Should we recommend reductions in saturated fat intake or in red/processed meat consumption? The SUN prospective cohort study

Background & aims: While most studies have shown increased mortality associated with excessive red/processed meat consumption, the association of saturated fatty acids (SFA) intake with mortality is less homogeneous. We aimed to prospectively assess the association of both, meat consumption (red, processed, red + processed, and total) and SFA intake, with the risk of all-cause death. Methods: We assessed 18,540 participants of the SUN (Seguimiento Universidad de Navarra) cohort, followed-up for a mean of 9.5 years. A validated 136-item FFQ was administered at baseline. We used Cox models adjusted for potential confounders. Results: We observed 255 deaths during 176,916 person-years of follow-up. Age modified the association between meat consumption and all-cause mortality (p for interaction = 0.027, 0.075, and 0.013, for red, total, and processed meat, respectively). Among participants aged >45 years the fully-adjusted HRs (95% CIs) for one additional serving/d of red, total, and red + processed meat consumption were 1.47 (1.06, 2.04), 1.23 (1.05, 1.45), and 1.32 (1.05, 1.65), respectively, with significant linear trends (P for trend 0.022, 0.012, and 0.018, respectively). In these participants, SFA intake was non-significantly associated with mortality. However, isocaloric replacement of monounsaturated fat or carbohydrates by SFA resulted in significantly higher mortality risk. Likewise, replacing 100 g of vegetables, fruits & nuts or cereals by 100 g of red meat resulted in higher mortality risk. No association of meat consumption or SFA with all-cause mortality was observed in participants younger than 46 years. Conclusions: Among highly educated persons, aged >45 years, a high consumption of red, total, and red + processed meat was related to increased all-cause mortality, compared with those with low consumption, whereas no significant associations were found for SFA intake. Dietary guidelines should specifically limit meat consumption and not relying only in limiting SFA intake

Environmental Impact of Dietary Choices: Role of the Mediterranean and Other Dietary Patterns in an Italian Cohort

Background: Current scientific literature suggests healthy dietary patterns may have less environmental impact than current consumption patterns, but most of the studies rely on theoretical modeling. The aim of this study was to assess the impact on resources (land, water, and energy) use and greenhouse gas (GHG) emissions of healthy dietary patterns in a sample of Italian adults. Methods: Participants (n = 1806) were recruited through random sampling in the city of Catania, southern Italy. Dietary consumption was assessed through a validated food frequency questionnaire (FFQ); dietary patterns were calculated through dietary scores. The specific environmental footprints of food item production/processing were obtained from various available life-cycle assessments; a sustainability score was created based on the impact of the four environmental components calculated. Results: The contribution of major food groups to the environmental footprint showed that animal products (dairy, egg, meat, and fish) represented more than half of the impact on GHG emissions and energy requirements; meat products were the stronger contributors to GHG emissions and water use, while dairy products to energy use, and cereals to land use. All patterns investigated, with the exception of the Dietary Approach to Stop Hypertension (DASH), were linearly associated with the sustainability score. Among the components, higher adherence to the Mediterranean diet and Alternate Diet Quality Index (AHEI) was associated with lower GHG emissions, dietary quality index-international (DQI-I) with land use, while Nordic diet with land and water use. Conclusions: In conclusion, the adoption of healthy dietary patterns involves less use of natural resources and GHG emissions, representing eco-friendlier options in Italian adults

Building parameters that influence overheating of apartment buildings in a temperate climate in Southern Europe

Overheating in dwellings is a global concern that is increasing due to global warming and more frequent and extreme heatwaves. This study assesses the relationship between different building parameters (built period, floor level, orientation, window area and solar shading) and compares indoor overheating hours during summer in twelve apartments monitored in Pamplona (North of Spain). They were selected as samples from different Spanish built periods related to different energy regulations, without mechanical cooling and with some kind of exterior solar shading. Overheating hours were calculated using the UNE-EN 16798 standard, which establishes a maximum acceptable operative temperature. This limit is adaptive and it is defined as the exponentially weighted running mean of the daily outdoor temperature. Multilevel mixed-effects linear and logistic regressions were used to analyse and compare overheating hours. Floor level, window area and solar shading were the parameters that showed a significant relationship with indoor overheating hours (p < 0.01). Orientation and built period did not reach a statistically significant value (p > 0.01). It is particularly noteworthy that the apartments built under the current Spanish Energy Regulations (after 2006) do not show a significant reduction in indoor overheating hours compared to those built without any energy regulations. This assessment reveals that current building energy regulations may not be enough to avoid overheating or ensure adaptation to warmer conditions. Therefore, this study contributes to establishing the main building parameters to improve in order to adapt Spanish apartment buildings to warming conditions in temperate climates

The role of dietary inflammatory index in cardiovascular disease, metabolic syndrome and mortality

Abstract: Inflammation is an underlying pathophysiological process in chronic diseases, such as obesity, type 2 diabetes mellitus and cardiovascular disease. In fact, a number of systematic reviews have shown the association between inflammatory biomarkers, such as CRP, IL-1 , IL-6, TNF- , IL-4, or IL-10, and cardio-metabolic diseases. Diet is one of the main lifestyle-related factors which modulates the inflammatory process. Different individual foods and dietary patterns can have a beneficial health effect associated with their anti-inflammatory properties. The dietary inflammatory index (DII) was recently developed to estimate the inflammatory potential of overall diet. The aim of this review is to examine the findings of recent papers that have investigated the association between the DII, cardio-metabolic risk factors and cardiovascular disease. The relevance of the DII score in the association between inflammation and cardio-metabolic diseases is critically appraised, as well as its role in the context of healthy dietary patterns. We conclude that the DII score seems to be a useful tool to appraise the inflammatory capacity of the diet and to better understand the relationships between diet, inflammation, and cardio-metabolic diseases

La importancia de la nutrición y los estilos de vida saludables en la infancia y adolescencia

Habiendo leído con atención la editorial de la Dra. Marti y el Dr. Martínez acerca de la necesidad imperiosa de actuar de forma inmediata en la alimentación del adolescente, queremos mostrar nuestro máximo acuerdo con los autores cuando urgen a frenar el avance de la obesidad mediante la adquisición de hábitos de vida saludable en edades tempranas de la vida

Consumo de jamón curado e incidencia de eventos cardiovasculares, hipertensión arterial o ganancia de peso

Fundamento y objetivo: El jamón curado es uno de los alimentos característicos de la dieta mediterránea española. Sin embargo, no existe ningún estudio epidemiológico prospectivo que haya valorado sus efectos sobre la salud humana. Nuestro objetivo fue evaluar la asociación entre el consumo de jamón curado y la incidencia de hipertensión arterial, enfermedad cardiovascular y/o ganancia de peso. Sujetos y método: En una cohorte epidemiológica prospectiva y dinámica de 13.293 graduados universitarios (Proyecto SUN) se analizó la incidencia de enfermedad cardiovascular, hipertensión arterial y la ganancia de peso a lo largo de un seguimiento máximo de 6 años. Se ajustaron modelos de regresión de Cox para estimar hazard ratios (riesgos relativos [RR]) tras ajustar por posibles factores de confusión. Resultados: El consumo de jamón en los niveles más altos (> 4 raciones/semana) no presentaba asociación con la incidencia de eventos cardiovasculares (RR=1,02; [IC 95%: 0,44-2,39]), tras ajustar por edad, sexo, ingesta energética total y patrón dietético, en comparación con los consumos inferiores a una vez por semana. Al repetir esta comparación para la hipertensión, y tras ajustar por edad, sexo, ingesta energética total e índice de masa corporal, se encontró un RR = 0.74 (IC 95%: 0.55-1.01). En la comparación del cambio de peso medio anual entre estas mismas categorías extremas de consumo (=4 raciones) se encontró una diferencia no significativa de 0,033 kg (IC 95%: -0,041 a +0,107) en la ganancia media de peso al año tras ajustar por sexo, edad, tabaco, actividad física e índice de masa corporal inicial. Conclusiones: Los resultados de esta cohorte no proporcionan evidencia de que el consumo de jamón curado se asocie a mayor riesgo cardiovascular, de hipertensión arterial o de ganancia de peso.Background and objective: Cured ham is a characteristic food in Spanish Mediterranean diet. However, no prospective epidemiologic study assessing its effects on human health is available. Our aim was to assess the association between the consumption of cured ham and cardiovascular disease, hypertension or weight gain. Subjects and Method: In a prospective and dynamic epidemiologic cohort composed exclusively of university graduates (the SUN Project, n=13,293), we analyzed the incidence of cardiovascular disease, hypertension or average yearly weight gain after a maximum follow-up of 6 years. Cox (proportional hazards) regression models were fitted to estimate hazard ratios (relative risks [RR]) after adjusting for potential confounding. Results: No association was found between higher levels of consumption of cured ham (> 4 servings/week) and the incidence of cardiovascular disease (RR=1.02; [95%CI]: 0.44-2.39), in analyses adjusted for age, sex, total energy intake and dietary pattern, compared to the consumption of less than one serving a week. When we repeated this comparison for the incidence of hypertension, and adjusting for age, sex, total energy intake and body mass index, the RR was 0.74 (95% CI: 0.55-1.01). In the comparison of average yearly weight gain between these extreme categories of cured ham consumption (=4 servings/week) a non-significant difference of 0.033 kg (95% CI: -0.041 to 0.107) was found after adjusting for sex, age, smoking, physical activity, and baseline body mass index. Conclusions: The results of this cohort study do not support any association between the consumption of cured ham and a higher risk of cardiovascular disease, hypertension or weight gain

Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury

AIM: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor. METHODS: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed. RESULTS: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality. CONCLUSION: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system

Karnofsky performance score in acute renal failure as a predictor of short-term survival

Karnofsky Performance Scale Index (KPS) is a measure of functional status that allows patients to be classified according to their functional impairment. We aim to assess if the prior KPS may predict the risk of death among patients with acute renal failure (ARF). METHODS: A cohort of 668 consecutive patients who had been admitted in an university-affiliated hospital between June 2000 and June 2006, and had been diagnosed with ARF, were studied. Three hundred and eighty-six patients with ARF who matched at least one of the RIFLE (Risk, Injury, Failure, Loss and End stage) criteria on increased serum creatinine were included for subsequent analysis. The group was divided into four categories, according to different Karnofsky scores measured by a nephrologist (>or=80, 70, 60 and <or=50). We used an adjusted logistic regression model to assess the relationship between the Karnofky score and mortality. RESULTS: A significant risk of in-hospital mortality within 90 days was observed when the other groups were compared with the >or=80 Karnofsky group. Adjusted odds ratios were 8.87 (95% confidence interval (CI) 3.03-25.99), 6.78 (95% CI 2.61-17.58) and 2.83 (95% CI 1.04-7.68), for Karnofsky groups of <or=50, 60 and 70, respectively. An adjusted odds ratio of 1.75 (95% CI 1.37-2.23) was observed for every 10 point decrease in KPS score. CONCLUSION: Functional status as indicated by the KPS is an independent predictor of death in this cohort of patients with ARF. Patients who presented lower scores had increased mortality rate

Nutri-Score, alimentos ultraprocesados y salud

El exceso de peso con un índice de masa corporal (IMC) elevado es uno de los factores de riesgo que contribuye en mayor medida a la mortalidad y carga global de enfermedad a nivel mundial1. Se estima que, en el año 2016, el 39% de la población adulta de todo el mundo presentaba sobrepeso y el 13% obesidad2. España no es una excepción. Según los datos de una muestra representativa de la población adulta española, el 62,3% de la población sufre sobrepeso u obesidad3. Ambos son importantes factores de riesgo para el desarrollo de enfermedades crónicas no transmisibles como la enfermedad cardiovascular, la diabetes tipo 2 o determinados tipos de cáncer4 . Los mecanismos asociados al desarrollo de un exceso de peso son multifactoriales, por lo que las estrategias preventivas también deben serlo. En este contexto, en el actual número de la revista Anales del Sistema Sanitario de Navarra se publica el artículo “Influencia de hábitos saludables sobre el índice de masa corporal en la población de 12-14 años en un área de Murcia (España)”, en el que Jiménez Candel y col5 exploraron en un estudio transversal, mediante una encuesta sobre hábitos saludables, los diferentes estilos de vida –incluyendo la alimentación, la actividad física, el uso de nuevas tecnologías y las relaciones sociales– de adolescentes en función de su IMC