Protecting the underscreened women in developed countries: the value of HPV test

Background: Poor attendance to cervical cancer (CC) screening is a major risk factor for CC. Efforts to capture underscreened women are considerable and once women agree to participate, the provision of longitudinal validity of the screening test is of paramount relevance. We evaluate the addition of high risk HPV test (HPV) to cervical cytology as a primary screening test among underscreened women in the longitudinal prediction of intraepithelial lesions grade 2 or worse (CIN2+). Methods: Women were included in the study if they were older than 39 years and with no evidence of cervical cytology in the previous five years within the Public Primary Health Care System in Catalonia (Spain). 1,832 underscreened women from eight public primary health areas were identified during 2007-2008 and followed-up for over three years to estimate longitudinal detection of CIN2+. Accuracy of each screening test and the combination of both to detect CIN2+ was estimated. The risk of developing CIN2+ lesions according to histology data by cytology and HPV test results at baseline was estimated using the Kaplan-Meier method. Results: At baseline, 6.7% of participants were HPV positive, 2.2% had an abnormal cytology and 1.3% had both tests positive. At the end of follow-up, 18 out of 767 (2.3%) underscreened women had a CIN2+, two of which were invasive CC. The three-year longitudinal sensitivity and specificity estimates to detect CIN2+ were 90.5% and 93.0% for HPV test and 38.2% and 97.8% for cytology. The negative predictive value was >99.0% for each test. No additional gains in validity parameters of HPV test were observed when adding cytology as co-test. The referral to colposcopy was higher for HPV but generated 53% higher detection of CIN2+ compared to cytology. Conclusions: Underscreened women had high burden of cervical disease. Primary HPV screening followed by cytology triage could be the optimal strategy to identify CIN2+ leading to longer and safe screen intervals

a-tricalcium phosphate synthesis from amorphous calcium phosphate: structural characterization and hydraulic reactivity

In the present study, amorphous tricalcium phosphate (TCP) has been synthetized by a wet route to obtain low temperature a-TCP at 650 °C (LT-aTCP) and compare its structural, physical–chemical and thermal properties with those of a-TCP obtained by the conventional solid-state reaction method at 1400 °C (HT-aTCP). Even if no significant differences were observed concerning the values of lattice parameters measured by Rietveld refinement, LT-aTCP presented lower crystallinity and higher crystal strains than HT-aTCP. The reactivity in water of the a-TCP obtained by the two different routes was assessed. Both raw samples appeared relatively inert in solution and did not favour the nucleation of calcium deficient apatite (CDA); the LT-aTCP and HT-aTCP were converted into apatite only after milling. The mechanical process leads to a decrease in crystallinity and the formation of an amorphous phase, which is supported in this work by Raman spectroscopy. The faster rate of conversion of milled LT-aTCP compared to HT-aTCP can be assigned to its higher specific surface area, lower crystallinity and higher residual crystal strain; these favour the dissolution of the a-TCP phase. Finally, the setting properties of a-TCP-based bone cements were compared regarding their synthesis route. Although the synthesis route does not significantly affect the setting times, the kinetic of conversion into CDA was faster for LT-aTCP than for HT-aTCP. Thus, the modulation of the dissolution rate of a-TCP-based cement determined by the preparation route and the grinding process allows control of the overall setting reaction.Peer ReviewedPostprint (author's final draft

Association between both total baseline urinary and dietary polyphenols and substantial physical performance decline risk in older adults: a 9-year follow-up of the InCHIANTI study

ABSTRACT Importance: The decline in physical performance that occurs in many older subjects is a strong predictor of falls, hospitalization, institutionalization and mortality. Polyphenols are bioactive compounds that may play a preventive role against physical performance decline due to their antioxidant and anti-inflammatory properties. Objective: To investigate the association between total urinary polyphenols (TUP) and total dietary polyphenols (TDP) and substantial physical performance decline over a nine-year period among older subjects. Methods: This longitudinal study included 368 participants aged 65 years or older from the InCHIANTI (Invecchiare in Chianti) study, an Italian population-based cohort. TUP and TDP concentrations were assessed at baseline using the Folin-Ciocalteau (F-C) assay and a validated food frequency questionnaire, respectively. Physical performance was objectively measured at baseline and at nine-year follow-up using the Short Physical Performance Battery (SPPB). A substantial decline in physical performance was considered as a decrease of three or more points in the SPPB score. Results: At the nine-year follow-up assessment, 71 participants had suffered a substantial decline in physical performance. In the fully adjusted logistic regression model, participants in the highest TUP tertile had a lower risk of substantial decline in physical performance than those in 2 the lowest tertile (OR, 0.40; 95% CI, 0.17-0.93; P trend=0.033). However, no significant association between TDP intake and physical performance decline was observed. Conclusion: This study shows that high TUP concentrations, a biomarker of polyphenol-rich exposure, were associated with lower risk of substantial decline in physical performance in community-dwelling older subjects over a nine-year period. These results suggest that a polyphenol-rich diet may play a role in protecting against physical performance decline in older people

Dietary Epicatechin Is Available to Breastfed Infants through Human Breast Milk in the Form of Host and Microbial Metabolites

Polyphenols play an important role in human health. To address their accessibility to a breastfed infant, we planned to evaluate whether breast milk (BM) (colostrum, transitional, and mature) epicatechin metabolites could be related to the dietary habits of mothers. The polyphenol consumption of breastfeeding mothers was estimated using a food frequency questionnaire and 24 h recalls. Solid-phase extraction–ultra performance liquid chromatography–tandem mass spectrometry (SPE–UPLC–MS/MS) was applied for direct epicatechin metabolite analysis. Their bioavailability in BM as a result of dietary ingestion was confirmed in a preliminary experiment with a single dose of dark chocolate. Several host and microbial phase II metabolites of epicatechin were detected in BM among free-living lactating mothers. Interestingly, a modest correlation between dihydroxyvalerolactone sulfate and the intake of cocoa products was observed. Although a very low percentage of dietary polyphenols is excreted in BM, they are definitely in the diet of breastfed infants. Therefore, evaluation of their role in infant health could be further promoted

Lockdown and eating habits among professionals and students

Des que l’Organització Mundial de la Salut (OMS) va declarar la COVID-19 una pandèmia mundial, el nombre de casos i morts ha anat augmentant ràpidament i ha obligat els països de tot el món a confinar la seva població per controlar la propagació del virus. En aquest estudi, s’han avaluat els canvis en els hàbits dietètics i l’estil de vida durant el confinament de març a juny del 2020 dins d’una població espanyola específica amb coneixements acadèmics en ciències de l’alimentació. Es va fer arribar un qüestionari en línia a professionals i estudiants de l’àmbit de les ciències de l’alimentació, que incloïa preguntes sobre les dades sociodemogràfiques, els hàbits dietètics, els comportaments relacionats amb l’alimentació i l’estil de vida. Durant el confinament, aquesta població va mostrar un augment significatiu en la ingesta de fruites, verdures, llegums, ous, peix i iogurt, juntament amb una disminució del consum de begudes alcohòliques. D’altra banda, també es va observar un augment del consum d’aperitius salats, xocolata i brioixeria casolana. Així mateix, les dades també van revelar una pitjor qualitat del son i un augment en el nombre d’hores dedicades a treballar i a realitzar activitats sedentàries. En general, aquesta població va mostrar una tendència envers l’adopció d’hàbits dietètics més saludables durant el confinament per la COVID-19 en comparació amb la població general.Since the World Health Organization (WHO) declared Covid-19 a global pandemic, the number of cases and deaths has risen rapidly, forcing countries around the world to confine their population in order to control the virus’s spread. In this study, changes in dietary habits and lifestyle during the Covid-19 lockdown from March to June 2020 have been evaluated in a specific Spanish population with an academic knowledge of food sciences. An online questionnaire, which covered sociodemographic data, dietary habits, food-related behaviours and lifestyle was distributed among professionals and students in the field of food sciences. During the lockdown, this population reported a significant increase in the consumption of fruits, vegetables, legumes, eggs, fish, and yogurt, along with a decrease in the intake of alcoholic beverages. Nevertheless, there was also an increase in the consumption of salty snacks, chocolate and homemade pastries. Poor sleep quality and increased working hours and sitting time were also reported. Overall, the studied population showed trends towards healthier dietary habits during the Covid-19 lockdown in comparison with the general population

Protecting the underscreened women in developed countries: the value of HPV test

Background: Poor attendance to cervical cancer (CC) screening is a major risk factor for CC. Efforts to capture underscreened women are considerable and once women agree to participate, the provision of longitudinal validity of the screening test is of paramount relevance. We evaluate the addition of high risk HPV test (HPV) to cervical cytology as a primary screening test among underscreened women in the longitudinal prediction of intraepithelial lesions grade 2 or worse (CIN2+). Methods: Women were included in the study if they were older than 39 years and with no evidence of cervical cytology in the previous five years within the Public Primary Health Care System in Catalonia (Spain). 1,832 underscreened women from eight public primary health areas were identified during 2007-2008 and followed-up for over three years to estimate longitudinal detection of CIN2+. Accuracy of each screening test and the combination of both to detect CIN2+ was estimated. The risk of developing CIN2+ lesions according to histology data by cytology and HPV test results at baseline was estimated using the Kaplan-Meier method. Results: At baseline, 6.7% of participants were HPV positive, 2.2% had an abnormal cytology and 1.3% had both tests positive. At the end of follow-up, 18 out of 767 (2.3%) underscreened women had a CIN2+, two of which were invasive CC. The three-year longitudinal sensitivity and specificity estimates to detect CIN2+ were 90.5% and 93.0% for HPV test and 38.2% and 97.8% for cytology. The negative predictive value was >99.0% for each test. No additional gains in validity parameters of HPV test were observed when adding cytology as co-test. The referral to colposcopy was higher for HPV but generated 53% higher detection of CIN2+ compared to cytology. Conclusions: Underscreened women had high burden of cervical disease. Primary HPV screening followed by cytology triage could be the optimal strategy to identify CIN2+ leading to longer and safe screen intervals

Metabolomic Pattern Analysis after Mediterranean Diet Intervention in a Nondiabetic Population: A 1- and 3‑Year Follow-up in the PREDIMED Study

The Mediterranean diet (MD) is considered a dietary pattern with beneficial effects on human health. The aim of this study was to assess the effect of an MD on urinary metabolome by comparing subjects at 1 and 3 years of follow-up, after an MD supplemented with either extra-virgin olive oil (MD + EVOO) or nuts (MD + Nuts), to those on advice to follow a control low-fat diet (LFD). Ninety-eight nondiabetic volunteers were evaluated, using metabolomic approaches, corresponding to MD + EVOO (<i>n</i> = 41), MD + Nuts (<i>n</i> = 27), or LFD (<i>n</i> = 30) groups. The ¹H NMR urinary profiles were examined at baseline and after 1 and 3 years of follow-up. Multivariate data analysis (OSC-PLS-DA and HCA) methods were used to identify the potential biomarker discriminating groups, exhibiting a urinary metabolome separation between MD groups against baseline and LFD. Results revealed that the most prominent hallmarks concerning MD groups were related to the metabolism of carbohydrates (3-hydroxybutyrate, citrate, and <i>cis</i>-aconitate), creatine, creatinine, amino acids (proline, <i>N</i>-acetylglutamine, glycine, branched-chain amino acids, and derived metabolites), lipids (oleic and suberic acids), and microbial cometabolites (phenylacetylglutamine and <i>p</i>-cresol). Otherwise, hippurate, trimethylamine-<i>N</i>-oxide, histidine and derivates (methylhistidines, carnosine, and anserine), and xanthosine were predominant after LFD. The application of NMR-based metabolomics enabled the classification of individuals regarding their dietary pattern and highlights the potential of this approach for evaluating changes in the urinary metabolome at different time points of follow-up in response to specific dietary interventions

Novel Multimetabolite Prediction of Walnut Consumption by a Urinary Biomarker Model in a Free-Living Population: the PREDIMED Study

The beneficial impact of walnuts on human health has been attributed to their unique chemical composition. In order to characterize the dietary walnut fingerprinting, spot urine samples from two sets of 195 (training) and 186 (validation) individuals were analyzed by an HPLC-q-ToF-MS untargeted metabolomics approach, selecting the most discriminating metabolites by multivariate data analysis (VIP ≥ 1.5). Stepwise logistic regression analysis was used to design a multimetabolite prediction biomarker model. The global performance of the model and each included metabolite in it was evaluated by receiver operating characteristic curves, using the area under the curve (AUC) values. Dietary exposure to walnuts was characterized by 18 metabolites, including markers of fatty acid metabolism, ellagitannin-derived microbial compounds, and intermediate metabolites of the tryptophan/serotonin pathway. The predictive model of walnut exposure included at least one compound of each class. The AUC (95% CI) for the combined biomarker model was 93.4% (90.1–96.8%) in the training set and 90.2% (85.9–94.6%) in the validation set. The AUCs for individual metabolites were ≤85%. As far as we know, this is the first study proposing a combination of biomarkers of walnut exposure in a population under free-living conditions, as considered in epidemiological studies examining associations between diet and health outcomes

Urolithins Are the Main Urinary Microbial-Derived Phenolic Metabolites Discriminating a Moderate Consumption of Nuts in Free-Living Subjects with Diagnosed Metabolic Syndrome

Walnuts (Juglans regia L.), hazelnuts (Corylus avellana L.), and almonds (Prunus dulcis Mill.) are rich sources of ellagitannins and proanthocyanidins. Gut microbiota plays a crucial role in modulating the bioavailability of these high molecular weight polyphenols. However, to date there are no studies evaluating the capacity to produce nut phenolic metabolites in subjects with metabolic syndrome (MetS), a pathology associated with an altered gut bacterial diversity. This study applied a LC-MS targeted approach to analyze the urinary excretion of nut phenolic metabolites in MetS subjects following 12 weeks of nut consumption, compared to sex- and age-matched individuals given a nut-free control diet. Metabolites were targeted in both hydrolyzed and nonhydrolyzed urine by LC-PDA-QqQ-MS/MS analysis, and identification of metabolites lacking available standards was confirmed by LC-ESI-ITD-FT-MS. Ellagitannin-derived urolithins A and B significantly increased after the nut-enriched-diet, urolithins C and D were also detected, and a complex combination of urolithin-conjugated forms was observed in nonhydrolyzed urine, confirming an extensive phase II metabolism after absorption. In contrast, no significant increases in proanthocyanidin microbial metabolites were observed in urine following nut consumption. Because the intestinal microbiota of the subjects in this study could catabolize ellagitannins into a wide range of urolithins, further research is strongly warranted on the in vivo potential of these microbial metabolites in reducing cardiometabolic risk