Analysis of the psychometric properties of the Sense of Coherence scale (SOC-13) in patients with cardiovascular risk factors: a study of the method effects associated with negatively worded items.

PURPOSE: The objectives of this study were to analyze the psychometric properties of the Sense of Coherence scale (SOC-13), determine the role of the method effect in the performance of the instrument, and identify the relationship with health perception, quality of life, and sleep quality in patients at cardiovascular risk. METHODS: The final sample consisted of 293 patients at cardiovascular risk, with a mean age of 61.9 years (SD = 8.8), 49.8% of whom were women. The SOC-13, the Patient Health Questionnaire (PHQ-9), and the Medical Outcomes Study-Sleep Scale (MOS-Sleep) were administered. In addition, the participant's self-perceived health and quality of life were also evaluated. All analyses were carried out with SPSS 26.0 and EQS 6.1 statistical software. RESULTS: The results showed adequate reliability for the SOC-13, with a Cronbach's alpha of .789. The fit of the structures was not adequate in any of the cases (.26 to .62 for one factor, .26 to.73 for three factors, .20 to .54 for one second-order factor, and .25, .42, and .54 for three first-order factors). The three structure models showed an improved fit when adding a latent factor resulting from the method effect (.6 to .85 for one factor, .11 to.90 for three factors, and .11 to .96 for one second-order factor). Moreover, positive correlations were found with health perception, perceived quality of life, and perceived sleep quality. CONCLUSION: The SOC-13 is a suitable instrument for patients with cardiovascular risk in Spain, and it is also an indicator of health perception, quality of life, and perceived quality of sleep. Control of the method effect improves the fit of the instrument's structure. As a future direction, it is recommended to conduct new studies in this and other samples and using different versions of the SOC. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number: ISRCTN76069254, 08/04/2015 retrospectively registered.

Effectiveness of physical activity prescription by primary care nurses using health assets: A randomized controlled trial.

AIM: To evaluate the effectiveness of a 12-month multifactorial intervention by primary care nurses using health assets in increasing adherence to physical activity prescription (150 min/week) in patients with two or more cardiovascular risk factors. BACKGROUND: Physical activity promotion is a priority and helps to decrease mortality risk due to cardiovascular diseases. However, adherence to the habitual physical activity prescription in primary healthcare settings is low. DESIGN: Multicentre, single-blind, parallel randomized (in two different branches) clinical trial. METHODS: In total, 263 participants from 20 primary healthcare centres in Mallorca completed the randomized controlled trial study (intervention group N = 128, control group N = 135). The intervention consisted in four visits and included a motivational interview and an individualized prescription of physical activity using health assets. Primary outcome measure was the number of participants performing at least 150 min of weekly physical activity. Secondary outcomes included physical activity level and physical fitness, Sense of Coherence, cardiovascular risk, sociodemographic data, trans-theoretical stage of change, sleep quality, and depression. RESULTS: Adherence to the recommendation of at least 150 min of physical activity was higher in the intervention than in the control group (χ2  = 3.951, p = .047). However, this higher adherence did not suppose higher physical activity levels because no differences between groups were found in the total physical activity performed after intervention (t=-0.915, p = .361). At the end of the intervention participants randomized to the intervention group spent more time walking than participants in the control group (t = 2.260, p = .025). CONCLUSION: The multifactorial intervention performed by primary care nurses induced a higher adherence to the 150-min of weekly physical activity recommendation. IMPACT: Adherence to the usual physical activity prescription in primary care is low. Physical activity prescription performed by primary care nurses and based on health assets and motivational interview can help to increase physical activity levels of patients. The main finding of the present study was that prescription using this approach was shown to be effective, leading to a higher adherence in the intervention group. This intervention is feasible in the nurse's primary healthcare setting, thus it could be implemented as the main tool when exercise is prescribed. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number: ISRCTN76069254.

Nurse-led telephone intervention for lifestyle changes on glycaemic control in people with prediabetes: Study protocol for a randomized controlled trial.

AIM: To evaluate the effectiveness of a nurse-led personalized telephone lifestyle intervention versus automated SMSs in the reduction of fasting plasma glucose in adults with prediabetes. DESIGN: The PREDIPHONE is a randomized controlled, parallel, two arms, superiority trial with 15 months of follow-up. Participants will be randomized to either the intervention group (teleconsultations) or the active control group (SMSs). METHODS: A total of 428 participants will be randomized in a 1:1 ratio to one of the two arms and followed up during 9 months. The teleconsultations group will receive nurse-led personalized advice, while the SMSs group will receive 4-5 brief SMSs a week. Participants in both groups will receive evidence-based recommendations for diet and physical activity (PA). Outcome measures will be collected at baseline, months 4 and 9 and at month 15, to evaluate post-intervention effects. DISCUSSION: Prevention of diabetes through the implementation of lifestyle interventions remains an important priority. The current pandemic situation has magnified its urgency as it heavily affected the functionality of the healthcare system. Moreover, it created the need of remotely delivering preventative interventions. This study will provide insights on the effectiveness and feasibility of a telephone-based intervention led by nurses in the amelioration of risk factors associated with diabetes. IMPACT: Findings from this study will offer health services decision-makers sound evidence regarding an alternative method to face-to-face consultations that could be practical, acceptable and inexpensive, and that concretely answers the need for easily implementable prevention strategies. TRIAL REGISTRATION: NCT04735640 (ClinicalTrials.gov identifier). PROTOCOL VERSION: V1.0, 18/02/2021.

Effectiveness of a complex intervention on smoking in adolescents: A cluster-randomized controlled trial.

Tobacco smoking is a major preventable cause of death, and a significant public health problem worldwide. Most smokers begin in adolescence, age at which they are more susceptible to nicotine addiction. The prevalence of smoking in adolescence is considerable. Therefore, it would be convenient to incorporate smoking prevention programs in the school environment. It is necessary to provide evidence of its effectiveness. The primary objective of the study was to evaluate the effectiveness of a teacher-delivered school-based intervention on the initiation of smoking in adolescents (ITACA smoking prevention education program). A multi-center cluster randomized trial was designed. Twenty-two secondary schools from Spain were enrolled in 2 successive cohorts, from 2010 to 2011. The intervention consisted in the application of the ITACA smoking prevention education program. A 4-year cognitive-behavioral intervention that is based on the social-influences model and is integrated into schools' regular curricular activities. A total of 1055 students were surveyed before the intervention (age: 12-13 years-old), and at the third year of the intervention (age: 14-15 years-old) of a 4-year education program. The outcome measures were daily and weekly use of cigarettes, and initiation of smoking. There was no evidence that the intervention impacted the incidence of regular smoking (OR = 1.08; 95% CI: 0.50-2.33) or the initiation of smoking (OR = 1.09; 95% CI: 0.56-1.72). This trial provides evidence supporting the non-effectiveness of a complex educational smoking prevention program at 3 years after the intervention. TRIAL REGISTRATION NUMBER: Current Controlled Trials: NCT01602796.

Energy, macronutrient and water intake during a mountain ultramarathon event: The influence of distance.

Adequate dietary strategies are essential for the successful participation in ultra-endurance races. The aim of this study was to evaluate and compare the energy and water intakes of participants during three different mountain ultra-endurance runs. The study took place at the "Ultra Mallorca Serra de Tramuntana" (Mallorca, Spain), an ultra-endurance mountain event with runners participating either in a 44-km (Marathon, n = 51), a 67-km (Trail, n = 109) or a 112-km (Ultra, n = 53) run competition. Participants in the study answered a questionnaire focused on the nutritional intake within an hour after finishing the competition. Mean energy intake during the competitions was 183 kcal · h¯1, with an average carbohydrate intake of 31 g · h¯1 (52.1% of participants consumed less than 30 g · h¯1). No significant differences between competitions were found in these parameters. However, a higher percentage of energy from lipids in participants in the Trail and the Ultra was found (P = 0.034). Furthermore, significant differences were observed in water intake per hour of competition (P = 0.039), with the lowest value for the intake during the Ultra competition. In conclusion, the majority of the participants in the study present low carbohydrate intakes. However, fluid intake seems to be adequate. Different distances did not significantly influence the participants' nutritional strategies.

Physical activity prescription by primary care nurses using health assets: Study design of a randomized controlled trial in patients with cardiovascular risk factors.

AIM: To analyse the efficacy of a 12-month multifactorial intervention by primary care nurses in increasing adherence to physical activity prescription (150 min/week) in patients with two or more cardiovascular risk factors and with cardiovascular risk up to 15% determined by the REGICOR equation. BACKGROUND: In Spain, cardiovascular diseases are responsible for 30.5% of deaths. Regular physical activity decreases mortality risk due to cardiovascular diseases but the effectiveness of physical activity prescription in routine in primary care settings has been shown to be low. DESIGN: Multicentre, single-blind, parallel randomized (in two different branches) clinical trial. METHODS: At least 368 participants will be recruited (184 control and 184 intervention), to show an 8% increase in adherence to the physical activity prescription (1.2% control group and 9.2% intervention group). Participants will be patients aged 35-75 years with at least two cardiovascular risk factors and with a cardiovascular risk of up to 15% measured using the Framingham-REGICOR equation. Intervention will be performed throughout baseline and three follow-up visits. A motivational interview, the trans-theoretical stages of changes of Prochaska and DiClemente and an individualized prescription of physical exercise using physical activity assets will be used in the intervention. Data will be collected at baseline and after the 1-year intervention. DISCUSSION: The present study will allow us to find out whether this brief multifactorial intervention induces greater adherence to physical activity prescription than usual practice, improving the quality of patient care. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN76069254. Protocol version 1.1, 6 July 2015.

Effects of Caffeine Supplementation on Plasma and Blood Mononuclear Cell Interleukin-10 Levels After Exercise.

This study compared the response of interleukin (IL)-10, and also of IL-6 and IL-12 p40, to exercise and caffeine supplementation between plasma and blood mononuclear cells (BMNCs). Participants in the study (n = 28) were randomly allocated in a double-blind fashion to either caffeine (n = 14) or placebo (n = 14) treatments. One hour before completing a 15-km run competition, athletes took 6 mg/kg body mass of caffeine or a placebo. Plasma and BMNCs were purified from blood samples taken before and after competition. Concentrations of interleukins (IL-10, IL-6, and IL-12 p40), cyclic adenosine monophosphate (cAMP), caffeine, adrenaline, and cortisol were measured in plasma. IL-10, IL-6, and IL-12 p40 and cAMP levels were also determined in BMNCs. Exercise induced significant increases in IL-6 and IL-10 plasma levels, with higher increases in the caffeine-supplemented group. After 2-hr recovery, these levels returned to almost preexercise values. However, no effect of caffeine on BMNC cytokines was observed. IL-10, IL-6, and IL-12 p40 levels in BMNCs increased mainly at 2 hr postexercise. cAMP levels increased postexercise in plasma and after recovery in BMNCs, but no effects of caffeine were observed. In conclusion, caffeine did not modify cytokine levels in BMNCs in response to exercise. However, higher increases of IL-10 were observed in plasma after exercise in the supplemented participants, which could suppose an enhancement of the anti-inflammatory properties of exercise.

Vitamin C supplementation does not influence plasma and blood mononuclear cell IL-6 and IL-10 levels after exercise.

The aim of this study was to determine whether the highest vitamin C supplementation associated with complete bioavailability influences the plasma and blood mononuclear cell IL-6 and IL-10 response to exercise. A double-blinded study of supplementation with vitamin C was performed. After 15 days of supplementation with vitamin C (500 mg · day(-1), n = 16) or a placebo (n = 15), participants in the study completed a 15-km run competition. Blood samples were taken before and after competition. Oxidative stress markers, antioxidants, cortisol, IL-6 and IL-10 were determined in plasma or serum. IL-6 and IL-10 protein and mRNA levels were measured in blood mononuclear cells. Although higher plasma and blood mononuclear cell vitamin C levels were observed in the supplemented group when compared with the placebo one, the two groups showed identical exercise-induced changes in all the measured parameters. Exercise induced increased IL-6 and IL-10 levels in plasma and blood mononuclear cells. IL-6 and IL-10 mRNA levels in blood mononuclear cells increased after the competition. After recovery, IL-6 mRNA returned to basal levels and IL-10 mRNA levels remained elevated. In conclusion, exercise induced increased IL-6 and IL-10 production in blood mononuclear cells. However, vitamin C supplementation did not influence IL-6 and IL-10 response to exercise.

Determinants and patterns of physical activity practice among Spanish university students.

The purpose of the present study was to investigate the socio-demographic and lifestyle determinants of physical activity practice, as well as the motivations for being or not being physically active in Spanish university students. A representative sample of students from a Spanish university (n = 2,051; 42.1% males; mean age 21.9, s = 4.8 years) participated in the present cross-sectional study. A questionnaire including questions regarding lifestyle, dietary habits, parents' characteristics, and physical activity habits was administered to the students. The socio-demographic and lifestyle determinants of physical activity practice were assessed using multivariable logistic regression. 68.4% of men and 48.4% of women reported to practise physical activity in the present sample. Those who practised physical activity consumed more fruits and were less likely to be smokers compared to non-physically active students. Also, physically inactive men spent more time in front of the computer and physically inactive women spent more time in front of the TV and were more likely to be frequent alcohol consumers. Maternal educational level and maternal physical activity habits were also important determinants of physical activity practice among men and women respectively. In conclusion, physically active students tended to engage in other healthy habits in the present population, suggesting the clustering of healthy or unhealthy lifestyle factors among specific subgroups.

Anthropometric characteristics and nutritional profile of young amateur swimmers.

The aim of this study was to evaluate nutritional and anthropometric profiles of young swimmers belonging to semiprofessional teams. Thirty-six caucasian adolescent swimmers (22 boys and 14 girls) participated voluntarily in the study. Anthropometric data, dietary intake, and blood parameters were determined. Female swimmers had greater values of triceps, suprailiac, and abdominal skinfolds. Endomorphic somatotype was twofold greater in girls compared with in boys. Energy intake and protein intake per kilogram of body weight were significantly greater in boys compared to in girls. On the other hand, girls had significantly greater polyunsaturated fatty acid intake compared that of boys. Energy intake of boys and girls was below their requirements. In contrast, protein intake doubled the requirements of the study population. Furthermore, inadequate intake of carotenes, vitamin A, vitamin E, vitamin D, and folic acid was found in both boys and girls; girls also had inadequate intake of iron and calcium. Plasma levels of iron, vitamins C and E, and carotenes were similar in male and females swimmers, and they were within the normal range. In conclusion, young swimmers participating in the present study had differences between sexes in somatotypes. Adolescent swimmers had low average total energy intakes, excessive protein intake, and lower intake of several micronutrients in both sexes.

Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts.

Adolescent high-performance gymnasts are considered to be at risk for low energy intake. The aim of the present study was to determine the effects of implementing a nutritional education program during the sports season on the nutritional status and nutrition knowledge of the female artistic gymnasts from the Technification Center of the Balearic Islands (n = 24; age, 14.1 ± 2.3 years). A quasi-experimental intervention design was applied, which consisted of implementing a nutritional education program of seven sessions given during eight months. Measurements of nutritional intake, nutrition knowledge, and anthropometric parameters, as well as hematological and biochemical blood parameters, were performed. Gymnasts reported low energy and carbohydrate intakes, with significant increases during the study (energy, 28.3 ± 1.4 vs. 32.8 ± 1.4 kcal kg-1, p = 0.015, carbohydrate 3.2 ± 0.2 vs. 3.9 ± 0.2 g kg-1, p = 0.004). The average values for parameters such as hemoglobin, ferritin, lipoprotein, and vitamin C and E levels in the plasma were within normal ranges. Low intakes of most of the food groups were observed during the study, with similar initial and final values. Nutrition knowledge did not change as a result of the study (28.0 ± 1.7 vs. 31.1 ± 1.3, p = 0.185). In conclusion, gymnasts reported low energy intakes. However, blood markers and most of the anthropometrical parameters measured were within normal ranges. The nutrition education program implemented did not produce significant improvements in the dietary habits or nutritional knowledge of gymnasts.

Association between Depression, Lifestyles, Sleep Quality and Sense of Coherence in a Population with Cardiovascular Risk.

People with cardiovascular risk have more depression than the general population. Depression and cardiovascular risk have been commonly linked to lower sense of coherence (SOC) values, unhealthy lifestyles, and poor sleep quality. The aim of this study was to analyze the association between depression, health-related lifestyles, sleep quality, and SOC in a population with cardiovascular risk. A cross-sectional study was conducted in 310 participants (aged 35-75 years) with cardiovascular risk. Sociodemographic and anthropometric characteristics, cardiovascular risk, SOC score, depression levels, sleep quality, and lifestyles (physical activity, diet quality (measured as the adherence to the Mediterranean diet), and tobacco and alcohol consumption) were determined. The regression analysis showed significant associations between depression levels and sex (odds ratio (OR): 2.29; 95% CI: 1.29, 4.07), diet (OR: 0.85; 95% CI: 0.73, 0.99), body mass index (BMI) (OR: 1.06; 95% CI: 1.01, 1.12), cardiovascular disease (CVD) (OR: 2.55; 95% CI: 1.18, 5.48), sleep quality (OR: 0.26; 95% CI: 0.15, 0.46), and SOC (OR: 0.96; 95% CI: 0.94, 0.98). Protective effects of male sex, a lower BMI, no CVD, a higher adherence to the Mediterranean diet, a high sleep quality, and a higher SOC were found. In conclusion, among lifestyles determined, only diet was associated with depression levels. SOC and sleep quality were also found as significant predictors for depression levels.

Fatty liver index and progression to type 2 diabetes: a 5-year longitudinal study in Spanish workers with pre-diabetes.

OBJECTIVE: The main aim of the study was to evaluate the association between non-alcoholic fatty liver disease (NAFLD), estimated by fatty liver index (FLI), and the development of type 2 diabetes (T2D) in a large cohort of adult workers with pre-diabetes. DESIGN: Prospective cohort study. SETTING: Occupational health services from Spain. PARTICIPANTS: 16 648 adult workers (aged 20-65 years) with pre-diabetes (fasting plasma glucose (FPG) of 100-125 mg/dL). OUTCOME AND MEASURES: FLI was calculated based on measurements of triglycerides, body mass index, waist circumference and γ-glutamyltransferase. The population was classified into three categories: FLI<30 (no hepatic steatosis), FLI 30-60 (intermediate status) and FLI>60 (hepatic steatosis). Sociodemographic, anthropometric, dietary habits, physical activity and clinical data were collected from all subjects. The incidence rate of T2D was determined after 5 years of follow-up. RESULTS: After 5 years of follow-up, 3706 of the 16 648 participants (22.2%) were diagnosed with T2D, corresponding to an annual rate of progression of 4.5%. FLI was strongly associated with T2D conversion. The incidence rates of T2D in the FLI<30, FLI 30-60 and FLI>60 groups were significantly different after 5 years of follow-up were 19/6,421 (0.3%), 338/4,318 (7.8%) and 3,349/5,909 (56.7%), respectively. This association remained significant for FLI>60 after adjustment for, age, diet, physical activity, FPG, blood pressure, social class and smoking habits (adjusted HR=6.879; 95% CI 5.873 to 8.057 for men, and HR=5.806; 95% CI 4.863 to 6.932 for women). CONCLUSION: NAFLD assessed by FLI independently predicted the risk of conversion to T2D among people with pre-diabetes. FLI may be an easily determined and valuable early predictor for T2D in people with pre-diabetes. FLI-based assessment of NAFLD in subjects with pre-diabetes in routine clinical practice could allow the adoption of effective measures to prevent and reduce their progression to T2D.

Socioeconomic Inequalities in Metabolic Syndrome by Age and Gender in a Spanish Working Population.

Lower socio-economic status (SES) is significantly associated with metabolic syndrome (MS) prevalence, possibly affecting women more than men, although evidence in Spain is still limited. The present cross-sectional study analyzed the association between MS and SES by age and gender among 42,146 working adults living in the Balearic Islands (Spain). Prevalence was higher in men (9.4% by ATP-III; 12.3% by IDF) than women (3.8% by ATP-III; 5.7% by IDF) and in the lower social class (7.9% by ATP-III; 10.7% by IDF) than the higher (4.1% by ATP-III; 5.9% by IDF). The SES gradient in MS prevalence was larger in women (PR 95% CI: 3.38, 2.50-4.58 by ATP-III; 3.06, 2.43-3.86 by IDF) than in men (1.23, 1.06-1.41 by ATP-III; 1.15, 1.03-1.30 by IDF) and was already evident from early adulthood, reaching the highest ratio at the late stages of middle adulthood (4.34, 1.11-16.98). Among men, it was significant during the late stages of early adulthood only (1.80, 1.19-2.73). Lower SES influenced MS prevalence in both genders, however, women seemed more affected than men. From a public health perspective, SES could be strongly associated with the burden of MS; in an effort to reduce its prevalence, public health policies should focus on gender differences in socio-economic inequality and consider women with low socio-economic resources as a priority.

Caffeine supplementation induces higher IL-6 and IL-10 plasma levels in response to a treadmill exercise test.

BACKGROUND: An acute bout of exercise induces an inflammatory response characterized by increases in several cytokines. Caffeine ingestion could modify this inflammatory response. The aim of this study was to determine the effects of caffeine supplementation on plasma levels of cytokines, mainly IL-10 and IL-6, in response to exercise. METHODS: In a randomized, crossover, double-blinded study design, thirteen healthy, well-trained recreational male athletes performed, on two different occasions, a treadmill exercise test (60 min at 70% VO2max) after ingesting 6 mg/kg body mass of caffeine or placebo. Blood samples were taken before exercising, immediately after finishing and 2 h after finishing the exercise. Plasma concentrations of IL-10, IL-6, IL-1ß, IL-1ra, IL-4, IL-8, IL-12 and IFN-γ, adrenaline, cortisol and cyclic adenosine monophosphate (cAMP) were determined. The capacity of whole blood cultures to produce cytokines in response to endotoxin (LPS) was also determined. Changes in blood variables were analyzed using a time (pre-exercise, post-exercise, recovery) x condition (caffeine, placebo) within-between subjects ANOVA with repeated measures. RESULTS: Caffeine supplementation induced higher adrenaline levels in the supplemented participants after exercise (257.3 ± 53.2 vs. 134.0 ± 25.7 pg·mL- 1, p = 0.03) and higher cortisol levels after recovery (46.4 ± 8.5 vs. 32.3 ± 5.6 pg·mL- 1, p = 0.007), but it did not influence plasma cAMP levels (p = 0.327). The exercise test induced significant increases in IL-10, IL-6, IL-1ra, IL-4, IL-8, IL-12 and IFN-γ plasma levels, with IL-6 and IL-10 levels remaining high after recovery. Caffeine supplementation influenced only IL-6 (3.04 ± 0.40 vs. 3.89 ± 0.62 pg·mL- 1, p = 0.003) and IL-10 (2.42 ± 0.54 vs. 3.47 ± 0.72 pg·mL- 1, p = 0.01) levels, with higher concentrations after exercise in the supplemented condition. No effect of caffeine was observed on the in vitro stimulated cytokine production. CONCLUSIONS: The results of the present study indicate a significant influence of caffeine supplementation increasing the response to exercise of two essential cytokines such as IL-6 and IL-10. However, caffeine did not influence changes in the plasma levels of other cytokines measured and the in vitro-stimulated cytokine production.

Effects of Habitual Caffeine Intake, Physical Activity Levels, and Sedentary Behavior on the Inflammatory Status in a Healthy Population.

Low-grade chronic inflammation is associated with many chronic diseases and pathological conditions. The aim of the present study was to determine the effect of regular caffeine intake, physical activity levels, and sedentary behavior on the inflammatory status in healthy participants. In total, 112 men and 132 women aged 18 to 55 years and belonging to the staff and student population of the University of the Balearic Islands volunteered to participate in this descriptive cross-sectional study. Plasma concentrations of pro-inflammatory and anti-inflammatory markers were measured. Weight, height, and body composition (bioelectrical impedance) were determined. Caffeine intake, physical activity levels and sitting time, and diet quality were determined using questionnaires. Statistical regression analysis showed that caffeine intake was a negative predictor of C-reactive protein (CRP) (p = 0.001). Body fat percentage was positively associated with CRP (p < 0.001) and inversely associated with adiponectin (p = 0.032) and interleukin (IL)-10 levels (p = 0.001). Visceral fat was the main predictor for IL-6 (p < 0.001) and tumor necrosis factor (TNF)-α (p < 0.001). Sitting time was found to be the main, inverse, predictor for IL-10 (p < 0.001), and a positive predictor for TNF-α (p < 0.001). In conclusion, regular caffeine consumption induced very limited anti-inflammatory effects. Sedentary behavior and body fat accumulation induced significant pro-inflammatory effects.

Agreement between Type 2 Diabetes Risk Scales in a Caucasian Population: A Systematic Review and Report.

Early detection of people with undiagnosed type 2 diabetes (T2D) is an important public health concern. Several predictive equations for T2D have been proposed but most of them have not been externally validated and their performance could be compromised when clinical data is used. Clinical practice guidelines increasingly incorporate T2D risk prediction models as they support clinical decision making. The aims of this study were to systematically review prediction scores for T2D and to analyze the agreement between these risk scores in a large cross-sectional study of white western European workers. A systematic review of the PubMed, CINAHL, and EMBASE databases and a cross-sectional study in 59,042 Spanish workers was performed. Agreement between scores classifying participants as high risk was evaluated using the kappa statistic. The systematic review of 26 predictive models highlights a great heterogeneity in the risk predictors; there is a poor level of reporting, and most of them have not been externally validated. Regarding the agreement between risk scores, the DETECT-2 risk score scale classified 14.1% of subjects as high-risk, FINDRISC score 20.8%, Cambridge score 19.8%, the AUSDRISK score 26.4%, the EGAD study 30.3%, the Hisayama study 30.9%, the ARIC score 6.3%, and the ITD score 3.1%. The lowest agreement was observed between the ITD and the NUDS study derived score (κ = 0.067). Differences in diabetes incidence, prevalence, and weight of risk factors seem to account for the agreement differences between scores. A better agreement between the multi-ethnic derivate score (DETECT-2) and European derivate scores was observed. Risk models should be designed using more easily identifiable and reproducible health data in clinical practice.

Lifestyle and Progression to Type 2 Diabetes in a Cohort of Workers with Prediabetes.

BACKGROUND: People with prediabetes have an increased risk of developing type 2 diabetes (T2D). Few studies have evaluated the influence of lifestyle factors on the risk of progression to diabetes and reversion to normoglycemia. The aim of this study was to determine the incidence of T2D in a large cohort of workers with prediabetes, and to evaluate the influence of sociodemographic, clinical, metabolic, and lifestyle factors that affect the persistence of prediabetes and the progression to T2D. METHODS: A cohort study of 27,844 adult workers (aged 20 to 65 years) from Spain who had prediabetes based on an occupational medical examination from 2012 to 2013. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL. At the baseline evaluation, sociodemographic, anthropometric, metabolic, and lifestyle data were collected. At the 5-year follow-up, incident T2D was defined as an FPG of at least 126 mg/dL or initiation of an antidiabetic medication. RESULTS: Among 235,995 initially screened workers, the prevalence of T2D was 14.19% (95% confidence interval (CI) 14.05 to 14.33) and the prevalence of prediabetes was 11.85% (95% CI 11.71 to 11.99). Follow-up data were available for 23,293 individuals with prediabetes. Among them, 36.08% (95% CI 35.46 to 36.70) returned to normoglycemia, 40.92% (95% CI 40.29 to 41.55) had persistent prediabetes, and 23.00% (95% CI 22.46 to 23.54) progressed to T2D. The risk for persistence of prediabetes and for progression to T2D increased with age, body mass index (BMI), triglyceride level, and less than 150 min/week of physical activity. An HbA1c level of 6% or greater was the strongest individual predictor of progression to T2D. CONCLUSIONS: Physical activity, diet, smoking, and BMI are modifiable factors that are associated with the persistence of prediabetes and the progression to T2D. The workplace is a feasible setting for the early detection of prediabetes and the promotion of lifestyles that can prevent progression to T2D.

Cluster Analysis of Health-Related Lifestyles in University Students.

Health-related lifestyles in young adults are a public health concern because they affect the risk for developing noncommunicable diseases. Although unhealthy lifestyles tend to cluster together, most studies have analyzed their effects as independent factors. This study assessed the prevalence, association, and clustering of health-related lifestyles (smoking, alcohol consumption, physical activity, and quality of diet) among university students. This cross-sectional study examined a sample of student participants from the University of the Balearic Islands (n = 444; 67.8% females; mean age: 23.1 years). A self-reported questionnaire was used to assess health-related lifestyles. Men that consumed more alcohol, had less healthy diets, were more likely to be overweight, and performed more physical activity. Women had a higher prevalence of low weight and performed less physical activity. Physical activity had a negative association with time using a computer (OR: 0.85; 95% CI: 0.76, 0.95) and a positive association with adherence to the Mediterranean diet (OR: 1.16; 95% CI: 1.02, 1.32). Adherence to the Mediterranean diet had a negative association with tobacco consumption (OR: 0.52; 95% CI: 0.30, 0.91), and positive associations with having breakfast every day (OR: 1.70; 95% CI: 1.05, 2.76) and consuming more daily meals (OR: 1.43; 95% CI: 1.10, 1.87). Cluster analysis indicated the presence of three distinct groups: Unhealthy lifestyles with moderate risk; unhealthy lifestyles with high risk; and healthy lifestyles with low risk. Health promotion interventions in the university environment that focus on multiple lifestyles could have a greater effect than interventions that target any single lifestyle.

Influence of an antioxidant vitamin-enriched drink on pre- and post-exercise lymphocyte antioxidant system.

BACKGROUND/AIMS: Our aim was to determine whether the consumption of a functional drink enriched with vitamin C and vitamin E could alleviate exercise-induced oxidative damage in lymphocytes. METHODS: Fourteen male amateur trained runners (32-36 years old) were randomized to receive antioxidant supplementation (152 mg vitamin C/day and 50 mg vitamin E/day) or placebo for 1 month in a double-blind study, and participated in a half-marathon race. The volunteers did not take any other antioxidant supplements. Blood samples were taken before and after the half-marathon and after 3 h recovery. RESULTS: Exercise increased lymphocyte malondialdehyde levels only in the placebo group (p < 0.001). Lymphocytes from the supplemented group accumulated more vitamin C and vitamin E than placebo after exercise and recovery (p < 0.05). Catalase and glutathione peroxidase activities increased only in the supplemented group after exercise, whereas superoxide dismutase activity increased in both groups (p < 0.05). Heme oxygenase-1 expression was enhanced during the recovery period only in the placebo group (p < 0.01). Bcl-2 expression decreased after exercise only in the placebo group and remained low during the recovery (p < 0.001). CONCLUSIONS: Intense exercise increases lipid peroxidation, decreases Bcl-2 expression and induces an antioxidant response in lymphocytes. Supplementation with moderate levels of antioxidant vitamins reduces exercise-induced oxidative damage, but without blocking the cellular adaptation to exercise.