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1.
Mol Nutr Food Res ; : e2000178, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32378786

RESUMO

SCOPE: The plasma metabolomics profiles of protein intake has been rarely investigated. We aimed to identify the distinct plasma metabolomics profiles associated with overall intakes of protein as well as with intakes from animal and plant protein sources. METHODS AND RESULTS: Cross-sectional analysis using data from 1,833 participants at high risk of cardiovascular disease. Plasma metabolomics analysis was performed using LC-MS. Associations between 385 identified metabolites and the intake of total, animal protein (AP) and plant protein (PP), and plant-to-animal ratio (PR) were assessed using elastic net continuous regression analyses. A double 10-cross-validation (CV) procedure was used and Pearson correlations coefficients between multi-metabolite weighted models and reported protein intake in each pair of training-validation datasets were calculated. A wide set of metabolites was consistently associated with each protein source evaluated. These metabolites mainly consisted of amino acids and their derivatives, acylcarnitines, different organic acids and lipid species. Few metabolites overlapped among protein sources (i.e. C14:0 SM, C20:4 carnitine, GABA and allantoin) but none of them towards the same direction. Regarding AP and PP approaches, C20:4 carnitine and dimethylglycine were positively associated with PP but negatively associated with AP. However, allantoin, C14:0 SM, C38:7 PE plasmalogen, GABA, metronidazole and trigonelline (N-methylnicotinate) behaved contrary. Ten-CV Pearson correlations coefficients between self-reported protein intake and plasma metabolomics profiles ranged from 0.21 for PR to 0.32 for total protein. CONCLUSIONS: Different sets of metabolites were associated with total, animal and plant protein intake. Further studies are needed to assess the contribution of these metabolites in protein biomarkers' discovery and prediction of cardiometabolic alterations. This article is protected by copyright. All rights reserved.

2.
Am J Clin Nutr ; 2020 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-32246717

RESUMO

BACKGROUND: Many food items included in the Mediterranean diet (MedDiet) are rich in polyamines, small aliphatic amines with potential cardioprotective effects. The consumption of a MedDiet could increase polyamine concentrations. Based on experimental models, polyamine concentrations may be also influenced by physical activity (PA). OBJECTIVES: We aimed to evaluate whether an intervention based on an energy-restricted MedDiet (er-MedDiet) and PA promotion, in comparison with an energy-unrestricted MedDiet and traditional health care, influences the serum pattern of polyamines and related metabolites in subjects at high risk of cardiovascular disease (CVD). METHODS: This was a substudy from the PREDIMED-Plus trial, an ongoing randomized clinical trial including 6874 participants allocated either to an intensive weight-loss lifestyle intervention based on er-MedDiet, PA promotion, and behavioral support (er-MedDiet + PA group), or to an energy-unrestricted MedDiet and traditional health care group (MedDiet group). A total of 75 patients (n = 38, er-MedDiet + PA group; n = 37, MedDiet group) were included in this study. Serum concentrations of arginine, ornithine, polyamines, and acetyl polyamines at baseline and 26 wk of intervention were measured by an ultra-high-performance LC-tandem MS platform. RESULTS: At week 26, study groups had similar adherence to the MedDiet but patients randomly assigned to the er-MedDiet + PA group showed significantly lower mean energy intake (-340.3 kcal/d; 95% CI: -567.3, -113.4 kcal/d; P = 0.004), higher mean PA (1290.6; 95% CI: 39.9, 2541.3 metabolic equivalent tasks · min/d; P = 0.043), and higher mean decrease in BMI (in kg/m2) (-1.3; 95% CI: -1.8, -0.6; P < 0.001) than the MedDiet group. However, no significant differences in serum polyamines or related metabolites were found between study groups after 26 wk of intervention and no significant between-group differences were found in glycated hemoglobin, HDL-cholesterol, or triglyceride concentrations. CONCLUSIONS: In individuals at high CVD risk, an er-MedDiet with increased PA did not result in significant changes of serum concentrations of polyamines or related metabolites in comparison with an energy-unrestricted MedDiet and no increase in PA. This trial was registered at isrctn.com as ISRCTN89898870.

4.
Am J Clin Nutr ; 2020 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-32330232

RESUMO

BACKGROUND: Telomere length (TL) is a marker of biological age that may be affected by dietary factors through oxidation and inflammation mechanisms. In addition, ultra-processed food (UPF) consumption has increased worldwide and it has been associated with the risk of developing several diseases. OBJECTIVES: We aimed to evaluate the association between UPF consumption and the risk of having short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project. METHODS: This is a cross-sectional study of 886 participants (645 men and 241 women) aged 57-91 y recruited from the SUN Project (Spain, 1999-2018). TL was measured from saliva samples by real-time qPCR at baseline and UPF consumption was collected using a validated 136-item FFQ and classified according to the NOVA system. We evaluated the association between consumption of energy-adjusted UPF categorized into quartiles (low, medium-low, medium-high, and high consumption) and the risk of having short telomeres (<20th percentile) using logistic regression models. RESULTS: Those participants with the highest UPF consumption had almost twice the odds of having short telomeres compared with those with the lowest consumption (adjusted OR: 1.82; 95% CI: 1.05, 3.22; P-trend = 0.03). CONCLUSIONS: A higher consumption of UPF (>3 servings/d) was associated with higher risk of having shorter telomeres in an elderly Spanish population of the SUN Project.This trial was registered at clinicaltrials.gov as NCT02669602.

5.
J Am Coll Cardiol ; 75(15): 1729-1739, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32147453

RESUMO

BACKGROUND: Olive oil intake has been associated with lower risk of cardiovascular disease (CVD) in Mediterranean populations, but little is known about these associations in the U.S population. OBJECTIVES: This study sought to examine whether olive oil intake is associated with total CVD, coronary heart disease (CHD), and stroke risk. METHODS: This study included 61,181 women from the Nurses' Health Study (1990 to 2014) and 31,797 men from the Health Professionals Follow-up Study (1990 to 2014) who were free of cancer, heart disease, and stroke at baseline. Diet was assessed using food frequency questionnaires at baseline and then every 4 years. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: During 24 years of follow-up, this study documented 9,797 incident cases of CVD, including 6,034 CHD cases and 3,802 stroke cases. After adjusting for major diet and lifestyle factors, compared with nonconsumers, those with higher olive oil intake (>0.5 tablespoon/day or >7 g/day) had 14% lower risk of CVD (pooled HR: 0.86; 95% CI: 0.79 to 0.94) and 18% lower risk of CHD (pooled HR: 0.82; 95% CI: 0.73 to 0.91). No significant associations were observed for total or ischemic stroke. Replacing 5 g/day of margarine, butter, mayonnaise, or dairy fat with the equivalent amount of olive oil was associated with 5% to 7% lower risk of total CVD and CHD. No significant associations were observed when olive oil was compared with other plant oils combined. In a subset of participants, higher olive oil intake was associated with lower levels of circulating inflammatory biomarkers and a better lipid profile. CONCLUSIONS: Higher olive oil intake was associated with lower risk of CHD and total CVD in 2 large prospective cohorts of U.S. men and women. The substitution of margarine, butter, mayonnaise, and dairy fat with olive oil could lead to lower risk of CHD and CVD.

6.
Sci Rep ; 10(1): 3472, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32103064

RESUMO

Physical activity (PA) has been hypothesized to be effective to maintaining cognitive function and delay cognitive decline in the elderly, but physical fitness (PF) could be a better predictor of cognitive function. We aimed to study the association between PA and PF with cognitive function and quality of life using cross-sectional data from 6874 participants of the PREDIMED-Plus trial (64.9 ± 4.9 years, 48.5% female). PF and PA were measured with a Chair Stand Test, the REGICOR and Rapid Assessment Physical Activity questionnaires. Cognitive function was measured with Mini-mental State Examination, Control Oral Word Association Test, Trail Making Test and Digit Span tests; whereas health-related quality of life was assessed with the SF36-HRQL test. Cognitive and quality of life scores were compared among PF quartiles and PA levels (low, moderate and high) with ANCOVA and with Chair Stand repetitions and energy expenditure from total PA with multivariable linear regression adjusted for confounding factors. PF associated with higher scores in phonemic and semantic verbal fluency tests and with lower TMT A time. However, PA was not associated with the neurocognitive parameters evaluated. Both PF and PA levels were strongly associated with a better quality of life. We concluded that PF, but not PA, is associated with a better cognitive function. This trial was retrospectively registered at the International Standard Randomized Controlled Trial (ISRCTN89898870, https://www.isrctn.com/ISRCTN89898870?q=ISRCTN89898870&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search) on 07/24/2014.

7.
Am J Clin Nutr ; 111(4): 835-844, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32060497

RESUMO

BACKGROUND: Glycolysis/gluconeogenesis and tricarboxylic acid (TCA) cycle metabolites have been associated with type 2 diabetes (T2D). However, the associations of these metabolites with T2D incidence and the potential effect of dietary interventions remain unclear. OBJECTIVES: We aimed to evaluate the association of baseline and 1-y changes in glycolysis/gluconeogenesis and TCA cycle metabolites with insulin resistance and T2D incidence, and the potential modifying effect of Mediterranean diet (MedDiet) interventions. METHODS: We included 251 incident T2D cases and 638 noncases in a nested case-cohort study within the PREDIMED Study during median follow-up of 3.8 y. Participants were allocated to MedDiet + extra-virgin olive oil, MedDiet + nuts, or control diet. Plasma metabolites were measured using a targeted approach by LC-tandem MS. We tested the associations of baseline and 1-y changes in glycolysis/gluconeogenesis and TCA cycle metabolites with subsequent T2D risk using weighted Cox regression models and adjusting for potential confounders. We designed a weighted score combining all these metabolites and applying the leave-one-out cross-validation approach. RESULTS: Baseline circulating concentrations of hexose monophosphate, pyruvate, lactate, alanine, glycerol-3 phosphate, and isocitrate were significantly associated with higher T2D risk (17-44% higher risk for each 1-SD increment). The weighted score including all metabolites was associated with a 30% (95% CI: 1.12, 1.51) higher relative risk of T2D for each 1-SD increment. Baseline lactate and alanine were associated with baseline and 1-y changes of homeostasis model assessment of insulin resistance. One-year increases in most metabolites and in the weighted score were associated with higher relative risk of T2D after 1 y of follow-up. Lower risks were observed in the MedDiet groups than in the control group although no significant interactions were found after adjusting for multiple comparisons. CONCLUSIONS: We identified a panel of glycolysis/gluconeogenesis-related metabolites that was significantly associated with T2D risk in a Mediterranean population at high cardiovascular disease risk. A MedDiet could counteract the detrimental effects of these metabolites.This trial was registered at controlled-trials.com as ISRCTN35739639.

8.
Int J Obes (Lond) ; 44(2): 330-339, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31217539

RESUMO

BACKGROUND: Whether short sleep duration or high sleep variability may predict less weight loss and reduction in measures of adiposity in response to lifestyle interventions is unknown. The aim of this study was to compare the 12-month changes in weight and adiposity measures between those participants with short or adequate sleep duration and those with low or high sleep variability (intra-subject standard deviation of the sleep duration) in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a primary prevention trial based on lifestyle intervention programs. METHODS: Prospective analysis of 1986 community-dwelling subjects (mean age 65 years, 47% females) with overweight/obesity and metabolic syndrome from the PREDIMED-Plus trial was conducted. Accelerometry-derived sleep duration and sleep variability and changes in average weight, body mass index (BMI), and waist circumference (WC) attained after 12-month interventions were analyzed. RESULTS: The adjusted difference in 12-month changes in weight and BMI in participants in the third tertile of sleep variability was 0.5 kg (95% CI 0.1 to 0.9; p = 0.021) and 0.2 kg/m2 (0.04 to 0.4; p = 0.015), respectively, as compared with participants in the first tertile. The adjusted difference in 12-month changes from baseline in WC was -0.8 cm (-1.5 to -0.01; p = 0.048) in participants sleeping <6 h, compared with those sleeping between 7 and 9 h. CONCLUSIONS: Our findings suggest that the less variability in sleep duration or an adequate sleep duration the greater the success of the lifestyle interventions in adiposity.

9.
Clin Nutr ; 39(3): 853-861, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30952534

RESUMO

BACKGROUND & AIMS: Few studies have compared micronutrient intake and fulfilment of average requirements (EAR) in non-diabetic, pre-diabetic and diabetic adults at high cardiovascular risk. We assessed these variables in a large sample of participants in the PREDIMED-PLUS randomized trial of primary cardiovascular prevention with diet and physical activity. DESIGN: Baseline assessment of nutritional adequacy in n = 5792 men and women, aged 55-75 years, with overweight/obesity and some metabolic syndrome features. METHODS: Participants were categorised as non-diabetic (n = 2390), pre-diabetic (n = 1322) or diabetic (n = 2080) by standard criteria. Food and nutrient intake were assessed using a validated food frequency questionnaire. Micronutrients examined were vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine. The proportion of micronutrient inadequacy was evaluated using the EAR or adequate intake (AI) cut-offs. Diet quality was also determined using a 17-item energy-restricted Mediterranean diet (MedDiet) questionnaire. RESULTS: Compared to non-diabetic participants, those with pre-diabetes had lower intakes of total carbohydrates (CHO) and higher intakes of total fat and saturated fatty acids (SFA) and were more likely to be below EAR for folic, while diabetic participants had lower intakes of total CHO and higher intakes of protein, total fat, monounsaturated fatty acids, SFA and cholesterol and were less likely to be below EAR for vitamins B2, and B6, Ca, Zn and iodine. Diabetic participants disclosed higher adherence to the MedDiet than the other two groups. CONCLUSIONS: Older Mediterranean individuals with metabolic syndrome and diabetes had better nutrient adequacy and adherence to the MedDiet than those with pre-diabetes or no diabetes.

10.
Neuroepidemiology ; 54(1): 45-57, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31600758

RESUMO

OBJECTIVES: To study and compare associations of 5 dietary patterns - Mediterranean dietary pattern (MDP), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative delay (MIND), Alternative Healthy Eating Index (AHEI-2010), and a pro-vegetarian diet (PVD) - with cognitive function. PATIENTS AND METHODS: A subgroup of 806 participants from the "Seguimiento Universidad de Navarra"(SUN) cohort of university graduates, >55 years old, was interviewed with the validated Spanish Telephone Interview for Cognitive Status (STICS-m) at baseline and after 2 and 6 years. For recruitment to the SUN cohort, participants completed a validated food-frequency questionnaire to calculate dietary adherence scores. These scores were used as independent variables in linear regression models (a model for each dietary pattern) to assess their association with the 6-year change in STICS-m as the dependent variable. Linear mixed models were also fitted to compare trajectories of STICS-m scores. All models were adjusted for relevant confounding factors. RESULTS: Adjusted differences showed advantages in the 6-year change in STICS-m score of 0.25 (95% CI 0.04-0.45) for an increase of 1-SD (9 points) in the AHEI-2010 and of 0.27 (95% CI 0.05-0.48) for an increase of 1-SD (1.5 points) in the MIND diet. The MDP, DASH, and PVD scores yielded positive differences in their point estimates for an increase in 1-SD, but results were not statistically significant. The MIND diet appeared to modify changes in cognitive function over time. CONCLUSIONS: Our results showed a beneficial association between the MIND diet and cognitive function and suggested a benefit for the AHEI-2010 pattern. Results for the MDP, DASH, and PVD were inconclusive.

11.
Int J Obes (Lond) ; 44(2): 320-329, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31467420

RESUMO

BACKGROUND: The use of oral contraceptives (OC) has been suggested to represent a potential risk factor for the development of obesity. However, the available literature assessing the relationship between OC use and the development of obesity is still scarce and characterised by controversial heterogeneity. We prospectively evaluated the association between the use of OC and the development of obesity in female participants of a middle-aged and free-living cohort. METHODS: The study population included 4920 female Spanish university graduates, initially nonobese women, with mean age (standard deviation) 28.2 (5.4) years. The study population was followed up for a mean of 8.6 (3.7) years. Self-reported use of OC and body mass index were assessed at baseline and biennially during follow-up. We used generalized estimating equation models to evaluate the association between exposure to OC and the development of obesity. RESULTS: After adjusting for potential confounders, baseline OC use was associated with higher odds of new-onset obesity during the full follow-up period (multivariable-adjusted odds ratio [OR] = 1.78; 95% Confidence Interval [CI]: 1.01-3.15). The continued use of OC for periods of time longer than 2 years was significantly associated with a higher risk of developing obesity (OR = 2.82, 95% CI: 1.17-6.82). CONCLUSIONS: According to our prospective cohort study, OC use is significantly associated with higher odds of obesity development, especially when the use of OC is steady and extends over periods of more than 2 years.

12.
Rev Esp Cardiol (Engl Ed) ; 73(3): 205-211, 2020 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31501028

RESUMO

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

13.
Nutr Metab Cardiovasc Dis ; 30(2): 214-222, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31791636

RESUMO

BACKGROUND AND AIMS: The prevalence of hyperuricemia has increased substantially in recent decades. It has been suggested that it is an independent risk factor for weight gain, hypertension, hypertriglyceridemia, metabolic syndrome (MetS), and cardiovascular disease. Results from epidemiological studies conducted in different study populations have suggested that high consumption of dairy products is associated with a lower risk of developing hyperuricemia. However, this association is still unclear. The aim of the present study is to explore the association of the consumption of total dairy products and their subtypes with the risk of hyperuricemia in an elderly Mediterranean population with MetS. METHODS AND RESULTS: Baseline cross-sectional analyses were conducted on 6329 men/women (mean age 65 years) with overweight/obesity and MetS from the PREDIMED-Plus cohort. Dairy consumption was assessed using a food frequency questionnaire. Multivariable-adjusted Cox regressions were fitted to analyze the association of quartiles of consumption of total dairy products and their subtypes with the prevalence of hyperuricemia. Participants in the upper quartile of the consumption of total dairy products (multiadjusted prevalence ratio (PR) = 0.84; 95% CI: 0.75-0.94; P-trend 0.02), low-fat dairy products (PR = 0.79; 95% CI: 0.70-0.89; P-trend <0.001), total milk (PR = 0.81; 95% CI: 0.73-0.90; P-trend<0.001), low-fat milk (PR = 0.80; 95% CI: 0.72-0.89; P-trend<0.001, respectively), low-fat yogurt (PR = 0.89; 95% CI: 0.80-0.98; P-trend 0.051), and cheese (PR = 0.86; 95% CI: 0.77-0.96; P-trend 0.003) presented a lower prevalence of hyperuricemia. Whole-fat dairy, fermented dairy, and yogurt consumption were not associated with hyperuricemia. CONCLUSIONS: High consumption of total dairy products, total milk, low-fat dairy products, low-fat milk, low-fat yogurt, and cheese is associated with a lower risk of hyperuricemia.

14.
Nutrition ; 71: 110620, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31838461

RESUMO

OBJECTIVE: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver morbidity. This condition often is accompanied by obesity, diabetes, and metabolic syndrome (MetS). The aim of this study was to evaluate the connection between lifestyle factors and NAFLD in individuals with MetS. METHODS: A cross-sectional study with 328 participants (55-75 y of age) diagnosed with MetS participating in the PREDIMED-Plus trial was conducted. NAFLD status was evaluated using the non-invasive hepatic steatosis index (HSI). Sociodemographic, clinical, and dietary data were collected. Adherence to the Mediterranean diet (mainly assessed by the consumption of olive oil, nuts, legumes, whole grain foods, fish, vegetables, fruits, and red wine) and physical activity were assessed using validated questionnaires. RESULTS: Linear regression analyses revealed that HSI values tended to be lower with increasing physical activity tertiles (T2, ß = -1.47; 95% confidence interval [CI], -2.73 to -0.20; T3, ß = -1.93; 95% CI, -3.22 to -0.65 versus T1, Ptrend = 0.001) and adherence to the Mediterranean diet was inversely associated with HSI values: (moderate adherence ß = -0.70; 95% CI, -1.92 to 0.53; high adherence ß = -1.57; 95% CI, -3.01 to -0.13 versus lower, Ptrend = 0.041). Higher tertiles of legume consumption were inversely associated with the highest tertile of HSI (T2, relative risk ratio [RRR], 0.45; 95% CI, 0.22-0.92; P = 0.028; T3, RRR, 0.48; 95% CI, 0.24-0.97; P = 0.041 versus T1). CONCLUSION: Physical activity, adherence to the Mediterranean diet, and consumption of legumes were inversely associated with a non-invasive marker of NAFLD in individuals with MetS. This data can be useful in implementing precision strategies aimed at the prevention, monitoring, and management of NAFLD.

15.
Acta otorrinolaringol. cir. cabeza cuello ; 48(Suplemento 1): 45-54, 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1095908

RESUMO

Desde el inicio de la pandemia por la enfermedad SARS-CoV-2 (COVID-19), la práctica médica viene sufriendo profundos cambios estructurales; quizá uno de los componentes en los que más se evidencian estos cambios es en la relación médico-paciente. Es claro que la praxis médica cambiará e incluirá herramientas tecnológicas presenciales y no presenciales, y nuevas medidas de protección para médicos y pacientes, lo que modificará la atmósfera médica tradicional. La enfermedad contagiosa transmisible obligará al otorrinolaringólogo a transformar las conductas de la relación médico-paciente, deberá asumir acciones en procura de cuidar a su paciente y cuidarse a sí mismo. Por otro lado, también obligará al paciente a tomar acciones de cuidado para su médico, no solo para sí mismo. Lo anterior en la relación bidireccional en la que se basa la atención médica. Dentro de esta nueva relación médico-paciente cobrará relevancia especial el consentimiento informado (CI), porque estará presente en muchas de las nuevas formas de prestación de servicio y además porque tiene un nuevo componente que, por ahora, será muy difícil dejar de lado, el riesgo de contagio por COVID-19. La explicación médica de lo que sucede con este virus y la aceptación por parte del paciente creará un nuevo proceder médico que será parte de esta nueva metodología de trabajo. El presente artículo explica el uso del CI en esta nueva práctica médica, desarrollado desde un enfoque histórico, legal y clínico protocolando al lector información actual referente a esta valiosa herramienta.


Since the onset of the SARS-CoV-2 (COVID-19) pandemic, the medical practice has undergone profound structural changes; one of the components in which these changes are seen is the doctor-patient relationship. It is clear that the praxis will modify the medicine as we know it, since the history taking in the medical consult, to performing the physical exam and the treatment options. From the pandemic onwards, new onsite and non-contact technological tools and protection measures for the patients and medical staff will be included, even the patient-physician relationship will change trying to avoid the contact as much as possible, modifying the traditional medical atmosphere. The contagious transmissible diseases will force otolaryngologists to transform their behavior and medical-patient relationship, forcing both parts to take action pursuing the care of themselves and the other, attending the two-way relationship of the medical attention. Within this new physician-patient relationship, the informed consent (IC) will take special relevance, not only because it will be present in many of the new service providing ways but also because it has a new component which, for now, will be very difficult to ignore: the risk of Covid19 Infection. The medical explanation of what is happening with this novel coronavirus and the acceptance by the patient, will create a new medical performance as part of a new methodology. This article explains the use of the IC in this new medical practice from its philosophical, medical and legal aspects, providing the reader with more information regarding this valuable tool.


Assuntos
Humanos , Consentimento Livre e Esclarecido , Otolaringologia , Bioética , Infecções por Coronavirus , Pandemias , Betacoronavirus
16.
Am J Clin Nutr ; 111(2): 291-306, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31868210

RESUMO

BACKGROUND: Overall quality of dietary carbohydrate intake rather than total carbohydrate intake may determine the risk of cardiovascular disease (CVD). OBJECTIVE: We examined 6- and 12-mo changes in carbohydrate quality index (CQI) and concurrent changes in several CVD risk factors in a multicenter, randomized, primary-prevention trial (PREDIMED-Plus) based on an intensive weight-loss lifestyle intervention program. METHODS: Prospective analysis of 5373 overweight/obese Spanish adults (aged 55-75 y) with metabolic syndrome (MetS). Dietary intake information obtained from a validated 143-item semiquantitative food-frequency questionnaire was used to calculate 6- and 12-mo changes in CQI (categorized in quintiles), based on 4 criteria (total dietary fiber intake, glycemic index, whole grain/total grain ratio, and solid carbohydrate/total carbohydrate ratio). The outcomes were changes in intermediate markers of CVD. RESULTS: During the 12-mo follow-up, the majority of participants improved their CQI by increasing their consumption of fruits, vegetables, legumes, fish, and nuts and decreasing their consumption of refined cereals, added sugars, and sugar-sweetened beverages. After 6 mo, body weight, waist circumference (WC), systolic and diastolic blood pressure (BP), fasting blood glucose, glycated hemoglobin (HbA1c), triglyceride levels, triglycerides and glucose (TyG) index, and TyG-WC decreased across successive quintiles of improvement in the CQI. After 12 mo, improvements were additionally observed for HDL cholesterol and for the ratio of total to HDL cholesterol. Favorable improvements (expressed in common units of SD and 95% CI) for quintile 5 compared with quintile 1 of CQI change were observed for most risk factors, including TyG-WC (SD -0.20; 95% CI -0.26, -0.15), HbA1c (SD -0.16; 95% CI -0.23, -0.10), weight (SD -0.12; 95% CI -0.14, -0.09), systolic BP (SD -0.11; 95% CI -0.19, -0.02) and diastolic BP (SD -0.11; 95% CI -0.19, -0.04). CONCLUSIONS: Improvements in CQI were strongly associated with concurrent favorable CVD risk factor changes maintained over time in overweight/obese adults with MetS. This trial was registered as ISRCTN 89898870.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Carboidratos da Dieta/administração & dosagem , Sobrepeso , Idoso , Dieta/normas , Carboidratos da Dieta/classificação , Carboidratos da Dieta/normas , Ingestão de Energia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
17.
Med Clin (Barc) ; 2019 Nov 29.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31791802

RESUMO

BACKGROUND AND OBJECTIVES: Cured ham is one of the most characteristic foods in the Spanish diet. Because it is a red processed meat and due to its nutritional composition, including high sodium content, a potential association between cured ham consumption and a higher risk of hypertension could be expected. However, epidemiological studies evaluating this association are scarce. We prospectively assessed the association between cured ham consumption and the incidence of hypertension. METHODS: The "Seguimiento Universidad de Navarra" (SUN) study is a cohort of Spanish middle-aged adult university graduates (average age: 38 (SD: 12) years, 60% women). We included 13,900 participants of the SUN cohort free of hypertension at baseline. One serving of cured ham is 50g. They were classified into 4 categories of cured ham consumption: <1; 1; 2-4 and ≥5servs/week. Multivariable-adjusted Cox regression models were fitted to assess the association between cured ham consumption and subsequent hypertension risk using the category of lowest consumption as the reference. RESULTS: After a median follow-up of 10.9 years, 1465 incident self-reported cases of hypertension were identified. After adjusting for potential confounders, including dietary confounders, a high consumption of cured ham (≥5servs/week vs. <1serv/week) was not significantly associated with hypertension risk in this prospective cohort (HR=0.88, 95% CI: 0.70-1.10, p linear trend=0.40). CONCLUSIONS: Our results showed that cured ham consumption was not associated with a significantly higher or lower risk of hypertension in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal and experimental studies are needed to disentangle the association between cured ham consumption and the risk of hypertension.

18.
J Chem Phys ; 151(23): 234705, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864279

RESUMO

Lead sulfide quantum dots (QDs) have been widely used for various optoelectronic devices due to their high absorption coefficient and tunable bandgap. However, the low mobility of QD films results in poor charge collection and device performance. By combining QDs with graphene into hybrid graphene/QD photodetectors, photocarriers from QDs are transferred to graphene, improving charge collection and transport, drastically increasing the photoresponsivity. Herein, we carry a systematic analysis on how critical tuning parameters such as QD size and QD film thickness affect responsivity, spectral response, and time response. We report the absorption coefficient, refractive index (n, k), penetration depth, and energy bandgap of PbS QDs of different sizes. We study systematically how the photocurrent, photoresponsivity, time response, and power density dependence vary with QD size in hybrid Gr/QD. The bandgap of lead sulfide quantum dots was size-tuned between 0.86 and 1.39 eV. The time response shows that subsecond modulation can be achieved for different QD sizes with a responsivity up to 107 A/W at power densities of 10-5 mW/cm2. We also studied how the performance of the photodetectors is affected by the thickness, discussing the limitations on the thickness by the compromise between light absorption and charge collection. We describe how the optical response shifts toward the infrared as QD films get thicker. Time responses below 1 s are obtained for graphene/QD devices with thickness from 150 nm to 1 µm. This systematic study provides important guidelines to design hybrid graphene/QD photodetectors and tune their spectral response and performance.

19.
Int J Behav Nutr Phys Act ; 16(1): 139, 2019 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882021

RESUMO

BACKGROUND: Consumption of certain foods is associated with long-term weight gains and abdominal fat accumulation in healthy, middle-aged and young, non-obese participants. Whether the same foods might be associated with changes in adiposity in elderly population at high cardiovascular risk is less known. OBJECTIVE: Using yearly repeated measurements of both food habits and adiposity parameters, we aimed to investigate how changes in the consumption of specific foods were associated with concurrent changes in weight or waist circumference (WC) in the PREDIMED trial. DESIGN: We followed-up 7009 participants aged 55-70 years at high cardiovascular risk for a median time of 4.8 years. A validated 137-item semi-quantitative Food Frequency Questionnaire was used for dietary assessment with yearly repeated measurements. We longitudinally assessed associations between yearly changes in food consumption (serving/d) and concurrent changes in weight (kg) or WC (cm). RESULTS: Yearly increments in weight were observed with increased consumption (kg per each additional increase in 1 serving/d) for refined grains (0.32 kg/serving/d), red meat (0.24), potatoes (0.23), alcoholic beverages (0.18), processed meat (0.15), white bread (0.07) and sweets (0.04); whereas inverse associations were detected for increased consumption of low-fat yogurt (- 0.18), and low-fat milk (- 0.06). Annual WC gain (cm per each additional increase in 1 serving/d) occurred with increased consumption of snacks, fast-foods and pre-prepared dishes (0.28), processed meat (0.18), alcoholic beverages (0.13), and sweets (0.08); whereas increased consumption of vegetables (- 0.23), and nuts (- 0.17), were associated with reductions in WC. CONCLUSIONS: In this assessment conducted in high-risk subjects using yearly repeated measurements of food habits and adiposity, some ultra-processed foods, refined carbohydrates (including white bread), potatoes, red meats and alcohol were associated with higher weight and WC gain, whereas increases in consumption of low-fat dairy products and plant foods were associated with less gain in weight and WC. TRIAL REGISTRATION: This study was registered at controlled-trials.com with International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.


Assuntos
Peso Corporal/fisiologia , Doenças Cardiovasculares/epidemiologia , Dieta/métodos , Circunferência da Cintura/fisiologia , Idoso , Animais , Comportamento Alimentar/fisiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco
20.
Clin Nutr ; 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31767135

RESUMO

BACKGROUND: Shorter telomeres are associated with several age-related diseases, and lifestyle factors could influence this relationship. The aim of this study was to examine associations between salivary telomere length (TL) and diet quality using 5 evidence-based dietary indexes in an elderly (>55 years old) Spanish population of the SUN project (n = 886). METHOD: TL was measured using the quantitative real-time polymerase chain reaction. Age-adjusted TL variable through residuals methods was used for all analysis. Diet quality was assessed by the Prime Diet Quality Score (PDQS), Fat Quality Index (FQI), Mediterranean Diet Adherence Screener (MEDAS), Dietary Approaches to Stop Hypertension (DASH) index and the Alternative Healthy Eating Index (AHEI-2010). RESULTS: TL did differ according to sex, smoking status, and dyslipidemia in elderly subjects of the SUN study. In addition, subjects with dyslipidemia (compared to absence of dyslipidemia) had a significantly higher risk (27% vs. 18%, p = 0.015) of short telomeres (

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