Mitochondrial Genetic Background May Impact Statins Side Effects and Atherosclerosis Development in Familial Hypercholesterolemia.

Heredity of familial hypercholesterolemia (FH) can present as a dominant monogenic disorder of polygenic origin or with no known genetic cause. In addition, the variability of the symptoms among individuals or within the same families evidence the potential contribution of additional factors than monogenic mutations that could modulate the development and severity of the disease. In addition, statins, the lipid-lowering drugs which constitute the first-line therapy for the disease, cause associated muscular symptoms in a certain number of individuals. Here, we analyze the evidence of the mitochondrial genetic variation with a special emphasis on the role of CoQ10 to explain this variability found in both disease symptoms and statins side effects. We propose to use mtDNA variants and copy numbers as markers for the cardiovascular disease development of FH patients and to predict potential statin secondary effects and explore new mechanisms to identify new markers of disease or implement personalized medicine strategies for FH therapy.

Nutrition Literacy and Healthy Diet: Findings from the Validation of a Short Seniors-Oriented Screening Tool, the Spanish Myths-NL.

A good level of nutrition literacy (NL) is proposed as a determinant factor for following a healthy diet. Improving seniors' NL might be particularly pertinent to enhance the quality of their diets. This study aimed to systematically design and validate a short seniors-oriented questionnaire as a screening tool to evaluate NL. We developed the Myths-NL questionnaire, composed of 10 widespread nutrition myths, and checked for its content and face validity. An observational cross-sectional study was conducted to explore the validity and the test-retest reliability, involving a community-dwelling group of 316 individuals aged 65 years and over. Construct validity was proved by establishing both discriminant and convergent validity. Cronbach α = 0.61 and Spearman r = 0.79 (p = 0.02) demonstrated internal consistency and test-retest reliability. Participants who had secondary/university studies scored significantly higher compared with those with primary (p < 0.001), and a significant linear relationship (R2 = 0.044, p = 0.001) with a positive slope (ß = 0.209) between Mediterranean Diet Adherence Screener (MEDAS) and Myths-NL scores was observed, proving construct validity. In conclusion, the Myths-NL questionnaire is a valid and reliable tool to screen NL in Spanish seniors and it might be useful as an assessment NL tool for designing and implementing lifestyle interventions to promote healthy eating.

Could squalene be an added value to use olive by-products?

Squalene (SQ) is an intermediate hydrocarbon in the biosynthesis of phytosterols and terpenes in plants. It is widely used for applications such as skin moisturizers, vaccines, or in carriers for active lipophilic molecules. It has commonly been obtained from sharks, but restrictions on their use have created a need to find alternative sources. We present a review of studies concerning SQ in olive groves to characterize its content and to provide new aspects that may increase the circular economy of the olive tree. There is a large variation in SQ content in virgin olive oil due to cultivars and agronomic issues such as region, climate, types of soil, crop practices, and harvest date. Cultivars with the highest SQ content in their virgin olive oil were 'Nocellara de Belice', 'Drobnica', 'Souri', and 'Oblica'. An interaction between cultivar and aspects such as irrigation practices or agricultural season is frequently observed. Likewise, the production of high SQ content needs precise control of fruit maturation. Leaves represent an interesting source, if its extraction and yield compensate for the expenses of their disposal. Supercritical carbon dioxide extraction from olive oil deodorizer distillates offers an opportunity to obtain high-purity SQ from this derivative. Exploiting SQ obtained from olive groves for the pharmaceutical or cosmetic industries poses new challenges and opportunities to add value and recycle by-products. © 2019 Society of Chemical Industry.

Evaluación del triaje realizado por enfermeras en el Servicio de Urgencias del Hospital Clínico Universitario «Lozano Blesa» (Zaragoza) / Evaluation of the triage performed by registered nurses in the Hospital Clínico Universitario «Lozano Blesa» Emergency service (Saragossa, Spain)

OBJETIVO: Evaluar la calidad y la adecuación del triaje realizado por enfermeras en el Servicio de Urgencias Hospitalarias (SUH) del Hospital Clínico Universitario de Zaragoza y comparar las características de las visitas «urgentes» y «no urgentes» detectadas. MÉTODO: Estudio descriptivo-retrospectivo de las visitas del último trimestre de 2015 (pediátricas, ginecológicas y tocológicas, y oftalmológicas excluidas) a partir de los datos del programa Puesto Clínico Hospitalario del SUH. La calidad del triaje realizado por enfermeras se evaluó con los 4 índices propuestos por Gómez Jiménez y la adecuación de la clasificación de los pacientes se estableció relacionando el nivel de triaje asignado con lugar de atención, tiempo de estancia en el SUH y tipo de alta. Se analizaron las diferencias entre las visitas «no urgentes» (atendidas en consultas ambulatorias del SUH) y las visitas «urgentes». RESULTADOS: Se incluyeron 22.047 individuos. Los índices de calidad relacionados con los tiempos de espera no se cumplen en su totalidad. Mayor gravedad de triaje se asocia con ser atendido en el área de Vital y Atención Médica, mayor tiempo de estancia en el SUH y mayor proporción de ingresos hospitalarios (p < 0,001) por lo que el triaje realizado por enfermeras se considera adecuado. Las visitas «no urgentes» obtienen menor gravedad de triaje, menor estancia en el SUH y mayor proporción de altas hospitalarias (p < 0,001). CONCLUSIONES: El triaje realizado por enfermeras necesita mejorar aspectos de calidad relacionados con los tiempos de espera pero es suficientemente correcto ya que discrimina lugar de atención y tipo de alta para cada nivel de triaje dentro de lo deseable

OBJECTIVE: To evaluate nurses' triage quality and adequacy in Saragossa's Hospital Clínico and to compare the main characteristics of "urgent" and "non-urgent" visits to the Hospital Emergency Department (HED). Method: This exploratory-retrospective research study was carried out over the last 3 months of 2015 (paediatrics, gynaecological and ophthalmologic emergencies were excluded). Data were obtained from the "Puesto Clínico Hospitalario" programme used in the HED. The quality of the triage performed by nurses was assessed using the 4 indexes proposed by Gómez Jimenez and the adequacy of patient classification was established by relating the level of triage assigned with the place of care, length of stay in the HED and type of discharge. Differences between "non-urgent" (seen in outpatient consultations of the HED) and "urgent" visits were analysed, RESULTS: 22,047 individuals were included. Quality indices relating to waiting times were not fully met. Higher severity of triage was associated with being attended in the area of Vital and Medical Care, a longer stay in the HED and a higher proportion of hospital admissions (p<.001), so that triage performed by nursing is considered adequate. "Non-urgent" visits obtained less severity of triage, a shorter stay in HED and a greater proportion of hospital discharges (p<.001). CONCLUSIONS: Nursing triage needs to improve quality aspects related to waiting times but is appropriate enough as it discriminates between place of care and type of discharge for each level of triage within the desirable limits

Hepatic subcellular distribution of squalene changes according to the experimental setting

Squalene is the main unsaponifiable component of virgin olive oil, the main source of dietary fat in Mediterranean diet, traditionally associated with a less frequency of cardiovascular diseases. In this study, two experimental approaches were used. In the first, New Zealand rabbits fed for 4 weeks with a chow diet enriched in 1% sunflower oil for the control group, and in 1% of sunflower oil and 0.5% squalene for the squalene group. In the second, APOE KO mice received either Western diet or Western diet enriched in 0.5% squalene for 11 weeks. In both studies, liver samples were obtained and analyzed for their squalene content by gas chromatography-mass spectrometry. Hepatic distribution of squalene was also characterized in isolated subcellular organelles. Our results show that dietary squalene accumulates in the liver and a differential distribution according to studied model. In this regard, rabbits accumulated in cytoplasm within small size vesicles, whose size was not big enough to be considered lipid droplets, rough endoplasmic reticulum, and nuclear and plasma membranes. On the contrary, mice accumulated in large lipid droplets, and smooth reticulum fractions in addition to nuclear and plasma membranes. These results show that the squalene cellular localization may change according to experimental setting and be a starting point to characterize the mechanisms involved in the protective action of dietary squalene in several pathologies

Current Insights into the Biological Action of Squalene.

Squalene is a triterpenic compound found in a large number of plants and other sources with a long tradition of research since it was first reported in 1926. Herein a systematic review of studies concerning squalene published in the last 8 years is presented. These studies have provided further support for its antioxidant, anti-inflammatory, and anti-atherosclerotic properties in vivo and in vitro. Moreover, an antineoplastic effect in nutrigenetic-type treatments, which depends on the failing metabolic pathway of tumors, has also been reported. The bioavailability of squalene in cell cultures, animal models, and in humans has been well established, and further progress has been made in regard to the intracellular transport of this lipophilic molecule. Squalene accumulates in the liver and decreases hepatic cholesterol and triglycerides, with these actions being exerted via a complex network of changes in gene expression at both transcriptional and post-transcriptional levels. Its presence in different biological fluids has also been studied. The combination of squalene with other bioactive compounds has been shown to enhance its pleiotropic properties and might lead to the formulation of functional foods and nutraceuticals to control oxidative stress and, therefore, numerous age-related diseases in human and veterinary medicine.

Hepatic subcellular distribution of squalene changes according to the experimental setting.

Squalene is the main unsaponifiable component of virgin olive oil, the main source of dietary fat in Mediterranean diet, traditionally associated with a less frequency of cardiovascular diseases. In this study, two experimental approaches were used. In the first, New Zealand rabbits fed for 4 weeks with a chow diet enriched in 1% sunflower oil for the control group, and in 1% of sunflower oil and 0.5% squalene for the squalene group. In the second, APOE KO mice received either Western diet or Western diet enriched in 0.5% squalene for 11 weeks. In both studies, liver samples were obtained and analyzed for their squalene content by gas chromatography-mass spectrometry. Hepatic distribution of squalene was also characterized in isolated subcellular organelles. Our results show that dietary squalene accumulates in the liver and a differential distribution according to studied model. In this regard, rabbits accumulated in cytoplasm within small size vesicles, whose size was not big enough to be considered lipid droplets, rough endoplasmic reticulum, and nuclear and plasma membranes. On the contrary, mice accumulated in large lipid droplets, and smooth reticulum fractions in addition to nuclear and plasma membranes. These results show that the squalene cellular localization may change according to experimental setting and be a starting point to characterize the mechanisms involved in the protective action of dietary squalene in several pathologies.

Evaluation of the triage performed by registered nurses in the Hospital Clínico Universitario «Lozano Blesa¼ Emergency service (Saragossa, Spain). / Evaluación del triaje realizado por enfermeras en el Servicio de Urgencias del Hospital Clínico Universitario «Lozano Blesa¼ (Zaragoza).

OBJECTIVE: To evaluate nurses' triage quality and adequacy in Saragossa's Hospital Clínico and to compare the main characteristics of "urgent" and "non-urgent" visits to the Hospital Emergency Department (HED). METHOD: This exploratory-retrospective research study was carried out over the last 3 months of 2015 (paediatrics, gynaecological and ophthalmologic emergencies were excluded). Data were obtained from the "Puesto Clínico Hospitalario" programme used in the HED. The quality of the triage performed by nurses was assessed using the 4 indexes proposed by Gómez Jimenez and the adequacy of patient classification was established by relating the level of triage assigned with the place of care, length of stay in the HED and type of discharge. Differences between "non-urgent" (seen in outpatient consultations of the HED) and "urgent" visits were analysed, RESULTS: 22,047 individuals were included. Quality indices relating to waiting times were not fully met. Higher severity of triage was associated with being attended in the area of Vital and Medical Care, a longer stay in the HED and a higher proportion of hospital admissions (p<.001), so that triage performed by nursing is considered adequate. "Non-urgent" visits obtained less severity of triage, a shorter stay in HED and a greater proportion of hospital discharges (p<.001). CONCLUSIONS: Nursing triage needs to improve quality aspects related to waiting times but is appropriate enough as it discriminates between place of care and type of discharge for each level of triage within the desirable limits.

Factores sociodemográficos asociados con el grado de adherencia al patrón de dieta mediterránea en personas mayores / Sociodemographic factors associated with adherence to the Mediterranean dietary pattern in elderly people

Objetivo. Evaluar el grado de adherencia al patrón de dieta mediterránea (DMedit) en personas mayores de 65 años en el ámbito rural y urbano de Comarca de la Hoya de Huesca e investigar si existen factores sociodemográficos relacionados con dicha adherencia. Material y métodos. Estudio exploratorio de tipo descriptivo transversal. Se utilizaron 2 cuestionarios: uno autoelaborado para datos sociodemográficos y el cuestionario validado PREDIMED para evaluar el grado de adherencia a la DMedit. Se recogieron 240 encuestas, previo consentimiento informado, durante 2 semanas consecutivas, en marzo del 2014. Resultados. El promedio de edad fue 74±6,8 años, con igual proporción de ámbito rural y urbano y de ambos sexos. Ambas poblaciones presentaron una adherencia al patrón de DMedit similar, con un score global medio de 9 en una escala de 0 a 14. Además, se observó la influencia de algunos factores sociodemográficos en el grado de adherencia a la DMedit, tales como el poder adquisitivo o la presencia de enfermedades crónicas relacionadas con la dieta. Conclusiones. La población urbana y rural de la Hoya de Huesca parece tener una buena adherencia a la DMedit, aunque existen algunos factores económicos y de salud que podrían modificarla (AU)

Objective. To assess the level of adherence to the Mediterranean dietary pattern (DMedit) in people over 65 in rural and urban areas of the region of Hoya de Huesca (Spain) and investigate whether there are sociodemographic factors related to that adherence. Material and methods. Exploratory cross-sectional study. Two questionnaires were used: one self-made for sociodemographic factors, and the PREDIMED validated questionnaire to assess the level of adherence to the DMedit. After prior informed consent, a total of 240 questionnaires were collected over a period of 2 consecutive weeks in March 2014. Results. The mean age was 74±6.8 years, with an equal proportion of rural and urban areas and both sexes. Both populations showed a similar adherence pattern to Dmedit, with an average overall score of 9 on a scale of 0 to 14. Furthermore, the influence of sociodemographic factors was observed on the level of adherence to the Dmedit, such as purchasing power or presence of chronic diet-related diseases. Conclusions. The urban and rural population of the Hoya de Huesca seems to have a good adherence to the Dmedit, although some economic and health factors could modify it (AU)

[Sociodemographic factors associated with adherence to the Mediterranean dietary pattern in elderly people]. / Factores sociodemográficos asociados con el grado de adherencia al patrón de dieta mediterránea en personas mayores.

OBJECTIVE: To assess the level of adherence to the Mediterranean dietary pattern (DMedit) in people over 65 in rural and urban areas of the region of Hoya de Huesca (Spain) and investigate whether there are sociodemographic factors related to that adherence. MATERIAL AND METHODS: Exploratory cross-sectional study. Two questionnaires were used: one self-made for sociodemographic factors, and the PREDIMED validated questionnaire to assess the level of adherence to the DMedit. After prior informed consent, a total of 240 questionnaires were collected over a period of 2 consecutive weeks in March 2014. RESULTS: The mean age was 74±6.8 years, with an equal proportion of rural and urban areas and both sexes. Both populations showed a similar adherence pattern to Dmedit, with an average overall score of 9 on a scale of 0 to 14. Furthermore, the influence of sociodemographic factors was observed on the level of adherence to the Dmedit, such as purchasing power or presence of chronic diet-related diseases. CONCLUSIONS: The urban and rural population of the Hoya de Huesca seems to have a good adherence to the Dmedit, although some economic and health factors could modify it.

Beneficios dietéticos asociados a la ingesta habitual de dosis moderadas de fitoesteroles presentes de forma natural en los alimentos / Dietetic benefits associated with the regular intake of moderate amounts of naturally-occurring phytosterols

Introducción Recientemente se ha demostrado que la ingesta habitual de dosis moderadas de fitoesteroles presentes de forma natural en los alimentos afecta al metabolismo global del colesterol dando lugar a menores niveles séricos. El objetivo del estudio fue caracterizar el patrón dietético de una población aragonesa con un consumo moderado de fitoesteroles con el fin de identificar los principales grupos de alimentos implicados e investigar la relación entre la ingesta de fitoesteroles y distintos factores dietéticos relacionados con la salud cardiovascular. Métodos Se estudiaron los hábitos dietéticos (usando un cuestionario de frecuencia de consumo de alimentos validado) de 85 voluntarios sanos. Estos se clasificaron en terciles de ingesta de fitoesteroles y se establecieron las diferencias en cuanto a consumo de alimentos, nutrientes y otros componentes de la dieta que afectan a la salud cardiovascular y al grado de adherencia al patrón de dieta mediterránea. Resultados El aumento en la ingesta total de fitoesteroles se asoció con un mayor consumo de frutas frescas y frutos secos, hortalizas y aceites vegetales, y menor de carnes y platos precocinados. A su vez, se asoció con un mayor grado de insaturación de la grasa, ingesta de fibra total, capacidad antioxidante de la dieta y ratio fitoesteroles/colesterol y menor ingesta de colesterol e índice colesterol-grasa saturada. Finalmente, la ingesta de fitoesteroles se correlacionó positivamente con el grado de adherencia al patrón de dieta mediterránea. Conclusión La ingesta habitual de dosis moderadas de fitoesteroles presentes de forma natural en los alimentos, además de tener beneficios hipocolesterolemiantes per se, se asocia con otros factores dietéticos relacionados con la prevención de enfermedad cardiovascular. La recomendación de aumentar el consumo habitual de alimentos fuentes de fitoesteroles está plenamente justificada (AU)

Background Recently it has been shown that the regular intake of moderate amounts of naturally-occurring phytosterols affects whole-body cholesterol metabolism giving rise to lower serum levels. The aim of the study was to describe the dietary pattern of a population from the region of Aragon (Spain) with a moderate consumption of phytosterols, to identify the major food groups involved, and to investigate the relationship between phytosterol intake and several dietary factors related to cardiovascular health. Methods A total of 85 healthy volunteers were studied as regards their dietary habits (using a validated food frequency questionnaire). Subjects were classified into tertiles of phytosterol intake and differences regarding foods, nutrients and other dietary components affecting cardiovascular health consumption as well as the adherence degree to the Mediterranean diet pattern were assessed. Results A higher phytosterols intake was associated with a higher consumption of fresh fruits and nuts, vegetables and vegetable oils, and lower in meat and pre-cooked meals. Furthermore, it was associated with higher level of unsaturated fat, total fibre intake, antioxidant capacity of the diet and phytosterols/cholesterol ratio, as well as a lower of cholesterol intake and cholesterol-saturated fat index. Finally, phytosterols intake correlated positively with the degree of adherence to the Mediterranean diet. Conclusion The regular intake of moderate amounts of naturally-occurring phytosterols, besides having cholesterol lowering benefits per se, is associated with other dietetic factors related to the prevention of cardiovascular disease. The recommendation of increasing the regular intake of phytosterols source foods is completely justified (AU)