Historia alimentaria y nutricional de España, 1940-1988

Tesis doctoral inédita. Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva. Fecha delectura: 21-6-9

Twenty-four-hour central (aortic) systolic blood pressure: Reference values and dipping patterns in untreated individuals

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de investigación, si lo hubiere, y los autores pertenecientes a la UAMCentral (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18–94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was −10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (−8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigationi24abc (International 24-Hour Ambulatory Aortic Blood Pressure Consortium) is a purely academic research project without industry funding. Funding of individual authors: J. Nemcsik was supported by the Hungarian Society of Hypertension; M. Agharazii was supported by the Canadian Institutes of Health Research; Y. Li is supported by grants from the National Natural Science Foundation (81770455 and 82070432) and the Ministry of Science and Technology, Beijing, China (2018YFC1704902); J.R. Banegas is supported by Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, and FEDER/FSE (grants PI16/01460 and PI19/00665); A. Maloberti and C. Giannatasio were supported by the Italian Ministry of University and Research (MIUR), Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); A.D. Protogerou’s team has received unrestricted research grant and equipment support from IEM Stolber

Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults

<p>Abstract</p> <p>Background</p> <p>Evidence on the relation between leisure-time physical activity (LTPA) and health-related quality of life (HRQoL) in older adults is based primarily on clinical trials of physical exercise programs in institutionalized persons and on cross-sectional studies of community-dwelling persons. Moreover, there is no evidence on whether leisure-time sedentary behavior (LTSB) is associated with HRQoL independently of LTPA. This study examined the longitudinal association between LTPA, LTSB, and HRQoL in older community-dwelling adults in Spain.</p> <p>Methods</p> <p>Prospective cohort study of 1,097 persons aged 62 and over. In 2003 LTPA in MET-hr/week was measured with a validated questionnaire, and LTSB was estimated by the number of sitting hours per week. In 2009 HRQoL was measured with the SF-36 questionnaire. Analyses were done with linear regression and adjusted for the main confounders.</p> <p>Results</p> <p>Compared with those who did no LTPA, subjects in the upper quartile of LTPA had better scores on the SF-36 scales of physical functioning (β 5.65; 95% confidence interval [CI] 1.32-9.98; p linear trend < 0.001), physical role (β 7.38; 95% CI 0.16-14.93; p linear trend < 0.001), bodily pain (β 6.92; 95% CI 1.86-11.98; p linear trend < 0.01), vitality (β 5.09; 95% CI 0.76-9.41; p linear trend < 0.004) social functioning (β 7.83; 95% CI 2.89-12.75; p linear trend < 0.001), emotional role (β 8.59; 95% CI 1.97-15.21; p linear trend < 0.02) and mental health (β 4.20; 95% CI 0.26-8.13; p linear trend < 0.06). As suggested by previous work in this field, these associations were clinically relevant because the β regression coefficients were higher than 3 points. Finally, the number of sitting hours showed a gradual and inverse relation with the scores on most of the SF-36 scales, which was also clinically relevant.</p> <p>Conclusions</p> <p>Greater LTPA and less LTSB were independently associated with better long-term HRQoL in older adults.</p

Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults

Background: There is emerging evidence of the role of diabetes as a risk factor for frailty. However, the mechanisms of this association are uncertain. Methods: Prospective cohort study of 1750 non-institutionalized individuals aged ≥60 years recruited in 2008-2010. At baseline, information was obtained on health behaviors, morbidity, cardiometabolic biomarkers, and antidiabetic treatments. Individuals were considered diabetic if they reported a physician-diagnosis or had fasting serum glucose ≥126 mg/dl. Study participants were followed-up through 2012 to assess incident frailty, defined as at least three of the five Fried criteria. Results: At baseline, the cohort included 346 individuals with diabetes and 1404 without it. Over a mean 3.5-year follow-up, 115 cases of incident frailty were ascertained. After adjustment for age, sex and education, participants with diabetes showed an increased risk of frailty (odds ratio [OR]: 2.18; 95% confidence interval [CI]: 1.42-3.37). Additional adjustment for health behaviors and abdominal obesity yielded a 29.7% reduction in the OR (OR: 1.83; 95%CI: 1.16-2.90). Subsequent adjustment for morbidity produced an additional 8.4% reduction (OR: 1.76; 95%CI: 1.10-2.82), and for cardiometabolic biomarkers, a further 44% reduction (OR: 1.32; 95% 0.70-2.49). In particular, adjustment for HbA1c, lipoproteins and triglycerides accounted for the greatest reductions. Finally, additional adjustment for oral antidiabetic medication reduced the OR to 1.01 (95%CI: 0.46-2.20), while adjustment for nutritional therapy increased it to 1.64 (95%CI: 0.77-3.49). Conclusions: Diabetes mellitus is associated with higher risk of frailty; this association is partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, diabetes nutritional therapy reduces the risk of frailtyBaseline data collection was funded by Sanofi-Aventis. Data collection during follow-up was funded by the Spanish Government FIS grants 09/1626 and 09/0104 (Instituto de Salud Carlos III). Funding specific for this analysis was obtained from the Spanish Government FIS grant 12/1166 (Instituto de Salud Carlos III) and the FP7-HEALTH-2012-Proposal No: 305483–2 (FRAILOMIC Initiative)

Valores de referencia y puntos de corte de leptina para identificar anormalidad cardiometabólica en la población española

Antecedentes y objetivo: Estimar los valores de referencia de leptina y calcular los puntos de corte de leptinemia que identifiquen anormalidad cardiometabólica en España. Métodos: Estudio transversal realizado de 2008 a 2010 sobre 11.540 individuos representativos de la población española ≥ 18 años. La información se obtuvo mediante examen físico estandarizado y las analíticas se realizaron en un laboratorio central. La leptinemia se midió por inmunoensayo enzimático. Se definió anormalidad cardiometabólica como la presencia de ≥ 2 de las siguientes anormalidades: presión arterial elevada; triglicéridos elevados; colesterol unido a lipoproteínas de alta densidad bajo; valores altos de resistencia a insulina según homeostasis model assessment; proteína C reactiva y glucosa elevada. Resultados: Los niveles de leptina fueron mayores en mujeres que en varones (media geométrica 21,9 ng/ml y 6,6 ng/ml, respectivamente, p<0.001) y aumentaban con la edad y el índice de masa corporal (p<0,001). La mediana fue 24,5 ng/ml en mujeres (rango intercuartílico P25-P75: 14,1-37,0) y 7,2 ng/ml en varones (P25-P75: 3,3-14,3). La leptinemia fue mayor en sujetos con obesidad general o abdominal, diabetes, hipertensión o síndrome metabólico (p<0.001 en todos los casos). Los valores de leptinemia que identificaron anormalidad cardiometabólica fueron 23,75 ng/ml en mujeres (área bajo la curva 0,722, 72,3% sensibilidad y 58,7% especificidad), y 6,45 ng/ml en varones (área bajo la curva 0,716, 71,4% sensibilidad y 60,2% especificidad). Conclusiones: Estos resultados facilitan la interpretación de los valores de leptinemia en estudios clínicos y poblacionales. La leptina tiene sensibilidad y especificidad moderadas para identificar anormalidad cardiometabólica en ambos sexosLos datos de este análisis proceden del estudio ENRICA, que fue financiado por Sanofi-Aventis. La financiación específica para este análisis procede de los proyectos FIS PI13/02321 y “Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular”, Madri

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: A population-based study of older individuals in Spain

Blood pressure (BP) variability and nocturnal decline in blood pressure are associated with cardiovascular outcomes. However, little is known about whether these indexes are associated with white-coat and masked hypertension. We performed a cross-sectional analysis of 1047 community-dwelling individuals aged ≥60 years in Spain in 2012. Three observer-measured home BPs and 24-h ambulatory blood pr essure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP s.d. and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime and night-time systolic BP s.d. and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (P &lt; 0.05) and were similar to subjects with sustained hypertension. In untreated subjects, 24-h but not daytime or night-time BP variability indexes were significantly higher in subjects with white-coat hypertension than in those with normotension (P &lt; 0.05). Percentage decrease in nocturnal systolic and diastolic BP was greatest in the white-coat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (P &lt; 0.05). Lack of nocturnal decline in systolic blood pressure was observed in 70.2% of subjects with normotension, 57.8% of subjects with white-coat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (P &lt; 0.001). In conclusion, 24-h BP variability was higher in subjects with white-coat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPMStudy partially funded by FIS grant PI13/02321 and PI16/01460 (Instituto de Salud Carlos III and FEDER/FSE) and CIBERES

Trends in hypertension control among the older population of Spain from 2000 to 2001 to 2008 to 2010: Role of frequency and intensity of drug treatment

This is the prepint version of the following article: Circulation: Cardiovascular Quality and Outcomes 8.1 (2015) , which has been published in final form at http://dx.doi.org/10.1161/CIRCOUTCOMES.114.001191Background—The use of antihypertensive medication and hypertension control has significantly increased during recent decades in some developed countries, but the impact of improved drug treatment on blood pressure (BP) control in the population is unknown. Methods and Results—Data were taken from 2 surveys representative of the population aged ≥60 years in Spain conducted with the same methodology in 2000 to 2001 and in 2008 to 2010. BP was measured 6×. The first BP reading was discarded, and the average of the remaining 3 to 5 BP readings was taken for analysis. Hypertension prevalence was 68.7% in 2000 to 2001 and 66.0% in 2008 to 2010. Between both time periods there was an improvement in hypertension awareness (63.6%–67.7%), drug treatment among those aware (84.5%–87.5%), and BP control among treated hypertensives (30.3%–42.9%). Overall, BP control among all hypertensives increased from 16.3% to 25.4%. After adjustment for age, sex, education, hypertension duration, smoking, alcohol consumption, body mass index, sedentary behavior, diabetes mellitus, cardiovascular disease, and visits to the physician through logistic regression, ≈7% of the improvement in BP control among all hypertensives was explained by higher hypertension awareness, and 36.2% was explained by a higher treatment rate. Among the treated hypertensives, 22.6% of the progress in BP control was because of the increase in the number of BP medications used in each patient. Conclusions—BP control among the older hypertensive population in Spain has improved from 2000 to 2001 to 2008 to 2010 because of a higher treatment rate and more intense antihypertensive drug treatmentThis work has been supported by Fondo de Investigación Sanitaria (FIS) grant PI13/02321 (Instituto de Salud Carlos III, Spain) and “Cátedra Universidad Autónoma de Madrid (UAM) de Epidemiología y Control del Riesgo Cardiovascular”, Madrid, Spain

Impact of ambulatory blood pressure monitoring on reclassification of hypertension prevalence and control in older people in Spain

This is the submitted version of the following article: Impact of ambulatory blood pressure monitoring on reclassification of hypertension prevalence and control in older people in Spain, Journal of Clinical Hypertension 17.6:453-61 which has been published in final form at http://dx.doi.org/10.1111/jch.12525. This article may be used for non-commercial purposes in accordance with the Wiley Self-Archiving Policy wiley.com/WileyCDA/Section/id- 820227.htmlAmbulatory blood pressure monitoring (ABPM) accurately classifies blood pressure (BP) status but its impact on the prevalence and control of hypertension is little known. The authors conducted a cross-sectional study in 2012 among 1047 individuals 60 years and older from the follow-up of a population cohort in Spain. Three casual BP measurements and 24-hour ABPM were performed under standardized conditions. Approximately 68.8% patients were hypertensive based on casual BP (≥140/90 mm Hg or current BP medication use) and 62.1% based on 24-hour ABPM (≥130/80 mm Hg or current BP medication use) (P=.009). The proportion of patients with treatment-eligible hypertension who met BP goals increased from 37.4% based on the casual BP target to 54.1% based on the 24-hour BP target (absolute difference, 16.7%; P<.01). These results were consistent across alternative BP thresholds. Therefore, compared with casual BP, 24-hour ABPM led to a reduction in the proportion of older patients recommended for hypertension treatment and a substantial increase in the proportion of those with hypertension controlData collection was funded by Fondo de Investigación Sanitaria (FIS) grants 09/1626 and 12/1166 (Ministry of Health of Spain) and by the ‘Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular’. Specific funding for this analysis was obtained from FIS grant PI13/02321

Physician Perception of Blood Pressure Control and Treatment Behavior in High-Risk Hypertensive Patients: A Cross-Sectional Study

Objective: We examined physician perception of blood pressure control and treatment behavior in patients with previous cardiovascular disease and uncontrolled hypertension as defined by European Guidelines. Methods: A cross-sectional study was conducted in which 321 primary care physicians throughout Spain consecutively studied 1,614 patients aged ≥18 years who had been diagnosed and treated for hypertension (blood pressure ≥140/90 mmHg), and had suffered a documented cardiovascular event. The mean value of three blood pressure measurements taken using standardized procedures was used for statistical analysis. Results: Mean blood pressure was 143.4/84.9 mmHg, and only 11.6% of these cardiovascular patients were controlled according to 2007 European Guidelines for Hypertension Management target of <130/80 mmHg. In 702 (49.2%) of the 1426 uncontrolled patients, antihypertensive medication was not changed, and in 480 (68.4%) of these cases this was due to the physicianś judgment that blood pressure was adequately controlled. In 320 (66.7%) of the latter patients, blood pressure was 130-139/80-89 mmHg. Blood pressure level was the main factor associated (inversely) with no change in treatment due to physician perception of adequate control, irrespective of sociodemographic and clinical factors. Conclusions: Physicians do not change antihypertensive treatment in many uncontrolled cardiovascular patients because they considered it unnecessary, especially when the BP values are only slightly above the guideline target. It is possible that the guidelines may be correct, but there is also the possibility that the care by the physicians is appropriate since BP <130/80 mmHg is hard to achieve, and recent reviews suggest there is insufficient evidence to support such a low BP targetFunding for this study was obtained from RECORDATI ESPAÑA, S.L through an unrestricted grant. Krista Lundelin has a ‘‘Rio Hortega’’ research training contract (Expediente CM10/00327) from the Ministry of Science and Innovation (Instituto de Salud Carlos III), Spain Governmen

Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals.

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18-94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was -10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (-8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation