40 kg/my, and fulfilled 3 or more criteria of metabolic syndrome. The intervention consisted of prescribing a low-calorie Mediterranean diet, exercise recommendations, and motivational talks. Anthropometric variables were recorded 11a month during the entire intervention. An analysis was made of the results using the Chi-squared and Student-t tests. The Odds Ratio of the variables associated with weight loss and their 95% confidence intervals was calculated using a non-conditional logistic regression. RESULTS: After the "rescue" intervention, the patients lost an average of 2.9% of the body weight and 2.1% of waist circumference, the target of the loss ≥ 3% of the weight and 26% of the sample the target of reduction ≥ 3% of waist circumference being achieved 38% of the sample. No statistically significant differences were observed in weight and waist circumference loss in any of the variables analysed. CONCLUSIONS: Intensive intervention, based on a low-calorie Mediterranean diet, with recommendations of physical activity and motivational talks, achieved a moderate weight loss in patients refractory to treatments for obesity.

Fermented dairy products, diet quality, and cardio-metabolic profile of a Mediterranean cohort at high cardiovascular risk.

BACKGROUND AND AIMS: Fermented dairy products have been associated with a better diet quality and cardio-metabolic profile. However, in Mediterranean populations, these associations have not been well characterized. The aim of this study was to assess the diet quality and the associations between the consumption of total fermented dairy products and their subtypes and the prevalence of Metabolic Syndrome (MetS) components in a Mediterranean population at high cardiovascular risk. METHODS AND RESULTS: Baseline cross-sectional analyses were conducted on 6,572 men and women (mean age: 65 years) with overweight or obesity and MetS recruited into the PREDIMED-Plus cohort. A 143-item Food Frequency Questionnaire (FFQ) was used, and anthropometrical, biochemical, and blood pressure measurements were recorded. Multivariate-adjusted Cox regressions were fitted to analyze the association between quartiles of consumption of fermented dairy products and their subtypes and MetS components to estimate the relative risk (RR) and 95% confidence intervals (95% CIs). Participants who were high consumers of fermented dairy products reported a higher consumption of fruit, vegetables, fish, nuts, and whole bread and a lower consumption of white bread, alcohol, and cookies. Participants in the higher quartile showed a lower prevalence of the low HDL-cholesterol component of the MetS (RR=0.88; 95% CI: 0.78-0.98) than those in the lowest quartile of cheese consumption. Cheese consumption was inversely associated with the prevalence of hypertriglyceridemia. Total fermented dairy products, yogurt, and its types were not associated with any of the MetS components. CONCLUSIONS: Compared to nonconsumers, participants consuming fermented dairy products reported a better diet quality and, particularly, cheese consumers presented a lower prevalence of hypertriglyceridemia and low HDL-cholesterol plasma levels, which are MetS components.

Dietary intake in the dependent elderly: evaluation of the risk of nutritional deficit.

BACKGROUND: Malnutrition is a frequent problem in elderly dependent patients and their prognosis is adversely affected. Assessment of food consumption and adequacy of energy and nutrient intake of dependent elderly is needed to plan any selected actions for this population. METHODS: The study comprised a multicentre cross-sectional study of 190 users (≥65 years) of a home care programme provided by primary care centers in Tarragona (Spain), at nutritional risk (Mini Nutritional Assessment: 17-23.5 points). Food consumption was assessed using a semiquantitative validated food frequency questionnaire. Energy intake was compared with the Spanish dietary reference intake (DRI) and nutritional intakes with the DRI of the American Institute of Medicine. RESULTS: Mean (SD) age was 85.0 (7.2) years (67.5% female). The food items consumed were varied but lower than the recommended portions for cereals, fruits, vegetables and legumes. Energy intake was 7454.2 (1553.9 kJ day(-1)) [1781.6 (371.4) kcal day(-1)] (97.7% of recommended dietary allowance; RDA) and protein intake was 1.0 (0.4) g kg(-1) of weight (121.4% of RDA). Proteins provided 13.3%, carbohydrates provided 39.9% and fats provided 45.8% of energy intake. The intakes of calcium, vitamin D, vitamin E and folates were less than two-thirds of the RDA and their probability of inadequate intake was >85%. CONCLUSIONS: Dietary intakes of elderly dependent patients at nutritional risk were well balanced. In general, energy and protein intakes meet the recommendations. The diet was high in energy density, low in complex carbohydrates, high in simple carbohydrates and excessive in fats. The dependent elderly had inadequate intake of micronutrients often related to fragility, such as calcium, vitamin D, vitamin E and folates.

Does the Mediterranean diet counteract the adverse effects of abdominal adiposity?

BACKGROUND AND AIM: We tested the hypothesis that an intervention with a Mediterranean diet (MeDiet) could mitigate the well-known harmful effects of abdominal obesity on cardiovascular health. METHODS AND RESULTS: We assessed the relationship between baseline waist-to-height ratio (WHtR) and major cardiovascular events during a median follow-up of 4.8 years in the Prevention with Mediterranean Diet (PREDIMED) randomized primary prevention trial, which tested a MeDiet against a control diet (advice on a low-fat diet). We also examined whether the MeDiet intervention was able to counteract the detrimental cardiovascular effects of an increased WHtR. The trial included 7447 participants (55-80 years old, 57% women) at high cardiovascular risk but free of cardiovascular disease (CVD) at enrollment. An increased risk of CVD events (myocardial infarction, stroke, or cardiovascular death) was apparent for the highest versus the lowest quartile of WHtR (multivariable-adjusted hazard ratio: 1.98) (95% confidence interval: 1.10-3.57; linear trend: p = 0.019) only in the control-diet group, but not in the two groups allocated to intervention with MeDiet (p for interaction = 0.034). This apparent interaction suggesting that the intervention counterbalanced the detrimental cardiovascular effects of adiposity was also significant for body mass index (BMI) (p = 0.01) and waist circumference (p = 0.043). CONCLUSIONS: The MeDiet may counteract the harmful effects of increased adiposity on the risk of CVD.

Physical activity below the minimum international recommendations improves oxidative stress, ADMA levels, resting heart rate and small artery endothelial function

Background: A moderate level of physical activity (PA), such as a daily 30-min walk, reduces cardiovascular risk. There is a lack of evidence about the cardiovascular benefits of PA below this recommendation of minimum PA level. Objective: We aimed to study the impact of a lower level of PA on cardiovascular health. Design: Sixty-four overweight/obese men and women were enrolled in a community programme consisting of 4 months of 1h, low-intensity PA two days per week. Before and after the intervention, PA level (METs/h/wk), endogenous antioxidant status (SOD and GPX concentration and activity and oxidised LDL), ADMA concentrations, endothelial function by small artery reactive hyperaemia index (saRHI), and resting heart rate (RHR) were assessed. Results: After the intervention, significant increases in saRHI (P=0.031), SOD and GPX activities, and a decrease in ADMA plasma concentrations, and RHR (P < 0.001 for all) were observed. Increases in PA were positively associated with increases in saRHI (r = 0.341, P = 0.022), GPx (r = 0.303, P = 0.047) and decreases in RHR (r=−0.302, P=0.047). Multivariate analyses showed that independent predictors of saRHI improvement were an increase in PA (2.65, 95%CI: 1.21–4.01), decrease in RHR (1.91, 95%CI: 1.01–4.98), and an increase in GPx (2.61, 95%CI: 1.16–5.01). Conclusion: In obese and overweight men and women, an increase in PA, even below the minimal international recommendations, improves antioxidant capacity, RHR and peripheral small artery reactivity

Introducción: Los niveles moderados de actividad física (AF), 30 min al día de caminar, reducen el riesgo cardiovascular. No existe evidencia si los niveles bajos de actividad física, por debajo de las recomendaciones internacionales, afectan la salud cardiovascular. Objetivo: Estudiar el efecto de los niveles bajos de actividad física sobre la salud cardiovascular Diseño: Se seleccionaron 64 hombres y mujeres con sobrepeso u obesidad para completar un programa comunitario de actividad física consistente en 1h, 2 días a la semana, durante 4 meses, de AF de intensidad baja. Antes y después del programa se evaluó la AF (MET/h/semana), el estado antioxidante endógeno (SOD y GPX concentración y actividad), las concentraciones de ADMA, la función endotelial de pequeña arteria mediante el índice de hiperemia reactiva (saRHI) y la frecuencia cardíaca (FC) en reposo. Resultados: Después de la intervención se observó un aumento significativo en el saRHI (p=0,031), en la actividad de la SOD y la GPX, y una disminución de las concentraciones plasmáticas de ADMA y de la FC (p<0,001 para todos). El aumento en la AF se asoció directamente con el aumento del saRHI (r = 0,341, p = 0,022), GPx (r = 0,303, p = 0,047) y disminución en FC (r = -0.297, p = 0,047). Los predictores independientes de la mejora del saRHI fueron un aumento en la AF (2,65; IC95%: 1,21-4,01), la disminución de la FC (1,91; IC95%:1,01-4,98) y el aumento de la GPx (2,61; IC95%:1,16-5,01). Conclusiones: Un aumento de la AF, incluso por debajo de las recomendaciones internacionales de AF, mejoró la capacidad antioxidante, la FC y la función endotelial de las pequeñas arterias en hombres y mujeres con sobrepeso u obesidad

Physical activity below the minimum international recommendations improves oxidative stress, ADMA levels, resting heart rate and small artery endothelial function.

BACKGROUND: A moderate level of physical activity (PA), such as a daily 30-min walk, reduces cardiovascular risk. There is a lack of evidence about the cardiovascular benefits of PA below this recommendation of minimum PA level. OBJECTIVE: We aimed to study the impact of a lower level of PA on cardiovascular health. DESIGN: Sixty-four overweight/obese men and women were enrolled in a community programme consisting of 4 months of 1h, low-intensity PA two days per week. Before and after the intervention, PA level (METs/h/wk), endogenous antioxidant status (SOD and GPX concentration and activity and oxidised LDL), ADMA concentrations, endothelial function by small artery reactive hyperaemia index (saRHI), and resting heart rate (RHR) were assessed. RESULTS: After the intervention, significant increases in saRHI (P=0.031), SOD and GPX activities, and a decrease in ADMA plasma concentrations, and RHR (P<0.001 for all) were observed. Increases in PA were positively associated with increases in saRHI (r=0.341, P=0.022), GPx (r=0.303, P=0.047) and decreases in RHR (r=-0.302, P=0.047). Multivariate analyses showed that independent predictors of saRHI improvement were an increase in PA (2.65, 95%CI: 1.21-4.01), decrease in RHR (1.91, 95%CI: 1.01-4.98), and an increase in GPx (2.61, 95%CI: 1.16-5.01). CONCLUSION: In obese and overweight men and women, an increase in PA, even below the minimal international recommendations, improves antioxidant capacity, RHR and peripheral small artery reactivity.

Associations between serum uric acid concentrations and metabolic syndrome and its components in the PREDIMED study.

BACKGROUND AND AIMS: Several studies have demonstrated a relationship between increased serum uric acid (SUA) concentrations and the prevalence of metabolic syndrome (MetS) in the oriental population. However, to the best of our knowledge, the association between SUA and MetS has never been investigated in elderly European individuals at high cardiovascular risk. The aim of this study was to conduct a cross-sectional and prospective evaluation of the associations between SUA concentrations and the MetS in elderly individuals at high cardiovascular risk. METHODS AND RESULTS: Men and women (55-80 years of age) from different PREDIMED (Prevención con DIeta MEDiterránea) recruiting centers were studied. Baseline cross-sectional (n = 4417) and prospective assessments (n = 1511) were performed. MetS was defined in accordance with the updated harmonized criteria. Anthropometric measurements and biochemical determinations were assessed at baseline and yearly during follow-up. Unadjusted and adjusted regression models were fitted to assess the risk of MetS and its components according to the levels of baseline SUA. Participants in the highest baseline sex-adjusted SUA quartile showed an increased prevalence of MetS than those in the lowest quartile, even after adjusting for potential confounders (odd ratio (OR): 2.3 (95% confidence interval (CI), 1.8-2.8); P < 0.001). Participants in the highest baseline sex-adjusted SUA quartile presented a higher incidence of new-onset MetS than those in the lowest quartile (hazard ratios (HR): 1.4 (95% CI, 1.1-1.9); P < 0.001). Participants initially free at baseline of hypertriglyceridemia (HR: 1.9 (1.6-2.4); P < 0.001), low high-density lipoprotein (HDL)-cholesterol (HR: 1.4 (1.1-1.7); P = 0.002), and hypertension components of MetS (HR: 2.0 (1.2-3.3); P = 0.008) and who were in the upper quartile of SUA had a significantly higher risk of developing these MetS components during follow-up. CONCLUSIONS: Elevated SUA concentrations are significantly associated with the development of MetS.

Comparative efficacy of two interventions to discontinue long-term benzodiazepine use: cluster randomised controlled trial in primary care.

BACKGROUND: Benzodiazepines are extensively used in primary care, but their long-term use is associated with adverse health outcomes and dependence. AIMS: To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use. METHOD: A multicentre three-arm cluster randomised controlled trial was conducted, with randomisation at general practitioner level (trial registration ISRCTN13024375). A total of 532 patients taking benzodiazepines for at least 6 months participated. After all patients were included, general practitioners were randomly allocated (1:1:1) to usual care, a structured intervention with follow-up visits (SIF) or a structured intervention with written instructions (SIW). The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription claims at 12 months. RESULTS: At 12 months, 76 of 168 (45%) patients in the SIW group and 86 of 191 (45%) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 (15%) in the control group. After adjusting by cluster, the relative risks for benzodiazepine discontinuation were 3.01 (95% CI 2.03-4.46, P<0.0001) in the SIW and 3.00 (95% CI 2.04-4.40, P<0.0001) in the SIF group. The most frequently reported withdrawal symptoms were insomnia, anxiety and irritability. CONCLUSIONS: Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity. A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits.

Inverse association between habitual polyphenol intake and incidence of cardiovascular events in the PREDIMED study.

BACKGROUND AND AIMS: Epidemiologic and biological evidence supports an inverse association between polyphenol consumption and the risk of cardiovascular disease (CVD). However, no previous studies have prospectively evaluated the relationship between polyphenol intake and the incidence of CVD in such a comprehensive way. The aim was to evaluate the association between intakes of total polyphenol and polyphenol subgroups, and the risk of major cardiovascular events (myocardial infarction, stroke or death from cardiovascular causes) in the PREDIMED study. METHODS AND RESULTS: The present work is an observational study within the PREDIMED trial. Over an average of 4.3 years of follow-up, there were 273 confirmed cases of CVD among the 7172 participants (96.3%) who completed a validated 137-item food frequency questionnaire (FFQ) at baseline. Polyphenol consumption was calculated by matching food consumption data from the FFQ with the Phenol-Explorer database on polyphenol content of each reported food. After multivariate adjustment, a 46% reduction in risk of CVD risk was observed comparing Q5 vs. Q1 of total polyphenol intake (HR = 0.54; 95% confidence interval [CI] = 0.33-0.91; P-trend = 0.04). The polyphenols with the strongest inverse associations were flavanols (HR = 0.40; CI 0.23-0.72; P-trend = 0.003), lignans (HR = 0.51; CI 0.30-0.86; P-trend = 0.007), and hydroxybenzoic acids (HR = 0.47; CI 0.26-0.86; P-trend 0.02). CONCLUSION: Greater intake of polyphenols, especially from lignans, flavanols, and hydroxybenzoic acids, was associated with decreased CVD risk. Clinical trials are needed to confirm this effect and establish accurate dietary recommendations.

Dietary glycemic index/load and peripheral adipokines and inflammatory markers in elderly subjects at high cardiovascular risk.

BACKGROUND AND AIMS: Epidemiological and clinical studies suggest that low-glycemic index diets could protect against weight gain. However, the relationship between these diets and adipokines or inflammatory markers is unclear. In the present study we examine how the dietary glycemic index (GI) and dietary glycemic load (GL) are associated with several adipokines and related metabolic risk markers of obesity and diabetes in a cross-sectional and longitudinal manner. METHODS AND RESULTS: 511 elderly community-dwelling men and women at high cardiovascular risk were recruited for the PREDIMED trial. Dietary data were collected at baseline and after 1 year of follow-up. The GI and GL were calculated. Plasma leptin, adiponectin and other metabolic risk markers were measured at baseline and after 1 year. At baseline, subjects in the highest quartiles of GI showed significantly higher levels of TNF and IL-6 than those in the lowest quartiles. Dietary GI index was negatively related to plasma leptin and adiponectin levels. After 1 year of follow-up, subjects with a higher increase in dietary GI or GL showed a greater reduction in leptin and adiponectin plasma levels. There was no association between GI or GL and the other metabolic markers measured. CONCLUSION: Our results suggest that the consumption of high-GI or high-GL diets may modulate plasma concentrations of leptin and adiponectin, both adipostatic molecules implicated in energy balance and cardiometabolic risk.

Análisis Bibliométrico de la producción Científica Internacional sobre atención primaria / Bibliometric analysis of International Scientific production on Primary Care

Objetivos: Describir la producción científica internacional en el ámbito de la atención primaria en el período 1985-2004.DiseñoAnálisis bibliométrico. Emplazamiento: Base de datos Medline. Acceso mediante WebSPIRS versión 4,3. Se analizan 2 períodos: 2000-2004 (transversal) y 1985-2004 (evolutivo). Búsqueda basada en MesH Major con los descriptores: Primary Care o Primary Health Care, Family Practice, Physicians Family, Nurse Practitioners y los Entry Terms relacionados con ellos. Mediciones principales: Se analizaron los indicadores bibliométricos de producción, circulación, dispersión y visibilidad. Criterios de inclusión: se consideró aquel registro (documento citable) indexado en Medline. Se incluyeron documentos originales y revisiones. Resultados: En 2000-2004 se publicaron 20.911 artículos, el 0,73% de la producción total. Con una tasa de crecimiento (1985-2004) del 221%, 2,4 veces más que la media. La tasa de transitoriedad fue 83,17%. El idioma inglés es el predominante (88,81%) sobre 34 idiomas, siendo el español el siguiente (2,6%). Dieciséis países producen el 95,67% de los artículos. España ocupa el séptimo lugar. Las universidades (52%) son la institución más productiva. Existen 1.074 revistas diferentes siendo las 10 más productoras: Br J Gen Pract, Adv Nurse Pract, Aust Fam Physician, Fam Pract, Fam Med, BMJ, Aten Primaria, Health Serv J, Can Fam Physician, J Fam Pract. La proporción de ensayos clínicos (5,43%) en atención primaria (AP) es similar a la del resto de disciplinas y ha aumentado el 453% (1985-2004). Conclusiones: La producción de AP supone cerca del 1% del total de la producción científica, con un crecimiento notorio y mayor que la media en 20 años. La proporción de ensayos clínicos es similar a otras disciplinas. Aunque los países y revistas anglosajones son los más productores, España y la revista Aten Primaria se encuentra entre los destacados(AU)

Objective: To present an international view of the scientific production in the field of primary care in the period 1985-2004.DesignRetrospective, observational study. Bibliometric analysis. Location: Medline database. WebSPIRS access through version 4.3. We analysed two periods: 2000-2004 (cross-sectional) and 1985-2004 (developmental). Search based on "MeSH Major" with descriptors: Primary Care or Primary Health Care, Family Practice, Family Physicians, Nurse Practitioners, and Entry Terms associated with these. Key Measures: We analysed the bibliometric indicators of production, circulation, dispersion, and visibility. Results: In 2000-2004, published 20911 articles were published, 0.73% of total production. There was a growth rate (1985-2004) of 221%, which was 2.4 times more than average. Transience rate was 83.17%. The English language is predominant (88.81%) over 34 languages, with Spanish being the next (2.6%). Sixteen countries produce 95.67% of the articles. Spain occupies the 7th place. Universities (52%) are the most productive institutions. There are 1074 different journals with the 10 most productive being: Br J Gen Pract, Adv Nurse Pract, Aust Fam Physician, Fam Pract, Fam Med, BMJ, Aten Primary Health Serv J, Can Fam Physician, J Fam Pract. The proportion of trials (5.43%) in PC is similar to other disciplines and has increased by 453% (1985-2004). Conclusions: The production of Primary care is about 1% of the total scientific output, with a noticeable and higher than average growth over 20 years. The proportion of clinical trials is similar to other disciplines. Although Anglo-Saxon countries and journals are the highest producers, Spain and the journal Aten Primaria is among those highlighted(AU)

[Bibliometric analysis of International Scientific production on primary care]. / Análisis Bibliométrico de la producción Científica Internacional sobre atención primaria.

OBJECTIVE: To present an international view of the scientific production in the field of primary care in the period 1985-2004. DESIGN: Retrospective, observational study. Bibliometric analysis. LOCATION: Medline database. WebSPIRS access through version 4.3. We analysed two periods: 2000-2004 (cross-sectional) and 1985-2004 (developmental). Search based on "MeSH Major" with descriptors: Primary Care or Primary Health Care, Family Practice, Family Physicians, Nurse Practitioners, and Entry Terms associated with these. KEY MEASURES: We analysed the bibliometric indicators of production, circulation, dispersion, and visibility. RESULTS: In 2000-2004, published 20911 articles were published, 0.73% of total production. There was a growth rate (1985-2004) of 221%, which was 2.4 times more than average. Transience rate was 83.17%. The English language is predominant (88.81%) over 34 languages, with Spanish being the next (2.6%). Sixteen countries produce 95.67% of the articles. Spain occupies the 7th place. Universities (52%) are the most productive institutions. There are 1074 different journals with the 10 most productive being: Br J Gen Pract, Adv Nurse Pract, Aust Fam Physician, Fam Pract, Fam Med, BMJ, Aten Primary Health Serv J, Can Fam Physician, J Fam Pract. The proportion of trials (5.43%) in PC is similar to other disciplines and has increased by 453% (1985-2004). CONCLUSIONS: The production of Primary care is about 1% of the total scientific output, with a noticeable and higher than average growth over 20 years. The proportion of clinical trials is similar to other disciplines. Although Anglo-Saxon countries and journals are the highest producers, Spain and the journal Aten Primaria is among those highlighted.

Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention.

AIMS/HYPOTHESIS: To assess the feasibility and effectiveness of an active real-life primary care lifestyle intervention in preventing type 2 diabetes within a high-risk Mediterranean population. METHODS: A prospective cohort study was performed in the setting of Spanish primary care. White-European individuals without diabetes aged 45-75 years (n = 2,054) were screened using the Finnish Diabetes Risk Score (FINDRISC) and a subsequent 2 h OGTT. Where feasible, high-risk individuals who were identified were allocated sequentially to standard care, a group-based or an individual level intervention (intensive reinforced DE-PLAN [Diabetes in Europe-Prevention using Lifestyle, Physical Activity and Nutritional] intervention). The primary outcome was the development of diabetes according to WHO criteria. Analyses after 4-year follow-up were performed based on the intention-to-treat principle with comparison of standard care and the combined intervention groups. RESULTS: The standard care (n = 219) and intensive intervention (n = 333) groups were comparable in age (62.0/62.2 years), sex (64.4/68.2% women), BMI (31.3/31.2 kg/m(2)), FINDRISC score (16.2/15.8 points), fasting (5.3/5.2 mmol/l), 2 h plasma glucose (7.1/6.9 mmol/l) and self-reported interest to make lifestyle changes at baseline. Diabetes was diagnosed in 124 individuals: 63 (28.8%) in the standard care group and 61 (18.3%) in the intensive intervention group. During a 4.2-year median follow-up, the incidences of diabetes were 7.2 and 4.6 cases per 100 person-years, respectively (36.5% relative risk reduction, p < 0.005). The number of participants needed to be treated by intensive intervention for 4 years to reduce one case of diabetes was 9.5. CONCLUSIONS/INTERPRETATION: Intensive lifestyle intervention is feasible in a primary care setting and substantially reduces diabetes incidence among high-risk individuals. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov NCT01519505. FUNDING: Commission of the European Communities, Institute of Health Carlos III, Spanish Ministry of Health and Department of Health, Generalitat de Catalunya.

Association between red meat consumption and metabolic syndrome in a Mediterranean population at high cardiovascular risk: cross-sectional and 1-year follow-up assessment.

BACKGROUND AND AIMS: Little is known about the role that red meat and processed red meat (RM) consumption plays in the development of the metabolic syndrome (MetS). The aim was to assess the relationship between RM consumption and the prevalence or incidence of the MetS and its components in a Mediterranean population at high risk of cardiovascular disease. METHODS AND RESULTS: Cross-sectional analyses were carried out at baseline and at 1-year follow-up and longitudinal analysis were conducted in a cohort of individuals at high risk of cardiovascular disease from the PREDIMED study. A 137-item validated semi-quantitative food frequency questionnaire, anthropometric measurements, blood pressure, fasting plasma glucose and lipid profile were evaluated both at baseline and after 1-year follow-up. The MetS was defined in accordance with the updated ATP III criteria. Subjects in the upper quartile of RM consumption were more likely to meet the criteria for the MetS at baseline (OR, 2.3; 95% CI, 1.4-3.9; P-trend = 0.001) and after 1-year follow-up (OR, 2.2; 95% CI, 1.3-3.7; P-trend = 0.034) compared with those in the quartile of reference, even after adjusting for potential confounders. The longitudinal analyses showed that individuals in the fourth quartile of RM consumption had an increased risk of MetS (OR, 2.7; 95% CI, 1.1-6.8; P-trend = 0.009) or central obesity incidence (OR, 8.1; 95% CI, 1.4-46.0; P-trend = 0.077) at the end of the follow-up compared to the lowest quartile. CONCLUSIONS: Higher RM consumption is associated with a significantly higher prevalence and incidence of MetS and central obesity in individuals at high risk of cardiovascular disease.

Bone quantitative ultrasound measurements in relation to the metabolic syndrome and type 2 diabetes mellitus in a cohort of elderly subjects at high risk of cardiovascular disease from the PREDIMED study.

OBJECTIVE: The aim of this study is to determine whether metabolic syndrome, its individual components, or the presence of type 2 diabetes mellitus are associated with a better bone status estimated by quantitative ultrasound at the calcaneus. DESIGN: Cross-sectional study. SETTING: Outpatient clinics. PARTICIPANTS: 251 elderly subjects at high cardiovascular risk from the PREDIMED study were included. MEASUREMENTS: MetS was defined according to the ATPIII diagnosis criteria. Calcaneus quantitative ultrasound (QUS) assessment was performed using the Sahara system. RESULTS: Subjects with MetS showed significantly lower 24-hour urinary deoxypyridinoline/creatinine (u-DPD/creatinine) levels and higher broadband ultrasound attenuation, and a tendency to higher bone mineral density (BMD) and quantitative ultrasound index (QUI) than their counterparts. Individuals with type 2 diabetes mellitus (T2DM) showed a significantly higher bone broadband ultrasound attenuation (BUA) and QUI than their non-diabetic counterparts, despite they shown a higher prevalence of osteoporotic fractures. Multiple linear regression analyses showed that quantitative ultrasound parameters were positively associated with the metabolic syndrome and T2DM. Of the bone biochemical markers, only u-DPD/creatinine was related to MetS, abdominal obesity, hypertriglyceridemia component of the MetS, and the number of features that define the MetS. CONCLUSION: This is the first study showing a positive association between MetS or T2DM with better bone status and lower bone resorption markers measured by quantitative ultrasound. Our results suggest that metabolic abnormalities have a positive effect on healthy bone in elderly subjects at high risk of cardiovascular disease.