Cataract Surgery in Elderly Subjects with Heterozygous Familial Hypercholesterolemia in Prolonged Treatment with Statins

Background: Cataracts are the main cause of blindness and represent one fifth of visual problems worldwide. It is still unknown whether prolonged statin treatment favors the development of cataracts. We aimed to ascertain the prevalence of cataract surgery in elderly subjects with genetically diagnosed heterozygous familial hypercholesterolemia (HeFH) receiving statin treatment for ≥5 years, and compare this with controls. Methods: This is an observational, multicenter, case–control study from five lipid clinics in Spain. We collected data with the following inclusion criteria: age ≥65 years, LDL cholesterol levels ≥220 mg/dL without lipid-lowering drugs, a pathogenic mutation in a candidate gene for HeFH (LDLR, APOB, or PCSK9) and statin treatment for ≥5 years. Controls were selected from relatives of HeFH patients without hypercholesterolemia. Linear and logistic regressions based on generalized linear models and generalized estimating equations (GEE) were used. Cataract surgery was used as a proxy for cataract development. Results: We analyzed 205 subjects, 112 HeFH, and 93 controls, with a mean age of 71.8 (6.5) and 70.0 (7.3) years, respectively. HeFH subjects presented no difference in clinical characteristics, including smoking, hypertension, and type 2 diabetes mellitus, compared with controls. The mean duration of lipid-lowering treatment in HeFH was 22.5 (8.7) years. Cataract surgery prevalence was not significantly different between cases and controls. The presence of cataracts was associated neither with LDLc nor with the length of the statin therapy. Conclusion: In the present study, HeFH was not a risk factor for cataract surgery and prolonged statin treatment did not favor it either. These findings suggest that statin treatment is not related with cataracts

Obesidad y sedentarismo en el siglo XXI: ¿qué se puede y se debe hacer?

En la actualidad, seis de los siete principales factores de riesgo de mortalidad prematura en Europa (presión sanguínea, colesterol, Índice de Masa Corporal, ingesta insuficiente de fruta y verdura, inactividad física y abuso del alcohol) están relacionados con los estilos de vida, especialmente con los hábitos alimentarios, el consumo de alcohol y la inactividad física y/o sedentarismo. En el ámbito de la salud pública es especialmente preocupante el aumento del sobrepeso y la obesidad en toda Europa. Para abordar este problema, tanto la Organización Mundial de la Salud (OMS) como la Comisión Europea abogan por un enfoque integrado, con la implicación de las partes interesadas a nivel europeo, nacional, regional y local. Sirva como magnífico ejemplo la muy reciente Declaración de Viena sobre Nutrición y Enfermedades No Transmisibles que la OMS promulgó tras la Conferencia Ministerial celebrada en Viena los pasados 4 y 5 de julio del 2013, en el contexto del programa “Health 2020”, en la que se reafirma el imprescindible abordaje multidisciplinar

Gradual Increase in Environmental Light Intensity Induces Oxidative Stress and Inflammation and Accelerates Retinal Neurodegeneration

Purpose: Retinitis pigmentosa (RP) is a blinding neurodegenerative disease of the retina that can be affected by many factors. The present study aimed to analyze the effect of different environmental light intensities in rd10 mice retina. Methods: C57BL/6J and rd10 mice were bred and housed under three different environmental light intensities: scotopic (5 lux), mesopic (50 lux), and photopic (300 lux). Visual function was studied using electroretinography and optomotor testing. The structural and morphological integrity of the retinas was evaluated by optical coherence tomography imaging and immunohistochemistry. Additionally, inflammatory processes and oxidative stress markers were analyzed by flow cytometry and western blotting. Results: When the environmental light intensity was higher, retinal function decreased in rd10 mice and was accompanied by light-dependent photoreceptor loss, followed by morphological alterations, and synaptic connectivity loss. Moreover, light-dependent retinal degeneration was accompanied by an increased number of inflammatory cells, which became more activated and phagocytic, and by an exacerbated reactive gliosis. Furthermore, light-dependent increment in oxidative stress markers in rd10 mice retina pointed to a possible mechanism for light-induced photoreceptor degeneration. Conclusions: An increase in rd10 mice housing light intensity accelerates retinal degeneration, activating cell death, oxidative stress pathways, and inflammatory cells. Lighting intensity is a key factor in the progression of retinal degeneration, and standardized lighting conditions are advisable for proper analysis and interpretation of experimental results from RP animal models, and specifically from rd10 mice. Also, it can be hypothesized that light protection could be an option to slow down retinal degeneration in some cases of RP.Supported by grants from the Spanish Ministry of Economy and Competitiveness (MINECO-FEDER BFU2015-67139-R); Spanish Ministry of Education (FPU16/04114); Instituto de Salud Carlos III co-financed by European Regional Development funds (RETICS-FEDER RD16/0008/0016); and Asociación Retina Asturias, FARPE-FUNDALUCE, Generalitat Valenciana (PROMETEO/2016/158, ACIF/2016/055 and FEDER IDIFEDER/2017/064)

Community nutrition in Spain: advances and drawbacks

Scientific evidence has placed community nutrition among the front-line strategies in health promotion. Community nutrition in different regions of Spain has developed at an unequal pace. Early initiatives in the mid 1980s provided good-quality population data and established a basis for nutrition surveillance including individual body measurements, dietary intake data, information on physical activity, and biomarkers. The Nutrition and Physical Activity for Obesity Prevention Strategy (NAOS) reinforces community nutrition action in Spain. Presented here is an overview of developments in community nutrition in Spain in recent years as well as potential trends under the scope of the NAOS.Publicad

Gastronomic, food and nutritional aspects of oriental Andalusia

Andalucía oriental se denomina Alta Andalucía por la elevada orografía de las cordilleras Béticas con las cumbres peninsulares más altas. Surge con la segmentación de España en provincias, e incluye Almería, Granada, Jaén y Málaga. Solo hay que detenerse en el fondo de nuestras ollas para encontrarnos el sincretismo de las tres grandes religiones monoteístas (árabe, judía y cristiana) que mezcló las fiestas de una con las comidas de otra y permitió la universalización de sus gastronomías; un sincretismo que ha llegado hasta hoy y hace difícil conocer el origen de una u otra receta. La cocina busca hoy la fusión entre el sabor y los ingredientes de la cocina tradicional con el saber y la técnica de la cocina moderna. La diversidad geográfica y climática de Andalucía oriental es proporcional a su despensa, y esta es la que surte su recetario. La población de Andalucía oriental se aparta del patrón mediterráneo y se acerca a la dieta global de los países desarrollados de Occidente. Esta tendencia a disminuir el consumo de alimentos propios de patrón mediterráneo parece mantenerse, aunque se observa una disminución en la caída de alguno de ellos. Además, el consumo elevado de grupos como el de carnes y derivados, bollería, dulces y azúcar tiende a moderarse. El patrón actual es compatible –como pone de manifiesto el estudio ANIBES– con unas ingestas elevadas de grasa saturada y total y de azúcares y una baja ingesta de fibra en un porcentaje importante de la población en España y, por tanto, en Andalucía.Eastern Andalusia, is also named Highland Andalusia, because the elevated orography of the Betics mountain range, with the highest Iberian Peninsula summits. This region arose with the division of the Spanish territory by provinces and currently includes Almeria, Granada, Jaen. You should only stop and look into the bottom of our cooking pots to find the syncretism of the three monotheistic religions, Christianity, Jewish and Muslin, which mixed parties of each one with meals of the others, thus allowing the globalization of their gastronomies that remained until nowadays and makes difficult to find the actual origin of a particular meal recipe. Modern cooking tries to find the fusion between tastes and ingredients of traditional cooking with current knowledge and technology. The geographic and climate diversities in Eastern Andalusia are proportional to its pantry, which in turn is the source of its meal recipes. The population of Eastern Andalusia is moving away of the Mediterranean pattern and getting closer to the developed Western countries diet. This trend to decrease the consumption of proprietary Mediterranean foods seems to be maintained in the last years although some of them start to recover. In addition, some food groups e.g. meat and meat derivatives, pastries and sweets, with actual elevated consumption, tend to be moderated. The current food pattern for the whole Spanish population, as well as for Eastern Andalusia, is compatible with high intakes of saturated fat, and total and free sugars, and low intakes of fiber in a high percentage of the Spanish population as reported by the ANIBES study

Guia de estilos de vida saudáveis da FINUT: além da pirâmide alimentar

La Organización Mundial de la Salud (World Health Organization: OMS) ha propuesto que la salud debe ser promovida y protegida a través del desarrollo de un medio ambiente que permita acciones sostenibles a nivel individual, comunitario, nacional y global. De hecho, se han desarrollado en numerosos países guías alimentarias (por ejemplo, las pirámides de alimentos) para divulgar información nutricional a la población general. Sin embargo, se necesitan recomendaciones más amplias sobre estilos activos de vida saludable, no restringidos únicamente a los alimentos. El objetivo de este trabajo es la propuesta de una pirámide tridimensional como una nueva estrategia para promover una nutrición adecuada y estilos activos de vida saludable de manera sostenible. En efecto, se ha diseñado la pirámide FINUT (Fundación Iberoamericana de Nutrición) sobre estilos de vida saludable como un tetraedro cuyas tres caras laterales se corresponden a los binomios alimentación y nutrición, actividad física y descanso, y educación e higiene. Cada cara lateral está dividida en dos triángulos. Estas caras muestran lo siguiente: 1. guías alimentarias y hábitos de alimentación saludable en relación a un medio ambiente sostenible; 2. recomendaciones sobre descanso y actividad física y temas de educación, sociales y culturales relacionados; 3. guías seleccionadas sobre higiene y educación que, en conjunto con las otras dos caras, puedan contribuir a una mejor salud para la población en un planeta sostenible. La nueva pirámide FINUT se dirige a la población general de todas las edades y debería servir como una guía para un estilo de vida saludable en un contexto social y cultural definido. La pirámide incluye una dimensión ambiental y sostenible que proporciona medidas para contribuir a la prevención de las enfermedades crónicas no transmisibles.The World Health Organization has proposed that health be promoted and protected through the development of an environment that enables sustainable actions at individual, community, national and global levels. Indeed, food-based dietary guidelines, i.e., food pyramids, have been developed in numerous countries to disseminate nutritional information to the general population. However, wider recommendations are needed, with information on an active, healthy lifestyle, not just healthy eating. The objective of the present work is to propose a three-dimensional pyramid as a new strategy for promoting adequate nutrition and active healthy lifestyles in a sustainable way. Indeed, the Iberomerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles has been designed as a tetrahedron, its three lateral faces corresponding to the binomials food and nutrition, physical activity and rest, and education and hygiene. Each lateral face is divided into two triangles. These faces show the following: 1. food-based guidelines and healthy eating habits as related to a sustainable environment; 2. recommendations for rest and physical activity and educational, social and cultural issues; 3. selected hygiene and educational guidelines that, in conjunction with the other two faces, would contribute to better health and provide measures to promote environmental sustainability. The new FINUT pyramid is addressed to the general population of all ages and should serve as a guide for living a healthy lifestyle within a defined social and cultural context. It includes an environmental and sustainability dimension providing measures that should contribute to the prevention of non-communicable chronic diseases.A Organização Mundial da Saúde propôs a promoção e a proteção da saúde através do desenvolvimento de um ambiente que permita ações sustentáveis nos aspectos individuais, comunitários, nacionais e globais. De fato, diversos países desenvolveram diretrizes nutricionais baseadas em pirâmides alimentares, para a disseminação de informações nutricionais para a população em geral. No entanto, há também a necessidade de recomendações mais amplas, com informações sobre estilos de vida ativos e saudáveis, não apenas sobre a alimentação saudável. E objetivo do presente trabalho é propor uma pirâmide tridimensional como nova estratégia para a promoção da alimentação adequada e estilos de vida ativos e saudáveis de uma forma sustentável. Na verdade, a pirâmide de estilos de vida saudáveis da Fundação Ibero-Americana de Nutrição (FINUT) foi concebida como um tetraedro, com suas três faces laterais correspondendo aos aspectos de alimentação e nutrição, atividade física e repouso, e educação e higiene. Cada face lateral apresenta dois triângulos. Essas faces apresentam as seguintes informações: 1) diretrizes baseadas em alimentos e hábitos alimentares saudáveis relacionados a um meio-ambiente sustentável; 2) recomendações para repouso e atividade física e questões educacionais, sociais e culturais; e 3) diretrizes específicas sobre higiene e educação que, em conjunto com as outras duas faces, contribuiriam para a melhoria da saúde das pessoas em um planeta sustentável. A nova pirâmide FINUT é voltada para a população geral de todas as idades e deve servir como guia para um estilo de vida saudável, em um contexto social e cultural definido. Ela inclui uma dimensão ambiental e sustentável, fornecendo medidas que devem contribuir para a prevenção de doenças crônicas não transmissíveis

Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study

This research was funded by Instituto Puleva de Nutricion (IPN), which is a non-profit entity that promotes scientific research, mainly in the field of nutrition and health: child nutrition, cardiovascular, bone and digestive health, etc., as well as the dissemination of quality scientific content. While the IPN is funded by the dairy company Lactalis, its actions are based on the decisions of an independent scientific board formed by renowned international scientists. A. G. is co-financed by the Research Plan of the Vice-Rectorate of Research and Transfer of the University of Granada, Spain.The authors would like to thank IPN for its support and technical advice. The results presented in this article constitute part of Casandra Madrigal Arellano’s doctoral thesis, performed in the Nutrition and Food Sciences Doctorate Program of the University of Granada and financed by the Consejo Nacional de Ciencia y Tecnología (CONACYT).Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to <10 years old (n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler's milk, and enriched and fortified milks) (n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to <10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.Instituto Puleva de Nutricion (IPN)dairy company LactalisResearch Plan of the Vice-Rectorate of Research and Transfer of the University of Granada, Spai

Usual Dietary Intake, Nutritional Adequacy and Food Sources of Calcium, Phosphorus, Magnesium and Vitamin D of Spanish Children Aged One to <10 Years. Findings from the EsNuPI Study †

The authors would like to thank IPN for its support and technical advice.Bone problems in the population begin to be establish in childhood. The present study aims to assess the usual calcium, phosphorus, magnesium, and vitamin D intakes, along with the food sources of these nutrients, in Spanish children participating in the EsNuPI (Estudio Nutricional en Población Infantil Española) study. Two 24 h dietary recalls were applied to 1448 children (1 to <10 years) divided into two sub-samples: one reference sample (RS) of the general population [n = 707] and another sample which exclusively included children consuming enriched or fortified milks, here called “adapted milks” (AMS) [n = 741]. Estimation of the usual intake shows that nutrient intake increased with age for all nutrients except vitamin D. Using as reference the Dietary Reference Values from the European Food Safety Authority (EFSA), calcium and magnesium intakes were found to be below the average requirement (AR) and adequate intake (AI), respectively, in a considerable percentage of children. Furthermore, phosphorus exceeded the AI in 100% of individuals and vitamin D was lower than the AI in almost all children studied. The results were very similar when considering only plausible reporters. When analyzing the food sources of the nutrients studied, milk and dairy products contributed the most to calcium, phosphorus, magnesium, and vitamin D. Other sources of calcium were cereals and vegetables; for phosphorus: meat, meat products, and cereals; for magnesium: cereals and fruits; and, for vitamin D: fish and eggs. These results highlight the desirability of improving the intake concerning these nutrients, which are involved in bone and metabolic health in children. The AMS group appeared to contribute better to the adequacy of those nutrients than the RS group, but both still need further improvement. Of special interest are the results of vitamin D intakes, which were significantly higher in the AMS group (although still below the AI), independent of age.Instituto Puleva de Nutricion (IPN

Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years—Results from the EsNuPI Study

This research was funded by Instituto Puleva de Nutricion (IPN), which is a non-profit entity that promotes scientific research, mainly in the field of nutrition and health: child nutrition, cardiovascular, bone and digestive health, etc., as well as the dissemination of quality scientific content. While the IPN is funded by the dairy company Lactalis, its actions are based on the decisions of an independent scientific board formed by renowned international scientists. a. G. is co-financed by the Research Plan of the Vice-Rectorate of Research and Transfer of the University of Granada, Spain.Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One “Spanish Reference Sample” (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler’s or growing up milk and fortified and enriched milks, here called “Adapted Milk Consumers Sample” (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.Instituto Puleva de Nutrición (IPN)dairy company LactalisResearch Plan of the Vice-Rectorate of Research and Transfer of the University of Granada, Spai

Biological evaluation of a protein mixture intended for enteral nutrition

La nutrición enteral (NE) es el mejor recurso para complementar la alimentación de los pacientes, siempre que el tracto gastrointestinal este funcional. Cuando se indica NE total, ésta representa la fuente exclusiva de alimento, por lo que es importante asegurar un alto valor biológico de la proteína incluida. Objetivo: Valorar la calidad biológica de una mezcla proteica constituida por 50% de caseinato potásico, 25% de proteínas de suero lácteo y 25% de proteína de guisante para ser utilizada en productos de nutrición enteral. Material y métodos: 40 ratas Wistar (20 hembras y 20 machos), con peso medio de 51 g, divididas en cuatro grupos. Dos de ellos fueron alimentados con dietas específicas para ratas: uno con caseína (Control) y otro con la proteína experimental (Experimental); los otros fueron alimentados con productos de NE diseñados para humanos y adaptados a los requerimientos de las ratas (Normoproteico e Hiperproteico), durante 10 días. Se determinó el índice de eficacia proteica (PER), el coeficiente de digestibilidad aparente (CDA), la relación nitrógeno retenido/ absorbido (R/A) y la relación nitrógeno retenido/ingerido (R/I). Resultados: El grupo experimental y el grupo control presentaron valores similares en todos los índices analizados. Asimismo, estos índices fueron similares entre los grupos normo e hiperproteicos, pero menores respecto a los grupos anteriores, exceptuando al PER, el cual fue a su vez similar entre el grupo normoproteico y el control. Conclusión: La calidad de la mezcla proteica utilizada es alta y adecuada para ser incluida en el desarrollo de nuevos productos para nutrición enteral.Enteral nutrition is the best way to feed or supplement the diet when gastrointestinal tract functions of patients are partially or totally preserved. Whenever total enteral nutrition is needed, it represents the only source of nutrients for patients. Thus, it is mandatory to ensure that high biological value proteins are included in enteral formulae. Objective: To assess the biological quality of a protein blend constituted by 50% potassium caseinate, 25% whey protein and 25% pea protein intended to be used in enteral nutrition products. Materials and methods: Forty Wistar rats (20 male and 20 female), with initial body weight of 51 g, where divided into four groups and feed for 10 days with: casein (Control), experimental protein blend (Experimental), liophylized normo- and hyperproteic enteral nutrition formulae adapted to the animal nutritional requirements (Normoproteic and Hyperproteic). Protein efficiency ratio (PER), apparent digestibility coefficient (ADC), relationship between retained and absorbed nitrogen (R/A) and relationship between retained and consumed nitrogen (R/I) where calculated. Results: Experimental and control groups had similar values for all analysed indices (PER, ADC, R/A and R/I). These indices where also similar between normo and hyperproteic groups, but lower than experimental and control groups, except in PER, where normoproteic group was either similar to control and hiperproteic group. Conclusion: The quality of the protein blend used in this study is high. It is a good protein source to be used in the development of new enteral nutritional products