Timing of Meals and Sleep in the Mediterranean Population: The Effect of Taste, Genetics, Environmental Determinants, and Interactions on Obesity Phenotypes.

Circadian rhythms regulate the sleep-wake and feeding-fasting cycles. Sleep and feeding constitute a complex cycle that is determined by several factors. Despite the importance of sleep duration and mealtimes for many obesity phenotypes, most studies on dietary patterns have not investigated the contribution of these variables to the phenotypes analyzed. Likewise, they have not investigated the factors related to sleep or mealtimes. Thus, our aims were to investigate the link between taste perception and eating/sleep patterns and to analyze the effect of the interactions between sleep/meal patterns and genetic factors on obesity phenotypes. We conducted a cross-sectional analysis on 412 adults from the Mediterranean population. We measured taste perception (bitter, sweet, salty, sour, and umami) and assessed sleep duration and waketime. The midpoint of sleep and social jetlag was computed. From the self-reported timing of meals, we estimated the eating window, eating midpoint, and eating jetlag. Adherence to the Mediterranean diet was measured with a validated score. Selected polymorphisms in the TAS2R38, CLOCK, and FTO genes were determined, and their associations and interactions with relevant phenotypes were analyzed. We found various associations between temporal eating, sleep patterns, and taste perception. A higher bitter taste perception was associated with an earlier eating midpoint (p = 0.001), breakfast time (p = 0.043), dinner time (p = 0.009), waketime (p < 0.001), and midpoint of sleep (p = 0.009). Similar results were observed for the bitter taste polymorphism TAS2R38-rs713598, a genetic instrumental variable for bitter perception, increasing the causality of the associations. Moreover, significant gene-sleep interactions were detected between the midpoint of sleep and the TAS2R38-rs713598 (p = 0.032), FTO-rs9939609 (p = 0.037), and CLOCK-rs4580704 (p = 0.004) polymorphisms which played a role in determining obesity phenotypes. In conclusion, our study provided more information on the sleep and mealtime patterns of the general Spanish Mediterranean population than on their main relationships. Moreover, we were able to show significant associations between taste perception, specifically bitter taste; sleep time; and mealtimes as well as an interaction between sleep time and several genetic variants linked to obesity phenotypes. However, additional research is needed to better characterize the causality and mechanisms behind these associations.

Associations between Dietary Polyphenols and Type 2 Diabetes in a Cross-Sectional Analysis of the PREDIMED-Plus Trial: Role of Body Mass Index and Sex.

Overweight and obesity are important risk factors for type 2 diabetes (T2D). Moving towards healthier diets, namely, diets rich in bioactive compounds, could decrease the odds of suffering T2D. However, those individuals with high body mass index (BMI) may have altered absorption or metabolism of some nutrients and dietary components, including polyphenols. Therefore, we aimed to assess whether high intakes of some classes of polyphenols are associated with T2D in a population with metabolic syndrome and how these associations depend on BMI and sex. This baseline cross-sectional analysis includes 6633 participants from the PREDIMED-Plus trial. Polyphenol intakes were calculated from food frequency questionnaires (FFQ). Cox regression models with constant time at risk and robust variance estimators were used to estimate the prevalence ratios (PRs) for polyphenol intake and T2D prevalence using the lowest quartile as the reference group. Analyses were stratified by sex and BMI groups (overweight and obese) to evaluate potential effect modification. Catechins, proanthocyanidins, hydroxybenzoic acids, and lignans were inversely associated with T2D. Hydroxycinnamic acids were directly related in men. These associations were different depending on sex and BMI, that is, women and overweight obtained stronger inverse associations.

[Qualitative study of the differences between men and women's perception of obesity, its causes, tackling and repercussions on health]. / Estudio de investigación cualitativa sobre las diferencias entre hombres y mujeres en la percepción de la obesidad, sus causas, abordaje y repercusiones para la salud.

INTRODUCTION: although obesity is a multidimensional health problem, few qualitative research studies have analyzed the discourse of obese individuals from the gender perspective in order to better understand the hard come by information gathered from quantitative research. AIM: to analyze the discourse of obese individuals in focus groups concerning factors underlying obesity, pathology risk perception, weight loss and other relevant factors. METHODS: two single-sex focus groups, with a total of 14 participants, were held in separate sessions. A moderator directed the session, addressing the different dimensions of the problem. The groups were recorded in audio and textually transcribed. The discourse was analyzed using qualitative methods. RESULTS: important differences were observed between male and female perspectives. The self-perceived causes of obesity for women were pregnancy and menopause. Men attributed obesity to eating habits and cultural customs. For men, the final aim of reducing weight was to improve their health, whereas women also included aesthetics. Both sexes believe that obesity can lead to greater problems. Women expressed their fear of putting on weight, but men did not. Differences were also observed in the strategies adopted for combating obesity. CONCLUSIONS: differences in the perception of the causes and how to tackle obesity between men and women show us the need to consider therapeutic and preventive measures that take gender into account, in addition to the environmental aspects surrounding the patient.

INTRODUCCIÓN: aunque la obesidad es un problema de salud multidimensional, pocos estudios de investigación cualitativa han analizado el discurso de personas obesas con perspectiva de género para conocer con mayor  profundidad información difícilmente obtenible con técnicas cuantitativas. OBJETIVO: analizar el discurso de personas obesas mediante grupos de discusión en cuanto a factores que subyacen en la obesidad, percepción del riesgo de patologías, pérdida peso y otros factores relevantes. MÉTODOS: se realizaron dos grupos de discusión en sesiones separadas, homogéneos por sexo, con un total de 14 participantes. Un moderador dirigió la sesión contemplando las distintas dimensiones del problema. Los grupos fueron grabados en audio y transcritos textualmente. Se analizó el discurso por métodos cualitativos. RESULTADOS: se observaron importantes diferencias en la perspectiva entre hombres y mujeres. Las causas autopercibidas de obesidad para las mujeres fueron el embarazo y el periodo menopáusico. Los hombres la atribuyeron a los hábitos alimenticios y costumbres culturales. Para los hombres la finalidad de disminuir el peso era mejorar su salud, sin embargo, las mujeres incluían también la estética. Ambos sexos pensaban que la obesidad puede acarrear grandes problemas. Ellas revelaron tener miedo a engordar, mientras que los hombres no lo expusieron. También se observaron diferencias en las estrategias de lucha contra la obesidad. CONCLUSIONES: las diferencias en la percepción de las causas y el abordaje de la obesidad entre hombres y mujeres nos indican la necesidad de considerar las medidas preventivas y terapéuticas teniendo en cuenta el sexo, así como aspectos ambientales que envuelven al paciente.

Estudio de investigación cualitativa sobre las diferencias entre hombres y mujeres en la percepción de la obesidad, sus causas, abordaje y repercusiones para la salud / Qualitative study of the differences between men and women’s perception of obesity, its causes, tackling and repercussions on health

Introducción: aunque la obesidad es un problema de salud multidimensional, pocos estudios de investigación cualitativa han analizado el discurso de personas obesas con perspectiva de género para conocer con mayor profundidad información difícilmente obtenible con técnicas cuantitativas. Objetivo: analizar el discurso de personas obesas mediante grupos de discusión en cuanto a factores que subyacen en la obesidad, percepción del riesgo de patologías, pérdida peso y otros factores relevantes. Métodos: se realizaron dos grupos de discusión en sesiones separadas, homogéneos por sexo, con un total de 14 participantes. Un moderador dirigió la sesión contemplando las distintas dimensiones del problema. Los grupos fueron grabados en audio y transcritos textualmente. Se analizó el discurso por métodos cualitativos. Resultados: se observaron importantes diferencias en la perspectiva entre hombres y mujeres. Las causas autopercibidas de obesidad para las mujeres fueron el embarazo y el periodo menopáusico. Los hombres la atribuyeron a los hábitos alimenticios y costumbres culturales. Para los hombres la finalidad de disminuir el peso era mejorar su salud, sin embargo, las mujeres incluían también la estética. Ambos sexos pensaban que la obesidad puede acarrear grandes problemas. Ellas revelaron tener miedo a engordar, mientras que los hombres no lo expusieron. También se observaron diferencias en las estrategias de lucha contra la obesidad. Conclusiones: las diferencias en la percepción de las causas y el abordaje de la obesidad entre hombres y mujeres nos indican la necesidad de considerar las medidas preventivas y terapéuticas teniendo en cuenta el sexo, así como aspectos ambientales que envuelven al paciente

Introduction: although obesity is a multidimensional health problem, few qualitative research studies have analyzed the discourse of obese individuals from the gender perspective in order to better understand the hard come by information gathered from quantitative research. Aim: to analyze the discourse of obese individuals in focus groups concerning factors underlying obesity, pathology risk perception, weight loss and other relevant factors. Methods: two single-sex focus groups, with a total of 14 participants, were held in separate sessions. A moderator directed the session, addressing the different dimensions of the problem. The groups were recorded in audio and textually transcribed. The discourse was analyzed using qualitative methods. Results: important differences were observed between male and female perspectives. The self-perceived causes of obesity for women were pregnancy and menopause. Men attributed obesity to eating habits and cultural customs. For men, the final aim of reducing weight was to improve their health, whereas women also included aesthetics. Both sexes believe that obesity can lead to greater problems. Women expressed their fear of putting on weight, but men did not. Differences were also observed in the strategies adopted for combating obesity. Conclusions: differences in the perception of the causes and how to tackle obesity between men and women show us the need to consider therapeutic and preventive measures that take gender into account, in addition to the environmental aspects surrounding the patient

Dairy product consumption and risk of colorectal cancer in an older mediterranean population at high cardiovascular risk.

Prospective studies have reported an inverse association between the consumption of total dairy products and milk and the risk of colorectal cancer (CRC). Nonetheless, there is little and inconsistent evidence regarding subtypes of dairy product and CRC risk. We assessed the associations between the consumption of total dairy products, their different subtypes and CRC risk in older Mediterranean individuals at high cardiovascular risk. We analyzed data from 7,216 men and women (55-80 years) without CRC at baseline from the PREvención con DIeta MEDiterránea study. Individuals were recruited between 2003 and 2009 and followed up until December 2012. At baseline and yearly thereafter, consumption of total and specific dairy products was assessed using a validated 137-item food-frequency questionnaire. Cox proportional hazards ratios (HRs) of CRC incidence were estimated for tertiles of mean consumption of dairy products during the follow-up. During a median [interquartile range] follow-up of 6.0 [4.4-7.3] years, we documented 101 incident CRC cases. In the multivariable-adjusted models, HRs and 95% confidence intervals (CIs) of CRC for the comparison of extreme tertiles of total dairy product and low-fat milk consumption were 0.55 (95% CI: 0.31-0.99; p-trend = 0.037) and 0.54 (95% CI: 0.32-0.92; p-trend = 0.022), respectively. No significant associations with other dairy products (whole-fat and low-fat dairy products; total, low-fat and whole-fat yogurt; cheese; total, low-fat and whole-fat milk; concentrated full-fat dairy products, sugar-enriched dairy products and fermented dairy products) were found. A high consumption of total dairy products and low-fat milk was significantly associated with a reduced CRC risk.

Association of Dietary Vitamin K1 Intake With the Incidence of Cataract Surgery in an Adult Mediterranean Population: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Cataract, one of the most frequent causes of blindness in developed countries, is strongly associated with aging. The exact mechanisms underlying cataract formation are still unclear, but growing evidence suggests a potential role of inflammatory and oxidative processes. Therefore, antioxidant and anti-inflammatory factors of the diet, such as vitamin K1, could play a protective role. Objective: To examine the association between dietary vitamin K1 intake and the risk of incident cataracts in an elderly Mediterranean population. Design, Setting, and Participants: A prospective analysis was conducted in 5860 participants from the Prevención con Dieta Mediterránea Study, a randomized clinical trial executed between 2003 and 2011. Participants were community-dwelling men (44.2%) and women (55.8%), and the mean (SD) age was 66.3 (6.1) years. Main Outcomes and Measures: Dietary vitamin K1 intake was evaluated using a validated food frequency questionnaire. The time to the cataract event was calculated as the time between recruitment and the date of the occurrence to cataract surgery, the time to the last visit of the follow-up, date of death, or the end of the study. Hazard ratios and 95% CIs for cataract incidence were estimated with a multivariable Cox proportional hazards model. Results: Participants were community-dwelling men (44.2%; n = 868) and women (55.8%; n = 1086), and the mean (SD) age was 66.3 (6.1) years. After a median of 5.6 years follow-up, we documented a total of 768 new cataracts. Participants in the highest tertile of dietary vitamin K1 intake had a lower risk of cataracts than those in the lowest tertile (hazard ratio, 0.71; 95% CI, 0.58-0.88; P = .002), after adjusting for potential confounders. Conclusions and Relevance: High intake of dietary vitamin K1 was associated with a reduced risk of cataracts in an elderly Mediterranean population even after adjusting by other potential confounders. Trial Registration: isrctn.org: ISRCTN35739639.

Associations between Both Lignan and Yogurt Consumption and Cardiovascular Risk Parameters in an Elderly Population: Observations from a Cross-Sectional Approach in the PREDIMED Study.

BACKGROUND: The study of dietary patterns is gaining interest. Although the health benefits of yogurt and lignans have been investigated separately, to our knowledge there are no studies on their associative effects. OBJECTIVE: The aim of this study was to evaluate a possible association between yogurt and lignans using biomarkers of cardiovascular disease risk in an elderly population. DESIGN: We conducted a cross-sectional analysis of the association between baseline dietary information and cardiovascular risk parameters using food frequency questionnaires. PARTICIPANTS: We enrolled 7,169 Spanish participants of the PREDIMED (Prevención con Dieta Mediterránea) study (elderly men and women at high cardiovascular risk) from June 2003 to June 2009. MAIN OUTCOME MEASURES: Cardiovascular risk parameters, including cholesterol, triglycerides, glucose, body mass index, weight, waist circumference, and blood pressure were measured. STATISTICAL ANALYSIS: General linear models were used to assess the relationship between categorical variables (yogurt, total dairy intake, lignans, and yogurt plus lignans) and cardiovascular risk parameters. RESULTS: The consumption of either yogurt or lignans seems to have beneficial effects on human health, but the consumption of both showed greater improvement in some cardiovascular health parameters. Indeed, participants with a higher consumption of both yogurt and lignans showed lower total cholesterol (estimated ß-coefficients=-6.18; P=0.001) and low-density lipoprotein cholesterol levels (ß=-4.92; P=0.005). In contrast, participants with lower yogurt and lignan consumption had a higher body mass index (ß=0.28; P=0.007) and weight (ß=1.20; P=0.008). CONCLUSIONS: High lignan and yogurt consumption is associated with a better cardiovascular risk parameters profile in an elderly Mediterranean population. Further research is warranted to determine the mechanisms and consequences of this potential effect.

Nutritional adequacy according to carbohydrates and fat quality.

PURPOSE: To investigate the association between carbohydrate quality, fat quality or adherence to the Mediterranean diet and intake adequacy of 19 micronutrients in the PREDIMED (PREvención con DIeta MEDiterránea) trial, a multicenter, randomized, controlled, parallel group and primary prevention trial conducted in Spain. METHODS: We assessed baseline dietary intake of 6,542 elderly subjects at high cardiovascular risk through a validated food frequency questionnaire (FFQ) and a validated 14-item Mediterranean diet (Med-diet) score. We used a multidimensional carbohydrate quality index (CQI) using four criteria and a fat quality index (FQI) according to the ratio (MUFA + PUFA)/(SFA + TFA). The probability of intake adequacy was calculated comparing the intakes to DRI, and also using the probabilistic approach. Absolute and adjusted probability of having inadequate intake for either ≥6 DRI or ≥8 DRI were estimated to assess nutritional adequacy according to quintiles of each index. RESULTS: The lowest prevalence of inadequate micronutrient intake (≥8 DRI) was found in the highest quintile of CQI or Med-diet score, and in the lowest quintile of FQI (adjusted fold risk: 1.4, 3.4 and 10.2 respectively in comparison with the lowest quintile). P for trend <0.001 in three multivariable models. A higher CQI or Med-Diet score and a lower FQI were significantly associated with a lower fold risk of unmet EAR values. CONCLUSIONS: A multidimensional assessment of CQI can be a useful tool to evaluate the quality of carbohydrates. This score and a 14-item Med-diet score were positively related to overall micronutrient adequacy in elderly participants.

Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial.

IMPORTANCE: Breast cancer is the leading cause of female cancer burden, and its incidence has increased by more than 20% worldwide since 2008. Some observational studies have suggested that the Mediterranean diet may reduce the risk of breast cancer. OBJECTIVE: To evaluate the effect of 2 interventions with Mediterranean diet vs the advice to follow a low-fat diet (control) on breast cancer incidence. DESIGN, SETTING, AND PARTICIPANTS: The PREDIMED study is a 1:1:1 randomized, single-blind, controlled field trial conducted at primary health care centers in Spain. From 2003 to 2009, 4282 women aged 60 to 80 years and at high cardiovascular disease risk were recruited after invitation by their primary care physicians. INTERVENTIONS: Participants were randomly allocated to a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). MAIN OUTCOMES AND MEASURES: Breast cancer incidence was a prespecified secondary outcome of the trial for women without a prior history of breast cancer (n = 4152). RESULTS: After a median follow-up of 4.8 years, we identified 35 confirmed incident cases of breast cancer. Observed rates (per 1000 person-years) were 1.1 for the Mediterranean diet with extra-virgin olive oil group, 1.8 for the Mediterranean diet with nuts group, and 2.9 for the control group. The multivariable-adjusted hazard ratios vs the control group were 0.32 (95% CI, 0.13-0.79) for the Mediterranean diet with extra-virgin olive oil group and 0.59 (95% CI, 0.26-1.35) for the Mediterranean diet with nuts group. In analyses with yearly cumulative updated dietary exposures, the hazard ratio for each additional 5% of calories from extra-virgin olive oil was 0.72 (95% CI, 0.57-0.90). CONCLUSIONS AND RELEVANCE: This is the first randomized trial finding an effect of a long-term dietary intervention on breast cancer incidence. Our results suggest a beneficial effect of a Mediterranean diet supplemented with extra-virgin olive oil in the primary prevention of breast cancer. These results come from a secondary analysis of a previous trial and are based on few incident cases and, therefore, need to be confirmed in longer-term and larger studies. TRIAL REGISTRATION: ISRCTN.org Identifier: ISRCTN35739639.

[SHORT TERM EFFECTS ON LIPID PROFILE AND GLYCAEMIA OF A LOW-FAT VEGETARIAN DIET]. / EFECTOS A CORTO PLAZO EN EL PERFIL LIPÍDICO Y LA GLUCEMIA DE UNA DIETA VEGETARIANA BAJA EN GRASA.

INTRODUCTION: vegetarian diets have been associated with lower risk of cardiovascular disease and a more favourable lipid profile in vegetarians who follow these diets for a long term period in observational studies, but the short-term effects of vegetarian diets are less known. OBJECTIVE: our objective was to analyze the short-term effects of a low-fat vegetarian diet on lipid profile and fasting glucose in previously non-vegetarian subjects from a Mediterranean population. METHODS: we carried out a nutritional intervention study in 159 volunteers (42 men and 117 women). A whole lacto-vegetarian diet low in fat (20%) was administered. A full daily menu was provided for 15 days under strict interned conditions. Fasting blood samples were obtained before and after dietary intervention and total cholesterol, HDL-C, LDL-C, triglycerides and fasting glucose were determined. Multivariate models for repeated measures were used. RESULTS: after dietary intervention, we detected statistically significant reductions in total cholesterol (-17.54 ± 37.14 mg/dl), LDL-C (-9.33 ± 34.29 mg/dl), HDL-C (-5.32 ± 12.16 mg/dl), and triglycerides (-18.92 ± 50.50 mg/dl). These reductions remained statistically significant after adjustment for sex and age. Significant weight changes were also detected. The additional adjustment for changes in body mass index (BMI) attenued the significance of the decrease in triglycerides (P = 0.067). CONCLUSION: a lacto-vegetarian diet low in fat, produces favourable and significant decreases in total cholesterol, LDL-C (independent of weight loss) and triglycerides (mediated by weight loss). This intervention also produced an expected decrease in HDL-C due to its reduced fat content.

Introducción: en estudios observacionales, las dietas vegetarianas se han asociado con menor riesgo de enfermedad cardiovascular y un perfil lipídico más favorable en las personas que siguen estas dietas a largo plazo pero sus efectos a corto plazo son menos conocidos. Objetivo: analizar el efecto a corto plazo en población mediterránea previamente no vegetariana de una dieta vegetariana baja en grasas sobre el perfil lipídico y la glucemia. Métodos: se realizó un estudio de intervención nutricional en 159 voluntarios (42 hombres y 117 mujeres) administrando un patrón de dieta completa lacto-vegetariana baja en grasa (20%). Se proporcionó un menú diario completo en condiciones de régimen de internado estricto durante 15 días. Se realizaron extracciones de sangre en ayunas antes y después de la intervención dietética y se determinó el colesterol total, C-HDL, C-LDL, triglicéridos y glucemia. Se emplearon modelos multivariantes de medidas repetidas. Resultados: tras la intervención dietética se detectaron reducciones estadísticamente significativas en el colesterol total (-17,54 ± 37,14 mg/dl), C-LDL (-9,33 ± 34,29 mg/ dl), C-HDL (-5,32 ± 12,16 mg/dl), y triglicéridos (-18,92 ± 50,50 mg/dl) que permanecieron tras ajustar por edad y sexo. También se produjeron cambios significativos de peso. El ajuste adicional por los cambios en el índice de masa corporal (IMC) restó significación a la disminución de los triglicéridos (P = 0.067). Conclusión: la dieta lacto-vegetariana baja en grasa a corto plazo produce descensos favorables y significativos de colesterol total, C-LDL (independientes de la pérdida de peso) y triglicéridos (mediados por la pérdida de peso). También produjo un descenso esperable de C-HDL al ser reducida en grasa.

Efectos a corto plazo en el perfil lipídico y la glucemia de una dieta vegetariana baja en grasa / Short term effects on lipid profile and glycaemia of a low-fat vegetarian diet

Introducción: en estudios observacionales, las dietas vegetarianas se han asociado con menor riesgo de enfermedad cardiovascular y un perfil lipídico más favorable en las personas que siguen estas dietas a largo plazo pero sus efectos a corto plazo son menos conocidos. Objetivo: analizar el efecto a corto plazo en población mediterránea previamente no vegetariana de una dieta vegetariana baja en grasas sobre el perfil lipídico y la glucemia. Métodos: se realizó un estudio de intervención nutricional en 159 voluntarios (42 hombres y 117 mujeres) administrando un patrón de dieta completa lacto-vegetariana baja en grasa (20%). Se proporcionó un menú diario completo en condiciones de régimen de internado estricto durante 15 días. Se realizaron extracciones de sangre en ayunas antes y después de la intervención dietética y se determinó el colesterol total, C-HDL, C-LDL, triglicéridos y glucemia. Se emplearon modelos multivariantes de medidas repetidas. Resultados: tras la intervención dietética se detectaron reducciones estadísticamente significativas en el colesterol total (-17,54 ± 37,14 mg/dl), C-LDL (-9,33 ± 34,29 mg/ dl), C-HDL (-5,32 ± 12,16 mg/dl), y triglicéridos (-18,92 ± 50,50 mg/dl) que permanecieron tras ajustar por edad y sexo. También se produjeron cambios significativos de peso. El ajuste adicional por los cambios en el índice de masa corporal (IMC) restó significación a la disminución de los triglicéridos (P = 0.067). Conclusión: la dieta lacto-vegetariana baja en grasa a corto plazo produce descensos favorables y significativos de colesterol total, C-LDL (independientes de la pérdida de peso) y triglicéridos (mediados por la pérdida de peso). También produjo un descenso esperable de C-HDL al ser reducida en grasa (AU)

Introduction: vegetarian diets have been associated with lower risk of cardiovascular disease and a more favourable lipid profile in vegetarians who follow these diets for a long term period in observational studies, but the short-term effects of vegetarian diets are less known. Objective: our objective was to analyze the short-term effects of a low-fat vegetarian diet on lipid profile and fasting glucose in previously non-vegetarian subjects from a Mediterranean population. Methods: we carried out a nutritional intervention study in 159 volunteers (42 men and 117 women). A whole lacto-vegetarian diet low in fat (20%) was administered. A full daily menu was provided for 15 days under strict interned conditions. Fasting blood samples were obtained before and after dietary intervention and total cholesterol, HDL-C, LDL-C, triglycerides and fasting glucose were determined. Multivariate models for repeated measures were used. Results: after dietary intervention, we detected statistically significant reductions in total cholesterol (-17.54 ± 37.14 mg/dl), LDL-C (-9.33 ± 34.29 mg/dl), HDL-C (-5.32 ± 12.16 mg/dl), and triglycerides (-18.92 ± 50.50 mg/dl). These reductions remained statistically significant after adjustment for sex and age. Significant weight changes were also detected. The additional adjustment for changes in body mass index (BMI) attenued the significance of the decrease in triglycerides (P = 0.067). Conclusion: a lacto-vegetarian diet low in fat, produces favourable and significant decreases in total cholesterol, LDL-C (independent of weight loss) and triglycerides (mediated by weight loss). This intervention also produced an expected decrease in HDL–C due to its reduced fat content (AU)

Blood pressure values and depression in hypertensive individuals at high cardiovascular risk.

BACKGROUND: Hypertension and depression are both important risk factors for cardiovascular diseases. Nevertheless, the association of blood pressure on and depression has not been completely established. This study aims to analyze whether depression may influence the control of blood pressure in hypertensive individuals at high cardiovascular risk. METHODS: Cross-sectional study, embedded within the PREDIMED clinical trial, of 5954 hypertensive patients with high cardiovascular risk factor profiles. The relationship between blood pressure control and depression was analyzed. A multivariate analysis (logistic and log-linear regression), adjusting for potential confounders (socio-demographic factors, body mass index, lifestyle, diabetes, dyslipidemia, and antihypertensive treatment), was performed. RESULTS: Depressive patients, with and without antidepressant treatment, had better blood pressure control (OR: 1.28, CI 95%: 1.06-1.55, and OR: 1.30, CI 95%: 1.03-1.65, respectively) than non-depressive ones. Regarding blood pressure levels, systolic blood pressure values (mmHg) were found to be lower in both treated and untreated depressive patients (Log coefficient Beta: -1.59, 95% CI: -0.50 to -2.69 and Log coefficient Beta: -3.49, 95% CI: -2.10 to -4.87, respectively). CONCLUSIONS: Among hypertensive patients at high cardiovascular risk, the control of blood pressure was better in those diagnosed with depression. TRIAL REGISTRATION: Unique identifier: ISRCTN35739639.

White blood cell counts as risk markers of developing metabolic syndrome and its components in the PREDIMED study.

BACKGROUND: The Metabolic Syndrome (MetS) is a cluster of metabolic abnormalities that includes hyperglucemia, hypertension, dyslipidemia and central obesity, conferring an increased risk of cardiovascular disease. The white blood cell (WBC) count has been proposed as a marker for predicting cardiovascular risk. However, few prospective studies have evaluated the relationship between WBC subtypes and risk of MetS. METHODS: Participants were recruited from seven PREDIMED study centers. Both a baseline cross-sectional (n = 4,377) and a prospective assessment (n = 1,637) were performed. Participants with MetS at baseline were excluded from the longitudinal analysis. The median follow-up was 3.9 years. Anthropometric measurements, blood pressure, fasting glucose, lipid profile and WBC counts were assessed at baseline and yearly during the follow-up. Participants were categorized by baseline WBC and its subtype count quartiles. Adjusted logistic regression models were fitted to assess the risk of MetS and its components. RESULTS: Of the 4,377 participants, 62.6% had MetS at baseline. Compared to the participants in the lowest baseline sex-adjusted quartile of WBC counts, those in the upper quartile showed an increased risk of having MetS (OR, 2.47; 95%CI, 2.03-2.99; P-trend<0.001). This association was also observed for all WBC subtypes, except for basophils. Compared to participants in the lowest quartile, those in the top quartile of leukocyte, neutrophil and lymphocyte count had an increased risk of MetS incidence. Leukocyte and neutrophil count were found to be strongly associated with the MetS components hypertriglyceridemia and low HDL-cholesterol. Likewise, lymphocyte counts were found to be associated with the incidence of the MetS components low HDL-cholesterol and high fasting glucose. An increase in the total WBC during the follow-up was also associated with an increased risk of MetS. CONCLUSIONS: Total WBC counts, and some subtypes, were positively associated with MetS as well as hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, all components of MetS. TRIAL REGISTRATION: Controlled-Trials.comISRCTN35739639.

Single tube optimisation of APOE genotyping based on melting curve analysis.

OBJECTIVES: To develop and validate a single-tube protocol for APOE genotyping using fluorescent probes. DESIGN AND METHODS: We have designed and validated a hybrid, single-tube, SimpleProbe/FRET probe protocol that takes advantage of the different probe wavelength emissions. RESULTS: Our method offers high quality outcomes, minimum interferences between probe signals and is 100% concordant with the reference protocol. CONCLUSIONS: This method is cheaper, faster and more reliable and versatile than other alternatives proposed.

Asociaciones de la concentración de adiponectina sérica con parámetros antropométricos, bioquímicos y presión arterial en población de alto riesgo cardiovascular / Serum adiponectin concentration association with anthropometric, biochemical and blood pressure measures in a population with high cardiovascular risk

Introducción. La adiponectinemia se ha asociado inversamente con obesidad abdominal, un perfil lipídico más favorable y menor resistencia a la insulina. Sin embargo, recientes estudios en población de alto riesgo cardiovascular, especialmente con función renal alterada, muestran que concentraciones elevadas son un indicador desfavorable. Nuestro objetivo ha sido estudiar la asociación entre adiponectinemia y parámetros antropométricos, bioquímicos y presión arterial (PA) en pacientes de alto riesgo cardiovascular. Pacientes y métodos. Se estudió a 185 pacientes (133 mujeres y 52 varones), participantes del estudio PREDIMED (edad media de 65,5 ± 4,3 años). Se obtuvieron datos clínicos, antropométricos, bioquímicos y de PA, así como adiponectinemia. Resultados. El índice de masa corporal (IMC) fue ligeramente superior en mujeres que en varones (31,1 ± 4,3 frente a 29,4 ± 4,0 kg/m2; p = 0,01). La prevalencia de diabetes fue del 42,2%, y era superior en los varones (61,5%) que en las mujeres (34,6%). La adiponectinemia fue superior en las mujeres que en los varones (11,0 ± 5,2 frente a 6,9 ± 3,3 µg/ml; p < 0,001). Tras ajustar por sexo, las concentraciones medias de adiponectina fueron más elevadas en no diabéticos que en diabéticos (10,3 ± 0,5 frente a 7,5 ± 0,5; p < 0,001). Se obtuvieron correlaciones positivas entre adiponectina y colesterol unido a lipoproteínas de alta densidad (cHDL) (r = 0,36; p < 0,001), y correlaciones negativas con triglicéridos plasmáticos (r = ­0,28; p < 0,001), glucemia (r = ­0,28; p < 0,001) y creatinina plasmática (r = ­0,28; p = 0,007). Ni la PA sistólica ni la diastólica se asociaron con la adiponectinemia. Conclusiones. La adiponectinemia en esta población de alto riesgo cardiovascular no presenta correlaciones tan claras con parámetros antropométricos y PA como en población general. Sí que se ha mostrado más baja en diabéticos y correlacionada inversamente con la creatinina (AU)

Introduction. Serum adiponectin concentrations have been inversely associated with abdominal obesity, a more favorable lipid profile, and less insulin resistance. Nevertheless, recent studies in the population at high cardiovascular risk, especially that with altered renal function, show that high adiponectin concentrations are an unfavorable indicator. The aim of this study was to analyze the association of adiponectinemia with anthropometric, biochemical and blood pressure parameters in patients with high cardiovascular risk. Patients and methods. We studied 185 patients (133 women and 52 men), participating in the PREDIMED study (mean age 65.5 ± 4.3 years). Clinical, anthropometric, biochemical and blood pressure data, as well as adiponectinemia, were analyzed. Results. The body mass index was slightly higher in women than in men (31.1 ± 4.3 kg/m2 versus 29.4 ± 4.0 kg/m2; p = 0.01). The prevalence of diabetes was 42.2% and was higher in men (61.5%) than in women (34.6%). Adiponectin concentrations were higher in women than in men (11.0 ± 5.2 versus 6.9 ± 3.3 µg/mL; p < 0.001). After adjustment for sex, mean adiponectin concentrations were higher in nondiabetic than in diabetic participants (10.3 ± 0.5 versus 7.5 ± 0.5; p < 0.001). Positive correlations between adiponectin and high-density lipoprotein cholesterol were obtained (r = 0.36; p < 0.001). Negative correlations with plasma triglycerides (r = ­0.28; p < 0.001), glycemia (r = ­0,28; p < 0.001) and plasma creatinine (r = ­0.28; p = 0.007) were found. No association was found between adiponectinemia and systolic or diastolic blood pressure. Conclusions. In the population studied with high cardiovascular risk, the correlations between adiponectinemia and anthropometric parameters and blood pressure were less clear than those in the general population. However, adiponectin concentrations were lower in diabetics and were inversely correlated with creatinine levels (AU)

Efecto del polimorfismo +2138InsCAGACC en el gen del receptor 3 de la melanocortina en el riesgo de obesidad en población española / Profile of patients with diabetic ketoacidosis in the intensive care unit

Objetivo: El receptor 3 de la melanocortina (MC3R) ha sido implicado en la regulación de la homeostasis energética y en el peso corporal. Nuestro objetivo es conocer si el polimorfismo +2138InsCAGACC en dicho gen se asocia con el riesgo de obesidad en población española. Material y método: Se ha realizado un estudio de casos y controles con 303 casos de obesidad y 606 controles apareados por sexo y edad. Se determinaron variables antropométricas y del estilo de vida y el polimorfismo +2138InsCAGACC en el gen del MC3R. Resultados: La frecuencia alélica para la variante +2138InsCAGACC para el total de la población fue de 0,29, y resultó ligeramente menos frecuente en el grupo de casos que en el de controles. Así, en el análisis bruto, los portadores de la variante +2138InsCAGACC presentan un menor riesgo de obesidad, en el límite de la significación estadística (odds ratio [OR]= 0,73; intervalo de confianza [IC] del 95%, 0,53-1,01; p = 0,056), que apenas se modificó al controlar por posibles variables de confusión. Al analizar la asociación entre este polimorfismo y el peso corporal, se encontró una asociación estadísticamente significativa con un menor peso. Esta asociación fue específica del grupo de personas obesas, de forma que los portadores de la variante +2138InsCAGACC presentaron un menor peso medio que los no portadores (99,8 ± 22,7 frente a 94,2 ± 20,7 kg; p = 0,04). Conclusiones: El polimorfismo +2138InsCAGACC se asocia con menor peso corporal en personas obesas y tiende a asociarse a un menor riesgo de obesidad. Son necesarios más estudios en otras poblaciones para confirmar estos hallazgos (AU)

Objective: The melanocortin 3 receptor gene (MC3R) has been implicated in the regulation of energy homeostasis and body weight. Our aim was to determine whether the +2138InsCAGACC polymorphism in that gene is associated with obesity risk in the Spanish population. Material and method: A case-control study was carried out, including 303 obesity cases paired by sex and age with 606 controls. Anthropometrical data, lifestyle, and the +2138InsCAGACC polymorphism in the MC3R gene were determined. Results: The allele frequency for the +2138InsCAGACC variant for the total population was 0.29 and was slightly less frequent in cases than in controls. Thus, in the raw analysis, +2138InsCAGACC carriers showed a lower obesity risk, at the limit of statistical significance (odds ratio [OR] = 0.73; 95% confidente interval [CI], 0.53-1.01; p = 0.056), which hardly changed after adjustment for potential confounders. Analysis of the association between this polymorphism and body weight revealed a statistically significant association with lower weight. This association was specific for the obese group; thus +2138InsCAGACC carriers had a lower mean weight than non-carriers (99.8 ± 22.7 vs 94.2 ± 20.7 kg; p = 0.04). Conclusions: The +2138InsCAGACC polymorphism is associated with lower body weight in obese people and tends to be associated with a lower risk of obesity. Further studies are required to confirm these findings (AU)

Effect of genetic variation in the leptin gene promoter and the leptin receptor gene on obesity risk in a population-based case-control study in Spain.

There are no good genetic markers for incorporating the study of genetic susceptibility to obesity in epidemiological studies. In animal models, the leptin (LEP) and the leptin receptor (LEPR) genes have been shown to be very important in obesity because leptin functions as a negative feedback signal in regulating body-weight through reducing food intake and stimulating energy expenditure. In humans, several polymorphisms in these genes have been described. However, their association with obesity is still very controversial because there are no good case-control studies designed to specifically test this association. Our objective has been to conduct a population-based case-control study to estimate the risk of obesity arising from the -2548G > A and Q223R polymorphisms in the LEP and LEPR genes, respectively. 303 obese cases (101 men and 202 women) and 606 controls (202 men and 404 women) were selected from a Spanish Mediterranean population. Genetic, clinical and life-style characteristics were analyzed. No association was found between the -2548G > A polymorphism and obesity. However, the Q223R variant was significantly associated with obesity in a recessive model, the RR genotype being more prevalent in controls than in obese subjects. The inverse association between the Q223R polymorphism and obesity (OR = 0.62; 95% CI: 0.39-0.99) remained significant even after additional adjustment for education, tobacco smoking, alcohol, physical activity, origin of the obese patient, and the -2548G > A polymorphism in the LEP gene (OR = 0.54; 95% CI: 0.32-0.89). In conclusion, the -2548G > A polymorphism is not a relevant obesity marker in this Mediterranean population, although Q223R does seen to be so.

[Factor V Leiden (G1691A) and prothrombin-G20210A alleles among patients with deep venous thrombosis and in the general population from Spain]. / Comparación de las frecuencias de los alelos factor V Leiden (G1691A) y protrombina-G20210A entre pacientes con trombosis venosa profunda y población general mediterránea Española.

BACKGROUND: Factor V leiden and the -G20210A variant of prothrombin gene are associated to a higher risk of deep venous thrombosis. AIM: To assess the frequency of factor V Leiden (G1691A) and prothrombin -G20210A alleles in patients with deep venous thrombosis (DVT) and in the general population from Spain. MATERIAL AND METHODS: Factor V Leiden (g1691a) and prothrombin-g20210a alleles were genotyped in 493 individuals from the Spanish general populations and in 131 patients with DVT. The presence of DVT was confirmed by phlebography. Allelic frequencies and the DVT risk associated with these variants were estimated. RESULTS: Allelic frequencies for the factor V Leiden (G1691A) allele were 0.019 in patients with DVT and 0.010 in the general population (p=0.235). The frequencies for the prothrombin-G20210A allele were 0.027 and 0.026 (p=0.975). After adjustment for age and gender, the odds ratio for DVT, associated with the presence of G1691A allele was 2.41, but not statistically significant (95% confidence intervals 0.63-9.19). CONCLUSIONS: Prothrombin-G20210A allele was more prevelant than factor V Leiden (G1691A) allele in the Spanish population. However, the magnitude of the association between the G20210A and DVT risk is very low. On the contrary, the G1691A allele is associated by itself with a two fold increase in DVT risk in this population although without reaching statistical significance due to its low frequency.

Comparación de las frecuencias de los alelos factor V Leiden (G1691A) y protrombina-G20210A entre pacientes con trombosis venosa profunda y población general mediterránea española / Factor V Leiden (G1691A) and prothrombin-G20210A alleles among patients with deep venous thrombosis and in the general population from Spain

Background: Factor V leiden and the -G20210A variant of prothrombin gene are associated to a higher risk of deep venous thrombosis. Aim: To assess the frequency of factor V Leiden (G1691A) and prothrombin -G20210A alleles in patients with deep venous thrombosis (DVT) and in the general population from Spain. Material and methods: Factor V Leiden (g1691a) and prothrombin-g20210a alleles were genotyped in 493 individuals from the Spanish general populations and in 131 patients with DVT. The presence of DVT was confirmed by phlebography. Allelic frequencies and the DVT risk associated with these variants were estimated. Results: Allelic frequencies for the factor V Leiden (G1691A) allele were 0.019 in patients with DVT and 0.010 in the general population (p=0.235). The frequencies for the prothrombin-G20210A allele were 0.027 and 0.026 (p=0.975). After adjustment for age and gender, the odds ratio for DVT, associated with the presence of G1691A allele was 2.41, but not statistically significant (95% confidence intervals 0.63-9.19). Conclusions: Prothrombin-G20210A allele was more prevelant than factor V Leiden (G1691A) allele in the Spanish population. However, the magnitude of the association between the G20210A and DVT risk is very low. On the contrary, the G1691A allele is associated by itself with a two fold increase in DVT risk in this population although without reaching statistical significance due to its low frequency.