Total and Subtypes of Dietary Fat Intake and Its Association with Components of the Metabolic Syndrome in a Mediterranean Population at High Cardiovascular Risk

The effect of dietary fat intake on the metabolic syndrome (MetS) and in turn on cardiovascular disease (CVD) remains unclear in individuals at high CVD risk. Objective: To assess the association between fat intake and MetS components in an adult Mediterranean population at high CVD risk. Design: Baseline assessment of nutritional adequacy in participants (n = 6560, men and women, 55–75 years old, with overweight/obesity and MetS) in the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial. Methods: Assessment of fat intake (total fat, monounsatured fatty acids: MUFA, polyunsaturated fatty acids: PUFA, saturated fatty acids: SFA, trans-fatty acids: trans-FA, linoleic acid, a-linolenic acid, and w-3 FA) using a validated food frequency questionnaire, and diet quality using 17-item Mediterranean dietary questionnaire and fat quality index (FQI). Results: Participants in the highest quintile of total dietary fat intake showed lower intake of energy, carbohydrates, protein and fiber, but higher intake of PUFA, MUFA, SFA, TFA, LA, ALA and !-3 FA. Differences in MetS components were found according to fat intake. Odds (5th vs. 1st quintile): hyperglycemia: 1.3–1.6 times higher for total fat, MUFA, SFA and w-3 FA intake; low high-density lipoprotein cholesterol (HDL-c): 1.2 higher for LA; hypertriglyceridemia: 0.7 lower for SFA and w-3 FA intake. Conclusions: Dietary fats played different role on MetS components of high CVD risk patients. Dietary fat intake was associated with higher risk of hyperglycemia.The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by Jordi Salas-Salvadó and Josep Vidal, 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, 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), the Especial Action Project entitled: Implementación y evaluación de una intervención intensive sobre la actividad física Cohorte PREDIMED-PLUS grant to Jordi Salas-Salvadó, the European Research Council (Advanced Research Grant 2013-2018; 340918) grant to Miguel Ángel Martínez-Gonzalez, the Recercaixa grant to Jordi Salas-Salvadó (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant, and CIBEROBN and FEDER funds (CB06/03), ISCIII. International Nut & Dried Fruit Council – FESNAD No. 201302: Miguel Ángel Martínez-Gonzalez (PI). Alicia Julibert, Maria del Mar Bibiloni, Cristina Bouzas, Lucía Ugarriza and Josep A. Tur are granted by Grant of support to research groups no. 35/2011 (Balearic Islands Gov.; FEDER funds), EU-COST ACTION CA16112, and Fundació La Marató TV3 (Spain) project ref. 201630.10

Total and Subtypes of Dietary Fat Intake and Its Association with Components of the Metabolic Syndrome in a Mediterranean Population at High Cardiovascular Risk

Background: The effect of dietary fat intake on the metabolic syndrome (MetS) and in turn on cardiovascular disease (CVD) remains unclear in individuals at high CVD risk. Objective: To assess the association between fat intake and MetS components in an adult Mediterranean population at high CVD risk. Design: Baseline assessment of nutritional adequacy in participants (n = 6560, men and women, 55-75 years old, with overweight/obesity and MetS) in the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial. Methods: Assessment of fat intake (total fat, monounsatured fatty acids: MUFA, polyunsaturated fatty acids: PUFA, saturated fatty acids: SFA, trans-fatty acids: trans-FA, linoleic acid, α-linolenic acid, and ω-3 FA) using a validated food frequency questionnaire, and diet quality using 17-item Mediterranean dietary questionnaire and fat quality index (FQI). Results: Participants in the highest quintile of total dietary fat intake showed lower intake of energy, carbohydrates, protein and fiber, but higher intake of PUFA, MUFA, SFA, TFA, LA, ALA and ω-3 FA. Differences in MetS components were found according to fat intake. Odds (5th vs. 1st quintile): hyperglycemia: 1.3-1.6 times higher for total fat, MUFA, SFA and ω-3 FA intake; low high-density lipoprotein cholesterol (HDL-c): 1.2 higher for LA; hypertriglyceridemia: 0.7 lower for SFA and ω-3 FA intake. Conclusions: Dietary fats played different role on MetS components of high CVD risk patients. Dietary fat intake was associated with higher risk of hyperglycemia

Ingesta lipídica y Síndrome Metabólico en adultos con algo riesgo cardiovascular

[spa] El Síndrome Metabólico (SMet) es una condición clínica caracterizada por varios factores metabólicos asociados con un mayor riesgo de diabetes y enfermedad cardiovascular (ECV). Estos factores de riesgo cardiovascular coexistentes incluyen obesidad (especialmente obesidad central), resistencia a la insulina y tolerancia a la glucosa alterada, dislipidemia aterogénica [niveles altos de triglicéridos (TG) y niveles bajos de lipoproteína-colesterol de alta densidad (HDL-c)] e hipertensión. La obesidad y, como consecuencia el SMet, se están convirtiendo en una epidemia. Este grupo de factores afectan aproximadamente entre el 10-25% de adultos en todo el mundo. Si el creciente aumento continúa, se espera que hasta el 20% de la población adulta del mundo sea obesa para 2030. En relación, la prevalencia de SMet variará según el perfil de la población, la edad, el sexo, el origen étnico, así como la definición utilizada. La prevención de la enfermedad cadiometabólica con intervenciones dietéticas y estilo de vida pueden ser más efectivas para prevenir el desarrollo del SMet que el tratamiento farmacológico. En consonancia, varios estudios han demostrado que las modificaciones en el estilo de vida, como el aumento de la actividad física, la adherencia a un patrón de alimentación saludable y/o la pérdida de peso, están asociadas con la reversión del SMet y sus componentes. Hay evidencia sólida de que la alimentación influye en la incidencia de SMet. Un alto consumo de grasa total y ácidos grasos saturados (AGS) y un consumo inadecuado de fibra están vinculados al peso corporal poco saludable y/o al riesgo de Diabetes Mellitus Tipo 2 (DMT2), dos de los principales componentes del SMet. Para abordar el problema, las sociedades científicas han recomendado un límite global de grasa en la dieta, resultando inevitablemente en un incremento de la ingesta de carbohidratos y una disminución de ácidos grasos insaturados saludables. Por esta razón, en 2015, el Comité Asesor de las Guías Dietéticas Americanas enfatizó la importancia de patrones de alimentación basados en alimentos, revisando el papel de la grasa en la salud. De hecho, la evidencia de ensayos controlados y aleatorizados no respalda las pautas actuales de grasa. Así, patrones de dieta como la Dieta Mediterránea (MedDiet), caracterizado por una alta proporción de grasas vegetales, la Dietary Approaches to Stop Hypertension y la vegetariana, han demostrado reducir la incidencia y la prevalencia del SMet y sus componentes. Sin embargo, existe controversia y lagunas de evidencia para definir el tratamiento dietético-nutricional más apropiado para el SMet. Por todo lo expuesto, el objetivo general de esta Tesis Doctoral es comparar la ingesta de grasa en una población con y sin SMet, así como, evaluar la ingesta dietéticonutricional de la población con SMet y su asociación con los componentes del SMet. La población de estudio son adultos, hombres entre 55-75 años y mujeres entre 60-75 años, sin ECV previamente documentada. La evidencia actual demuestra una asociación significativa entre la ingesta de ácidos grasos y el riesgo de SMet. Los resultados reflejan que los sujetos con SMet reportan una ingesta de carbohidratos y fibra más baja, y una ingesta de grasa total más alta que los sujetos sin SMet. Los sujetos con SMet también reportan una ingesta mayor de ácidos grasos monoinsaturados (AGM) y menor de ácidos grasos poliinsaturados (AGP) ω-3 y ω-6 (sólo en mujeres) que los sujetos sin SMet. En cambio, no se observan diferencias en la ingesta de AGS y ácidos grasos trans (AGTrans) en hombres. En consonancia, los sujetos con SMet están por debajo del Rango Aceptable de Distribución de los Macronutrientes, propuesto por el Institute of Medicine, para los carbohidratos, y por encima para la grasa total y los AGM que los sujetos sin MetS. Los resultados son similares respecto a los Objetivos Nutricionales 2020 de la Sociedad Española de Nutrición Comunitaria. Ambos grupos están por encima de la ingesta recomendada para AGTrans y el consumo de frutas y verduras, pero es mayor en los sujetos con SMet. Al analizar el riesgo de prevalencia de los componentes del SMet según la ingesta de grasa, los resultados reflejan: por un lado, un aumento significativo del riesgo de hiperglucemia en sujetos con mayor ingesta total de grasa, AGM, AGS, y AGP ω-3, un aumento del riesgo de tener los niveles de HDL-c bajos en los sujetos con mayor ingesta de ácido linoleico, y por otro lado, una disminución del riesgo de tener elevados niveles plasmáticos de TG en sujetos con mayor ingesta de AGS y AGP ω-3. Sin embargo, no se observan diferencias entre la ingesta de AGTrans y los componentes del SMet. El 82% de los sujetos con SMet consumen frutos secos, a pesar de que la cantidad media de consumo diario es de 12.6 g/día. Los consumidores de frutos secos tienen mayores ingestas de energía total, hidratos de carbono, grasa total, AGM, AGP, colesterol, fibra, vitaminas y minerales que los no consumidores. A su vez, se observa que los consumidores de frutos secos tienen menor probabilidad de estar por debajo de los Requerimientos Medios Estimados y por encima de la Ingesta Adecuada para la mayoría de los nutrientes evaluados. También presentan una mayor adherencia a la MedDiet que los no consumidores. Finalmente, según el consumo de frutos secos a 1 año de seguimiento de la población de estudio con SMet, los resultados reflejan que la circunferencia de la cintura, los TG plasmáticos, la presión arterial sistólica, el peso corporal y el Índice de Masa Corporal disminuyen significativamente con un mayor consumo de frutos secos, mientras que la glucemia y la presión arterial diastólica tienden a disminuir y los niveles de HDL-c a aumentar. La ingesta dietético-nutricional en sujetos adultos con SMet se aleja de las recomendaciones dietético-nutricionales actuales y de un patrón de alimentación saludable. La Tesis actual y el futuro trabajo de intervención del ensayo PREDIMED-Plus contribuirán a una mejor comprensión y diseño del perfil de ácidos grasos de una dieta saludable para revertir las comorbilidades del SMet en individuos de edad avanzada.[cat] La Síndrome Metabòlica (SMet), és una condició clínica caracteritzada per diversos factors metabòlics associats amb un alt risc de diabetis i malaltia cardiovascular. Aquests factors coexistents, inclouen, l’obesitat (especialment l’anomenada obesitat central), la resistència a la insulina i la tolerància a la glucosa alterada, la dislipèmia aterogènica [nivells alts de triglicèrids (TG) i nivells baixos de lipoproteïna-colesterol d’alta densitat (HDL-c)], i la hipertensió. L’obesitat, i en conseqüència l’SMet, s’estan convertint en epidèmia. Cal assenyalar que aquest grup de factors, aproximadament, afecten entre el 10 i el 25% de les persones adultes d’arreu del món. Si aquest percentatge contínua augmentant als ritmes actuals, s’espera que fins el 20% de la població adulta del món, sigui obesa el 2030. En relació en aquest percentatge, la prevalença de l’SMet variarà segons el perfil de la població, l’edat, el sexe, l’origen ètnic, així com també la definició utilitzada. Les intervencions dietètiques i d’estil de vida, poden ser mesures més efectives que el propi tractament farmacològic, per prevenir el desenvolupament de l’SMet. En concordança, diversos estudis han demostrat que les modificacions en l’estil de vida, com l’augment de l’activitat física, l’adherència a un patró d’alimentació saludable i/o la pèrdua de pes, estan associades amb la reversió de l’SMet i el seus components. Hi ha evidència sòlida que l’alimentació influeix en la incidència de l’SMet. Un alt consum de greix total i àcids grassos saturats (AGS), i un consum inadequat de fibra, estan vinculats a dos dels principals components de l’SMet: el pes corporal poc saludable i/o al risc de Diabetis Mellitus Tipus 2 (DMT2). Per atendre aquesta problemàtica, la comunitat científica ha recomanat un límit global de greix en la dieta. Aquesta recomanació, com a resultat inevitable, es focalitza en l’increment de la ingesta d’hidrats de carboni, i en la disminució d’àcids grassos insaturats saludables. Per aquesta raó, el 2015, el Comitè Assessor de les Guies Dietètiques Americanes, va remarcar la importància dels patrons d’alimentació basats en aliments, fent-ne una revisió dels efectes que provoca el greix en la salut. De fet, l’evidència d’assajos clínics i aleatoritzats, no donen suport a les pautes actuals de greix. Així, patrons de dieta com la Dieta Mediterrània (MedDiet), caracteritzada per una alta proporció de greixos vegetals, la Dietary Approaches to Stop Hypertension, i la dieta vegetariana, han demostrat reduir la incidència i la prevalença de l‘SMet i el seus components. Malgrat això, hi ha controvèrsia, i alhora llacunes d’evidència, per definir el tractament dietètic-nutricional més apropiat per l’SMet. Per tot el que s’ha exposat abans, l’objectiu general d’aquesta Tesi doctoral és comparar la ingesta de greix en una població amb i sense SMet, així com, avaluar la ingesta dietèticanutricional de la població amb SMet, i la seva associació amb els components d’aquesta. La població d’estudi són persones adultes, per una banda homes d’entre 55 i 75 anys, i per l’altra, dones d’entre 60 i 75 anys, ambdós, sense malaltia cardiovascular prèviament documentada. L’evidència actual demostra una associació significativa entre la ingesta d’àcids grassos, i el risc de l’SMet. Els resultats reflecteixen que el subjectes que pateixen aquesta síndrome, reporten una ingesta d’hidrats de carboni i fibra més baixa, i alhora, una ingesta de greix total més alta que el subjectes sense aquesta. Els subjectes amb SMet, també reporten una ingesta major d’àcids grassos monoinsaturats (AGM), i una menor d’àcids grassos poliinsaturats (AGP) ω-3 y ω-6 (només en les dones) que el subjectes sense SMet. En canvi, no s’observen diferències en relació a la ingesta d’AGS i d’àcids grassos trans (AGTrans) (sols en els homes). En concordança, els subjectes amb SMet estan per sota del Rang Acceptable de Distribució dels Macronutrients, proposat per l’Institute of Medicine, per als hidrats de carboni, i per damunt, respecte al greix total i als AGM, establint-ne una comparativa amb les persones participants de l’estudi, què no presenten l’SMet. Els resultats, són similars quan s’avaluen els Objectius Nutricionals 2020 proposats per la Societat Espanyola de Nutrició Comunitària. A més, ambdós grups d’estudi estan per damunt de la ingesta recomanada per AGTrans i el consum de fruites i verdures, però és major en el subjectes amb SMet. Una vegada analitzat el risc de prevalença dels components de l’SMet, segons la ingesta de greix, el resultats reflecteixen el següent: per una banda, un augment significatiu del risc de hiperglucèmia en els subjectes amb major ingesta de greix total, AGM, AGS i AGP ω-3 , un augment del risc de tenir el nivells d’HDL-c baixos en el subjectes amb major ingesta d’àcid linoleic; i per l’altra banda, una disminució del risc de tenir els TG plasmàtics elevats en aquells amb més ingesta d’AGS i AGP ω-3. Malgrat això, no s’observen diferències entre la ingesta d’AGTrans i els components de l’SMet. El 82% dels subjectes amb SMet consumeixen fruits secs, tot i que la quantitat mitjana de consum diari és de 12.6 g/dia. Les persones que consumeixen fruits secs, tenen majors ingestes d’energia total, d’hidrats de carboni, de greix total, d’AGM, d’AGP, de colesterol, de fibra, de vitamines i de minerals, en comparació amb les què no els consumeixen. Alhora, s’observa que els subjectes que consumeixen els fruits secs, tenen menys probabilitat d’estar per sota dels Requeriments Mitjans Estimats, i per damunt de la Ingesta Adequada per a la majoria de nutrients avaluats. A més, presenten també una major adherència a l’MedDiet, respecte els què no en consumeixen. Finalment, segons el canvi en el consum de fruits secs realitzat al primer any de seguiment de la població d’estudi amb SMet, els resultats mostren que la circumferència de la cintura, els TG plasmàtics, la pressió arterial sistòlica, el pes corporal i l’Índex de Massa Corporal, disminueixen significativament amb un major consum de fruits secs; mentre que la glucèmia i la pressió arterial diastòlica, tendeixen a disminuir, i a augmentar el nivells de HDL-c. La ingesta dietètic-nutricional en subjectes adults amb SMet, s'allunya de les recomanacions dietètic-nutricionals actuals i d'un patró d'alimentació saludable. La Tesi actual, i el futur treball d'intervenció de l'assaig PREDIMED-Plus, contribuiran a una millor comprensió i disseny del perfil d'àcids grassos d'una dieta saludable, per a revertir les comorbiditats del’SMet, en individus d'edat avançada.[eng] The Metabolic Syndrome (MetS) is a clinical condition characterized by a collection of metabolic factors associated with a higher risk of developing diabetes and cardiovascular disease (CVD). Such coexisting cardiometabolic risk factors include obesity (especially central obesity), insulin resistance, impaired glucose tolerance, atherogenic dyslipidaemia [high triglycerides levels (TG) and low levels of high-density lipoprotein (HDL-c)] and hypertension. Obesity, and consequently the MetS, are becoming an epidemic, as they are currently affecting approximately between 10-20% of adults worldwide. If such an epidemic continues to grow, up to 20% of the world's population is expected to be obese by 2030. Consistent with the latter, prevalence of the MetS will vary according to specific to population, age, gender, and ethnic origins, and the definition which might be used The use of dietary and lifestyle treatments for cardiometabolic disease prevention could be more effective than pharmacological therapy in preventing the development of the MetS. Accordingly, various studies have demonstrated that lifestyle modification, such as increased physical activity, adherence to a healthy dietary pattern and/or weight loss, are associated with the reversion of the MetS and its components. There is solid evidence that food intake is associated with the incidence of the MetS. High total fat and saturated fatty acids (SFA) intakes and an inadequate intake of fiber are closely linked to an unhealthy weight and/or to an increased risk of developing Type 2 Diabetes Mellitus (T2DM), which are also two of the main components of the MetS. In order to address the issue, scientific societies recommended a global limit to fat intake, which inevitably resulted in an increased consumption of carbohydrates and a reduced consumption of healthy unsaturated fatty acids. For this reason, in 2015, the Advisory Committee of the Dietary Guidelines for Americans emphasized the importance of food based dietary patterns, hence reconsidering the role of fat in health. Indeed, data from randomized controlled clinical trials does not support current dietary fat intake guidelines: dietary patterns such as the Mediterranean Diet (MedDiet), marked by high levels of vegetable fats, the Dietary Approaches to Stop Hypertension diet and vegetarian diets, have shown that MetS and its components are decreased in incidence and prevalence. Nevertheless, when it comes to describe the most appropriate dietary treatment for MetS, controversies and gaps of evidence still exists. For all the above reasons, the general purpose of this Doctoral Thesis is to compare fat intake in a population with and without MetS, to assess dietary intake and nutritional status in the MetS population and their possible association with the MetS components. The population of the study consists of adults, male between 55-75 years and women between 60-75 years, without previous CVD. The evidence collected demonstrates a significant association between fatty acids intakes and risk of developing the MetS. Subjects with MetS report lower intakes of fiber and carbohydrates, and a higher intake of fat as compared to subjects without MetS. More specific to the type of fat, subjects with MetS report a higher intake of monounsaturated fatty acids (MUFA) and a lower intake of polyunsaturated fatty acids (PUFA) ω-3 y ω-6 (women only) than subjects without MetS. On the other hand, no differences are observed in relation to SFA and trans fatty acids (Trans FA) (in men) intakes. Moreover, subjects with MetS are more likely to fall short of meeting the Acceptable Macronutrient Distribution Range proposed by the Institute of Medicine for carbohydrates and go above the recommended limits of total fat and MUFA, as compared to subjects without MetS. Results remain consistent when assessing the Nutritional Objective by 2020 of the Spanish Society of Community Nutrition. Both populations consume above the recommended intakes of Trans FA, fruits and vegetables, nevertheless consumption is higher in subjects with MetS. In relation to the association between the risk of prevalence of MetS components by fat intake, the results show a significant increase in the risk of hyperglycemia in subjects in the highest total fat intake, MUFA, SFA and PUFAω-3, a significant increase in the risk of presenting low levels of HDL-c in subjects with higher intakes of linoleic acid, and, on the other hand, a significant reduction in the risk of presenting high plasma TG levels in subjects with higher intakes of SFA and PUFA ω-3. However, no differences between Trans FA intakes and MetS components were observed. 82% of MetS subjects consume nuts, although the average daily intake is only 12.6 g/day. Subjects that consume dried nuts also have higher consumption of total energy, carbohydrates, total fat, MUFA and PUFA, cholesterol, fiber, vitamins and minerals than those that do not consume nuts. In turn, subjects that consume nuts are less likely to fall below the Acceptable Macronutrient Distribution Range and, at the same time, to exceed Adequate Intakes of most evaluated nutrients. Moreover, they are also more likely to have higher adherence to the MedDiet as compared to those that do not consume nuts. Finally, analysis at one-year follow-up of the population with MetS, show that with higher intake of nuts, waist circumference, plasma TG, systolic blood pressure, body weight, and Body Mass Index, are significantly reduced; concomitantly, there is a tendency for blood glucose and diastolic blood pressure to decrease, and HDL-c levels to increase. Dietary intake and nutritional status in adult subjects with MetS do not match dietetic recommendations for a healthy eating pattern. The present Thesis and the future work of intervention in the context of the PREDIMED-Plus trial will contribute to a better understanding of the role of fatty acids as part of the dietary approach used to reverse MetS-associated comorbidities in older individuals

Ten-Year Trends (1999-2010) of Adherence to the Mediterranean Diet among the Balearic Islands' Adult Population.

The aim of this work was to assess ten-year trends (1999-2010) of adherence to the Mediterranean dietary pattern (MDP) among the Balearic Islands' adult population. Two independent cross-sectional dietary surveys (1999-2000, n = 1200 and 2009-2010 n = 1388, including participants aged 16-65 years) were carried out in the Balearic Islands, Spain. Dietary habits were assessed by means of two 24 h diet recalls and a validated semi-quantitative food-frequency questionnaire that covers 145 food items. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high monounsaturated fatty acids:saturated fatty acids (MUFA:SFA) ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables, and fish consumption, and low consumption of meat and milk. Socio-economic status, education level, lifestyle factors and health status were also assessed. Adherence to the MDP was 43.1% (SD 5.8) in 1999-2000 and 44.6% (SD 8.3) in 2009-2010. Higher age was directly associated with higher adherence to the MDP, and this association was stronger in males than in females. Young generations and smokers showed the lowest adherence to MDP, whereas people with higher educational and socio-economic level, and who were physically active showed the highest adherence. According to the place of birth, the increase in the percentage of the adherence to the MDP was observed to be smaller among the Balearic Island's natives than among people born abroad. In 2009-2010, individuals in the MDP's fourth quartile were more likely to be older (aged 46-65 years), and were less likely to have a low occupational level, to have a light physical activity level and to be smoker than in 1999-2000. The adherence to the MDP has been stabilized and slightly recovered among the Balearic Islands' adult population in the last decade

Hydration habits before, during and after training and competition days among amateur basketball players

Background: fluid intake before, during and after exercise is the most important way to replace water lost during exercise and avoid dehydration.Aim: to assess fluid intake habits before, during and after exercise in amateur basketball players on both training and competition days.Methods: one hundred and eighty-three amateur basketball players (87 women and 96 men, 19-29 years old) were interviewed. Data was obtained from a drinking habits questionnaire.Results: overall, 20.8%, 5.5% and 2.7% of subjects did not drink before, during and after exercise on training days, respectively; 17.5% of subjects did not drink before exercise on competition days. Water was the preferred beverage before, during and after exercise on both training and competition days, with fruit juice being the second most consumed beverage before exercise. All subjects also drank fizzy drinks and other beverages during exercise on competition days. According to the recommendations, good hydration habits were found in 54.6%, 74.2% and 76.5% of subjects before, during and after training days, respectively.Conclusions: most amateur basketball players drink before, during and after exercise on both training and competition days, but not all of them complied with the hydration recommendations

Adherence to the Mediterranean Diet and Inflammatory Markers.

[eng] The aim was to assess inflammatory markers among adults and adolescents in relation to the adherence to the Mediterranean diet. A random sample (219 males and 379 females) of the Balearic Islands population (12-65 years) was anthropometrically measured and provided a blood sample to determine biomarkers of inflammation. Dietary habits were assessed and the adherence to the Mediterranean dietary pattern calculated. The prevalence of metabolic syndrome increased with age in both sexes. The adherence to the Mediterranean diet in adolescent males was 51.3% and 45.7% in adults, whereas in females 53.1% and 44.3%, respectively. In males, higher adherence to the Mediterranean diet was associated with higher levels of adiponectin and lower levels of leptin, tumor necrosis factor alpha (TNF-α), plasminogen activator inhibitor 1 (PAI-1) and high-sensitivity C-reactive protein (hs-CRP) in adults, but not in young subjects. In females, higher adherence was associated with lower levels of leptin in the young group, PAI-1 in adults and hs-CRP in both groups. With increasing age in both sexes, metabolic syndrome increases, but the adherence to the Mediterranean diet decreases. Low adherence to the Mediterranean dietary pattern (MDP) is directly associated with a worse profile of plasmatic inflammation markers

Western and Mediterranean Dietary Patterns and Physical Activity and Fitness among Spanish Older Adults.

[eng] To assess prevailing food patterns, and its association with physical activity and fitness among Spanish older adults. Methods: Cross-sectional study in Spain, collecting data from a sample (n = 380; 54% female) aged 55-80 years (men) and 60-80 years (women) with no previously documented cardiovascular disease. Body weight, body fat and waist circumference were assessed. Physical activity performed was measured using the Minnesota Leisure-time Physical Activity Questionnaire (LTPA). Physical fitness was assessed using a validated physical fitness test battery. Food consumption was assessed by a validated semi-quantitative food-frequency questionnaire. Factor analysis identified two major dietary food patterns: 'Western' (WDP) and 'Mediterranean' (MDP) dietary patterns. Results: Participants in MDP's fourth quartile were classified in the second (men) and third (men and women) tertile of LTPA. After adjusting for age, body fat, waist-to-height ratio, and METs, in both sexes, a negative significant association was found between 30-s Chair stand and 6-min walking test, a positive significant association was found between 30-m Gait speed and 8-foot Time Up-and-Go (except in men) tests with WDP. The 30-m Gait speed test was negatively associated with MDP in men. Conclusions: MDP is associated with more time spent on LTPA, and this association was independent of body composition and a fast gait speed in men. WDP is associated with slower gait speed and lower body strength, agility and aerobic endurance. MDP has protective effect on healthy physical fitness, and WDP may be a contributor to frailty

Associations between dietary polyphenols and type 2 diabetes in a cross-sectional analysis of the PREDIMED-Plus Trial: role of body mass index and sex

Overweight and obesity are important risk factors for type 2 diabetes (T2D). Moving towards healthier diets, namely, diets rich in bioactive compounds, could decrease the odds of suffering T2D. However, those individuals with high body mass index (BMI) may have altered absorption or metabolism of some nutrients and dietary components, including polyphenols. Therefore, we aimed to assess whether high intakes of some classes of polyphenols are associated with T2D in a population with metabolic syndrome and how these associations depend on BMI and sex. This baseline cross-sectional analysis includes 6633 participants from the PREDIMED-Plus trial. Polyphenol intakes were calculated from food frequency questionnaires (FFQ). Cox regression models with constant time at risk and robust variance estimators were used to estimate the prevalence ratios (PRs) for polyphenol intake and T2D prevalence using the lowest quartile as the reference group. Analyses were stratified by sex and BMI groups (overweight and obese) to evaluate potential effect modification. Catechins, proanthocyanidins, hydroxybenzoic acids, and lignans were inversely associated with T2D. Hydroxycinnamic acids were directly related in men. These associations were different depending on sex and BMI, that is, women and overweight obtained stronger inverse associations.The PREDIMED-Plus trial 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 co-funded by the European Regional Development Fund (four coordinated Fondo de Investigaciones Sanitarias 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, and PI17/00926), the Especial Action Project entitled Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., European Research Council (Advanced Research Grant 2014–2019, 340918) to M.Á.M.-G., the Recercaixa grant to J.S.-S. (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN grant, a CICYT grant provided by the Ministerio de Ciencia, Innovación y Universidades (AGL2016-75329-R), and funds from the European Regional Development Fund (CB06/03). Food companies Hojiblanca (Lucena, Spain) and Patrimonio Comunal Olivarero (Madrid, Spain) donated extra virgin olive oil, and the Almond Board of California (Modesto, CA, USA), American Pistachio Growers (Fresno, CA, USA), and Paramount Farms (Wonderful Company, LLC, Los Angeles, CA, USA) donated nuts. J.K. was supported by the “FOLIUM” program within the FUTURMed project entitled Talent for the medicine within the future from the Fundació Institut d’Investigació Sanitària Illes Balears. This call was co-financed at 50% with charge to the Operational Program FSE 2014-2020 of the Balearic Islands

Adherence to the mediterranean lifestyle and desired body weight loss in a mediterranean adult population with overweight: a PREDIMED-Plus Study

Background: Body weight dissatisfaction is a hindrance to following a healthy lifestyle and it has been associated with weight concerns. Objectives: The aim of this study was to assess the association between the adherence to the Mediterranean lifestyle (diet and exercise) and the desired body weight loss in an adult Mediterranean population with overweight. Methods: Cross-sectional analysis in 6355 participants (3268 men; 3087 women) with metabolic syndrome and BMI (Body mass index) between 27.0 and 40.0 kg/m2 (55-75 years old) from the PREDIMED-Plus trial. Desired weight loss was the percentage of weight that participants wished to lose. It was categorized into four cut-offs of this percentage (Q1: <10%, n = 1495; Q2: 10-15%, n = 1804; Q3: <15-20%, n = 1470; Q4: ≥20%, n = 1589). Diet was assessed using a validated food frequency questionnaire and a 17-item Mediterranean diet questionnaire. Physical activity was assessed by the validated Minnesota-REGICOR and the validated Spanish version of the Nurses' Health Study questionnaire. Results: Participants reporting higher percentages of desired weight loss (Q3 and Q4) were younger, had higher real and perceived BMI and were more likely to have abdominal obesity. Desired weight loss correlated inversely to physical activity (Q1: 2106 MET min/week; Q4: 1585 MET min/week. p < 0.001) and adherence to Mediterranean diet (Q1: 8.7; Q4: 8.3. p < 0.001). Conclusions: In older Mediterranean individuals with weight excess, desired weight loss was inversely associated with Mediterranean lifestyle adherence. Deeply rooted aspects of the MedDiet remained similar across groups. Longitudinal research is advised to be able to establish causality.The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (five coordinated FIS projects led by J.S.-S. and J.Vidal, 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 2013–2018, 340918) to Miguel Ángel Martínez-González, the Recercaixa Grant to J.S.-S. (2013ACUP00194), Grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a Grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN Grant, EU-COST Action CA16112, a Grant of support to research groups no. 35/2011 from the Balearic Islands Government, Grants from Balearic Islands Health Research Institute (IDISBA), funds from the European Regional Development Fund (CIBEROBN CB06/03 and CB12/03) and from the European Commission (EAT2BENICE_H2020_SFS2016). M. Rosa Bernal-López was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the European Regional Development Fund. Jordi Salas-Salvadó is partially supported by ICREA under the ICREA Academia programme. Cristina Bouzas received a Fernando Tarongí Bauzà PhD Grant. I.M Gimenez-Alba received a grant FPU from the Ministry of Science, Innovation and Univesities (reference FPU 18/01703). The funding sponsors had no role in the design of the study, in the collection, analyses, or interpretation of the data; in the writing of the manuscript, and in the decision to publish the results

Dietary polyphenol intake is associated with HDL-cholesterol and a better profile of other components of the metabolic syndrome: a PREDIMED-Plus sub-study

Dietary polyphenol intake is associated with improvement of metabolic disturbances. The aims of the present study are to describe dietary polyphenol intake in a population with metabolic syndrome (MetS) and to examine the association between polyphenol intake and the components of MetS. This cross-sectional analysis involved 6633 men and women included in the PREDIMED (PREvención con DIeta MEDiterranea-Plus) study. The polyphenol content of foods was estimated from the Phenol-Explorer 3.6 database. The mean of total polyphenol intake was 846 ± 318 mg/day. Except for stilbenes, women had higher polyphenol intake than men. Total polyphenol intake was higher in older participants (>70 years of age) compared to their younger counterparts. Participants with body mass index (BMI) >35 kg/m2 reported lower total polyphenol, flavonoid, and stilbene intake than those with lower BMI. Total polyphenol intake was not associated with a better profile concerning MetS components, except for high-density lipoprotein cholesterol (HDL-c), although stilbenes, lignans, and other polyphenols showed an inverse association with blood pressure, fasting plasma glucose, and triglycerides. A direct association with HDL-c was found for all subclasses except lignans and phenolic acids. To conclude, in participants with MetS, higher intake of several polyphenol subclasses was associated with a better profile of MetS components, especially HDL-c.The PREDIMED-Plus trial was supported by 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 co-funded by the European Regional Development Fund (four coordinated FIS projects led by J.S.-S. and J.Vi., 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, and PI17/00926), the Special Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., the Recercaixa grant to J.S.-S. (2013ACUP00194), a grant from the Fundació la Marató de TV3 (PI044003), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018),grants from the Generalitat Valenciana (PROMETEO/2017/017, APOSTD/2019/136), a SEMERGEN grant, a CICYT grant provided by the Ministerio de Ciencia, Innovación y Universidades (AGL2016-75329-R) and funds from the European Regional Development Fund (CB06/03). The Spanish Ministry of Science Innovation and Universities for the Formación de Profesorado Universitario (FPU17/00785) contract. Food companies Hojiblanca (Lucena, Spain) and Patrimonio Comunal Olivarero (Madrid, Spain) donated extra virgin olive oil, and the Almond Board of California (Modesto, CA), American Pistachio Growers (Fresno, CA), and Paramount Farms (Wonderful Company, LLC, Los Angeles, CA) donated nuts. This call is co-financed at 50% with charge to the Operational Program FSE 2014-2020 of the Balearic Islands