Beverage consumption in the context of a mediterranean diet, cardiovascular risk factors and mental health

La prevalença i incidència de les malalties cardiovasculars ha augmentat en els darrers anys. La majoria d'aquestes patologies es poden prevenir abordant factors d'estil de vida modificables (dieta, l'activitat física, l'hàbit tabàquic). Tot i això, i malgrat el seu consum diari, l'evidència epidemiològica que ha explorat l'associació entre el consum d'aigua, begudes i els factors de risc cardiovascular és limitada i contradictòria. A més a més, a vegades les guies alimentàries no inclouen recomanacions sobre el seu consum. L'objectiu general de la present Tesi Doctoral va ser avaluar el patró de consum de begudes d'una població mediterrània d'edat avançada amb síndrome metabòlic i la seva associació amb factors de risc cardiovascular i rendiment cognitiu. Per això es van analitzar les dades de l'estudi PREDIMED-Plus, un assaig clínic multicèntric, aleatoritzat i controlat, de grups paral·lels desenvolupat a Espanya per la prevenció primària de la malaltia cardiovascular. Les anàlisis es van fer amb l'enfocament d'un estudi de cohort prospectiu. Els principals resultats derivats d'aquesta tesi reforcen el paper del patró de consum de begudes del Mediterrani en el compliment de les recomanacions de l'EFSA per a la ingesta total d'aigua, així com la seva associació amb un estil de vida saludable; proporcionen evidència sobre l'associació entre el consum d'aigua, el pes corporal i l'adipositat; contribueixen amb nous coneixements sobre el consum de suc de fruites i la seva associació amb la salut cardiometabòlica; i donen suport al paper del consum de cafè i la ingesta de cafeïna en la prevenció del deteriorament cognitiu i la salut mental. En conclusió, el patró de consum de begudes mediterrànies es va associar amb un estil de vida més saludable, un major compliment de les recomanacions de l'EFSA sobre ingesta d'aigua, un millor pronòstic en alguns factors de risc cardiovascular i un rendiment cognitiu en persones grans amb SM. A més, algunes molècules presents als líquids, com la cafeïna, podrien estar associades amb altres aspectes de la salut mental, com l'ansietat. Si aquests resultats són confirmats per estudis d'intervenció amb un grau adequat d'evidència científica, les guies dietètiques haurien de ressaltar la importància del consum d'aigua i begudes per al manteniment de la salut.La prevalencia e incidencia de las enfermedades cardiovasculares ha aumentado en los últimos años. Estas patologías se pueden prevenir abordando factores de estilo de vida modificables (dieta, la actividad física y hábito tabáquico). Sin embargo, la evidencia epidemiológica que ha explorado la asociación entre el consumo de agua, bebidas y los factores de riesgo cardiovascular es limitada y contradictoria. Aunado a esto, en ocasiones las guías alimentarias no incluyen recomendaciones sobre su consumo. El objetivo general de la presente Tesis Doctoral fue evaluar el patrón de consumo de bebidas de una población mediterránea de edad avanzada con síndrome metabólico y su asociación con factores de riesgo cardiovascular y salud mental. Para ello se analizaron los datos del estudio PREDIMED-Plus, un ensayo clínico multicéntrico, aleatorizado y controlado, de grupos paralelos desarrollado en España para la prevención primaria de la enfermedad cardiovascular (ECV). Los análisis se realizaron con el enfoque de un estudio de cohorte prospectivo. Los principales hallazgos derivados de esta tesis refuerzan el papel del patrón de consumo de bebidas del Mediterráneo en el cumplimiento de las recomendaciones de la EFSA para la ingesta total de agua, así como su asociación con un estilo de vida saludable; proporcionan evidencia acerca de la asociación entre el consumo de agua potable, el peso corporal y la adiposidad; contribuyen con nuevos conocimientos sobre el consumo de zumo de frutas y su asociación con la salud cardiometabólica; y respaldan el papel del consumo de café y la ingesta de cafeína en la prevención del deterioro cognitivo y la salud mental. En conclusión, el patrón de consumo de bebidas mediterráneas se asoció con un estilo de vida más saludable, mayor cumplimiento de las recomendaciones de la EFSA sobre ingesta de agua, mejor pronóstico en algunos factores de riesgo cardiovascular y rendimiento cognitivo en personas mayores con SM. Además de que, algunas moléculas presentes en los líquidos, tales como la cafeína, podrían estar asociadas con otros aspectos de la salud mental, como la ansiedad.Cardiovascular diseases prevalence and incidence have exponential increase in the last years. Most of these diseases can be prevented by addressing modifiable lifestyle factors (diet, physical activity, smoking habits). However, epidemiological evidence exploring the association between drinking water, beverages, and cardiovascular risk factors is limited and contradictory, and sometimes dietary guidelines do not include recommendations on their consumption. The general objective of the present Doctoral Thesis was to assess the beverage consumption pattern of an elderly Mediterranean population with metabolic syndrome and its association with cardiovascular risk factors and cognition. For this purpose data from the PREDIMED-Plus study, a multicenter randomized clinical trial conducted in Spain for the primary prevention of cardiovascular disease (CVD), was analyzed as a prospective cohort design study. The main findings derived from this dissertation reinforce the role of the Mediterranean beverage consumption pattern in the compliance of European Food Safety Authority (EFSA) recommendations for total water intake and its association with a healthy lifestyle; provide evidence for the association between drinking water consumption, body weight and adiposity; contribute with new insights regarding fruit juice consumption and its association with cardiometabolic health; and support the role of coffee consumption and caffeine intake in the prevention of cognitive decline and mental health. In conclusion, the Mediterranean beverage consumption pattern is associated with a healthier lifestyle, higher compliance with the EFSA’s recommendations for water intake, better prognosis in some cardiovascular risk factors, and cognitive performance in elderly individuals with MetS. Further, some molecules present in liquids, such as caffeine, could be associated with aspects of mental health, such as anxiety

How Did the COVID-19 Lockdown Pandemic Affect the Depression Symptomatology in Mediterranean Older Adults with Metabolic Syndrome?

Background and Aims. To control the COVID-19 spread, in March 2020, a forced home lockdown was established in Spain. In the present study, we aimed to assess the effect of mobility and social COVID-19-established restrictions on depressive symptomatology in older adults with metabolic syndrome. We hypothesize that severe restrictions might have resulted in detrimental changes in depressive symptomatology. Methods. 2,312 PREDIMED-Plus study participants (%; mean years) who completed a COVID-19 lockdown questionnaire to assess the severity of restrictions/lockdown and the validated Spanish version of the Beck Depression Inventory-II (BDI-II) during the three established phases concerning the COVID-19 lockdown in Spain (prelockdown, lockdown, and postlockdown) were included in this longitudinal analysis. Participants were categorized according to high or low lockdown severity. Analyses of covariance were performed to assess changes in depressive symptomatology across lockdown phases. Results. No significant differences in participant depression symptomatology changes were observed between lockdown severity categories (low/high) at the studied phases. During the lockdown phase, participants showed a decrease in BDI-II score compared to the prelockdown phase (mean (95% CI), -0.48 (-0.24, -0.72), ); a nonsignificantly larger decrease was observed in participants allocated in the low-lockdown category (low: -0.59 (-0.95, -0.23), high: -0.43 (-0.67, -0.19)). Similar decreases in depression symptomatology were found for the physical environment dimension. The post- and prelockdown phase BDI-II scores were roughly similar. Conclusions. The COVID-19 pandemic lockdown was associated with a decrease in depressive symptomatology that returned to prelockdown levels after the lockdown. The degree of lockdown was not associated with depressive symptomatology. The potential preventive role of the physical environment and social interactions on mental disorders during forced home lockdown should be further studied. This trial is registered with ISRCTN89898870. Retrospectively registered on 24 July 2014.European Union (EU) 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 PI14/01471European Research Council (ERC) 340918La Caixa Foundation 2013ACUP00194Junta de Andalucia PI0458/2013 PS0358/2016 PI0137/2018 MFE-171207Department of Health of the Junta de AndaluciaICREACIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN)MICIN/AEI/FEDER, UEInstituto de Salud Carlos III (ISCIII), through the Fondo de Investigacion para la Salud (FIS) SLT006/17/00246Especial Action Project entitled: Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus CEX2021-001234-MGeneralitat de CatalunyaFundacion Francisco Soria Melguiz

Inflammatory potential of diet and bone mineral density in a senior Mediterranean population : a cross-sectional analysis of PREDIMED-Plus study

Inflammation could play a key role in tissue damage and bone metabolism. The modified dietary inflammatory score (M-DIS) is a validated tool to estimate the inflammatory potential of the diet. In the present study, we evaluate the associations between the M-DIS and bone mineral density (BMD) in a senior Mediterranean population with overweight/obesity and metabolic syndrome. Baseline cross-sectional association between the M-DIS and bone mineral density was assessed in 1134 participants of the multicenter PREDIMED-Plus trial (aged 55-75 with overweight/obesity and metabolic syndrome). BMD was measured using Dual-energy X-ray Absorptiometry scans and participants answered a food frequency questionnaire to determine the M-DIS. BMD was categorized as low BMD when T score was equal or lower than -1 and normal BMD in another case. Associations between BMD and M-DIS were evaluated by using linear and logistic regressions adjusted by other co-variates. Participants in the top tertile of the M-DIS had a lower BMD at total femur [β (95% CI) − 0.02 (− 0.04, − 0.01)], trochanter areas [β (95% CI) − 0.03 (− 0.05, − 0.01)] and lumbar spine area [β (95% CI) − 0.03 (− 0.07, 0.01)] (but in the last case, measures were less precise and hence not statistically significant) compared to those in the lower M-DIS tertile. Multiple logistic regression analyses showed that the odds of the total femur and femoral trochanter osteopenia/osteoporosis were higher in participants in the top tertile compared to those in the lowest tertile of M-DIS [OR (95% CI) 1.71 (1.12, 2.64), P for trend 0.015; 2.02 (1.29, 3.21), P for trend 0.002, respectively]. A high pro-inflammatory diet, measured by the M-DIS, is associated with lower BMD in a senior Mediterranean population with metabolic syndrome. The online version contains supplementary material available at 10.1007/s00394-021-02751-5

Water intake, hydration status and 2-year changes in cognitive performance: a prospective cohort study

BackgroundWater intake and hydration status have been suggested to impact cognition; however, longitudinal evidence is limited and often inconsistent. This study aimed to longitudinally assess the association between hydration status and water intake based on current recommendations, with changes in cognition in an older Spanish population at high cardiovascular disease risk.MethodsA prospective analysis was conducted of a cohort of 1957 adults (aged 55-75) with overweight/obesity (BMI between >= 27 and = 300 mmol/L (dehydrated). Water intake was assessed as total drinking water intake and total water intake from food and beverages and according to EFSA recommendations. Global cognitive function was determined as a composite z-score summarizing individual participant results from all neuropsychological tests. Multivariable linear regression models were fitted to assess the associations between baseline hydration status and fluid intake, continuously and categorically, with 2-year changes in cognitive performance.ResultsThe mean baseline daily total water intake was 2871 +/- 676 mL/day (2889 +/- 677 mL/day in men; 2854 +/- 674 mL/day in women), and 80.2% of participants met the ESFA reference values for an adequate intake. Serum osmolarity (mean 298 +/- 24 mmol/L, range 263 to 347 mmol/L) indicated that 56% of participants were physiologically dehydrated. Lower physiological hydration status (i.e., greater serum osmolarity) was associated with a greater decline in global cognitive function z-score over a 2-year period (beta: - 0.010; 95% CI - 0.017 to - 0.004, p-value = 0.002). No significant associations were observed between water intake from beverages and/or foods with 2-year changes in global cognitive function.ConclusionsReduced physiological hydration status was associated with greater reductions in global cognitive function over a 2-year period in older adults with metabolic syndrome and overweight or obesity. Future research assessing the impact of hydration on cognitive performance over a longer duration is needed

Dairy product consumption and changes in cognitive performance: two-year analysis of the PREDIMED-Plus Cohort

Scope: Dairy consumption has been suggested to impact cognition; however, evidence is limited and inconsistent. This study aims to longitudinally assess the association between dairy consumption with cognitive changes in an older Spanish population at high cardiovascular disease risk. Methods and results: Four thousand six hundred sixty eight participants aged 55–75 years, completed a validated food frequency questionnaire at baseline and a neuropsychological battery of tests at baseline and 2-year follow-up. Multivariable linear regression models are used, scaled by 100 (i.e., the units of β correspond to 1 SD/100), to assess associations between baseline tertile daily consumption and 2-year changes in cognitive performance. Participants in the highest tertile of total milk and whole-fat milk consumption have a greater decline in global cognitive function (β: –4.71, 95% CI: –8.74 to –0.69, p-trend = 0.020 and β: –6.64, 95% CI: –10.81 to –2.47, p-trend = 0.002, respectively) compared to those in the lowest tertile. No associations are observed between low fat milk, yogurt, cheese or fermented dairy consumption, and changes in cognitive performance. Conclusion:Results suggest there are no clear prospective associations between consumption of most commonly consumed dairy products and cognition, although there may be an association with a greater rate of cognitive decline over a 2-year period in older adults at high cardiovascular disease risk for whole-fat milk

Impact of COVID-19 pandemic on the PREDIMED-Plus randomized clinical trial: Effects on the interventions, participants follow-up, and adiposity

Background: The COVID-19 pandemic has affected the implementation of most ongoing clinical trials worldwide including the PREDIMED-Plus study. The PREDIMED-Plus is an ongoing, multicenter, controlled intervention trial, aimed at weight-loss and cardiovascular disease prevention, in which participants were randomized (1:1 ratio) to an intervention group (energy-reduced Mediterranean diet, promotion of physical activity, and behavioral support) or to a control group (Mediterranean diet with usual care advice). When the pandemic began, the trial was in the midst of the planned intervention. The objective of this report was to examine the effects of the pandemic on the delivery of the intervention and to describe the strategies established to mitigate the possible adverse effects of the pandemic lockdown on data collection and adiposity. Methods: We assessed the integrity of the PREDIMED-Plus trial during 5 identified periods of the COVID-19 pandemic determined according to restrictions dictated by the Spanish government authorities. A standardized questionnaire was delivered to each of the 23 PREDIMED-Plus recruiting centers to collected data regarding the trial integrity. The effect of the restrictions on intervention components (diet, physical activity) was evaluated with data obtained in the three identified lockdown phases: pre lockdown, lockdown proper, and post lockdown. Results: During the lockdown (March/2020-June/2021), 4,612 participants (48% women, mean age 65y) attended pre-specified yearly follow-up visits to receive lifestyle recommendations and obtain adiposity measures. The overall mean (SD) of the proportions reported by each center showed that 40.4% (25.4) participants had in-person visits, 39.8% (18.2) participants were contacted by telephone and 35% (26.3) by electronic means. Participants' follow-up and data collection rates increased across lockdown periods (from ≈10% at onset to ≈80% at the end). Compared to pre-lockdown, waist circumference increased during (0.75 cm [95% CI: 0.60-0.91]) and after (0.72 cm [95% CI: 0.56-0.89]) lockdown. Body weight did not change during lockdown (0.01 kg [95% CI: -0.10 to 0.13) and decreased after lockdown (-0.17 kg [95% CI: -0.30 to -0.04]). Conclusion: Mitigating strategies to enforce the intervention and patient's follow-up during lockdown have been successful in preserving the integrity of the trial and ensuring its continuation, with minor effects on adiposity. Clinical trial registration: https://doi.org/10.1186/ISRCTN89898870, identifier ISRCTN89898870. Keywords: COVID-19; Mediterraean diet; PREDIMED-Plus; clinical trial; lockdown; weight-loss. Copyright © 2023 Paz-Graniel, Fitó, Ros, Buil-Cosiales, Corella, Babio, Martínez, Alonso-Gómez, Wärnberg, Vioque, Romaguera, López-Miranda, Estruch, Tinahones, Lapetra, Serra-Majem, Bueno-Cavanillas, Tur, Martín-Sánchez, Pintó, Gaforio, Matía-Martín, Vidal, Vázquez, Daimiel, García-Gavilán, Toledo, Nishi, Sorlí, Castañer, García-Ríos, García de la Hera, Barón-López, Ruiz-Canela, Morey, Casas, Garrido-Garrido, Tojal-Sierra, Fernández-García, Vázquez-Ruiz, Fernández-Carrión, Goday, Peña-Orihuela, Compañ-Gabucio, Schröder, Martínez-Gonzalez and Salas-Salvadó. Conflict of interest statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest

Consumption of caffeinated beverages and kidney function decline in an elderly Mediterranean population with metabolic syndrome

It remains unclear whether caffeinated beverages could have deleterious renal effects in elderly population with underlying comorbid conditions. We investigated the associations between coffee, tea, or caffeine intake and 1-year changes in glomerular filtration rate (eGFR) in a large Spanish cohort of overweight/obese elderly with metabolic syndrome (MetS). This prospective analysis includes 5851 overweight/obese adults (55-75 years) with MetS from the PREDIMED-Plus study. We assessed coffee, tea, and caffeine consumption from a validated food-frequency questionnaire and creatinine-based eGFR using the Chronic Kidney Disease Epidemiology Collaboration equation. Multivariate-adjusted regression models were applied to test associations between baseline coffee, tea, or caffeine intake and 1-year eGFR changes. Caffeinated coffee (> 2 cups/day) and tea (at least 1 cup/day) drinkers had 0.88 and 0.93 mL/min/1.73 m2 greater eGFR decrease respectively, compared to those with less than 1 cup/day of coffee consumption or non-tea drinkers. Furthermore, caffeinated coffee consumption of > 2 cups/day was associated with 1.19-fold increased risk of rapid eGFR decline > 3 mL/min/1.73 m2 (95% CI 1.01-1.41). Similarly, individuals in the highest (median, 51.2 mg/day) tertile of caffeine intake had a 0.87 mL/min/1.73 m2 greater eGFR decrease. Decaffeinated coffee was not associated with eGFR changes. In conclusion, higher consumption of caffeinated coffee, tea, and caffeine was associated with a greater 1-year eGFR decline in overweight/obese adults with MetS

How Did the COVID-19 Lockdown Pandemic Affect the Depression Symptomatology in Mediterranean Older Adults with Metabolic Syndrome?

Background and Aims. To control the COVID-19 spread, in March 2020, a forced home lockdown was established in Spain. In the present study, we aimed to assess the effect of mobility and social COVID-19-established restrictions on depressive symptomatology in older adults with metabolic syndrome. We hypothesize that severe restrictions might have resulted in detrimental changes in depressive symptomatology. Methods. 2,312 PREDIMED-Plus study participants (men = 53:9%; mean age = 64:9±4:8 years) who completed a COVID-19 lockdown questionnaire to assess the severity of restrictions/lockdown and the validated Spanish version of the Beck Depression Inventory-II (BDI-II) during the three established phases concerning the COVID-19 lockdown in Spain (prelockdown, lockdown, and postlockdown) were included in this longitudinal analysis. Participants were categorized according to high or low lockdown severity. Analyses of covariance were performed to assess changes in depressive symptomatology across lockdown phases. Results. No significant differences in participant depression symptomatology changes were observed between lockdown severity categories (low/high) at the studied phases. During the lockdown phase, participants showed a decrease in BDI-II score compared to the prelockdown phase (mean (95% CI), -0.48 (-0.24, -0.72), P < 0:001); a nonsignificantly larger decrease was observed in participants allocated in the low-lockdown category (low: -0.59 (-0.95, -0.23), high: -0.43 (-0.67, -0.19)). Similar decreases in depression symptomatology were found for the physical environment dimension. The post- and prelockdown phase BDI-II scores were roughly similar. Conclusions. The COVID-19 pandemic lockdown was associated with a decrease in depressive symptomatology that returned to prelockdown levels after the lockdown. The degree of lockdown was not associated with depressive symptomatology. The potential preventive role of the physical environment and social interactions on mental disorders during forced home lockdown should be further studie

Association between Eating Speed and Classical Cardiovascular Risk Factors: A Cross-Sectional Study

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality around the world. Lifestyle is recognized as a key factor in the development of metabolic disorders and CVD. Recently, eating speed has been of particular interest since some studies have associated it with the development of obesity and other cardiometabolic disorders. We aimed to assess the association between eating speed and various cardiovascular risk factors. We conducted a cross-sectional analysis within the framework of the PREDIMED (Prevenci&oacute;n con Dieta Mediterr&aacute;nea) study with 792 participants from the Reus-Tarragona center. Eating speed was self-reported according to participant perception and categorized as slow, medium, or fast. The association between eating speed and cardiovascular risk factors was assessed using Cox regression models with constant time of follow-up for all individuals. Compared to participants in the slow eating speed category, those in the faster eating speed category were 59% more likely to have the hypertriglyceridemia component of the metabolic syndrome (MetS) (Hazard Ratio, (HR) 1.59; 95% Confidence Interval (CI) 1.16&ndash;2.17), even after adjustment for potential confounders (HR 1.47; 95% CI 1.08&ndash;2.02). No other significant differences were observed. Eating speed was positively associated with the prevalence of the hypertriglyceridemia component of the MetS in a senior population at high cardiovascular risk

Eating Speed, Eating Frequency, and Their Relationships with Diet Quality, Adiposity, and Metabolic Syndrome, or Its Components

Excess body weight is a major global health concern, particularly due to its associated increased health risks. Several strategies have been proposed to prevent overweight and obesity onset. In the past decade, it has been suggested that eating speed/rate and eating frequency might be related to obesity. The main aim of this narrative review was to summarize existing evidence regarding the impact of eating speed/rate and eating frequency on adiposity, metabolic syndrome (MetS), or diet quality (DQ). For this purpose, a literature search of observational and interventional trials was conducted between June and September 2020 in PubMed and Web of Sciences databases, without any data filters and no limitations for publication date. Results suggest that children and adults with a faster eating speed/rate may be associated with a higher risk of developing adiposity, MetS or its components. Furthermore, a higher eating frequency could be associated with diet quality improvement, lower adiposity, and lower risk of developing MetS or its components. Further interventional trials are warranted to clarify the mechanism by which these eating behaviors might have a potential impact on health