COVID-19 and Cognitive Decline in Older Adults with High-Cardiovascular Risk: A Post Hoc Analysis.

Cognitive decline has been reported as a short-term sequela in patients hospitalized for coronavirus disease-19 (COVID-19). Whether COVID-19 is associated with late cognitive impairment in older free-living individuals with high cardiovascular risk, a group at greater risk of cognitive decline, is unknown. We determined this association of COVID-19 through a longitudinal evaluation of post-COVID-19 cognitive performance and impairment as post hoc analysis in 5,179 older adults (48% female) with mean (SD) age 68.5 (5.0) years, body mass index 31.7 (3.7) kg/m2, harboring ≥ 3 criteria for metabolic syndrome (e.g., hypertension, hyperlipidemia, hyperglycemia etc.) enrolled in PREDIMED-Plus trial. Pre- and post-COVID-19 cognitive performance was ascertained from scheduled assessments conducted using a battery of neuropsychological tests, including 5 domains: Global Cognitive Function, General Cognitive Function, Execution Function, Verbal Fluency and Attention domains, which were standardized for the cohort. Cognitive impairment was defined as the bottom 10 percentile of the sample. Multivariable linear and logistic regression models assessed the association of COVID-19 with cognitive decline and impairment, respectively. After a mean 50-week follow-up, no significant associations were observed between COVID-19 status and post-COVID-19 scores of all tapped neuropsychological domains, except Global Cognitive Function (GCF). When fully adjusted, COVID-19 was marginally associated with higher (better) post-pandemic GCF score (ßadj (95% CI): 0.06 (0.00, 0.13) p=.05). However, the odds for post-COVID-19 cognitive impairment in GCF domain were not associated with the disease (ORadj (95% CI): 0.90 (0.53, 1.51) p=.68). In the PREDIMED-Plus cohort, COVID-19 status and cognitive impairment determined 50 weeks post-infection showed no association in older adults at high cardiovascular risk. This suggests that cognitive changes observed shortly after COVID-19 revert over time. However, cautious interpretation is warranted as these data were obtained within the framework of a clinical trial encouraging a healthy lifestyle.

Effect of an Intensive Lifestyle Intervention on Circulating Biomarkers of Atrial Fibrillation-Related Pathways among Adults with Metabolic Syndrome: Results from a Randomized Trial.

Background: Lifestyles influence atrial fibrillation (AF) risk. Determining the effect of lifestyle interventions on blood concentrations of biomarkers of AF-related pathways could help understand AF pathophysiology and contribute to AF prevention. Methods: We studied 532 participants enrolled in the PREDIMED-Plus trial, a Spanish randomized trial conducted in adults (55-75 years) with metabolic syndrome and body mass index between 27-40 kg/m2. Eligible participants were randomized 1:1 to an intensive lifestyle intervention, emphasizing physical activity, weight loss, and adherence to an energy-reduced Mediterranean diet or to a control group. Serum biomarkers [carboxy-terminal propeptide of procollagen type I (PICP), high-sensitivity troponin T (hsTnT), high-sensitivity C reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)] were measured at baseline, 3 and 5 years after randomization. Mixed models were used to evaluate the effect of intervention on changes in biomarkers through year 5. Mediation analysis was performed to examine the proportion mediated by each component of the intervention. Results: At baseline, participants' mean age was 65, 40% were female, and 50% were assigned to the intervention. After five years, mean changes in log-transformed biomarkers were -0.01 (PICP), 0.20 (hsTnT), -0.17 (hsCRP), 0.12 (3-NT), and 0.27 (NT-proBNP). Compared to the control group, participants in the intervention group experienced greater decreases in hsCRP (-14%, 95% confidence interval (CI) -26%, 0%) or smaller increases in 3-NT (-16%, 95% CI -25%, -5%) and NT-proBNP (-12%, 95% CI -23%, 1%). The intervention had minimal impact on hsTnT (-3%, 95% CI -7%, 2%) or PICP concentrations (-2%, 95% CI -9%, 6%). The effect of the intervention on hsCRP was primarily mediated by weight loss (89% at year 5). Conclusions: Over five years, a dietary and lifestyle intervention for weight-loss favorably affected concentrations of hsCRP, 3-NT, and NT-proBNP, pointing to specific mechanisms in pathways linking lifestyles and AF.

Effect of 1-year lifestyle intervention with energy-reduced Mediterranean diet and physical activity promotion on the gut metabolome and microbiota: a randomized clinical trial.

BACKGROUND: The health benefits of the Mediterranean diet (MedDiet) have been linked to the presence of beneficial gut microbes and related metabolites. However, its impact on the fecal metabolome remains poorly understood. OBJECTIVES: Our goal was to investigate the weight-loss effects of a 1-y lifestyle intervention based on an energy-reduced MedDiet coupled with physical activity (intervention group), compared with an ad libitum MedDiet (control group), on fecal metabolites, fecal microbiota, and their potential association with cardiovascular disease risk factors. METHODS: A total of 400 participants (200 from each study group), aged 55-75 y, and at high cardiovascular disease risk, were included. Dietary and lifestyle information, anthropometric measurements, blood biochemical parameters, and stool samples were collected at baseline and after 1 y of follow-up. Liquid chromatography-tandem mass spectrometry was used to profile endogenous fecal metabolites, and 16S amplicon sequencing was employed to profile the fecal microbiota. RESULTS: Compared with the control group, the intervention group exhibited greater weight loss and improvement in various cardiovascular disease risk factors. We identified intervention effects on 4 stool metabolites and subnetworks primarily composed of bile acids, ceramides, and sphingosines, fatty acids, carnitines, nucleotides, and metabolites of purine and the Krebs cycle. Some of these were associated with changes in several cardiovascular disease risk factors. In addition, we observed a reduction in the abundance of the genera Eubacterium hallii group and Dorea, and an increase in alpha diversity in the intervention group after 1 y of follow-up. Changes in the intervention-related microbiota profiles were also associated with alterations in different fecal metabolite subnetworks and some cardiovascular disease risk factors. CONCLUSIONS: An intervention based on an energy-reduced MedDiet and physical activity promotion, compared with an ad libitum MedDiet, was associated with improvements in cardiometabolic risk factors, potentially through modulation of the fecal microbiota and metabolome. This trial was registered at https://www.isrctn.com/ as ISRCTN89898870 (https://doi.org/10.1186/ISRCTN89898870).

Plasma metabolite profile of legume consumption and future risk of type 2 diabetes and cardiovascular disease.

BACKGROUND: Legume consumption has been linked to a reduced risk of type 2 diabetes (T2D) and cardiovascular disease (CVD), while the potential association between plasma metabolites associated with legume consumption and the risk of cardiometabolic diseases has never been explored. Therefore, we aimed to identify a metabolite signature of legume consumption, and subsequently investigate its potential association with the incidence of T2D and CVD. METHODS: The current cross-sectional and longitudinal analysis was conducted in 1833 PREDIMED study participants (mean age 67 years, 57.6% women) with available baseline metabolomic data. A subset of these participants with 1-year follow-up metabolomics data (n = 1522) was used for internal validation. Plasma metabolites were assessed through liquid chromatography-tandem mass spectrometry. Cross-sectional associations between 382 different known metabolites and legume consumption were performed using elastic net regression. Associations between the identified metabolite profile and incident T2D and CVD were estimated using multivariable Cox regression models. RESULTS: Specific metabolic signatures of legume consumption were identified, these included amino acids, cortisol, and various classes of lipid metabolites including diacylglycerols, triacylglycerols, plasmalogens, sphingomyelins and other metabolites. Among these identified metabolites, 22 were negatively and 18 were positively associated with legume consumption. After adjustment for recognized risk factors and legume consumption, the identified legume metabolite profile was inversely associated with T2D incidence (hazard ratio (HR) per 1 SD: 0.75, 95% CI 0.61-0.94; p = 0.017), but not with CVD incidence risk (1.01, 95% CI 0.86-1.19; p = 0.817) over the follow-up period. CONCLUSIONS: This study identified a set of 40 metabolites associated with legume consumption and with a reduced risk of T2D development in a Mediterranean population at high risk of cardiovascular disease. TRIAL REGISTRATION: ISRCTN35739639.

Effect of an intensive lifestyle intervention on the structural and functional substrate for atrial fibrillation in people with metabolic syndrome.

AIMS: To evaluate the effect of an intensive lifestyle intervention (ILI) on the structural and functional cardiac substrate of atrial fibrillation (AF) in overweight or obese people with metabolic syndrome (Mets). METHODS AND RESULTS: Participants of the PREvención con DIeta MEDiterranea-Plus trial (n = 6874) were randomized 1:1 to an ILI programme based on an energy-reduced Mediterranean diet, increased physical activity, and cognitive-behavioural weight management or to a control intervention of low-intensity dietary advice. A core echocardiography lab evaluated left atrial (LA) strain, function, and volumes in 534 participants at baseline, 3-year, and 5-year follow-ups. Mixed models were used to evaluate the effect of the ILI on LA structure and function. In the subsample, the baseline mean age was 65 years [standard deviation (SD) 5 years], and 40% of the participants were women. The mean weight change after 5 years was -3.9 kg (SD 5.3 kg) in the ILI group and -0.3 kg (SD 5.1 kg) in the control group. Over the 5-year period, both groups experienced a worsening of LA structure and function, with increases in LA volumes and stiffness index and decreases in LA longitudinal strain, LA function index, and LA emptying fraction over time. Changes in the ILI and control groups were not significantly different for any of the primary outcomes {LA emptying fraction: -0.95% [95% confidence interval (CI) -0.93, -0.98] in the control group, -0.97% [95% CI -0.94, -1.00] in the ILI group, Pbetween groups = 0.80; LA longitudinal strain: 0.82% [95% CI 0.79, 0.85] in the control group, 0.85% [95% CI 0.82, 0.89] in the ILI group, Pbetween groups = 0.24} or any of the secondary outcomes. CONCLUSION: In overweight or obese people with Mets, an ILI had no impact on the underlying structural and functional LA substrate measurements associated with AF risk.

This study evaluated whether an intervention-modifying lifestyle had an effect on the parts of the heart involved in the development of atrial fibrillation (AF), a common problem of the heart rhythm. This intervention was implemented in people who had excessive body weight and the metabolic syndrome (Mets), which is a combination of several cardiovascular risk factors. The lifestyle intervention included promoting a Mediterranean diet low in calories and increasing exercise to facilitate weight loss, and this intervention was compared with a control intervention to follow a healthy diet. We performed repeated studies of the heart structure and function with imaging over a period of 5 years. During the 5 years of the study, both study groups (intervention and control) showed changes in their heart consistent with ageing. However, these changes were not different in those who were receiving the lifestyle intervention. Also, participants who lost more weight, adhered better to the study diet, or did more physical activity, overall did not show any differences in their heart compared with those who did not achieve their lifestyle goals.In conclusion, a lifestyle intervention focusing on weight loss, better diet, and more exercise was not effective in improving parts of the heart potentially involved with the risk of AF.In people with metabolic syndrome, a weight control lifestyle intervention, based on an energy-reduced Mediterranean diet and physical activity, had no effect on the structural and functional cardiac substrate of atrial fibrillation.

Higher circulating vitamin B12 is associated with lower levels of inflammatory markers in individuals at high cardiovascular risk and in naturally aged mice.

BACKGROUND: Vitamin B12 is an essential nutrient that is involved in numerous physiological processes, and its deficiency can lead to various complications, including neurological and haematological disorders. Some studies have suggested that vitamin B12 may have anti-inflammatory effects, but the mechanisms underlying this relationship are not yet fully understood. We investigated the relationship between circulating vitamin B12 and inflammatory markers interleukin (IL)-6 and C-reactive protein (CRP). The association of peripheral levels of vitamin B12 with IL-6 and CRP was assessed in 136 human samples from a high cardiovascular risk population. To corroborate the results from the human trial, the analysis was replicated in naturally aged mice. RESULTS: Individuals with higher serum levels of vitamin B12 showed lower concentrations of IL-6 and CRP after adjustment for potential confounders, and an inverse association was also found between serum IL-6 and vitamin B12 levels in naturally aged mice. CONCLUSION: Circulating vitamin B12 was inversely associated with IL-6 and CRP in humans and with IL-6 in mice, suggesting that it may exert an anti-inflammatory effect through modulation of these pro-inflammatory molecules. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Plasma lipidome and risk of atrial fibrillation: results from the PREDIMED trial

The potential role of the lipidome in atrial fibrillation (AF) development is still widely unknown. We aimed to assess the association between lipidome profiles of the Prevención con Dieta Mediterránea (PREDIMED) trial participants and incidence of AF. We conducted a nested case–control study (512 incident centrally adjudicated AF cases and 735 controls matched by age, sex, and center). Baseline plasma lipids were profiled using a Nexera X2 U-HPLC system coupled to an Exactive Plus orbitrap mass spectrometer. We estimated the association between 216 individual lipids and AF using multivariable conditional logistic regression and adjusted the p values for multiple testing. We also examined the joint association of lipid clusters with AF incidence. Hitherto, we estimated the lipidomics network, used machine learning to select important network-clusters and AF-predictive lipid patterns, and summarized the joint association of these lipid patterns weighted scores. Finally, we addressed the possible interaction by the randomized dietary intervention.Forty-one individual lipids were associated with AF at the nominal level (p < 0.05), but no longer after adjustment for multiple-testing. However, the network-based score identified with a robust data-driven lipid network showed a multivariable-adjusted ORper+1SD of 1.32 (95% confidence interval: 1.16–1.51; p < 0.001). The score included PC plasmalogens and PE plasmalogens, palmitoyl-EA, cholesterol, CE 16:0, PC 36:4;O, and TG 53:3. No interaction with the dietary intervention was found. A multilipid score, primarily made up of plasmalogens, was associated with an increased risk of AF. Future studies are needed to get further insights into the lipidome role on AF. (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

Impacto de Life's Simple 7 en la incidencia de eventos cardiovasculares mayores en adultos españoles con alto riesgo de la cohorte del estudio PREDIMED / Impact of Life's Simple 7 on the incidence of major cardiovascular events in high-risk Spanish adults in the PREDIMED study cohort

INTRODUCCIÓN Y OBJETIVOS: La estrategia Life's Simple 7 de la American Heart Association propuso 7 métricas de salud cardiovascular ideal: índice de masa corporal (IMC)<25, no fumar, dieta saludable, actividad física moderada ≥ 150min a la semana, colesterol total <200mg/dl, presión arterial sistólica <120mmHg y diastólica <80mmHg y glucemia basal <100mg/dl. Resulta de gran interés valorar el efecto combinado de estas 7 metas. Se analizó prospectivamente el impacto de las métricas basales Life's Simple 7 en la incidencia de eventos cardiovasculares mayores en la cohorte PREDIMED (el 57,5% mujeres; media de edad inicial, 67 años). MÉTODOS: La métrica de dieta saludable se definió como alcanzar al menos 9 puntos en una escala validada de 14 puntos de adhesión a dieta mediterránea. Se definió evento cardiovascular mayor incidente como infarto de miocardio, ictus o muerte de causa cardiovascular. Se usó regresión de Cox para estimar hazard ratios (HR) ajustadas multivariables con intervalos de confianza del 95% (IC95%) para categorías sucesivas de métricas de salud cardiovascular. RESULTADOS: Tras seguir a 7.447 participantes durante una mediana de 4,8 años, se registraron 288 eventos. Respecto a los participantes con solo 0-1 métricas, tras ajustar por edad, sexo, centro y grupo de intervención, se observaron HR (IC95%) 0,73 (0,54-0,99), 0,57 (0,41-0,78) y 0,34 (0,21-0,53), para 2, 3 y 4 o más métricas respectivamente. CONCLUSIONES: En una población española con alto riesgo cardiovascular, la presencia de un mayor número de métricas se asoció progresivamente con una reducción sustancial en la tasa de eventos cardiovasculares mayores

INTRODUCTION AND OBJECTIVES: The Life's Simple 7 strategy of the American Heart Association proposes 7 metrics of ideal cardiovascular health: body mass index (BMI) <25mg/m2, not smoking, healthy diet, moderate physical activity ≥ 150min/wk, total blood cholesterol <200mg/dL, systolic and diastolic blood pressures <120 and <80mmHg, respectively, and fasting blood glucose <100mg/dL. It is important to assess the combined effect of these 7 metrics in the Spanish population. We prospectively analyzed the impact of baseline Life's Simple 7 metrics on the incidence of major cardiovascular events in the PREDIMED cohort (57.5% women, average baseline age, 67 years). METHODS: The healthy diet metric was defined as attaining ≥ 9 points on a validated 14-item Mediterranean diet adherence screener. An incident major cardiovascular event was defined as a composite of myocardial infarction, stroke, or cardiovascular death. Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and their 95% confidence intervals (95%CI) for successive categories of health metrics. RESULTS: After a median follow-up of 4.8 years in 7447 participants, there were 288 major cardiovascular events. After adjustment for age, sex, center, and intervention group, HRs (95%CI) were 0.73 (0.54-0.99), 0.57 (0.41-0.78), and 0.34 (0.21-0.53) for participants with 2, 3, and ≥ 4 metrics, respectively, compared with participants with only 0 to 1 metrics. CONCLUSIONS: In an elderly Spanish population at high cardiovascular risk, better adherence to Life's Simple 7 metrics was progressively associated with a substantially lower rate of major cardiovascular events

Dieta mediterránea hipocalórica y factores de riesgo cardiovascular: análisis transversal de PREDIMED-Plus / Adherence to an energy-restricted Mediterranean diet score and prevalence of cardiovascular risk factors in the PREDIMED-plus: a cross-sectional study

Introducción y objetivos: Los beneficios cardiovasculares de la dieta mediterránea se han evaluado bajo supuestos de ingesta total de energía ad libitum (sin restricción de energía). En el presente trabajo se estudia basalmente la cohorte de un gran ensayo en marcha denominado PREDIMED-Plus y la asociación entre la adherencia a la dieta mediterránea hipocalórica según la escala de 17 puntos (MedDiet) de este ensayo con la prevalencia inicial de factores de riesgo cardiovascular (FRCV). Métodos: Evaluación transversal de los participantes de PREDIMED-Plus (6.874 adultos mayores con sobrepeso/obesidad y síndrome metabólico). Se evaluó a los participantes para determinar la prevalencia de 4 FRCV (hipertensión, obesidad, diabetes, dislipemia). Se estimaron diferencias de medias y razones de prevalencia para FRCV individuales y agrupados con modelos multivariables. Resultados: Una mejor adhesión al patrón MedDiet se asoció significativamente con niveles más bajos de triglicéridos, índice de masa corporal y perímetro abdominal. Comparado con una baja adhesión (≤ 7 puntos en el score de 17 puntos), una mejor adhesión a la MedDiet (11-17 puntos) mostró asociaciones inversas con hipertensión (razón de prevalencia=0,97; IC95%, 0,94-1,00) y obesidad (razón de prevalencia=0,96; IC95% 0,92-1,00), pero se observaron asociaciones positivas con diabetes (razón de prevalencia=1,19; IC95% 1,07-1,32). Comparado con el tercil más bajo de adhesión, las mujeres en el tercil superior mostraron un riesgo menor para la agrupación de 3 o más FRCV (razón de prevalencia=0,91; IC95% 0,83-0,98). Conclusiones: Entre participantes con alto riesgo cardiovascular, la mejor adhesión a MedDiet se asoció a mejores perfiles lipídicos y medidas de adiposidad, y entre las mujeres mostró asociaciones inversas significativas con la agregación de FRCV

Introduction and objectives: The cardiovascular benefits of the Mediterranean diet have usually been assessed under assumptions of ad libitum total energy intake (ie, no energy restriction). In the recently launched PREDIMED-Plus, we conducted exploratory analyses to study the baseline associations between adherence to an energy-restricted Mediterranean diet (MedDiet) and the prevalence of cardiovascular risk factors (CVRF). Methods: Cross-sectional assessment of all PREDIMED-Plus participants (6874 older adults with overweight/obesity and metabolic syndrome) at baseline. The participants were assessed by their usual primary care physicians to ascertain the prevalence of 4 CVRF (hypertension, obesity, diabetes, and dyslipidemia). A 17-point PREDIMED-Plus score was used to measure adherence to the MedDiet. Multivariable models were fitted to estimate differences in means and prevalence ratios for individual and clustered CVRF. Results: Better adherence to a MedDiet pattern was significantly associated with lower average triglyceride levels, body mass index, and waist circumference. Compared with low adherence (≤ 7 points in the 17-point score), better adherence to the MedDiet (11-17 points) showed inverse associations with hypertension (prevalence ratio=0.97; 95%CI, 0.94-1.00) and obesity (prevalence ratio=0.96; 95%CI, 0.92-1.00), but positive associations with diabetes (prevalence ratio=1.19; 95%CI, 1.07-1.32). Compared with the lowest third of adherence, women in the upper third showed a significantly lower prevalence of the clustering of 3 or more CVRF (prevalence ratio=0.91; 95%CI, 0.83-0.98). Conclusions: Among participants at high cardiovascular risk, better adherence to a MedDiet showed significant inverse associations with CVRF among women, and improved lipid profiles and adiposity measures

Validation study of a Spanish version of the modified Telephone Interview for Cognitive Status (STICS-m) / Validación de la versión en español de la Telephone Interview for Cognitive Status modificada

Objective: To compare the Spanish version of the modified Telephone Interview of Cognitive Status (STICS-m) with the Mini-Mental State Examination (MMSE) and predict its ability to detect the development of dementia. Method: 106 participants in a dietary intervention trial underwent face-to-face evaluation with the MMSE, and phone interview with the STICS-m. The correlation between STICS-m and MMSE was assessed with the intraclass correlation coefficient (ICC) of consistency. Secondly, 932 participants over 55 years old from the "Seguimiento Universidad de Navarra" cohort were evaluated with the STICS-m and data on dementia diagnosis were gathered (median follow-up time of 6.5 years). A logistic regression model evaluated the association between STICS-m score or 2-year changes in STICS-m score and risk of developing dementia, adjusting for ApoE, age and years of university education. Results: The ICC between the MMSE and the STICS-m was 0.31 (95% confidence interval [95%CI]: 0.13-0.48). The adjusted odds ratio (OR) for the development of dementia for each additional point in the baseline STICS-m score was 0.85 (95%CI: 0.72-1.02; p=0.084). When considering the 2-year change in the STICS-m score as exposure, the OR for the development of dementia was 0.79 (95%CI: 0.67-0.93; p=0.006). Conclusions: The weak correlation between the STICS-m and the MMSE reflects moderate-low concurrent validity. Even so, the STICS-m can be regarded as an useful tool in the epidemiological setting since increasing scores appear to be able to predict a lower risk of developing dementia

Objetivo: Estudiar la correlación de la Telephone Interview for Cognitive Status modificada en español (STICS-m) con el Mini-Mental State Examination (MMSE) y predecir la capacidad de la primera para detectar el desarrollo de demencia. Método: Ciento seis sujetos de un estudio de intervención dietética fueron evaluados personalmente con el MMSE y por teléfono con la STICS-m. La correlación entre ambos se midió con el coeficiente de correlación intraclase (CCI) de consistencia. Además, 932 participantes mayores de 55 años de la cohorte "Seguimiento Universidad de Navarra" fueron evaluados con la STICS-m. Durante una mediana de seguimiento de 6,5 años, se recogió información sobre el desarrollo de demencia. Mediante regresión logística se estudió la asociación entre la puntuación de la STICS-m o el cambio a 2 años en la puntuación y el riesgo de desarrollar demencia, ajustando por apolipoproteína E, edad y años de educación universitaria. Resultados: El CCI entre el MMSE y la STICS-m fue de 0,31 (intervalo de confianza del 95% [IC95%]: 0,13-0,48). La odds ratio (OR) ajustada para el desarrollo de demencia para cada punto adicional en la puntuación basal de la STICS-m fue de 0,85 (IC95%: 0,72-1,02; p=0,084). Al considerar el cambio en la puntuación a los 2 años como variable independiente, la OR fue de 0,79 (IC95%: 0,67-0,93; p=0,006). Conclusiones: La correlación débil entre la STICS-m y el MMSE refleja solo una moderada-baja validez concurrente. Aun así, la STICS-m puede considerarse útil en el contexto epidemiológico, ya que aumentos en la puntuación parecen predecir un menor riesgo de desarrollar demencia

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)

Grasa epicárdica en la población general de mediana edad y su asociación con el síndrome metabólico / Epicardial adipose tissue in the general middle-aged population and its association with metabolic syndrome

Introducción y objetivos: Actualmente hay cada vez más interés en el tejido adiposo epicárdico (TAE) como marcador de enfermedad cardiovascular. Nuestro objetivo es describir el TAE medido por ecocardiograma, y determinar su asociación con el síndrome metabólico (SM), dentro del estudio poblacional RIVANA. Métodos: Se incluyó a 880 sujetos de 45 a 74 años (492 con SM según la definición armonizada). Se realizó una exploración física y se tomó una muestra sanguínea para obtener el perfil bioquímico. Se midió el espesor del TAE con ecocardiografía transtorácica al final de la sístole. Resultados: Entre los sujetos sin SM, la prevalencia de TAE ≥ 5 mm aumentaba significativamente con la edad (> 65 frente a 45-54 años, OR = 8,22; IC95%, 3,90-17,35; p lineal < 0,001). El TAE se asoció significativamente con el SM (5.o frente a 1.er quintil, OR = 3,26; IC95%, 1,59-6,71; p lineal = 0,001). Respecto a los criterios individuales, el TAE se asoció independientemente con los criterios colesterol unido a lipoproteínas de alta densidad bajo (5.o frente a 1.er quintil, OR = 2,65; IC95%, 1,16-6,05; p lineal = 0,028), triglicéridos altos (5.o frente a 1.er quintil, OR = 2,22; IC95%, 1,26-3,90; p lineal = 0,003) y elevado perímetro abdominal (5.o frente a 1.er quintil, OR = 6,85; IC95%, 2,91-16,11; p lineal < 0,001). Conclusiones En una submuestra de la población general, la grasa epicárdica aumentó significativa e independientemente con la edad, y su incremento se asoció independientemente con el SM, el colesterol unido a lipoproteínas de alta densidad bajo, los triglicéridos altos y un elevado perímetro abdominal (AU)

Introduction and objectives: There is currently increasing interest in epicardial adipose tissue (EAT) as a marker of cardiovascular disease. Our purpose was to describe EAT, measured by transthoracic echocardiography, and to assess its association with metabolic syndrome (MS) in the RIVANA population-based study. Methods: Physical examination was performed in 880 participants aged 45 to 74 years (492 of them with MS according to the harmonized definition). Fasting glucose, high-density lipoprotein cholesterol, triglyceride, and C-reactive protein concentrations were determined in a blood sample. In all participants, EAT thickness was measured with transthoracic echocardiography at end-systole. Results: Among participants without MS, the prevalence of EAT ≥ 5 mm significantly increased with age (OR > 65 years vs 45-54 years = 8.22; 95%CI, 3.90-17.35; P for trend < .001). Increasing EAT quintiles were significantly associated with MS (OR fifth quintile vs first quintile = 3.26; 95%CI, 1.59-6.71; P for trend = .001). Considering the different MS criteria, increasing quintiles of EAT were independently associated with low high-density lipoprotein cholesterol (OR fifth quintile vs first quintile = 2.65; 95%CI, 1.16-6.05; P for trend = .028), high triglycerides (OR fifth quintile vs first quintile = 2.22; 95%CI, 1.26-3.90; P for trend = .003), and elevated waist circumference (OR fifth quintile vs first quintile = 6.85; 95%CI, 2.91-16.11; P for trend < .001). Conclusions: In a subsample of the general population, EAT measured by echocardiography increased significantly and independently with age. Increased EAT thickness was independently associated with MS and with low high-density lipoprotein cholesterol, high triglycerides, and elevated waist circumference as individual criteria (AU)

Increasing Trend in the Prevalence of Morbid Obesity in Spain: From 1.8 to 6.1 per Thousand in 14 Years

La obesidad, especialmente la obesidad mórbida, incrementa el riesgo cardiovascular y de otras enfermedades. Nuestro objetivo es valorar las tendencias de la obesidad mórbida en España de 1993 a 2006 usando datos representativos de 106.048 participantes (Encuestas Nacionales de Salud). Se realizó un modelo de regresión de Poisson usando la presencia de obesidad mórbida como variable dependiente, estratificando por sexo y ajustando por edad.Se observó un incremento de la prevalencia de obesidad mórbida de más del 200%, pues se pasó de 1,8 a 6,1/1.000 habitantes. La prevalencia de obesidad mórbida es superior en mujeres. Tras ajustar por edad, en ambos sexos se incrementó significativamente la prevalencia de obesidad mórbida: el incremento relativo anual fue del 4% en mujeres y el 12% en varones. Estos incrementos hacen que las medidas preventivas resulten prioritarias (AU)

Obesity, and especially morbid obesity, increases the risk of cardiovascular as well as non-cardiovascular diseases. Our objective was to ascertain the trends in morbid obesity in Spain from 1993 to 2006 using representative data from 106,048 participants in the National Health Surveys. An age-adjusted Poisson regression model stratified by sex was fitted using morbid obesity as the dependent variable.An increasing trend in prevalent morbid obesity from 1.8 to 6.1 per thousand participants was found (increase>200%). Morbid obesity prevalence was higher in women. After adjusting for age, a monotonically increasing prevalence of morbid obesity was apparent for both men and women: the relative increase was 4% per year in women and 12% per year in men. These trends highlight the importance of preventive actions (AU)

Aspirina, analgésicos y riesgo de hipertensión arterial en la Cohorte SUN / Aspirin, non-aspirin analgesics and the risk of hypertension in the SUN cohort

Introducción y objetivos. Se ha relacionado el consumo de aspirina y de otros analgésicos con cambios en la presión arterial. El objetivo de nuestro estudio fue valorar prospectivamente la asociación del uso habitual de aspirina y otros analgésicos con la incidencia de hipertensión arterial. Métodos. El proyecto SUN es una cohorte prospectiva y dinámica que incluyó a 9.986 graduados universitarios españoles inicialmente libres de hipertensión, enfermedad cardiovascular, diabetes o cáncer (media de edad, 36 años). Fueron reclutados durante el periodo 1999- 2005 y se los siguió prospectivamente durante una media de 51 meses. El uso habitual de aspirina y otros analgésicos, así como la presencia de otros factores de riesgo de hipertensión arterial, se valoró mediante un cuestionario basal. La incidencia de hipertensión se valoró con cuestionarios de seguimiento bienales. Resultados. Durante el seguimiento se identificaron 543 casos nuevos de hipertensión arterial. El uso habitual de aspirina (2 o más días/semana) se asoció con un mayor riesgo de hipertensión (hazard ratio [HR] = 1,45; intervalo de confianza [IC] del 95%, 1,02-2,04) tras ajustar por diversos factores de confusión. El uso habitual de otros analgésicos diferentes de la aspirina también se asoció a un mayor riesgo de hipertensión arterial (HR = 1,69; IC del 95%, 1,28-2,23). Conclusiones. El uso habitual tanto de aspirina como de otros analgésicos diferentes a la aspirina parece asociarse a mayor riesgo de hipertensión arterial, independientemente de otros factores de riesgo (AU)

Introduction and objectives. The use of aspirin and non-aspirin analgesics has been associated with changes in blood pressure. The aim of this study was to investigate prospectively the association between the regular use of aspirin and non-aspirin analgesics and the incidence of hypertension. Methods. The SUN project is an ongoing, continuously expanding, prospective cohort of Spanish university graduates initially free of hypertension, cardiovascular disease, diabetes and cancer; 9986 (mean age 36 years) were recruited during 1999-2005 and followed up for a mean of 51 months. Regular aspirin and non-aspirin analgesic use and the presence of other risk factors for hypertension were assessed by questionnaire at baseline, and the incidence of hypertension was assessed using biennial follow-up questionnaires. Results. In total, 543 new cases of hypertension were identified during follow-up. Regular aspirin use (i.e. 2 or more days/week) was associated with a higher risk of hypertension (hazard ratio=1.45; 95% confidence interval, 1.02-2.04) after adjustment for various confounding factors. Regular use of non-aspirin analgesic drugs was also associated with a higher risk of hypertension (hazard ratio=1.69; 95% confidence interval, 1.28-2.23). Conclusions. The regular use of aspirin and non-aspirin analgesics were both associated with an increased risk of developing hypertension, independently of other risk factors (AU)

Evolución de los cambios en el peso corporal según hábito tabáquico: análisis longitudinal de la cohorte SUN / Effect of smoking on body weight: longitudinal analysis of the SUN cohort

Introducción y objetivos. El objetivo de este estudio es evaluar prospectivamente la asociación de dos factores de riesgo cardiovascular, el hábito tabáquico y la ganancia de peso. Métodos. Se evaluó prospectivamente a 7.565 participantes de una cohorte dinámica durante una mediana de seguimiento de 50 meses. El peso y la actividad física declarados fueron validados previamente. Como referenciase usó a los nunca fumadores, y se calcularon diferencias ajustadas de ganancia media de peso para diferentes exposiciones al tabaco. Resultados. Tras ajustar por edad, índice de masa corporal inicial, sedentarismo, cambios de actividad física, ingesta energética y de fibra, comidas entre horas, consumo de refrescos, de comida rápida y de alcohol, los participantes que dejaron de fumar durante el seguimiento presentaron una mayor ganancia relativa de peso: varones, +1,63 (intervalo de confianza [IC] del 95%, 1,07-2,19) kg; mujeres, +1,51 (IC del 95%, 1,11-1,91) kg. Los fumadores activos presentaron también mayor ganancia de peso que los nunca fumadores: varones, +0,49 (IC del95%, 0,11-0,87) kg; mujeres, +0,36 (IC del 95%, 0,07-0,65) kg. Conclusiones. Los participantes que dejaron de fumar durante el seguimiento y los fumadores activos experimentaron mayores ganancias de peso que los nunca fumadores. La asociación de estos dos factores de riesgo cardiovascular debe ser tenida en cuenta en los programas de prevención (AU)

Introduction and objectives. Our aim was to investigate prospectively the association between two major cardiovascular risk factors: smoking and weight gain. Methods. We prospectively evaluated 7565 individuals taking part in a dynamic cohort study over a median follow-up period of 50 months. Self-reported weight and physical activity levels had been validated previously. The adjusted mean difference in weight gain relative to never smokers(the reference group) was estimated for different levels of tobacco exposure. Results. After adjusting for age, baseline body mass index, sedentary lifestyle, changes in physical activity level, total energy intake, fiber intake, food consumption between meals, and sugary soft drink, fast food and alcohol consumption, it was found that individuals who stopped smoking during follow-up had a greater relative weight gain: men 1.63 kg (95% confidence interval [CI],1.07-2.19 kg), and women 1.51 kg (95% CI, 1.11-1.91 kg).In addition, active smokers had a greater weight gain than never-smokers: men 0.49 kg (95% CI, 0.11-0.87 kg), and women 0.36 kg (95% CI, 0.07-0.65 kg).Conclusions. Individuals who stopped smoking during follow-up and active smokers both experienced significantly greater weight gains than never-smokers. This association between cardiovascular risk factors should be taken into account when developing prevention programs (AU)

Consumo de alcohol e incidencia de hipertensión en una cohorte mediterránea: el estudio SUN / Alcohol Consumption and the incidence of Hypertension in a Mediterranean Cohort: the SUN Study

Introducción y objetivos. Evaluar prospectivamente la asociación entre el consumo de alcohol, incluidas la bebida alcohólica preferida y la frecuencia semanal de consumo, y el riesgo de hipertensión en una cohorte mediterránea. Métodos. Se siguió de manera prospectiva a 9.963 varones y mujeres españoles inicialmente libres de hipertensión. La información recogida sobre dieta y diagnóstico de hipertensión arterial fue la declarada por los pacientes y luego validada. Resultados. Durante el seguimiento (mediana [intervalo intercuartílico], 4,2 [2,5-6,1] años) se identificaron 554 casos incidentes de hipertensión entre 43.562 personasaño. La hazard ratio (HR) de hipertensión para un consumo de alcohol ≥ 5 días por semana fue 1,28 (intervalo de confianza [IC] del 95%, 0,97-1,70) comparados con abstemios. Entre consumidores de alcohol al menos 5 días por semana, la HR de hipertensión para consumos ≥ 1 copa al día fue 1,45 (IC del 95%, 1,06-2) comparados con los abstemios. El consumo de cerveza y licores, pero no de vino, se asoció con mayor riesgo de hipertensión. La HR para el consumo diario de más de 0,5 copas de cerveza y licores, en comparación con los no bebedores, fue 1,53 (IC del 95%, 1,18-1,99). En cambio, la asociación entre el consumo de vino tinto y el riesgo de hipertensión fue inversa pero no significativa. Conclusiones. En esta población mediterránea, el consumo de cerveza y licores, pero no de vino, se asoció con mayor riesgo de hipertensión. El patrón de consumo semanal de alcohol, sin embargo, no tuvo un impacto significativo en el riesgo de hipertensión (AU)

Introduction and objectives. To assess prospectively the association between alcohol consumption, including alcoholic beverage preference and days of consumption per week, and the risk of hypertension in a Mediterranean cohort.Methods. We prospectively followed 9,963 Spanish men and women initially without hypertension. Self-reported and validated data on diet and hypertension diagnoses were collected.results. During follow-up (median [interquartile range], 4.2 [2.5-6.1] years), 554 incident cases of hypertension were identified over a total of 43,562 person-years. The hazard ratio for hypertension among those who consumed alcohol on ≥5 days per week was 1.28 (95% confidence interval, 0.97-1.7) compared to abstainers. Among those who drank alcohol ≥5 days per week, the hazard ratio for hypertension associated with consuming ≥1 drink per day was 1.45 (95% confidence interval, 1.06-2) compared with abstainers. The consumption of beer or spirits, but not wine, was associated with an increased risk of hypertension. The hazard ratio associated with consuming >0.5 drinks of beer or spirits per day was 1.53 (95% confidence interval, 1.18-1.99) compared with abstainers. In contrast, there was a nonsignificant inverse association between red wine intake and the risk of hypertension.Conclusions. In this Mediterranean population, the consumption of beer or spirits, but not wine, was associated with a higher risk of developing hypertension. However, the weekly pattern of alcohol consumption did not have a significant impact on the risk of hypertension (AU)

Metabolic risk factors in a cohort of young adults and their association with a body-mass index between 22 and 25kg/m2

Background and objectives: Although health risks associated to excessive body fat increase with small increases in body weight, measurement of body fat is usually grouped in very few categories. The aim of our study was to assess whether the risk for a combined end-point including the incidence of either hypertension and/or type 2 diabetes mellitus and/or the metabolic syndrome was elevated even within the “normal” limits of body-mass index (BMI). Material and methods: We followed up 10,639 initially healthy university graduates participating in the SUN dynamic cohort for a variable period ranging 2 to 6 years. Baseline BMI and physical activity were the major exposures. The combined end-point was defined by the incidence of either hypertension and/or type 2 diabetes and/or the metabolic syndrome during the follow-up period. We fitted non-conditional logistic regression models and nonparametric regression models (restricted cubic splines). Results: We observed 768 incident cases of the combined outcome (incidence of 16/1000 person-years) and found a monotonic linear association between BMI and the combined end-point. The multivariate-adjusted odds ratios for the combined end-point were 1.4 (95% CI: 1.1–1.7) for BMI 22–24.9kg/m2, 2.7 (2.1–3.5) for 25–29.9kg/m2 and 4.0 (2.8–5.6) for ≥30kg/m2. We observed a threshold effect in the association between physical activity and the combined end-point multivariate-adjusted odds ratio=0.8 (0.7–0.9) for >15METs-h/week. Conclusions: Our findings suggest that the incidence of metabolic risk factors (hypertension, diabetes mellitus and/or metabolic syndrome) is already increased at a BMI of 22kg/m2 in young adults. These results deserve consideration for judging whether the cut-off point for “normal” weight should be lowered (AU)

Fundamento y objetivo: Aunque el riesgo asociado a excesiva adiposidad aumente con pequeños incrementos de ésta, la medida de la grasa corporal (índice de masa corporal, IMC) se ha agrupado frecuentemente en pocas categorías. Este estudio pretende valorar si el riesgo de un desenlace combinado incluyendo la incidencia de hipertensión y/o diabetes y/o síndrome metabólico se eleva incluso dentro del rango considerado habitualmente como ‘‘normal’’ para el IMC. Material y métodos: 10.639 graduados universitarios inicialmente sanos de la cohorte dinámica SUN fueron seguidos durante un periodo variable de 2 a 6 años. El IMC y el ejercicio al inicio del estudio fueron las exposiciones estudiadas .Se definió un desenlace combinado que incluía la incidencia de hipertensión y/o diabetes mellitas tipo 2 y/o síndrome metabólico durante el seguimiento. Se ajustaron modelos de regresión logística no condicional y no paramétricos (restricted cubic splines). Resultados: Se hallaron 768 casos incidentes del desenlace combinado (incidencia de 16/1000 personas- año) y una asociación lineal progresiva entre el IMC y el desenlace combinado. Las odds ratios multivariables para el desenlace combinado fueron 1,4 (IC95%:1,1–1,7) para IMC22–24,9kg/m2, 2,7 (AU)

Influencia del sedentarismo y el hábito de comer entre horas sobre la ganancia de peso / Relative role of physical inactivity and snacking between meals in weight gain

FUNDAMENTO: La dieta y el estilo de vida sedentario son considerados los principales factores que pueden explicar el incremento actual en la obesidad. Aunque en ciertos países se haya registrado un descenso en la ingestión de grasas, el porcentaje de sobrepeso y obesidad ha aumentado en los últimos tiempos. Se piensa que la ingestión de grasa no tiene por qué ser el principal factor que determine la creciente prevalencia de obesidad. El objetivo de este estudio es determinar el papel que desempeñan una vida sedentaria y el hábito de comer entre horas como determinantes en un cambio de peso reciente (en los últimos 5 años). MÉTODO: Se han analizado de forma transversal los datos basales del proyecto SUN (Seguimiento Universidad de Navarra) un estudio prospectivo de cohortes basado en cuestionarios enviados por correo. A partir de estos datos, se ajustaron modelos de regresión logística no condicional para estimar las odds ratio (OR) de ganar peso ajustando por edad, actividad física durante el tiempo libre, horas dedicadas a ver la televisión, dormir la siesta, hábito tabáquico, hábito de comer entre horas e ingestión de diversos nutrientes. RESULTADOS: Se encontró una asociación negativa entre el incremento del ejercicio físico y la probabilidad de ganar peso, que sólo resultó significativa para varones (OR = 0,93; intervalo de confianza [IC] del 95 per cent, 0,88-0,98) pero se aproximó a la significación estadística entre las mujeres. El hábito de comer entre horas se asoció con una mayor probabilidad de ganar peso en varones (OR = 1,88; IC del 95 per cent, 1,40-2,53) y en mujeres (OR = 1,38; IC del 95 per cent, 1,101,73). CONCLUSIONES: Se encontraron evidencias que apoyan la hipótesis de que comer entre horas es un importante determinante en la ganancia de peso en edades medias de la vida (AU)