A risk score to predict type 2 diabetes mellitus in an elderly spanish mediterranean population at high cardiovascular risk.

Introduction: To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. Materials and Methods: A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC). Results: The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of $6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. Discussion: We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire

White blood cell counts as risk markers of developing metabolic syndrome and its components in the Predimed study.

Background The Metabolic Syndrome (MetS) is a cluster of metabolic abnormalities that includes hyperglucemia, hypertension, dyslipidemia and central obesity, conferring an increased risk of cardiovascular disease. The white blood cell (WBC) count has been proposed as a marker for predicting cardiovascular risk. However, few prospective studies have evaluated the relationship between WBC subtypes and risk of MetS. Methods Participants were recruited from seven PREDIMED study centers. Both a baseline cross-sectional (n = 4,377) and a prospective assessment (n = 1,637) were performed. Participants with MetS at baseline were excluded from the longitudinal analysis. The median follow-up was 3.9 years. Anthropometric measurements, blood pressure, fasting glucose, lipid profile and WBC counts were assessed at baseline and yearly during the follow-up. Participants were categorized by baseline WBC and its subtype count quartiles. Adjusted logistic regression models were fitted to assess the risk of MetS and its components. Results Of the 4,377 participants, 62.6% had MetS at baseline. Compared to the participants in the lowest baseline sex-adjusted quartile of WBC counts, those in the upper quartile showed an increased risk of having MetS (OR, 2.47; 95%CI, 2.03-2.99; P-trend<0.001). This association was also observed for all WBC subtypes, except for basophils. Compared to participants in the lowest quartile, those in the top quartile of leukocyte, neutrophil and lymphocyte count had an increased risk of MetS incidence. Leukocyte and neutrophil count were found to be strongly associated with the MetS components hypertriglyceridemia and low HDL-cholesterol. Likewise, lymphocyte counts were found to be associated with the incidence of the MetS components low HDL-cholesterol and high fasting glucose. An increase in the total WBC during the follow-up was also associated with an increased risk of MetS. Conclusions Total WBC counts, and some subtypes, were positively associated with MetS as well as hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, all components of MetS

Cross-sectional assessment of nut consumption and obesity, metabolic syndrome and other cardiometabolic risk factors: the PREDIMED study

INTRODUCTION: Prospective studies have consistently suggested that nut consumption is inversely related to fatal and non-fatal coronary heart disease. Limited data are available on the epidemiological associations between nut intake and cardiometabolic risk factors. OBJECTIVE: To evaluate associations between frequency of nut consumption and prevalence of cardiometabolic risk factors [obesity, metabolic syndrome (MetS), type-2 diabetes, hypertension, and dyslipidemia] in a Mediterranean population at high cardiovascular risk. MATERIALS AND METHODS: Cross-sectional study of 7,210 men and women (mean age, 67 y) recruited into the PREDIMED study. MetS was defined by the harmonized ATPIII and IDF criteria. Diabetes and hypertension were assessed by clinical diagnosis and dyslipidemia (high triglycerides, low HDL-cholesterol, and hypercholesterolemia) by lipid analyses. Nut consumption was assessed using a validated food frequency questionnaire and categorized as 3 servings/wk. Control of confounding was done with multivariate logistic regression. RESULTS: Compared to participants consuming 3 servings/wk had lower adjusted odds ratios (OR) for obesity (0.61, 95% confidence interval 0.54 to 0.68; P-trend <0.001), MetS (0.74, 0.65 to 0.85; P-trend<0.001), and diabetes (0.87, 0.78 to 0.99; P-trend = 0.043). Higher nut consumption was also associated with lower risk of the abdominal obesity MetS criterion (OR 0.68, 0.60 to 0.79; P-trend<0.001). No significant associations were observed for the MetS components high blood pressure, dyslipidemia, or elevated fasting glucose. CONCLUSIONS: Nut consumption was inversely associated with the prevalence of general obesity, central obesity, MetS, and diabetes in subjects at high cardiovascular risk

A Risk Score to Predict Type 2 Diabetes Mellitus in an Elderly Spanish Mediterranean Population at High Cardiovascular Risk

Abstract Introduction: To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. Materials and Methods: A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC). Results: The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of $6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. Discussion: We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire

Aspectos dietéticos relacionados con la diabetes tipo 2

Hypothesis and objectives. The Mediterranean diet (MedDiet) reduces the risk of developing type 2 diabetes (T2DM) in population at high cardiovascular risk. The intake of any of its components, such as nuts and vegetables, especially green leafy vegetables which are rich in vitamin k, also reduce the risk of T2DM and improve several cardiometabolic risk factors. We have analysed the effect of a MedDiet supplemented with olive oil or nuts compared to a low-fat diet on the risk of developing T2DM in subjects at high cardiovascular risk, and the association between nut consumption and vitamin K intake andT2DM, metabolic syndrome (MS) and other cardiovascular risk factors. Results. The MedDiet is associated with a 52% lower risk of T2DM compared to a low fat diet, while an increased intake of vitamin K is associated with a 51% lower risk of T2DM. The intake of more than 3 servings of nuts per week is inversely associated with the prevalence of general obesity, metabolic syndrome and T2DM.Hipótesis y objetivos. La dieta mediterránea (DietMed) reduce el riesgo de desarrollar diabetes tipo 2 (DM2) en una población de elevado riesgo cardiovascular. Además, la ingesta de alguno de sus componentes, como los frutos secos y las verduras, especialmente las verduras de hoja verde ricas en vitamina k, reducen el riesgo de DM2 y mejoran distintos factores de riesgo cardiometabólicos. Así pues, se pretende estudiar el efecto de una DietMed suplementada con aceite de oliva o frutos secos y el riesgo a desarrollar DM2 en comparación a una dieta baja en grasa en una población de elevado riesgo cardiovascular, así como la asociación entre la ingesta de frutos secos y vitamina K sobre la DM2, el síndrome metabólico (SM) y diferentes factores de riesgo cardiovascular. Resultados. La DietMed se asocia con un 52% menor riesgo de DM2 en comparación a una dieta baja en grasa; a la vez que, un aumento de la ingesta de vitamina k se asocia con un 51% menor riesgo a desarrollar DM2. Por otro lado, la ingesta de más de 3 raciones de frutos secos a la semana se asocia inversamente con la prevalencia de obesidad general, SM y DM2

Baseline characteristics of the study participants.

<p> <i>Abbreviations: BMI, body mass index. HDL, high-density lipoprotein; IDM, incident Diabetes Mellitus; LDL, low-density lipoprotein, NIDM, non incident Diabetes Mellitus.</i></p><p> <i>Data expressed as mean (SD) or number (percent). P value^a of the difference between incident diabetic and non-incident diabetic subjects. P value^b of the difference between individuals in the derivation sample and individuals in the validation sample (T-test for continuous variables or Chi-square tests for categorical variables).</i></p

Baseline risk factors for incidence of type 2 diabetes in the PREDIMED cohort (Cox regression model).

<p><i>Abbreviations: T2DM, Type 2 Diabetes Mellitus; BMI, body mass index; SDU, standard drink unit; CI, confidence interval; FPG, Fasting Plasma Glucose. One standard drink unit corresponds to 10 grams of pure alcohol. Alcohol consumption is considered when</i> ≥1.5 SDU in women or ≥3 in men. <i>Hypertension is considered when subjects use blood pressure medication or when pressure level ≥130/85 mmHg. All models were adjusted by intervention group. The score values were estimated on the basis of the β coefficients of the Cox regression models.</i></p

Diabetes incidence by categories of the Clinical Score during follow-up in the PREDIMED derivation sample and the DE-PLAN-CAT validation sample.

a<p>Percentage of individuals with incident diabetes in each category of PREDIMED-clinical Score.</p

The predictive performance of different risk scores applied to the PREDIMED and the DE-PLAN-CAT cohorts.

<p> <i>Abbreviations: AUC, area under the receiver operating characteristic curve; CI, confidence interval; PPV, positive predictive value. The scores were calculated based on different variables included in each of them. Clinical scores include fasting plasma glucose (mg/L) as a variable.</i></p>*<p> <i>P value<0.05 compared to PREDIMED-personal score,</i></p>†<p> <i>P value<0.05 compared to PREDIMED-clinical score.</i></p

White blood cell counts as risk markers of developing metabolic syndrome and its components in the PREDIMED study.

Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; TRIAL REGISTRATION Controlled-Trials.comISRCTN35739639.BACKGROUND The Metabolic Syndrome (MetS) is a cluster of metabolic abnormalities that includes hyperglucemia, hypertension, dyslipidemia and central obesity, conferring an increased risk of cardiovascular disease. The white blood cell (WBC) count has been proposed as a marker for predicting cardiovascular risk. However, few prospective studies have evaluated the relationship between WBC subtypes and risk of MetS. METHODS Participants were recruited from seven PREDIMED study centers. Both a baseline cross-sectional (n = 4,377) and a prospective assessment (n = 1,637) were performed. Participants with MetS at baseline were excluded from the longitudinal analysis. The median follow-up was 3.9 years. Anthropometric measurements, blood pressure, fasting glucose, lipid profile and WBC counts were assessed at baseline and yearly during the follow-up. Participants were categorized by baseline WBC and its subtype count quartiles. Adjusted logistic regression models were fitted to assess the risk of MetS and its components. RESULTS Of the 4,377 participants, 62.6% had MetS at baseline. Compared to the participants in the lowest baseline sex-adjusted quartile of WBC counts, those in the upper quartile showed an increased risk of having MetS (OR, 2.47; 95%CI, 2.03-2.99; P-trend<0.001). This association was also observed for all WBC subtypes, except for basophils. Compared to participants in the lowest quartile, those in the top quartile of leukocyte, neutrophil and lymphocyte count had an increased risk of MetS incidence. Leukocyte and neutrophil count were found to be strongly associated with the MetS components hypertriglyceridemia and low HDL-cholesterol. Likewise, lymphocyte counts were found to be associated with the incidence of the MetS components low HDL-cholesterol and high fasting glucose. An increase in the total WBC during the follow-up was also associated with an increased risk of MetS. CONCLUSIONS Total WBC counts, and some subtypes, were positively associated with MetS as well as hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, all components of MetS.This study was funded, in part, by the Spanish Ministry of Health (ISCIII), PI1001407, Thematic Network G03/140, RD06/0045, FEDER (Fondo Europeo de Desarrollo Regional), and the Centre Català de la Nutrició de l'Institut d'Estudis Catalans. None of the funding sources played a role in the design, collection, analysis or interpretation of the data or in the decision to submit the manuscript for publication. CIBERobn is an initiative of ISCIII, Spain.Ye