Factores de riesgo de neumonía en las primeras 48 horas en pacientes en ventilación mecánica

Consultable des del TDXTítol obtingut de la portada digitalitzadaLa neumonía nosocomial es la complicación infecciosa más frecuente en los pacientes que ingresan en las Unidades de Cuidados Intensivos (UCI). Sin embargo, esta entidad no se presenta con igual frecuencia en todos los grupos de pacientes, existiendo mayor riesgo en algunas poblaciones. Sin embargo, la calificación de nosocomial ha excluido aquellos pacientes con neumonía dentro de las primeras 48 a 72 horas. La hipótesis de este trabajo ha sido que los factores de riesgo para el desarrollo de neumonía en el período inmediatamente posterior a la intubación son diferentes al resto de períodos que el paciente permanece en ventilación mecánica. El objetivo principal del estudio fue identificar los factores de riesgo para el desarrollo de neumonía en pacientes intubados desde la instauración de la ventilación mecánica hasta las primeras 48 horas y comparar si estos factores de riesgo que pueden influir en otros períodos. Los objetivos secundarios fueron investigar si la etiología es diferente entre los períodos, investigar si el uso de un sistema de aspiración continua de secreciones subglóticas (ACSS) y el uso de antibioterapia o la combinación de ambas influye en la aparición de neumonía en las primeras 48 horas. Para responder a esta hipótesis se realizó un estudio prospectivo y observacional durante 24 meses en una UCI polivalente médico-quirúrgica. Se incluyeron todos los pacientes intubados y con más de 24 horas de ventilación mecánica y se excluyeron aquellos pacientes intubados durante menos de 24 horas y aquellos de los que no se pudo completar datos. Se evaluaron diversos grupos de variables: demográficas, comorbilidades, tratamiento usado y presencia o no de infección previa. Las variables continuas se compararon mediante el test de t y análisis de la varianza o el test U de Mann-Whitney para variables no paramétricas. Para comparar las diferencias entre grupos con variables discretas se utilizó el test exacto de Fisher de dos colas. La variable dependiente fue la presencia o no de neumonía las primeras 48 horas de ventilación mecánica. Las variables identificadas en el análisis univariante con p< 0,1 y presente en más del 10% de los pacientes fueron elegidas para el análisis de regresión logística multiple. La etiología de la neumonía en el período de las 48 horas iniciales estuvo formada mayoritariamente por Staphylococcus aureus sensible a oxacilina, Streptococcus pneumoniae y Haemophilus influenzae, mientras que en el resto de períodos Pseudomonas aeruginosa fue el agente etiológico más frecuente. Las variables asociadas al desarrollo de neumonía en el análisis univariante fueron la presencia de reanimación cardiopulmonar, aspiración, coma, intubación en situación de emergencia, sedación continua, intubación por personal no experimentado, infección previa, administración previa de antibiótico, edad inferior a 55 años. La ACSS no influyó en la incidencia de neumonía en este período. El análisis multivariado seleccionó como factores de riesgo independientes para el desarrollo de neumonía en las primeras 48 horas de ventilación mecánica, la presencia de RCP (ods ratio 4,4; IC 95%: 2,2;9), aspiración (OR: 3,3; IC 95%: 1,5;7,5) y sedación (OR:2,9; IC 95%: 1,5; 5,9). La administración previa de antibiótico, en cambio, se presentó como factor protector para la presencia de neumonía en los primeros dos días de ventilación mecánica (OR: 0,2; IC 95%: 0,09; 0,4). Ninguna de las variables analizadas se encontró relacionada con la presencia de neumonía en los períodos posteriores. En conclusión, los pacientes en los cuales se ha realizado reanimación cardiopulmonar, han presentado broncoaspiración o han estado bajo tratamiento con sedación continua presentan un mayor riesgo de presentar neumonía en el período inmediatamente posterior a la instauración de la ventilación mecánica. Al contrario, la administración de antibioterapia aparece como un factor protector.In Intensive Care Unit patients nosocomial pneumonia is the most frequent infectious complication. In addition, nosocomial pneumonia presents very differents rates on incidence between patients subgroups. Several risk factors for pneumonia have been investigated for two decades. However, classical nosocomial pneumonia definition have excluded the first 48-72 hours of mechanical ventilation. Study hypothese was that risk factors for pneumonia in the period following intubation are differents from the other periods under mechanical ventilation. Main study objectives were to identify risk factors for penumonia in intubated patients from starting mechanical ventilation and to compare the influence of these risk factors on other periods. Secondary objectives were to investigate the etiology between differents periods, to investigate if continuous aspiration of subglottic secretions system and antibiotic use or both have effect on the occurrence of pneumonia in the first 48 hours. We performed a prospective and observational study for 24 months in medical-surgical ICU. Inclussion criteria were all patients intubated for more than 24 hours. Exclussion criteria were mechanical ventilation time less than 24 hours and absence of important data. Several variables were analized including demographical, comorbidities, treatment and previous infection. Continuous variables were compared with t test and analysis of variance or U Mann-Whitney test for nonparametric variables. Differences between groups for discretes variables were analized with Fisher exact test. Dependent variable was the presence of pneumonia within the first 48 hours of mechanical ventilation. Significant variables at the univariate analysis with p<0,1 and present in more than 10% of patients were elegible for multivariate analysis. Odds ratio and confidence intervals were calculated with standandardized methods. Etiologies within the first 48 hours were mostly due to oxacillin-sensitive Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae, whereas in later periods the microorganism most frequently isolated was Pseudomonas aeruginosa. Univariate analysis showed as associated variables with pneumonia the presence of cardiopulmonary resuscitation, aspiration, coma, emergence intubation, continuous sedation, intubation performed by a physician with low training, age lower than 55 years, whereas prior infection, and prior antibiotic exposure acted as protective. Continuous aspiration of subglottic secretions did not have impact in the incidence of pneumonia in this period. Multivariate analysis selected as independent risk factors for pneumonia within the first 48 hours of mechanical ventilation the presence of cardiopulmonary resuscitation (ods ratio 4,4; CI 95%: 2,2;9), aspiration (OR: 3,3; IC 95%: 1,5;7,5) and continuous sedation (OR:2,9; IC 95%: 1,5; 5,9). Prior antibiotic exposure were protective in this period (OR: 0,2; IC 95%: 0,09; 0,4). None of these variables were associated with pneumonia in later periods. In summary, patients requiring cardiopulmonary resuscitation, evidence of aspiration of gastric contents into airway or treated with continuous sedation are at higher risk for pneumonia within the first 48 hours of mechanical ventilation. In contrast, prior antibiotic exposure decrease the risk of pneumonia within the first 48 hours

Diferencias entre la mejor marca en piscina de 25 vs 50 metros en la prueba de 200 estilos individual en relación al sexo

Antecedentes: La natación de competición se realiza en piscina corta (25 m) y larga (50 m). Los nadadores normalmente realizan mejores tiempos en piscina corta debido a la mayor cantidad de virajes, por lo que existe un factor de corrección para transformar las marcas realizadas en piscina a corta a marcas equivalentes en piscina larga. Sin embargo, las diferencias entre piscina corta y largas según el sexo en las pruebas de estilos todavía no se conoce. Objetivo: El principal objetivo de este estudio es analizar las diferencias entre la mejor marca en una prueba de 200 estilos en piscina corta y piscina larga en función del sexo. Método: Para ello, se seleccionaron los mejores tiempos realizados en piscina corta y larga en la prueba de 200 estilos de 100 nadadores nacionales españoles de primer nivel en dos temporadas. Resultados: Se llevó a cabo un análisis de los datos mediante una prueba T de student para muestras independientes. Los resultados muestran que en ambos sexos la mejor marca corresponde a la realizada en piscina corta (p<0,001). A su vez, los nadadores masculinos muestran mayores diferencias frente a las mujeres en la prueba de 200 estilos individual entre piscina corta y piscina larga (p<0,05). Conclusiones: De acuerdo con estos resultados, se sugiere la utilización de un factor de corrección diferente para poder transformar los tiempos entre piscina corta y larga en función del sexo para la prueba de 200 estilos individual

Bacteremia is an independent risk factor for mortality in nosocomial pneumonia: a prospective and observational multicenter study

Introduction: Since positive blood cultures are uncommon in patients with nosocomial pneumonia (NP), the responsible pathogens are usually isolated from respiratory samples. Studies on bacteremia associated with hospital-acquired pneumonia (HAP) have reported fatality rates of up to 50%. The purpose of the study is to compare risk factors, pathogens and outcomes between bacteremic nosocomial pneumonia (B-NP) and nonbacteremic nosocomial pneumonia (NB-NP) episodes. Methods: This is a prospective, observational and multicenter study (27 intensive care units in nine European countries). Consecutive patients requiring invasive mechanical ventilation for an admission diagnosis of pneumonia or on mechanical ventilation for > 48 hours irrespective of admission diagnosis were recruited. Results: A total of 2,436 patients were evaluated; 689 intubated patients presented with NP, 224 of them developed HAP and 465 developed ventilation-acquired pneumonia. Blood samples were extracted in 479 (69.5%) patients, 70 (14.6%) being positive. B-NP patients had higher Simplified Acute Physiology Score (SAPS) II score (51.5 ± 19.8 vs. 46.6 ± 17.5, P = 0.03) and were more frequently medical patients (77.1% vs. 60.4%, P = 0.01). Mortality in the intensive care unit was higher in B-NP patients compared with NB-NP patients (57.1% vs. 33%, P < 0.001). B-NP patients had a more prolonged mean intensive care unit length of stay after pneumonia onset than NB-NP patients (28.5 ± 30.6 vs. 20.5 ± 17.1 days, P = 0.03). Logistic regression analysis confirmed that medical patients (odds ratio (OR) = 5.72, 95% confidence interval (CI) = 1.93 to 16.99, P = 0.002), methicillin-resistant Staphylococcus aureus (MRSA) etiology (OR = 3.42, 95% CI = 1.57 to 5.81, P = 0.01), Acinetobacter baumannii etiology (OR = 4.78, 95% CI = 2.46 to 9.29, P < 0.001) and days of mechanical ventilation (OR = 1.02, 95% CI = 1.01 to 1.03, P < 0.001) were independently associated with B-NP episodes. Bacteremia (OR = 2.01, 95% CI = 1.22 to 3.55, P = 0.008), diagnostic category (medical patients (OR = 3.71, 95% CI = 2.01 to 6.95, P = 0.02) and surgical patients (OR = 2.32, 95% CI = 1.10 to 4.97, P = 0.03)) and higher SAPS II score (OR = 1.02, 95% CI = 1.01 to 1.03, P = 0.008) were independent risk factors for mortality. Conclusions: B-NP episodes are more frequent in patients with medical admission, MRSA and A. baumannii etiology and prolonged mechanical ventilation, and are independently associated with higher mortality rates

Biological Activity of Extracts from Aromatic Plants as Control Agents against Spoilage Molds Isolated from Sheep Cheese

[EN] The aim of this work was to assess the antifungal and antioxidant activity of essential oils and ethanolic extracts from distilled solid by-products from aromatic plants (Artemisia dracunculus, Hyssopus officinalis, Lavandula stoechas, Origanum vulgare and Satureja montana) against 14 fungi strains isolated from sheep cheese and identified at species level using DNA barcoding based on β-tubulin sequence analysis. In addition, capacity of fungi to produce ochratoxin A, patulin, cyclopiazonic acid and sterigmatocystin was analyzed. Of the isolates, 85.7% belonged to Penicillium (P. commune/biforme, P. crustosum) and 14.3% to Aspergillus (A. puulaauensis and A. jensenii), the first time that these Aspergillus species have been found in sheep’s cheese. All P. commune isolates were producers of cyclopiazonic acid, and the two Aspergillus strains produced sterigmatocystin, but the others did not produce any tested mycotoxin. Among the essential oils tested, oregano, savory and tarragon had a significant antifungal activity against all the isolated strains, but no ethanolic extract showed antifungal activity. By contrast, ethanolic extracts showed great potential as antioxidants. The identification of new molds in cheese will help the dairy industry to know more about those molds affecting the sector, and the use of aromatic plants in the control of fungal spoilage could be a suitable alternative to chemical preservatives used in the agri-food industrySIThis research was financially supported by the Spanish National Institute for Agricultural Research and Experimentation (INIA, http://inia.es) by the project RTA2015-00018-C03-0

Pandemic and post-pandemic Influenza A (H1N1) infection in critically ill patients

Background: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. Methods: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. Results: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Conclusion: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection

Fever of unkown origin in children. An approach to diagnosis and intervention in primary health care

Este trabajo obtuvo el Primer “Premio Colegio Oficial de Médicos” de Granada en la convocatoria 15 de Diciembre de 2009.Introducción. La fiebre es un motivo de consulta frecuente. Debido a que gran parte de lo publicado se refiere a atención Hospitalaria, nuestro objetivo es evaluar su diagnóstico, manejo e intervención en Pediatría de Atención Primaria. Material y métodos. Estudio transversal descriptivo, sobre población menor de 14 años con diagnóstico Fiebre 780.6 del CIE 9 (FSF), en dos consultas de pediatria. Se utiliza como comparativo el Proceso Fiebre en el Niño. Los datos se procesan con SPSS 15 y software de soporte para datos tabulados Epidat 3.1, se utiliza en su análisis la frecuencia 2 relativa y el test de la ÷ , como diferencia significativa p < 0,05. Resultados. Porcentaje medio de FSF 0,55 %, predominio de niños sobre niñas (p<0,05), del grupo de 3-36 meses de edad 59, 2%. Derivados a hospital 3,9 %. Bajo registro del grado de temperatura 26,2 %. Consulta en menos de 24 h del inicio febril 72,3 %. Solicitud exámenes complementarios 27,2 %, tira de orina en < 1 año 48,9 % y en fiebre de más de 48 h 19 %. Ausencia de registro antitérmico prescrito 34 %, vacunados contra neumococo 64,5 %. Revisión tras consulta inicial 34,5 % de ellos que se llego a un diagnóstico 88,7 %. Conclusiones. Bajo registro de FSF en AP. Rápida consulta por parte de los padres tras comienzo de fiebre. Más casos en el grupo de 3-36 meses. Bajo registro de temperatura y antitérmico recomendado. Escasa derivación al hospital, mayor en menor edad. Probable auto resolución de muchos casos. Poca variabilidad entre profesionales.Introduction. Fever is a common complaint leading patients to seek medical attention. Since majority of published papers deals with hospital attention, our aim is to evaluate its diagnosis, management and intervention in Paediatric consultations in Primary Health Care (PHC). Materials and methods. Transverse descriptive study, performed on <14-year-old population diagnosed with Fever 780.6 of the CIE 9 (FUO), in two paediatric surgeries. Procedure Fever in Child is used as comparative. The data is 2 processed with SPSS 15 and tabulated data support software Epidat 3.1. Relative frequency and the ÷ test was used in the analysis, with the p <0,05 significant difference. Results. Average percentage of FUO 0,55 %, predominant in boys (p < 0,001) and in 3-36 month-old age group 59, 2 %. Percentage sent to hospital 3,9 %. Actual temperature level recorded in few cases 26,2 %. Medical assistance sought in less than 24 h from the onset of fever. Complementary tests requested in 27,2 %, urine strips in <1 year olds 48,9 % and in fever lasting longer than 48 h 19 %. Register of antithermics prescribed absent in 34 %, vaccinated against pneumococcus 64,5 %. Follow-up appointment after the first consultation 34,5 % with diagnosis in 88,7 %. Conclusions. Low recordings of FUO in PHC. Fever checked briefly by parents on its onset. More cases found in the 3-36 months-old age group. Low percentage of temperatures documented and antipyretics prescribed. Few cases hospitalised, higher in younger age groups. In many cases fever resolved itself. Minor differences between professionals

Ecoescuelas: una estrategia de inclusión de la dimensión ambiental

A lo largo de la historia, el resultado de la actividad industrial y la insostenibilidad de los modelos de producción han generado hábitos de consumo no responsables, explosión demográfica, pobreza en sectores urbanos, abandono del sector rural y establecimiento de modelos productivos extractivos; aspectos que han derivado en problemáticas ambientales que han impactado negativamente los ecosistemas y que han producido agotamiento paulatino de los recursos naturales, pérdida de biodiversidad, gestión inadecuada del recurso hídrico, de la energía y de los resi - duos sólidos producidos por el mismo sistema económico, el cual se ha centrado en la concepción de desarrollo como crecimiento económico. Por lo anterior, se evi - dencia la necesidad de transformar la situación descrita y llevar a cabo procesos educativos de manera más concreta, específicamente con los Proyectos Ambien - tales Escolares (PRAE), cuyo fortalecimiento ha constituido una política nacional a partir del Decreto 1743 de 1994. Teniendo en cuenta que la Universidad Libre, desde el Consultorio Ambiental, ha estado asesorando a instituciones educativas en este sentido, además de la experiencia adquirida a partir de los convenios con la Corporación Autónoma Regional, se plantea como objetivo general de investigación: implementar la es - trategia Ecoescuelas para la inclusión de la dimensión ambiental en el currículo y el fortalecimiento de los PRAE en instituciones educativas del departamento de Cundinamarca, involucrando aspectos de gestión pedagógica y ambiental. En este sentido, el libro es una recopilación de las experiencias significativas producto de los procesos de intervención y fortalecimiento de la dimensión ambiental, en el contexto de la investigación-acción participativa, cuyo fin es describir los resultados de aplicación de las herramientas de análisis y diálogo permanente entre los actores educativos desde su rol y área de conocimiento. Se incorporaron aspectos conceptuales, metodológicos y técnicos que permiten la interpretación y el planteamiento de alternativas de solución a problemáticas ambientales. La ambientalización del currículo o inclusión de la dimensión ambiental estipulada en la Política Nacional de Educación Ambiental implica introducir contenidos ambientales en las diferentes áreas del conocimiento como parte del diseño, desarrollo y evaluación de los PRAE, y desde este marco se sustenta el estudio. Por lo anterior, los objetivos específicos que orientaron el proceso partieron de la identificación de las problemáticas ambientales prioritarias del entorno escolar y del análisis documental del Proyecto Educativo Institucional y de los componentes del PRAE de las instituciones educativas, empleando herramientas de diagnóstico participativo. Posteriormente, se implementó un proceso de formación con los docentes de las instituciones educativas, en el cual se abordaron temáticas de construcción de los PRAE, ecoeficiencia y ambientalización curricular y construcción de matrices de transversalización; así como la instalación, puesta en marcha y seguimiento de estrategias técnicas de gestión ambiental en los componentes de ahorro y uso eficiente del agua, de la energía, del manejo adecuado de residuos sólidos, del mejoramiento del entorno y de la biodiversidad y la gestión del riesgo. El libro está organizado en dos partes: la primera se centra en aspectos metodológicos, en la que se describen las etapas de la estrategia empleada durante la intervención en las instituciones educativas. También describe (capítulo 2) el referente teórico del proyecto, plantea el problema de investigación y presenta un análisis de resultados de inclusión de la dimensión ambiental en 33 instituciones educativas de Cundinamarca, desde el enfoque de Ecoescuelas, así como las contribuciones del proyecto. El enfoque mencionado se ubica en el contexto de la sostenibilidad, y concibe la escuela como un sistema complejo donde se visibiliza una oportunidad para la innovación curricular y la integración de aspectos ecológicos ambientales con el quehacer y las buenas prácticas ejecutadas por la comunidad educativa. La segunda parte del libro presenta seis experiencias concretas de intervención, que constituyeron el trabajo de grado en Ingeniería Ambiental de estudiantes participantes en el proyecto. Finalmente, se presentan las conclusiones del estudio realizado. Por cada institución se describen diferentes iniciativas a partir de la aplicación de las cuatro etapas de la estrategia metodológica propuesta, teniendo en cuenta aspectos como ubicación (ya sea rural o urbana), resultados del diagnóstico, características de los documentos institucionales, componentes ambientalespriorizados y necesidad de estrategias técnicas para el fortalecimiento del proceso ambiental institucional. Los resultados han permitido generar planes de acción a corto, mediano y largo plazo en las instituciones educativas, teniendo como fundamento el PRAE y su fortalecimiento desde las dimensiones pedagógica, social y técnica con un enfoque de gestión ambiental como aporte para la transformación en escuelas ecoeficientes, orientadas hacia modelos ambientalmente sostenible

Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial

Introduction: Large randomized trials testing the effect of a multifactorial weight-loss lifestyle intervention including Mediterranean diet (MedDiet) on renal function are lacking. Here, we evaluated the 1-year efficacy of an intensive weight-loss intervention with an energy-reduced MedDiet (erMedDiet) plus increased physical activity (PA) on renal function. Methods: Randomized controlled "PREvención con DIeta MEDiterránea-Plus"(PREDIMED-Plus) trial is conducted in 23 Spanish centers comprising 208 primary care clinics. Overweight/obese (n = 6,719) adults aged 55-75 years with metabolic syndrome were randomly assigned (1:1) to an intensive weight-loss lifestyle intervention with an erMedDiet, PA promotion, and behavioral support (intervention) or usual-care advice to adhere to an energy-unrestricted MedDiet (control) between September 2013 and December 2016. The primary outcome was 1-year change in estimated glomerular filtration rate (EGFR). Secondary outcomes were changes in urine albumin-to-creatinine ratio (UACR), incidence of moderately/severely impaired EGFR (<60 mL/min/1.73 m2) and micro-to macroalbuminuria (UACR ≥30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m2) to mildly impaired GFR (60 to <90 mL/min/1.73 m2) or micro-to macroalbuminuria. Results: After 1 year, EGFR declined by 0.66 and 1.25 mL/min/1.73 m2 in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m2; 95% CI: 0.15-1.02). There were no between-group differences in mean UACR or micro-to macroalbuminuria changes. Moderately/severely impaired EGFR incidence and reversion of moderately to mildly impaired GFR were 40% lower (HR 0.60; 0.44-0.82) and 92% higher (HR 1.92; 1.35-2.73), respectively, in the intervention group. Conclusions: The PREDIMED-Plus lifestyle intervention approach may preserve renal function and delay CKD progression in overweight/obese adults.This work was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigación para la Salud (FIS), which is cofunded by the European Regional Development Fund (5 coordinated FIS projects leaded by J.S.-S and J.V., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926; PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, and PI19/01332); the Especial Action Project entitled Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S.; the European Research Council (Advanced Research Grant 2014–2019; agreement #340918) granted to M.Á.M.-G.; the Recercaixa (No. 2013ACUP00194) grant to J.S.-S.; grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018); the PROMETEO/2017/017 grant from the Generalitat Valenciana; the SEMERGEN grant; funds from the European Regional Development Fund (CB06/03); International Nut & Dried Fruit Council – FESNAD (Long-term effects of an energyrestricted Mediterranean diet on mortality and cardiovascular disease 2014–2015, No. 201302) (PI: M.Á.M.-G.); the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 (PI: D.R.); grant of support to research groups No. 35/2011 (Balearic Islands Gov.; FEDER funds) (J.A.T. and C.B.); the JR17/00022 (ISCIII) grant to O.C.; the Boosting young talent call grant program for the development of IISPV research projects 2019–2021 (Ref.: 2019/IISPV/03 grant to A.D.-L.); the Societat Catalana d’Endocrinologia i Nutrició (SCEN) Clinical-Research Grant 2019 (IPs: J.S.-S. and A.D.-L.). Collaborative Nutrition and/or Obesity Project for Young Researchers 2019 supported by CIBEROBN entitled Lifestyle Interventions and Chronic Kidney Disease: Inflammation, Oxidative Stress and Metabolomic Profile (LIKIDI study) grant to A.D.-L

Dietary diversity and nutritional adequacy among an older Spanish population with metabolic syndrome in the PREDIMED-Plus study: a cross-sectional analysis

Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55-75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80-39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55-18.65), fruits OR = 11.62 (95% CI 6.81-19.81), dairy products OR = 6.54 (95% CI 4.64-9.22) and protein foods OR = 6.60 (95% CI 1.96-22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s

Prospective associations between a priori dietary patterns adherence and kidney function in an elderly Mediterranean population at high cardiovascular risk

Purpose To assess the association between three different a priori dietary patterns adherence (17-item energy reduced-Mediterranean Diet (MedDiet), Trichopoulou-MedDiet and Dietary Approach to Stop Hypertension (DASH)), as well as the Protein Diet Score and kidney function decline after one year of follow-up in elderly individuals with overweight/obesity and metabolic syndrome (MetS). Methods We prospectively analyzed 5675 participants (55-75 years) from the PREDIMED-Plus study. At baseline and at one year, we evaluated the creatinine-based estimated glomerular filtration rate (eGFR) and food-frequency questionnaires-derived dietary scores. Associations between four categories (decrease/maintenance and tertiles of increase) of each dietary pattern and changes in eGFR (ml/min/1.73m(2)) or >= 10% eGFR decline were assessed by fitting multivariable linear or logistic regression models, as appropriate. Results Participants in the highest tertile of increase in 17-item erMedDiet Score showed higher upward changes in eGFR (beta: 1.87 ml/min/1.73m(2); 95% CI: 1.00-2.73) and had lower odds of >= 10% eGFR decline (OR: 0.62; 95% CI: 0.47-0.82) compared to individuals in the decrease/maintenance category, while Trichopoulou-MedDiet and DASH Scores were not associated with any renal outcomes. Those in the highest tertile of increase in Protein Diet Score had greater downward changes in eGFR (beta: - 0.87 ml/min/1.73m(2); 95% CI: - 1.73 to - 0.01) and 32% higher odds of eGFR decline (OR: 1.32; 95% CI: 1.00-1.75). Conclusions Among elderly individuals with overweight/obesity and MetS, only higher upward change in the 17-item erMedDiet score adherence was associated with better kidney function after one year. However, increasing Protein Diet Score appeared to have an adverse impact on kidney health. Trial Registration Number: ISRCTN89898870 (Data of registration: 2014).Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigacion para la Salud (FIS), which is co-funded by the European Regional Development Fund (six coordinated FIS projects leaded by JS-S and JVi, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332, PI20/01802, PI20/00138, PI20/01532, PI20/00456, PI20/00339, PI20/00557, PI20/00886, PI20/01158); the Especial Action Project entitled: Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus grant to JS-S; the European Research Council (Advanced Research Grant 2014-2019; agreement #340918) granted to MAMG.; the Recercaixa (number 2013ACUP00194) grant to JS-S; grants from the Consejeria de Salud de la Junta de Andalucia (PI0458/2013, PS0358/2016, PI0137/2018); the PROMETEO/2017/017 and the PROMETEO 21/2021 grant from the Generalitat Valenciana; the SEMERGEN grant; the Boosting young talent call grant program for the development of IISPV research projects 2019-2021 (Ref.: 2019/IISPV/03 grant to AD-L); the Societat Catalana d'Endocrinologia i Nutricio (SCEN) Clinical-Research Grant 2019 (IPs: JS-S and AD-L). Collaborative Nutrition and/or Obesity Project for Young Researchers 2019 supported by CIBEROBN entitled: Lifestyle Interventions and Chronic Kidney Disease: Inflammation, Oxidative Stress and Metabolomic Profile (LIKIDI study) grant to AD-L. Jordi Salas-Salvado, gratefully acknowledges the financial support by ICREA under the ICREA Academia programme. M.R.-G., is supported by the Ministry of Education of Spain (FPU17/06488). None of the funding sources took part in the design, collection, analysis, interpretation of the data, or writing the report, or in the decision to submit the manuscript for publication