Sociodemographic and Lifestyle Determinants of Adherence to Current Dietary Recommendations and Diet Quality in Middle-Aged Spanish Premenopausal Women

Background: A healthy diet when approaching menopause could prevent some of the symptoms associated with the climacteric. Few studies examine adherence to current healthy dietary recommendations in middle-aged premenopausal women. Our objective was to analyze the diet quality and the adherence to the Spanish Society of Community Nutrition (SENC) dietary recommendations in middle-aged Spanish premenopausal women, and to identify the associated sociodemographic and lifestyle factors. Methods: This is a cross-sectional study based on 1251 premenopausal women, aged 39-50, who attended to Madrid City Council Medical Diagnostic Center. Women completed an epidemiological and a food frequency questionnaire. Degree of adherence to the SENC recommendations was estimated with a score that evaluated null (0 points) and full (1 point) adherence of each specific recommendation. Associations were explored using an ordinal logistic multivariable regression model. Results: Regarding food groups, the worst adherence was found for sweets, red/processed meat, olive oil and eggs. Most of the participants exceeded the recommended caloric intake from proteins and fats, and practically all of them showed vitamin D intake deficiency. The overall score ranged from 2 to 12 (out of 15), with a median of 6.0 (interquartile range: 5.0-7.0). Former smokers (OR: 1.38; 95%CI: 1.08-1.78), as well as those with higher educational level (ORSSecondary:1.68; 95%CI: 0.97-2.93, ORUniversity:1.82; 95%IC: 1.05-3.14), with two or more children (OR: 1.31; 95%IC: 1.00-1.72), with higher caloric intake (OR>2188.2kcal/day: 8.22; 95%CI: 6.19-10.92) and with greater physical activity (OR≥21METS-h/week: 1.29; 95%CI: 0.95-1.76) showed greater adherence. Conclusions: Almost two-thirds of middle-aged premenopausal participants showed low or moderate compliance with SENC recommendations. Education, smoking, parity, and physical activity were associated with the degree of adherence to these recommendations.This study was funded by the Spanish Ministry of Health (EC11–273) and by the Instituto de Salud Carlos III (PI15CIII/0029). The article presents independent research.S

Toxic metals in toenails as biomarkers of exposure: A review

Toenails have been used as biomarkers of exposure to toxic metals, but their validity for this purpose is not yet clear and might differ depending on the specific agent. To evaluate this issue, we reviewed the literature on: a) the time-window of exposure reflected by toenails; b) the reproducibility of toenail toxic-metal levels in repeated measures over time; c) their relationship with other biomarkers of exposure, and; d) their association with potential determinants (i.e. sociodemographic, anthropometric, or lifestyle characteristics) or with sources of exposure like diet or environmental pollution. Thus, we performed a systematic review, searching for articles that provided original data for levels of any of the following toxic metals in toenails: aluminum, beryllium, cadmium, chromium, mercury, nickel, lead, thallium and uranium. We identified 88 articles, reporting data from 67 different research projects, which were quite heterogeneous with regard to population profile, sample size and analytical technique. The most commonly studied metal was mercury. Concerning the time-window of exposure explored by toenails, some reports indicate that toenail cadmium, nickel and lead may reflect exposures that occurred 7-12 months before sampling. For repeated samples obtained 1-6 years apart, the range of intraindividual correlation coefficients of aluminum, chromium and mercury was 0.33-0.56. The correlation of toxic metal concentrations between toenails and other matrices was higher for hair and fingernails than for urine or blood. Mercury levels were consistently associated with fish intake, while other toxic metals were occasionally associated with specific sources (e.g. drinking water, place of residence, environmental pollution, and occupation). The most frequently evaluated health endpoints were cardiovascular diseases, cancer, and central nervous system diseases. Available data suggest that toenail mercury levels reflected long-term exposures and showed positive associations with fish intake. The lack of standardization in sample collection, quality control, analytical techniques and procedures - along with the heterogeneity and conflicting results among studies - mean it is still difficult to conclude that toenails are a good biomarker of exposure to toxic metals. Further studies are needed to draw solid conclusions about the suitability of toenails as biomarkers of exposure to toxic metals.This work was supported by FIS grants PI12/00150, PI17CIII/00034, PI18/00287 (Instituto de Salud Carlos III, State Secretary of R + D + I and European Union (ERDF/ESF, “Investing in your future")), P42ES010349 and P30ES009089 (National Institute of Environmental Health Sciences).S

Risk of gastric cancer in the environs of industrial facilities in the MCC-Spain study

Background: Gastric cancer is the fifth most frequent tumor worldwide. In Spain, it presents a large geographic variability in incidence, suggesting a possible role of environmental factors in its etiology. Therefore, epidemiologic research focused on environmental exposures is necessary. Objectives: To assess the association between risk of gastric cancer (by histological type and tumor site) and residential proximity to industrial installations, according to categories of industrial groups and specific pollutants released, in the context of a population-based multicase-control study of incident cancer conducted in Spain (MCC-Spain). Methods: In this study, 2664 controls and 137 gastric cancer cases from 9 provinces, frequency matched by province of residence, age, and sex were included. Distances from the individuals' residences to the 106 industries located in the study areas were computed. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1 km to 3 km) to industries, adjusting for matching variables and potential confounders. Results: Overall, no excess risk of gastric cancer was observed in people living close to the industrial installations, with ORs ranging from 0.73 (at ≤2.5 km) to 0.93 (at ≤1.5 km). However, by industrial sector, excess risks (OR; 95%CI) were found near organic chemical industry (3.51; 1.42-8.69 at ≤2 km), inorganic chemical industry (3.33; 1.12-9.85 at ≤2 km), food/beverage sector (2.48; 1.12-5.50 at ≤2 km), and surface treatment using organic solvents (3.59; 1.40-9.22 at ≤3 km). By specific pollutant, a statistically significant excess risk (OR; 95%CI) was found near (≤3 km) industries releasing nonylphenol (6.43; 2.30-17.97) and antimony (4.82; 1.94-12.01). Conclusions: The results suggest no association between risk of gastric cancer and living in the proximity to the industrial facilities as a whole. However, a few associations were detected near some industrial sectors and installations releasing specific pollutants.The authors thank all those who took part in this study by providing questionnaire data. This study was funded by: Scientific Foundation of the Spanish Association Against Cancer (Fundación Científica de la Asociación Española Contra el Cáncer (AECC) e grants EVP-1178/14 and GCTRA18022MORE); “Acción Transversal del Cáncer”, approved on the Spanish Ministry Council on October 11, 2007; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP); Spain’s Health Research Fund (Fondo de Investigación Sanitaria - FIS 12/01416); Carlos III Institute of Health (ISCIII) grants, co-funded by ERDF fundsea way to build Europee (grants PI08/0533, PI08/1359, PI08/1770, PS09/00773, PS09/01286, PS09/01662, PS09/01903, PS09/02078, PI11/00226, PI11/01403, PI11/01810, PI11/01889, PI11/02213, PI12/00150, PI12/00265, PI12/00488, PI12/00715, PI12/01270, PI14/00613, PI14/01219, PI15/00069, PI15/00914, PI15/01032, PI17-00092, PI17CIII/00034); the Fundación Marqués de Valdecilla (API 10/09); the Junta de Castilla y León (LE22A10-2); the Consejería de Salud of the Junta de Andalucía (PI-0571-2009, PI-0306-2011, salud201200057018tra); the Conselleria de Sanitat of the Generalitat Valenciana (AP_061/10); the Recercaixa (2010ACUP 00310); the European Commission grants FOOD-CT-2006-036224-HIWATE; the Catalan Government-Agency for Management of University and Research Grants (AGAUR) grants 2017SGR723 and 2014SGR850; the Catalan Government DURSI grant 2014SGR647; the Fundación Caja de Ahorros de Asturias; and the University of Oviedo. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program.N

Clinical and Sociodemographic Determinants of Adherence to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Recommendations in Breast Cancer Survivors-Health-EpiGEICAM Study

Breast cancer (BC) survivors are advised to follow the WCRF/AICR cancer prevention recommendations, given their high risk of developing a second tumour. We aimed to explore compliance with these recommendations in BC survivors and to identify potentially associated clinical and sociodemographic factors. A total of 420 BC survivors, aged 31-80, was recruited from 16 Spanish hospitals. Epidemiological, dietary and physical activity information was collected through questionnaires. A 7-item score to measure compliance with the recommendations was built according to the 2018 WCRF/AICR scoring criteria. Standardized prevalences and standardized prevalence ratios of moderate and high compliance across participant characteristics were estimated using multinomial and binary logistic regression models. The mean score was 3.9 (SD: 1.0) out of 7 points. Recommendations with the worst adherence were those of limiting consumption of red/processed meats (12% of compliance, 95% CI: 8.2-15.0) and high fibre intake (22% of compliance, 95% CI: 17.6-27.0), while the best compliance was observed for the consumption of fruits and vegetables (73% of compliance, 95% CI: 69.2-77.7). Overall, adherence was worse in women with university education and in those with first-degree relatives with BC. This information may be of interest to design and implement personalized preventive measures adapted to the characteristics of these patients.This research was funded by the Fundación Científica Asociación Española Contra el Cancer (AECC) (Scientific Foundation of the Spanish Association against Cancer 2016). This article presents independent research. The views expressed are those of the authors and not necessarily those of the Carlos III Institute of Health.S

II Jornada del Centro Nacional de Epidemiología "Conoce el CNE". Segundo bloque: Departamento de enfermedades crónicas

Presentación del bloque del Departamento de enfermedades dentro de las II Jornada del Centro Nacional de Epidemiología "Conoce el CNE". Moderadora: Virginia Lope Carvajal

Inequalities in mortality from breast and gynecological cancers according to level of education: a population-based study in Spain

XLI Reunión anual de la Sociedad Española de Epidemiología (SEE) y XVIII Congresso da Associação Portuguesa de Epidemiología (APE). Porto (Portugal), del 5 al 8 de septiembre de 2023.Background/Objectives: Educational level is one of the classic axes of inequality in public health. The recent incorporation in Spain of this information into individual mortality data makes it possible for the first time to analyze the cancer mortality risk gradient according to educational level in this country. Breast and gynecological cancers are a major public health issue, accounting for more than 30% of all cancer mortality among women in Spain. They are strongly related to lifestyle choices, preventive care, or adherence to screening programs, factors that are often conditioned by educational level. The aim of this study is to assess the magnitude of the educational gap in the risk of mortality from these cancers in women residing in Spain. Methods: The population data and mortality from breast and gynecological cancers in the period 2016-2020 by age (from 30 years old), level of education (from primary to doctorate) and province of residence, were provided by the Spanish National Institute of Statistics. For each tumor and two age groups (30-44 and 45+), the risk of mortality by educational level were estimated using a Poisson regression model adjusted for age and province. The relative risk (RR) of cancer mortality was also calculated by comparing the group with the highest level of education with the group with the lowest level. This RR was given for the entire cohort when no interaction was found between educational level and the age group. Results: Mortality risk was inversely associated with level of education for most gynecological cancers (cervix, corpus uterus, vulva, vagina). This was particularly the case for cervix cancer (RR = 0.26, 95%CI = 0.19 to 0.36) in young women (30-44 years) and for vulva cancer (RR = 0.48, 95%CI = 0.32 to 0.72). On the other hand, this relationship was inverted for breast cancer (RR = 1.43, 95%CI = 1.35 to 1.52) and ovarian cancer (RR = 1.21, 95%CI = 1.09 to 1.35). Conclusions/Recommendations: The relationship between mortality risk and educational level changes markedly whether the cancer is breast or gynecological. The identification of groups of women at high risk of death from these cancers according to their level of education and age group can be useful for targeting interventions and monitoring cancer disparities.N

La importancia de que el aceite de oliva sea virgen para prevenir el cáncer de mama

Artículo de divulgación publicado en The Conversation España el día 31/03/2022.No basta con tomar aceite de oliva en lugar de otro vegetal. También debería ser virgen, incluso si es para freír, porque la evidencia afirma que así podría disminuir el riesgo de cáncer de mama.N

High adherence to Western dietary pattern increases breast cancer risk (an EPIC-Spain study)

Objective: To explore the association between three previously identified and validated dietary patterns (Western, Prudent and Mediterranean) and breast cancer risk by tumour subtype and menopausal status. Methods: Data from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study provided epidemiological information (including diet and cancer incidence) from 24,892 women (639 breast cancer cases) recruited between 1992 and 1996. The associations between adherence to the three dietary patterns and breast cancer risk (overall and by tumour subtype) were explored by fitting multivariate Cox proportional hazards regression models stratified by region, among other variables. A possible interaction with menopausal status (changing over time) was explored. Results: No clear association of the Prudent and Mediterranean dietary patterns with breast cancer risk was found. When compared with women with a level of adherence to the Western diet in the first quartile, women with a level of adherence in the third (hazard ratio (95 % confidence interval) (HR(95%CI)):1.37 (1.07;1.77)) and fourth quartiles (1.37 (1.03;1.83)); p for curvature of splines = 0.016) showed a non-linear increased risk, especially postmenopausal women (HR (95 % CI) 1.30 (0.98;1.72) in the third and 1.42 (1.04;1.94) in the fourth quartiles; p for curvature of splines = 0.081) and for estrogen or progesterone receptor positive with human epidermal growth factor receptor 2 negative tumours (HR (95 % CI) 1.62 (1.10;2.38) and 1.71 (1.11;2.63) for the third and fourth quartiles respectively; p for curvature of splines = 0.013). Conclusions: Intake of foods such as high-fat dairy products, red and processed meats, refined grains, sweets, caloric drinks, convenience food and sauces might be associated with a higher risk of breast cancer.This study was supported by Alcala de Henares and Autonomous community of Madrid (CM/JIN/2019-041). The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The EPIC-Spain cohort is supported by the Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), the Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology-ICO (Spain).S