Effect of physical activity, obesity and sleep on health-related quality of life in individuals with Metabolic Syndrome

218 p.[ES] Introducción La calidad de vida relacionada con la salud (CVRS) se ha convertido en un parámetro indispensable para la salud pública, pudiendo estimar la carga de enfermedad global en las poblaciones, siendo un buen predictor de mortalidad. Debido al aumento en la prevalencia del síndrome metabólico (SMet) en la población resulta imprescindible averiguar cuál es la relación entre el SMet y la CVRS. Por este motivo, el objetivo principal de la presente tesis doctoral es estimar la CVRS en adultos que padecen SMet y los factores relacionados que influyen en la misma. Metodología Se utilizó la información disponible del estudio PREDIMED-Plus, un ensayo clínico aleatorizado multicéntrico, que recoge los datos sobre CVRS mediante el cuestionario SF-36, así como medidas antropométricas, nivel de actividad física y duración de sueño mediante acelerometría. Se realizó un análisis descriptivo transversal de la CVRS. Mediante modelos de regresión lineal ajustados por potenciales factores confusores, se evaluó la asociación entre la CVRS, el nivel de actividad física, el grado de obesidad y la duración del sueño, al comienzo del estudio y al año de seguimiento. Además, se realizaron modelos de regresión logística para averiguar si la actividad física, el índice de masa corporal (IMC) y la duración del sueño predicen cambios clínicamente significativos en la CVRS. Resultados Nuestros resultados reflejan que el aumento en la actividad física conlleva un incremento en las puntuaciones medias de la CVRS. En las mujeres, se encontraron hasta 10 puntos de diferencia entre la actividad física ligera y la moderada-vigorosa en la función física, rol físico, vitalidad, función social y rol emocional. Además, aquellos sujetos que mejoraron sus niveles de actividad física a lo largo del año de seguimiento, tuvieron un 91% de posibilidades de mejora clínicamente significativa de su componente agregado físico (PCS), respecto a aquellos que se mantuvieron inactivos durante un año (OR = 1,91; IC 95%: 1,23-2,96). En cuanto al grado de obesidad, cuanto mayor es el IMC, menores son las puntuaciones medias en las esferas físicas. Sin embargo, un IMC >30kg/m2, predice una mejora de dichas esferas a un año y son aquellos sujetos que pierden peso a lo largo del año los que más probabilidades tienen de mejorar su CVRS, respecto a aquellos que no modificaron su IMC (PCS OR = 1,85; IC 95% = 1,43-2,40). Se observa que los valores extremos en la duración de sueño de noche (9h) afectan negativamente a la PCS. También, se ha encontrado una correlación entre dormir la siesta y la mejora del componente agregado mental (MCS) en aquellos individuos con un sueño nocturno corto (<7h) (Coeficiente β = 6,3 (1,3-11,3) p= 0,01). Conclusiones Nuestros resultados ponen de manifiesto que el SMets afecta negativamente en las esferas físicas de la CVRS. El nivel de actividad física, el IMC y la duración del sueño son factores relacionados que influyen en la misma. Se sugiere que una mejora en estos factores provoca una mejoría de la CVRS en individuos que padecen SMets. No obstante, se precisan más ensayos clínicos para evaluar estas asociaciones.[EN] Introduction Health-related quality of life (HRQoL) has become an essential parameter for public health, given its ability to estimate the global burden of disease in populations makes it a good predictor of mortality. Due to the increased prevalence of metabolic syndrome (MetS) in the population, it is vital to discern the relationship between MetS and HRQoL. As such, the main objective of this doctoral thesis is to estimate HRQoL in adults with MetS and the related factors that influence it. Methods Available information was used from the PREDIMED-Plus study, a multicenter randomized clinical trial that collects data on HRQoL using the SF-36 questionnaire, anthropometric measurements, level of physical activity and sleep duration using accelerometry. A cross-sectional descriptive analysis of HRQoL was performed. Through linear regression models adjusted for potential confounding factors, the association between HRQoL, level of physical activity, degree of obesity, and sleep duration was evaluated at the start of the study and at a one-year follow-up. Additionally, logistic regression models were fit to discern whether physical activity, body mass index (BMI), and sleep duration predict clinically significant changes in HRQoL. Results Our results reflect that increased physical activity leads to an increase in the mean HRQoL scores. In women, up to a 10-point difference was found between light and moderate-to-vigorous physical activity in physical function, physical role, vitality, social function, and emotional role. Furthermore, subjects who improved their physical activity levels throughout the follow-up year had a 91% chance of clinically significant improvement in their physical aggregate component (PCS), compared to those who remained inactive during that year (OR = 1.91; 95% CI: 1.23-2.96). In terms of obesity, the higher the BMI, the lower the average scores in physical areas. However, a BMI >30kg/m2 predicts an improvement in these areas at one year and subjects who lose weight throughout the year are more likely to improve their HRQoL, compared to those whose BMI was unchanged (PCS OR = 1.85, 95% CI = 1.43-2.40). We observed that extreme values in nightly sleep duration (9h) negatively affect the PCS. A correlation was also found between napping and improving the physical aggregate component (MCS) in individuals with a short night's sleep (<7h) (Coefficient β = 6.3 (1.3-11.3) p= 0.01). Conclusions Our results show that MetS negatively affects the physical domains of HRQoL and physical activity level, BMI and sleep duration are related factors that influence it. Results suggest that improving these factors leads to an improved HRQoL in individuals with MetS. However, more clinical trials are needed to evaluate these associations

Sleep and breast and prostate cancer risk in the MCC-Spain study

Breast and prostate cancers have been associated with circadian disruption. Some previous studies examined associations of sleep duration and breast or prostate cancer risk though findings remain inconsistent. This study examines associations of a range of detailed sleep characteristics and breast and prostate cancer risk in a large-scale population-based case-control study, MCC-Spain. A total of 1738 incident breast cancer cases, 1112 prostate cancer cases and frequency matched controls (n = 1910, and 1493 respectively) were recruited. Detailed data on habitual sleep duration, quality, timing, and daytime napping ("siesta") were collected at recruitment. Additional data on sleep habits during both the previous year and at age 40 years were also subsequently captured. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated. There were no associations of habitual sleep duration (h), timing of sleep, or any or specific sleep problems, and either breast and prostate cancer risk. There was a significant positive association of ever taking habitual siestas at recruitment and breast cancer risk (OR = 1.22, 95% CI 1.06-1.42), which strengthened with increased frequency or duration. There were also significant positive associations observed for both breast and prostate cancer, among those reporting recent sleep problems, but not sleep problems at age 40 years, in a subsequent circadian questionnaire. Adverse associations with siesta and disturbed sleep during the previous year likely reflect symptoms of developing/diagnosed cancer and comorbidities. Overall, there was no clear association between various sleep characteristics and breast or prostate cancer risk observed.Funding: The study was partially funded by the ‘Accion Transversal del Cancer’, approved by the Spanish Ministry Council on 11 October 2007, by the Instituto de Salud Carlos III-FEDER (PI08/1770, PI08/1359, PI09/00773, PI09/01286, PI09/01903, PI09/02078, PI09/01662, PI11/01403, PI11/01889, PI11/02213; PI12/00265, PI12/01270, PI12/00715, PI12/00150, PI14/01219, PI14/0613, PI15/00069, PI15/00914, PI15/01032, PI17CIII/00034, CIBERESP CB06/02/0073), 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 Regional Government of the Basque Country, the European Commission grants FOOD-CT-2006-036224-HIWATE, the Spanish Association Against Cancer (AECC) Scientifc Foundation, the Catalan Government DURSI grant 2014SGR647, 2017SGR723, 2017SGR1085 and 2014SGR850, the Fundación Caja de Ahorros de Asturias and by the University of Oviedo. MCT is funded by a Ramón y Cajal fellowship (RYC-2017-01892) from the Spanish Ministry of Science, Innovation and Universities and co-funded by the European Social Fund. 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

Alcohol use and family-related factors among Spanish university students: the unHicos project

Background: During adolescence and youth there are relevant changes in the consolidation, gain or loss of consumption habits and lifestyles and the family factors has a fundamental role to development these habits. The study of the consumption of toxins, such as alcohol intake, is crucial at this stage due to the repercussions that said consumption presents in adulthood. Therefore, the objective of our study was to evaluate the associations between alcohol consumption patterns and related family factors (family functioning, family history of alcohol consumption) in Spanish university students. Methods: Observational, descriptive, cross-sectional, multicenter study, carried out in first-year university students from 11 Spanish universities. Through an online questionnaire, alcohol consumption (risky consumption and intensive consumption or binge drinking), family functioning and history of alcohol in the family were evaluated. Risky alcohol consumption and binge drinking were assessed using the AUDIT test, and family functioning was assessed using the family APGAR questionnaire. A descriptive analysis of the data was performed, as well as the Chi-Square test and Student's T-Test, and non-conditional logistic regression models were carried out to examine this association. Results: The prevalence of risky alcohol consumption identified in the 10,167 respondents was 16.9% (95% CI = 16.2–17.6), and that of BD was 48.8% (95% CI = 47.9–48.8). There is a significant association between risky alcohol consumption and family functioning in students of both sexes, with greater consumption in the face of severe dysfunctional support (men OR = 1.72; p < 0.001 and women OR = 1.74; p < 0.001) and family history of consumption (p = 0.005). Regarding the binge drinking pattern, no statistically significant differences were observed. Conclusions: Risky alcohol consumption in university students is associated with dysfunctional family support, unlike the binge drinking pattern, where there is no such association. The findings of this study show the importance of creating prevention programs focused on the family approach in university students, which include alcohol screening in the population with a family history of this substance, and greater social support from health services.This work was supported by the National Drug Plan, Ministry of Health, Social Services and Equality of Spain (Codes: 2010|145, 2013|034 and 2020|030) and project PI16/01947

Association of time of breakfast and nighttime fasting duration with breast cancer risk in the multicase-control study in Spain

Circadian nutritional behaviors, defined by the daily eating/fasting cycle, have been linked with breast cancer. This study aimed to further disentangle the association of nighttime fasting duration and time of breakfast with breast cancer risk. We analyzed data from 1,181 breast cancer cases and 1,326 population controls from the Spanish multicase-control study (MCC-Spain), 2008-2013. We collected circadian nutritional behaviors at mid-age via a telephonic interview. We applied logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for the association of nighttime fasting duration and time of breakfast with breast cancer risk in all women and stratified by menopausal status. Models were adjusted for age, center, education, family history of breast cancer, age at menarche, number of children, breastfeeding, age at first child, body mass index (BMI), contraceptive use, and hormonal replacement therapy (HRT). A later time of breakfast was associated with a non-significant increased risk of breast cancer (OR = 1.05, 95% CI: 0.95-1.16, per hour increase). This association was stronger among premenopausal women, among whom each hour later, the time of breakfast was associated with an 18% increase in breast cancer risk (OR = 1.18, 95% CI: 1.01-1.40). The association was not observed in postmenopausal women. We did not observe an association between nighttime fasting duration and breast cancer risk after adjusting for the time of breakfast. In this study, late breakfast was associated with increased breast cancer risk, especially among premenopausal women, compared with early breakfast. Aside from nutritional quality, circadian nutritional behaviors should be further studied in relation to cancer

Association of time of breakfast and nighttime fasting duration with breast cancer risk in the multicase-control study in Spain

Circadian nutritional behaviors, defined by the daily eating/fasting cycle, have been linked with breast cancer. This study aimed to further disentangle the association of nighttime fasting duration and time of breakfast with breast cancer risk. We analyzed data from 1,181 breast cancer cases and 1,326 population controls from the Spanish multicase-control study (MCC-Spain), 2008-2013. We collected circadian nutritional behaviors at mid-age via a telephonic interview. We applied logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for the association of nighttime fasting duration and time of breakfast with breast cancer risk in all women and stratified by menopausal status. Models were adjusted for age, center, education, family history of breast cancer, age at menarche, number of children, breastfeeding, age at first child, body mass index (BMI), contraceptive use, and hormonal replacement therapy (HRT). A later time of breakfast was associated with a non-significant increased risk of breast cancer (OR = 1.05, 95% CI: 0.95-1.16, per hour increase). This association was stronger among premenopausal women, among whom each hour later, the time of breakfast was associated with an 18% increase in breast cancer risk (OR = 1.18, 95% CI: 1.01-1.40). The association was not observed in postmenopausal women. We did not observe an association between nighttime fasting duration and breast cancer risk after adjusting for the time of breakfast. In this study, late breakfast was associated with increased breast cancer risk, especially among premenopausal women, compared with early breakfast. Aside from nutritional quality, circadian nutritional behaviors should be further studied in relation to cancer

Genomic complexity and IGHV mutational status are key predictors of outcome of chronic lymphocytic leukemia patients with TP53 disruption.

The clinical course of chronic lymphocytic leukemia (CLL) is extremely heterogeneous and while some patients achieve a normal lifespan, others succumb to the disease shortly after diagnosis. Recurrent chromosomal aberrations as detected by chromosome banding analysis (CBA) or fluorescent in situ hybridization (FISH) have a reproducible prognostic power in terms of response to therapy and survival.1–3 In particular, patients whose tumor cells harbor 17p deletions (17p-) are considered to have a shorter survival and, hence, high-risk CLL. This poor prognosis is, however, not universally true for all patients with 17p- CLL. Indeed, we and others have observed that some clinical-biological features, such as presence of B symptoms, advanced clinical stage, size of the 17p- clone, β2-microglobulin (β2M) concentration and IGH mutational status have a significant impact on the outcome of this subgroup of patients.4,5 Novel molecular studies have helped in the understanding of 17p- CLL. On one hand, TP53 mutations are present in more than 80% of cases with 17p deletion and in around 5% of patients without 17p deletion.6,7 On the other hand, next generation sequencing studies have revealed novel genetic aberrations such as NOTCH1 and SF3B1 mutations that have a negative impact on survival.8–10 Finally, genomic complexity, as defined by karyotyping1 or copy number (CN) arrays, has also been independently associated with disease transformation and poor outcome in patients with CLL.11,12 The aim of this study was to evaluate the prognostic value of concomitant molecular abnormalities in patients with CLL and TP53 aberrations as diagnosed by FISH, CBA or DNA sequencing

Assessment of the Effectiveness, Safety, and Reproducibility of Micro-Ureteroscopy in the Treatment of Distal Ureteral Stones in Women: A Multicenter Prospective Study

Purpose: The aim of this study is to assess the effectiveness, safety, and reproducibility of the micro-ureteroscopy (m-URS) in the treatment of distal ureteral stones in women. Materials and Methods: A multicenter, prospective observational study was designed and conducted between March and December 2015. We included women having at least one stone in the distal ureter and being a candidate for surgical treatment using the 4.85F sheath of MicroPerc®. Patients with clinical criteria and/or laboratory analysis indicating sepsis or coagulation alteration were excluded. Results: Thirty-nine women were operated in eight hospitals. The profile of the patients was fairly homogeneous among hospitals. Only differences were found in age, preoperative stent, and the result of the previous urine culture. Immediate stone-free status was achieved in 88.2% and 100% 7 days after the procedure. 97.4% of patients did not present any complication in the postoperative period, with only one case with complication Clavien II. Postureteroscopic Lesion Scale (PULS) in 76.9% of patients did not show any injury, 20.5% had lesions grade 1, and grade 2 lesions 2.6%. As for the reproducibility of m-URS between hospitals, statistical analysis of the results showed differences between all the centers participating in the study. Conclusions: m-URS is an effective, safe, and reproducible technique that minimizes surgical aggression to the ureteral anatomy. Satisfactory and comparable results to “conventional” ureteroscopy were obtained in the treatment of distal ureteral stones in women, although clinical trials are needed. The reduction of the ureteral damage may reduce secondary procedures and increase the cost-effectiveness of the procedure

Association Among Polyphenol Intake, Uric Acid, and Hyperuricemia: A CrossSectional Analysis in a Population at High Cardiovascular Risk

Dietary polyphenol intake has been associated with a decreased risk of hyperuricemia, but most of this knowledge comes from preclinical studies. The aim of the present study was to assess the association of the intake of different classes of polyphenols with serum uric acid and hyperuricemia. This cross- sectional analysis involved baseline data of 6332 participants. Food polyphenol con- tent was estimated by a validated semiquantitative food frequency questionnaire and from the Phenol-Explorer database. Multivariable-adjusted linear regression models with serum uric acid (milligrams per deciliter) as the outcome and polyphenol intake (quintiles) as the main independent variable were fitted. Cox regression models with constant follow-up time (t=1) were performed to estimate the prevalence ratios (PRs) of hyperuricemia (≥7 mg/dL in men and ≥6 mg/dL in women). An inverse association between the intake of the phenolic acid class (β coefficient, −0.17 mg/dL for quintile 5 versus quintile 1 [95% CI, −0.27 to −0.06]) and hydroxycinnamic acids (β coefficient, −0.19 [95% CI, −0.3 to −0.09]), alkylmethoxyphenols (β coefficient, −0.2 [95% CI, −0.31 to −0.1]), and methoxyphenols (β coefficient, −0.24 [95% CI, −0.34 to −0.13]) subclasses with serum uric acid levels and hyperuricemia (PR, 0.82 [95% CI, 0.71– 0.95]; PR, 0.82 [95% CI, 0.71– 0.95]; PR, 0.80 [95% CI, 0.70– 0.92]; and PR, 0.79 [95% CI, 0.69– 0.91]; respectively) was found. The intake of hydroxybenzoic acids was directly and significantly as- sociated with mean serum uric acid levels (β coefficient, 0.14 for quintile 5 versus quintile 1 [95% CI, 0.02– 0.26]) but not with hyperuricemia

Role of NAFLD on the Health Related QoL Response to Lifestyle in Patients With Metabolic Syndrome: The PREDIMED Plus Cohort

ObjectiveTo evaluate the effect of Non-alcoholic fatty liver disease (NAFLD) status in the impact of lifestyle over Health-related quality of life (HRQoL) in patients with metabolic syndrome (MetS). MethodsBaseline and 1 year follow up data from the PREDIMED-plus cohort (men and women, 55-75 years old with overweight/obesity and MetS) were studied. Adherence to an energy-restricted Mediterranean Diet (er-MeDiet) and Physical Activity (PA) were assessed with a validated screeners. Hepatic steatosis index (HSI) was implemented to evaluate NAFLD while the SF-36 questionnaire provided HRQoL evaluation. Statistical analyses were performed to evaluate the influence of baseline NAFLD on HRQoL as affected by lifestyle during 1 year of follow up. ResultsData from 5205 patients with mean age of 65 years and a 48% of female participants. Adjusted linear multivariate mixed regression models showed that patients with lower probability of NAFLD (HSI < 36 points) were more responsive to er-MeDiet (beta 0.64 vs beta 0.05 per er-MeDiet adherence point, p< 0.01) and PA (beta 0.05 vs beta 0.01 per MET-h/week, p = 0.001) than those with high probability for NAFLD in terms Physical SF-36 summary in the 1 year follow up. 10 points of er-MeDiet adherence and 50 MET-h/week were thresholds for a beneficial effect of lifestyle on HRQoL physical domain in patients with lower probability of NAFLD. ConclusionThe evaluation of NAFLD by the HSI index in patients with MetS might identify subjects with different prospective sensitivity to lifestyle changes in terms of physical HRQoL (http://www.isrctn.com/ISRCTN89898870)