Role of Eating Behavior and Stress in Maintenance of Dietary Changes During the PREVIEW Intervention.

OBJECTIVE: To examine whether eating behavior and perceived stress predict the maintenance of self-reported dietary change and adherence to dietary instructions during an intervention. DESIGN: A secondary analysis of the behavior maintenance stage (6-36 months) of the 3-year PREVIEW intervention (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World). PARTICIPANTS: Adults (n = 1,311) with overweight and prediabetes at preintervention baseline. VARIABLES MEASURED: Eating behavior (Three-Factor Eating Questionnaire), stress (Perceived Stress Scale), and dietary intake (4-day food records on 4 occasions) were reported. ANALYSIS: Associations between predictors and dietary outcomes were examined with linear mixed-effects models for repeated measurements. RESULTS: Eating behaviors and stress at 6 months did not predict the subsequent change in dietary outcomes, but higher cognitive restraint predicted lower energy intake, and both higher disinhibition and hunger predicted higher energy intake during the following behavior maintenance stage. In addition, higher disinhibition predicted higher saturated fat intake and lower fiber intake, and higher hunger predicted lower fiber intake. Stress was not associated with energy intake or dietary quality. Eating behaviors and stress were not consistently associated with adherence to dietary instructions. CONCLUSIONS AND IMPLICATIONS: Higher cognitive restraint predicted lower energy intake (food quantity), but disinhibition and hunger were also associated with dietary quality.

Estimated Phytate Intake Is Associated with Bone Mineral Density in Mediterranean Postmenopausal Women.

The main objective of this work was to explore the association of dietary phytate intake with bone mineral density (BMD) in a Mediterranean population of postmenopausal women. For this purpose, a cross-sectional analysis of 561 women aged 55-75 years with overweight/obesity and metabolic syndrome from a Mediterranean area and with data on dual-energy X-ray absorptiometry (DXA) scans in femur and lumbar spine was performed. Estimated phytate intake was calculated using a validated food frequency questionnaire. Our results indicated that phytate intake was associated with BMD [ß(95%CI) per each 25 mg/100 kcal] in femoral neck [0.023(0.060-0.040) g/cm2], femoral Ward's triangle [0.033(0.013-0.054) g/cm2], total femur [0.018(0.001-0.035) g/cm2], and all the analyzed lumbar spine sites [L1-L4: 0.033(0.007-0.059) g/cm2] after adjusting for potential confounders. The sensitivity analysis showed that phytate intake was directly associated with lumbar spine BMD in women younger than 66 years, with a body mass index higher than 32.6 kg/cm2 and without type 2 diabetes (all p-for interactions < 0.05). The overall results indicated that phytate, a substance present in food as cereals, legumes and nuts, was positively associated with BMD in Mediterranean postmenopausal women. Phytate may have a protective effect on bone resorption by adsorbing on the surfaces of HAP. Nevertheless, large, long-term, and randomized prospective clinical studies must be performed to assess the possible benefits of phytate consumption on BMD in postmenopausal women.

Fecal Microbiota Composition as a Metagenomic Biomarker of Dietary Intake.

Gut microbiota encompasses the set of microorganisms that colonize the gastrointestinal tract with mutual relationships that are key for host homeostasis. Increasing evidence supports cross intercommunication between the intestinal microbiome and the eubiosis-dysbiosis binomial, indicating a networking role of gut bacteria as potential metabolic health surrogate markers. The abundance and diversity of the fecal microbial community are already recognized to be associated with several disorders, such as obesity, cardiometabolic events, gastrointestinal alterations, and mental diseases, which suggests that intestinal microbes may be a valuable tool as causal or as consequence biomarkers. In this context, the fecal microbiota could also be used as an adequate and informative proxy of the nutritional composition of the food intake and about the adherence to dietary patterns, such as the Mediterranean or Western diets, by displaying specific fecal microbiome signatures. The aim of this review was to discuss the potential use of gut microbial composition as a putative biomarker of food intake and to screen the sensitivity value of fecal microbiota in the evaluation of dietary interventions as a reliable and precise alternative to subjective questionnaires.

p27Kip1 Deficiency Impairs Brown Adipose Tissue Function Favouring Fat Accumulation in Mice.

The aim of this work was to investigate the effect of the whole-body deletion of p27 on the activity of brown adipose tissue and the susceptibility to develop obesity and glucose homeostasis disturbances in mice, especially when subjected to a high fat diet. p27 knockout (p27-/-) and wild type (WT) mice were fed a normal chow diet or a high fat diet (HFD) for 10-weeks. Body weight and composition were assessed. Insulin and glucose tolerance tests and indirect calorimetry assays were performed. Histological analysis of interscapular BAT (iBAT) was carried out, and expression of key genes/proteins involved in BAT function were characterized by qPCR and Western blot. iBAT activity was estimated by 18F-fluorodeoxyglucose (18FDG) uptake with microPET. p27-/- mice were more prone to develop obesity and insulin resistance, exhibiting increased size of all fat depots. p27-/- mice displayed a higher respiratory exchange ratio. iBAT presented larger adipocytes in p27-/- HFD mice, accompanied by downregulation of both Glut1 and uncoupling protein 1 (UCP1) in parallel with defective insulin signalling. Moreover, p27-/- HFD mice exhibited impaired response to cold exposure, characterized by a reduced iBAT 18FDG uptake and difficulty to maintain body temperature when exposed to cold compared to WT HFD mice, suggesting reduced thermogenic capacity. These data suggest that p27 could play a role in BAT activation and in the susceptibility to develop obesity and insulin resistance.

Association of the leptin receptor rs1805134 polymorphism with obesity parameters, dietary intakes, and metabolic syndrome in Caucasian obese subjects / Asociación del polimorfismo del receptor de leptina rs 1805134 con parámetros de obesidad, ingesta alimentaria y síndrome metabólico en sujetos caucásicos con obesidad

Background: some studies have evaluated the association of the rs1805134 genetic variant of the LEPR gene with obesity. Aims: the objective was to explore the association of the rs1805134 genetic variant of the LEPR gene with obesity measures and metabolic syndrome in obese Caucasian adults. Methods: we conducted a cross-sectional study in 212 obese subjects with body mass index (BMI) greater than 30 kg/m2. Measurements of adiposity parameters, blood pressure, fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), lipid profile, C-reactive protein, and prevalence of metabolic syndrome were determined. Results: the distribution of rs1805134 was 128 TT (60.4 %), 77 TC (36.3 %), and 7 CC (3.3 %). C-allele carriers showed higher levels of BMI, body weight, body fat mass, waist circumference, insulin, HOMA-IR, triglycerides, total energy intake, and carbohydrate intake than non-C-allele carriers. A logistic regression analysis reported a high percentage of elevated waist circumference (OR = 2.22, 95 % CI = 1.201-4.97; p = 0.02), hyperglycemia (OR = 1.54, 95 % CI = 1.01-5.44; p = 0.01), and metabolic syndrome percentage (OR = 1.41, 95 % CI = 1.04-5.39; p = 0.03) in C-allele carriers. Conclusions: subjects with the C-allele of the rs1805134 variant of the LEPR gene showed a worse metabolic pattern with a higher percentage of metabolic syndrome, central obesity and hyperglycaemia, probably related to higher energy intake. (AU)

Antecedentes: algunos estudios han evaluado la asociación de la variante genética rs1805134 del gen LEPR con la obesidad. Objetivos: el objetivo fue explorar la asociación de la variante genética rs1805134 del gen LEPR con los parámetros de obesidad y síndrome metabólico en adultos caucásicos obesos. Métodos: realizamos un estudio transversal en 212 sujetos obesos con índice de masa corporal (IMC) superior a 30 kg/m2 . Se determinaron los parámetros de adiposidad, presión arterial, glucemia en ayunas, concentración de insulina, resistencia a la insulina (HOMA-IR), perfil lipídico, proteína C-reactiva y prevalencia de síndrome metabólico. Resultados: la distribución del rs1805134 fue de 128 TT (60,4 %), 77 TC (36,3 %) y 7 CC (3,3 %). Los portadores del alelo C mostraron niveles más altos de IMC, peso corporal, masa grasa corporal, circunferencia de la cintura, insulina, HOMA-IR, triglicéridos, ingesta total de energía y consumo de carbohidratos que los portadores sin alelo C. El análisis de regresión logística mostró un alto porcentaje de pacientes con elevada circunferencia de la cintura (OR = 2,22, IC 95 % = 1,201-4,97; p = 0,02), hiperglucemia (OR = 1,54, IC 95 % = 1,01-5,44; p = 0,01) y síndrome metabólico (OR = 1,41, IC 95 % = 1,04-5,39; p = 0,03) en los portadores del alelo C. Conclusiones: los sujetos con alelo C de la variante rs1805134 del gen LEPR mostraron un peor patrón metabólico con mayor porcentaje de síndrome metabólico, obesidad central e hiperglucemia, probablemente relacionado con una mayor ingesta energética. (AU)

Dietary intervention with 2 different fat profiles; role of the rs822393 variant in metabolic parameter changes / Intervención dietética con 2 perfiles diferentes de grasa; papel de la variante rs822393en la modificación de parámetros metabólicos

Introduction: rs822393 is related to dietary intervention responses. The aim of our study was to analyze the metabolic effects of 2 hypocaloric diets with a different fat profile during 3 months according to the genetic variant rs822393. Methods: a population of 361 obese patients were randomly allocated to one of two diets; Diet P (enriched in polyunsaturated fatty acids) vs. Diet M (enriched in monounsaturated fatty acids). Adiposity and biochemical parameters were determined. rs822393 was assessed by real-time PCR, with a dominant model analysis (CC vs CT+TT). Results: genotype distribution was: 221 CC (61.2 %), 115 CT (31.9 %) and 25 TT (6.9 %). Basal and post-intervention HDL cholesterol, adiponectin levels and adiponectin/leptin ratio were lower in T-allele than non-T-allele carriers. After both diets, BMI, weight, fat mass, waist circumference, systolic blood pressure, insulin levels, HOMA-IR, leptin, total cholesterol and LDL-cholesterol improved significantly in both genotype groups. After Diet P, HDL-cholesterol (delta: 5.6 ± 1.1 mg/dl vs. 2.7 ± 0.9 mg/dl; p = 0.01), serum adiponectin (20.1 ± 2.9 ng/dl vs. 6.8 ± 3.0 ng/dl; p = 0.02) and adiponectin/leptin ratio (0.57 ± 0.1 units vs. 0.20 ± 0.08 units; p = 0.03) improved in non-T allele carriers. The same improvements were observed after Diet M: HDL-cholesterol (delta: 5.5 ± 0.8 mg/dl vs. 3.1 ± 0.9 mg/dl; p = 0.03), serum adiponectin (19.5 ± 2.9 ng/dl vs. 4.5 ± 2.8 ng/dl; p = 0.01), and adiponectin/leptin ratio (0.54 ± 0.1 units vs. 0.15 ± 0.08 units; p = 0.03). These parameters remained unchanged in T-allele carriers. (AU)

Introducción: el polimorfismo rs822393 está relacionado con las respuestas a las intervenciones dietéticas. El objetivo de nuestro estudio fue analizar los efectos metabólicos de 2 dietas hipocalóricas con diferente perfil graso durante 3 meses según la variante genética rs822393. Métodos: una muestra de 361 pacientes obesos se asignó aleatoriamente a una de dos dietas: dieta P (enriquecida en ácidos grasos poliinsaturados) y dieta M (enriquecida en ácidos grasos monoinsaturados). Se determinaron parámetros de adiposidad y bioquímicos; rs822393 se evaluó mediante PCR en tiempo real, con un análisis de modelo dominante (CC frente a CT+TT). Resultados: la distribución del genotipo fue: 221 CC (61,2 %), 115 CT (31,9 %) y 25 TT (6,9 %). El colesterol HDL basal y posterior a la intervención, los niveles de adiponectina y la relación adiponectina/leptina fueron más bajos en los portadores del alelo T que en los no portadores del alelo T. Tras la intervención con ambas dietas, el IMC, el peso, la masa grasa, la circunferencia de la cintura, la presión arterial sistólica, los niveles de insulina, el HOMA-IR, la leptina, el colesterol total y el colesterol LDL mejoraron significativamente en ambos grupos de genotipo. Después de la dieta P: HDL-colesterol (delta: 5,6 ± 1,1 mg/dl vs. 2,7 ± 0,9 mg/dl; p = 0,01), adiponectina sérica (20,1 ± 2,9 ng/dl vs. 6,8 ± 3,0 ng/dl; p = 0,02) y la relación adiponectina/leptina (0,57 ± 0,1 unidades frente a 0,20 ± 0,08 unidades; p = 0,03) mejoraron en los no portadores del alelo T. Se observaron los mismos resultados después de la dieta M: HDL-colesterol (delta: 5,5 ± 0,8 mg/dl frente a 3,1 ± 0,9 mg/dl; p = 0,03), adiponectina sérica (19,5 ± 2,9 ng/dl frente a 4,5 ± 2,8 ng /dl; p = 0,01) y relación adiponectina/leptina (0,54 ± 0,1 unidades vs. 0,15 ± 0,08 unidades; p = 0,03). Estos parámetros permanecieron sin cambios en los portadores del alelo T. (AU)

Association of the leptin receptor rs 1805134 polymorphism with obesity parameters, dietary intakes, and metabolic syndrome in Caucasian obese subjects.

Introduction: Background: some studies have evaluated the association of the rs1805134 genetic variant of the LEPR gene with obesity. Aims: the objective was to explore the association of the rs1805134 genetic variant of the LEPR gene with obesity measures and metabolic syndrome in obese Caucasian adults. Methods: we conducted a cross-sectional study in 212 obese subjects with body mass index (BMI) greater than 30 kg/m2. Measurements of adiposity parameters, blood pressure, fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), lipid profile, C-reactive protein, and prevalence of metabolic syndrome were determined. Results: the distribution of rs1805134 was 128 TT (60.4 %), 77 TC (36.3 %), and 7 CC (3.3 %). C-allele carriers showed higher levels of BMI, body weight, body fat mass, waist circumference, insulin, HOMA-IR, triglycerides, total energy intake, and carbohydrate intake than non-C-allele carriers. A logistic regression analysis reported a high percentage of elevated waist circumference (OR = 2.22, 95 % CI = 1.201-4.97; p = 0.02), hyperglycemia (OR = 1.54, 95 % CI = 1.01-5.44; p = 0.01), and metabolic syndrome percentage (OR = 1.41, 95 % CI = 1.04-5.39; p = 0.03) in C-allele carriers. Conclusions: subjects with the C-allele of the rs1805134 variant of the LEPR gene showed a worse metabolic pattern with a higher percentage of metabolic syndrome, central obesity and hyperglycaemia, probably related to higher energy intake.

Introducción: Antecedentes: algunos estudios han evaluado la asociación de la variante genética rs1805134 del gen LEPR con la obesidad. Objetivos: el objetivo fue explorar la asociación de la variante genética rs1805134 del gen LEPR con los parámetros de obesidad y síndrome metabólico en adultos caucásicos obesos. Métodos: realizamos un estudio transversal en 212 sujetos obesos con índice de masa corporal (IMC) superior a 30 kg/m2. Se determinaron los parámetros de adiposidad, presión arterial, glucemia en ayunas, concentración de insulina, resistencia a la insulina (HOMA-IR), perfil lipídico, proteína C-reactiva y prevalencia de síndrome metabólico. Resultados: la distribución del rs1805134 fue de 128 TT (60,4 %), 77 TC (36,3 %) y 7 CC (3,3 %). Los portadores del alelo C mostraron niveles más altos de IMC, peso corporal, masa grasa corporal, circunferencia de la cintura, insulina, HOMA-IR, triglicéridos, ingesta total de energía y consumo de carbohidratos que los portadores sin alelo C. El análisis de regresión logística mostró un alto porcentaje de pacientes con elevada circunferencia de la cintura (OR = 2,22, IC 95 % = 1,201-4,97; p = 0,02), hiperglucemia (OR = 1,54, IC 95 % = 1,01-5,44; p = 0,01) y síndrome metabólico (OR = 1,41, IC 95 % = 1,04-5,39; p = 0,03) en los portadores del alelo C. Conclusiones: los sujetos con alelo C de la variante rs1805134 del gen LEPR mostraron un peor patrón metabólico con mayor porcentaje de síndrome metabólico, obesidad central e hiperglucemia, probablemente relacionado con una mayor ingesta energética.

Dietary intervention with 2 different fat profiles; role of the rs822393 variant in metabolic parameter changes.

Introduction: Introduction: rs822393 is related to dietary intervention responses. The aim of our study was to analyze the metabolic effects of 2 hypocaloric diets with a different fat profile during 3 months according to the genetic variant rs822393. Methods: a population of 361 obese patients were randomly allocated to one of two diets; Diet P (enriched in polyunsaturated fatty acids) vs. Diet M (enriched in monounsaturated fatty acids). Adiposity and biochemical parameters were determined. rs822393 was assessed by real-time PCR, with a dominant model analysis (CC vs CT+TT). Results: genotype distribution was: 221 CC (61.2 %), 115 CT (31.9 %) and 25 TT (6.9 %). Basal and post-intervention HDL cholesterol, adiponectin levels and adiponectin/leptin ratio were lower in T-allele than non-T-allele carriers. After both diets, BMI, weight, fat mass, waist circumference, systolic blood pressure, insulin levels, HOMA-IR, leptin, total cholesterol and LDL-cholesterol improved significantly in both genotype groups. After Diet P, HDL-cholesterol (delta: 5.6 ± 1.1 mg/dl vs. 2.7 ± 0.9 mg/dl; p = 0.01), serum adiponectin (20.1 ± 2.9 ng/dl vs. 6.8 ± 3.0 ng/dl; p = 0.02) and adiponectin/leptin ratio (0.57 ± 0.1 units vs. 0.20 ± 0.08 units; p = 0.03) improved in non-T allele carriers. The same improvements were observed after Diet M: HDL-cholesterol (delta: 5.5 ± 0.8 mg/dl vs. 3.1 ± 0.9 mg/dl; p = 0.03), serum adiponectin (19.5 ± 2.9 ng/dl vs. 4.5 ± 2.8 ng/dl; p = 0.01), and adiponectin/leptin ratio (0.54 ± 0.1 units vs. 0.15 ± 0.08 units; p = 0.03). These parameters remained unchanged in T-allele carriers. Conclusion: after two different hypocaloric diets, obese subjects with the T allele of rs822393 did not improve their adiponectin levels, ratio adiponectin/leptin, and HDL-cholesterol, despite loss of weight.

Introducción: Introducción: el polimorfismo rs822393 está relacionado con las respuestas a las intervenciones dietéticas. El objetivo de nuestro estudio fue analizar los efectos metabólicos de 2 dietas hipocalóricas con diferente perfil graso durante 3 meses según la variante genética rs822393. Métodos: una muestra de 361 pacientes obesos se asignó aleatoriamente a una de dos dietas: dieta P (enriquecida en ácidos grasos poliinsaturados) y dieta M (enriquecida en ácidos grasos monoinsaturados). Se determinaron parámetros de adiposidad y bioquímicos; rs822393 se evaluó mediante PCR en tiempo real, con un análisis de modelo dominante (CC frente a CT+TT). Resultados la distribución del genotipo fue: 221 CC (61,2 %), 115 CT (31,9 %) y 25 TT (6,9 %). El colesterol HDL basal y posterior a la intervención, los niveles de adiponectina y la relación adiponectina/leptina fueron más bajos en los portadores del alelo T que en los no portadores del alelo T. Tras la intervención con ambas dietas, el IMC, el peso, la masa grasa, la circunferencia de la cintura, la presión arterial sistólica, los niveles de insulina, el HOMA-IR, la leptina, el colesterol total y el colesterol LDL mejoraron significativamente en ambos grupos de genotipo. Después de la dieta P: HDL-colesterol (delta: 5,6 ± 1,1 mg/dl vs. 2,7 ± 0,9 mg/dl; p = 0,01), adiponectina sérica (20,1 ± 2,9 ng/dl vs. 6,8 ± 3,0 ng/dl; p = 0,02) y la relación adiponectina/leptina (0,57 ± 0,1 unidades frente a 0,20 ± 0,08 unidades; p = 0,03) mejoraron en los no portadores del alelo T. Se observaron los mismos resultados después de la dieta M: HDL-colesterol (delta: 5,5 ± 0,8 mg/dl frente a 3,1 ± 0,9 mg/dl; p = 0,03), adiponectina sérica (19,5 ± 2,9 ng/dl frente a 4,5 ± 2,8 ng /dl; p = 0,01) y relación adiponectina/leptina (0,54 ± 0,1 unidades vs. 0,15 ± 0,08 unidades; p = 0,03). Estos parámetros permanecieron sin cambios en los portadores del alelo T. Conclusión: tras las dos dietas hipocalóricas diferentes, los sujetos obesos con el alelo T de rs822393 no mejoraron los niveles de adiponectina, ratio adiponectina/leptina y colesterol HDL, a pesar de la pérdida de peso.

Health associations of liver enzymes and inflammatory scores with urinary citrus flavonoid metabolites.

Background: Dietary flavonoid intake is associated with a reduced risk of some cardiometabolic disorders, attributed in part to their claimed anti-inflammatory activity. Our aim was to investigate the potential association between specific urine flavonoid metabolites, liver enzymes, and inflammatory status in individuals with metabolic syndrome (MetS). Methods: In this cross-sectional study, clinical and dietary data from 267 participants, aged 55 to 75 years, participating in the PREDIMED Plus study (PREvención con DIeta MEDiterránea) were analyzed. At the baseline, spot urine samples were collected and seven urinary flavonoid metabolites were quantified using ultra-performance liquid chromatography coupled to triple quadrupole mass spectrometry (UPLC-Q-q-Q MS). Liver enzymes, inflammatory scores, and urinary flavonoid concentrations were inverse normally transformed. Results: Adjusted linear regression models showed an inverse association between urinary citrus flavanone concentrations and gamma-glutamyl transferase (GGT) (all p-values <0.05). Naringenin 7'-GlcUA was significantly associated with a lower aggregate index of systemic inflammation (AISI) (Bper 1SD = -0.14; 95% CI: -0.27 to -0.02; p-value = 0.025) and systemic inflammation index (SII) (Bper 1SD = -0.14; 95% CI: -0.27 to -0.02; p-value = 0.028). To investigate the relationship between flavanone subclasses and GGT levels, we fitted a score of citrus-flavanones, and subjects were stratified into quartiles. The highest values of the citrus-flavanone score (per 1-SD increase) were associated with lower GGT levels (Bper 1SD = -0.41; 95% CI: -0.74 to -0.07), exhibiting a linear trend across quartiles (p-trend = 0.015). Conclusion: This cross-sectional study showed that higher urinary excretion of citrus-flavanone metabolites was associated with lower GGT levels in subjects diagnosed with MetS and obesity.

Acute and repeated impact of sweeteners and sweetness enhancers in solid and semi-solid foods on appetite: protocol for a multicentre, cross-over, RCT in people with overweight/obesity - the SWEET Project.

INTRODUCTION: Intake of free sugars in European countries is high and attempts to reduce sugar intake have been mostly ineffective. Non-nutritive sweeteners and sweetness enhancers (S&SEs) can maintain sweet taste in the absence of energy, but little is known about the impact of acute and repeated consumption of S&SE in foods on appetite. This study aims to evaluate the effect of acute and repeated consumption of two individual S&SEs and two S&SE blends in semisolid and solid foods on appetite and related behavioural, metabolic and health outcomes. METHODS AND ANALYSIS: A work package of the SWEET Project; this study consists of five double-blind randomised cross-over trials which will be carried out at five sites across four European countries, aiming to have n=213. Five food matrices will be tested across three formulations (sucrose-sweetened control vs two reformulated products with S&SE blends and no added sugar). Participants (body mass index 25-35 kg/m2; aged 18-60 years) will consume each formulation for 14 days. The primary endpoint is composite appetite score (hunger, inverse of fullness, desire to eat and prospective food consumption) over a 3-hour postprandial incremental area under the curve during clinical investigation days on days 1 and 14. ETHICS AND DISSEMINATION: The trial has been approved by national ethical committees and will be conducted in accordance with the Declaration of Helsinki. Results will be published in international peer-reviewed open-access scientific journals. Research data from the trial will be deposited in an open-access online research data archive. TRIAL REGISTRATION NUMBER: NCT04633681.

Interactive Role of Surrogate Liver Fibrosis Assessment and Insulin Resistance on the Incidence of Major Cardiovascular Events.

Introduction: The combination of easy-to-obtain validated biomarkers is interesting in the prognostic evaluation of patients at cardiovascular risk in a precision medicine scenario. The evaluation of the effect modification of insulin resistance and liver fibrosis with the Triglyceride-Glucose index (TyG) and Fibrosis-4 index (FIB4) might provide prognostic information in patients at cardiovascular risk. Patients and methods: A retrospective cohort study was performed with 2055 patients recruited in the Vascular Metabolic CUN cohort. The studied outcome was the incidence rate of major cardiovascular events (MACE). The Systematic Coronary Risk Evaluation (SCORE), FIB4 and TyG indexes were calculated according to validated formulas. Results: FIB4 and TyG showed a synergistic interaction using validated cut-offs for both indexes in the prediction of MACE (Hazard ratio (HR) 1.05 CI95% 1.01-1.08) which remained after adjustment by age, sex, SCORE subgroup, presence of diabetes, or previous MACE using standardized cut-off (HR 2.29 CI95% 1.33-3.94). Finally, a subgroup with significant TyG and FIB4 showed a higher cardiovascular risk in the study population (adjusted HR 3.34 CI 95% 1.94-5.77). Conclusion: The combined interpretation of TyG and FIB4 indexes might have a potential predictive value of major cardiovascular events.

Dietary diversity and depression: cross-sectional and longitudinal analyses in Spanish adult population with metabolic syndrome. Findings from PREDIMED-Plus trial.

OBJECTIVE: To examine the cross-sectional and longitudinal (2-year follow-up) associations between dietary diversity (DD) and depressive symptoms. DESIGN: An energy-adjusted dietary diversity score (DDS) was assessed using a validated FFQ and was categorised into quartiles (Q). The variety in each food group was classified into four categories of diversity (C). Depressive symptoms were assessed with Beck Depression Inventory-II (Beck II) questionnaire and depression cases defined as physician-diagnosed or Beck II >= 18. Linear and logistic regression models were used. SETTING: Spanish older adults with metabolic syndrome (MetS). PARTICIPANTS: A total of 6625 adults aged 55-75 years from the PREDIMED-Plus study with overweight or obesity and MetS. RESULTS: Total DDS was inversely and statistically significantly associated with depression in the cross-sectional analysis conducted; OR Q4 v. Q1 = 0·76 (95 % CI (0·64, 0·90)). This was driven by high diversity compared to low diversity (C3 v. C1) of vegetables (OR = 0·75, 95 % CI (0·57, 0·93)), cereals (OR = 0·72 (95 % CI (0·56, 0·94)) and proteins (OR = 0·27, 95 % CI (0·11, 0·62)). In the longitudinal analysis, there was no significant association between the baseline DDS and changes in depressive symptoms after 2 years of follow-up, except for DD in vegetables C4 v. C1 = (ß = 0·70, 95 % CI (0·05, 1·35)). CONCLUSIONS: According to our results, DD is inversely associated with depressive symptoms, but eating more diverse does not seem to reduce the risk of future depression. Additional longitudinal studies (with longer follow-up) are needed to confirm these findings.

Hematological- and Immunological-Related Biomarkers to Characterize Patients with COVID-19 from Other Viral Respiratory Diseases.

COVID-19 has overloaded health system worldwide; thus, it demanded a triage method for an efficient and early discrimination of patients with COVID-19. The objective of this research was to perform a model based on commonly requested hematological variables for an early featuring of patients with COVID-19 form other viral pneumonia. This investigation enrolled 951 patients (mean of age 68 and 56% of male) who underwent a PCR test for respiratory viruses between January 2019 and January 2020, and those who underwent a PCR test for detection of SARS-CoV-2 between February 2020 and October 2020. A comparative analysis of the population according to PCR tests and logistic regression model was performed. A total of 10 variables were found for the characterization of COVID-19: age, sex, anemia, immunosuppression, C-reactive protein, chronic obstructive pulmonary disease, cardiorespiratory disease, metastasis, leukocytes and monocytes. The ROC curve revealed a sensitivity and specificity of 75%. A deep analysis showed low levels of leukocytes in COVID-19-positive patients, which could be used as a primary outcome of COVID-19 detection. In conclusion, this investigation found that commonly requested laboratory variables are able to help physicians to distinguish COVID-19 and perform a quick stratification of patients into different prognostic categories.

Longwise Cluster Analysis for the Prediction of COVID-19 Severity within 72 h of Admission: COVID-DATA-SAVE-LIFES Cohort.

The use of routine laboratory biomarkers plays a key role in decision making in the clinical practice of COVID-19, allowing the development of clinical screening tools for personalized treatments. This study performed a short-term longitudinal cluster from patients with COVID-19 based on biochemical measurements for the first 72 h after hospitalization. Clinical and biochemical variables from 1039 confirmed COVID-19 patients framed on the "COVID Data Save Lives" were grouped in 24-h blocks to perform a longitudinal k-means clustering algorithm to the trajectories. The final solution of the three clusters showed a strong association with different clinical severity outcomes (OR for death: Cluster A reference, Cluster B 12.83 CI: 6.11−30.54, and Cluster C 14.29 CI: 6.66−34.43; OR for ventilation: Cluster-B 2.22 CI: 1.64−3.01, and Cluster-C 1.71 CI: 1.08−2.76), improving the AUC of the models in terms of age, sex, oxygen concentration, and the Charlson Comorbidities Index (0.810 vs. 0.871 with p < 0.001 and 0.749 vs. 0.807 with p < 0.001, respectively). Patient diagnoses and prognoses remarkably diverged between the three clusters obtained, evidencing that data-driven technologies devised for the screening, analysis, prediction, and tracking of patients play a key role in the application of individualized management of the COVID-19 pandemics.

Contribution of cardio-vascular risk factors to depressive status in the PREDIMED-PLUS Trial. A cross-sectional and a 2-year longitudinal study.

BACKGROUND: Cardio-vascular disease and depression are thought to be closely related, due to shared risk factors. The aim of the study was to determine the association between cardio-vascular risk (CVR) factors and depressive status in a population (55-75 years) with metabolic syndrome (MetS) from the PREDIMED-Plus trial. METHODS AND FINDINGS: Participants were classified into three groups of CVR according to the Framingham-based REGICOR function: (1) low (LR), (2) medium (MR) or (3) high/very high (HR). The Beck Depression Inventory-II (BDI-II) was used to assess depressive symptoms at baseline and after 2 years. The association between CVR and depressive status at baseline (n = 6545), and their changes after 2 years (n = 4566) were evaluated through multivariable regression models (logistic and linear models). HR women showed higher odds of depressive status than LR [OR (95% CI) = 1.78 (1.26, 2.50)]. MR and HR participants with total cholesterol <160 mg/mL showed higher odds of depression than LR [OR (95% CI) = 1.77 (1.13, 2.77) and 2.83 (1.25, 6.42) respectively)] but those with total cholesterol ≥280 mg/mL showed lower odds of depression than LR [OR (95% CI) = 0.26 (0.07, 0.98) and 0.23 (0.05, 0.95), respectively]. All participants decreased their BDI-II score after 2 years, being the decrease smaller in MR and HR diabetic compared to LR [adjusted mean±SE = -0.52±0.20, -0.41±0.27 and -1.25±0.31 respectively). MR and HR participants with total cholesterol between 240-279 mg/mL showed greater decreases in the BDI-II score compared to LR (adjusted mean±SE = -0.83±0.37, -0.77±0.64 and 0.97±0.52 respectively). CONCLUSIONS: Improving cardiovascular health could prevent the onset of depression in the elderly. Diabetes and total cholesterol in individuals at high CVR, may play a specific role in the precise response. International Standard Randomized Controlled Trial (ISRCTN89898870).

Association between Physical Activity and Non-Alcoholic Fatty Liver Disease in Adults with Metabolic Syndrome: The FLIPAN Study.

Background: A lifestyle with regular PA (physical activity) and Mediterranean diet has benefits on NAFLD (non-alcoholic fatty liver disease) and MetS (metabolic syndrome). Objectives: To assess the association between physical activity and NAFLD in adults with MetS. Design: Cross-sectional study in 155 participants (40−60 years old) from Balearic Islands and Navarra (Spain) with diagnosis of NAFLD and MetS, and BMI (body mass index) between 27 and 40 Kg/m2. Methods: PA level was categorized into two groups according to weekly METs (metabolic equivalents of tasks). PA was assessed using a validated Minnesota questionnaire and accelerometers. MetS parameters were assessed by blood collection analysis and NAFLD by abdominal MRI (magnetic resonance imaging). Results: Participants with high PA showed more energy expenditure and expended more calories than ingested (−143.9 Kcal/day; p < 0.001). PA was a risk factor for AST (aspartate aminotransferase) (adjusted OR: 7.26; 95% CI: 1.79−29.40) and a protective factor for ALT (alanine aminotransferase) (adjusted OR: 0.24; 95% CI: 0.12−0.48), GGT (gamma-glutamyl transferase) (adjusted OR: 0.52; 95% CI: 0.29−0.94) and IFC-NMR (intrahepatic fat content by nuclear magnetic resonance) (adjusted OR: 0.26; 95% CI: 0.12−0.56) when sociodemographic confounders were considered. Conclusions: NAFLD patients with high PA showed more positive relationship on MetS parameters and liver profile (ALT, GGT, IFC-NMR) than subjects with low PA, but not for AST. Difference between calories ingested and expended influenced this relationship.

Adopting a High-Polyphenolic Diet Is Associated with an Improved Glucose Profile: Prospective Analysis within the PREDIMED-Plus Trial.

Previous studies suggested that dietary polyphenols could reduce the incidence and complications of type-2 diabetes (T2D); although the evidence is still limited and inconsistent. This work analyzes whether changing to a diet with a higher polyphenolic content is associated with an improved glucose profile. At baseline, and at 1 year of follow-up visits, 5921 participants (mean age 65.0 ± 4.9, 48.2% women) who had overweight/obesity and metabolic syndrome filled out a validated 143-item semi-quantitative food frequency questionnaire (FFQ), from which polyphenol intakes were calculated. Energy-adjusted total polyphenols and subclasses were categorized in tertiles of changes. Linear mixed-effect models with random intercepts (the recruitment centers) were used to assess associations between changes in polyphenol subclasses intake and 1-year plasma glucose or glycosylated hemoglobin (HbA1c) levels. Increments in total polyphenol intake and some classes were inversely associated with better glucose levels and HbA1c after one year of follow-up. These associations were modified when the analyses were run considering diabetes status separately. To our knowledge, this is the first study to assess the relationship between changes in the intake of all polyphenolic groups and T2D-related parameters in a senior population with T2D or at high-risk of developing T2D.

Integrative development of a short screening questionnaire of highly processed food consumption (sQ-HPF).

BACKGROUND: Recent lifestyle changes include increased consumption of highly processed foods (HPF), which has been associated with an increased risk of non-communicable diseases (NCDs). However, nutritional information relies on the estimation of HPF consumption from food-frequency questionnaires (FFQ) that are not explicitly developed for this purpose. We aimed to develop a short screening questionnaire of HPF consumption (sQ-HPF) that integrates criteria from the existing food classification systems. METHODS: Data from 4400 participants (48.1% female and 51.9% male, 64.9 ± 4.9 years) of the Spanish PREDIMED-Plus ("PREvention with MEDiterranean DIet") trial were used for this analysis. Items from the FFQ were classified according to four main food processing-based classification systems (NOVA, IARC, IFIC and UNC). Participants were classified into tertiles of HPF consumption according to each system. Using binomial logistic regression, food groups associated with agreement in the highest tertile for at least two classification systems were chosen as items for the questionnaire. ROC analysis was used to determine cut-off points for the frequency of consumption of each item, from which a score was calculated. Internal consistency of the questionnaire was assessed through exploratory factor analysis (EFA) and Cronbach's analysis, and agreement with the four classifications was assessed with weighted kappa coefficients. RESULTS: Regression analysis identified 14 food groups (items) associated with high HPF consumption for at least two classification systems. EFA showed that items were representative contributors of a single underlying factor, the "HPF dietary pattern" (factor loadings around 0.2). We constructed a questionnaire asking about the frequency of consumption of those items. The threshold frequency of consumption was selected using ROC analysis. Comparison of the four classification systems and the sQ-HPF showed a fair to high agreement. Significant changes in lifestyle characteristics were detected across tertiles of the sQ-HPF score. Longitudinal changes in HPF consumption were also detected by the sQ-HPF, concordantly with existing classification systems. CONCLUSIONS: We developed a practical tool to measure HPF consumption, the sQ-HPF. This may be a valuable instrument to study its relationship with NCDs. TRIAL REGISTRATION: Retrospectively registered at the International Standard Randomized Controlled Trial Registry ( ISRCTN89898870 ) on July 24, 2014.

Lifestyle and Health-Related Quality of Life Relationships Concerning Metabolic Disease Phenotypes on the Nutrimdea Online Cohort.

Obesity, diabetes and cardiovascular events are non-communicable diseases (NCDs) directly related to lifestyle and life quality. Rises on NCDs rates are leading to increases in early deaths concerning metabolic morbidities. Health-related quality of life (HRQoL) has been described as a subjective perception about the influence of health and personal features on human well-being. This study aimed to characterize phenotypic and lifestyle roles on the occurrence of metabolic diseases and determine the potential mutual interactions and with HRQoL. Data from an online adult population (NUTRiMDEA study, n = 17,332) were used to estimate an adapted Obesogenic Score (ObS), while logistic regression analyses were fitted in order to examine relevant factors related to the prevalence of different metabolic diseases including HRQoL. Sex and age showed significant differences depending on lifestyle and metabolic health (p < 0.05). Adherence to the Mediterranean diet and physical activity showed a mutual interaction concerning ObS (p < 0.001), as well with metabolic health (p = 0.044). Furthermore, metabolic diseases showed own features related to sociodemographic and lifestyle characteristics in this population. Metabolic syndrome components may be differently influenced by diverse lifestyle or socioeconomic factors which in turn affect the perceived HRQoL. These outcomes should be taken into account individually for a precision medicine and public health purposes.

Inflammatory potential of diet and bone mineral density in a senior Mediterranean population: a cross-sectional analysis of PREDIMED-Plus study.

PURPOSE: Inflammation could play a key role in tissue damage and bone metabolism. The modified dietary inflammatory score (M-DIS) is a validated tool to estimate the inflammatory potential of the diet. In the present study, we evaluate the associations between the M-DIS and bone mineral density (BMD) in a senior Mediterranean population with overweight/obesity and metabolic syndrome. METHODS: Baseline cross-sectional association between the M-DIS and bone mineral density was assessed in 1134 participants of the multicenter PREDIMED-Plus trial (aged 55-75 with overweight/obesity and metabolic syndrome). BMD was measured using Dual-energy X-ray Absorptiometry scans and participants answered a food frequency questionnaire to determine the M-DIS. BMD was categorized as low BMD when T score was equal or lower than -1 and normal BMD in another case. Associations between BMD and M-DIS were evaluated by using linear and logistic regressions adjusted by other co-variates. RESULTS: Participants in the top tertile of the M-DIS had a lower BMD at total femur [ß (95% CI) - 0.02 (- 0.04, - 0.01)], trochanter areas [ß (95% CI) - 0.03 (- 0.05, - 0.01)] and lumbar spine area [ß (95% CI) - 0.03 (- 0.07, 0.01)] (but in the last case, measures were less precise and hence not statistically significant) compared to those in the lower M-DIS tertile. Multiple logistic regression analyses showed that the odds of the total femur and femoral trochanter osteopenia/osteoporosis were higher in participants in the top tertile compared to those in the lowest tertile of M-DIS [OR (95% CI) 1.71 (1.12, 2.64), P for trend 0.015; 2.02 (1.29, 3.21), P for trend 0.002, respectively]. CONCLUSION: A high pro-inflammatory diet, measured by the M-DIS, is associated with lower BMD in a senior Mediterranean population with metabolic syndrome.