Marcadores de adiposidad, patrones dietéticos y función pulmonar en sujetos fumadores sin enfermedad respiratoria

L'objectiu és determinar la relació entre diversos marcadors d’adipositat i el patró dietètic i l'alteració de la funció pulmonar en fumadors de 35 a 70 anys, d’ambdós sexes i sense patologia respiratòria en Atenció Primària. Per a això, es van plantejar tres estudis: 1) l'avaluació de l'associació entre els marcadors d’adipositat i la funció pulmonar: estudi transversal realitzat en una mostra representativa del projecte ESPITAP; 2) l'avaluació de l'associació entre els patrons dietètics i la funció pulmonar: estudi transversal realitzat en una submostra del projecte RESET; 3) el disseny d'un estudi d'intervenció per augmentar l'adherència a la Dieta Mediterrània (DM) i millorar la funció pulmonar. Els resultats observats mostren una associació negativa entre la circumferència de cintura i els paràmetres de funció pulmonar (FVC: β= -0,34, p= 0,035; FEV1: β= -0,51, p= 0,007) i la mateixa associació s'observa entre l'índex cintura altura i el FEV1 (β= -52,17, p= 0,041) en homes. A més, en la població d'estudi es van identificar tres patrons associats amb la funció respiratòria: un patró de consum d'alcohol associat de forma estadísticament significativa amb un alt risc d'alteració de la funció pulmonar en tota la mostra (OR 4,56; IC95% 1,58- 13,18), i especialment en dones (OR 11,47; IC95% 2,25-58,47); un patró occidentalitzat associat amb un major risc d'alteració de la funció pulmonar en dones (OR 5,62; IC95% 1,17-27,02); i un patró d'estil Mediterrani que va mostrar una associació no significativa amb l'aparició d'alteració pulmonar (OR 0,71; IC95%: 0,28 a 1,79), suggerint un efecte protector sobre la funció respiratòria. En resum, la composició corporal i el patró de la dieta són factors de risc d'alteració de la funció pulmonar que han de ser considerats per preservar la funció pulmonar. A més de la recomanació fonamental de l'abandonament del tabaquisme, els fumadors podrien beneficiar-se de seguir un programa nutricional específic basat en la DM.El objetivo es determinar la relación entre diversos marcadores de adiposidad y el patrón dietético y la alteración de la función pulmonar en fumadores de 35 a 70 años, de ambos sexos y sin patología respiratoria en Atención Primaria. Para ello, se plantearon tres estudios: 1) la evaluación de la asociación entre los marcadores de adiposidad y la función pulmonar: estudio transversal realizado en una muestra representativa del proyecto ESPITAP; 2) la evaluación de la asociación entre los patrones dietéticos y la función pulmonar: estudio transversal realizado en una submuestra del proyecto RESET; 3) el diseño de un estudio de intervención para aumentar la adherencia a la Dieta Mediterránea (DM) y mejorar la función pulmonar. Los resultados muestran una asociación negativa entre la circunferencia de cintura y los parámetros de función pulmonar (FVC: β= -0,34, p= 0,035; FEV1: β= -0,51, p= 0,007) y la misma asociación se observa entre el índice cintura altura (ICA) y el FEV1 (β= -52,17, p= 0,041) en hombres. Además, en la población de estudio se identificaron tres patrones asociados con la función respiratoria: un patrón de consumo de alcohol asociado de forma estadísticamente significativa con un alto riesgo de alteración de la función pulmonar en toda la muestra (OR 4,56; IC95% 1,58- 13,18), y especialmente en mujeres (OR 11,47; IC95% 2,25-58,47); un patrón occidentalizado asociado con un mayor riesgo de alteración de la función pulmonar en mujeres (OR 5,62; IC95% 1,17-27,02); y un patrón de estilo Mediterráneo que mostró una asociación no significativa con la aparición de alteración pulmonar (OR 0,71; IC95%: 0,28 a 1,79), sugiriendo un efecto protector sobre la función respiratoria. En resumen, la composición corporal y el patrón de la dieta son factores de riesgo de alteración de la función pulmonar que deben ser consideradas para preservar la función pulmonar. Además de la recomendación fundamental del abandono del hábito, los fumadores podrían beneficiarse de seguir un programa nutricional específico basado en la DM.The objective is to determine the relationship between various markers of adiposity and dietary pattern and impaired lung function in smokers of 35 to 70 years, of both sexes and without respiratory disease in primary care. To this end, three studies were presented: 1) the evaluation of the association between adiposity markers and pulmonary function: cross-sectional study in a representative sample of the ESPITAP project; 2) evaluation of the association between dietary patterns and lung function: cross-sectional study in a subsample of the RESET project; 3) designing an intervention study to increase adherence to the Mediterranean Diet (MD) to improve lung function. The results show a negative association between waist circumference and lung function parameters (FVC: β = -0.34, p = 0.035; FEV1: β = -0.51, p = 0.007) and the same association was observed between waist to height ratio (WHtR) and FEV1 (β = -52.17, p = 0.041) in men. In addition, the study population three associate with breathing patterns were identified: an alcohol consumption pattern associated statistically significantly with a high risk of impaired lung function in total sample (OR 4.56, 95% CI 1.58- 13.18), and especially in women (OR 11.47, 95% CI 2.25 to 58.47); a Westernized pattern associated with an increased risk of impaired lung function in women (OR 5.62, 95% CI 1.17 to 27.02); and a Mediterranean-like pattern that showed no significant association with the occurrence of pulmonary impairment (OR 0.71, 95% CI 0.28 to 1.79), suggesting a protective effect on respiratory function. In short, the body composition and diet pattern are risk factors for impaired lung function that should be considered to preserve lung function. In addition to the key recommendation of quitting, smokers could benefit from follow a specific nutritional program based on the MD

A clinical trial to evaluate the effect of the Mediterranean diet on smokers lung function

Mediterranian diet; Smoke; Lung functionDieta mediterránea; Fumar; Función pulmonarDieta mediterrània; Fumar; Funció pulmonarData on the association between lung function and some dietary patterns have been published. However, it is not yet well known if whether the Mediterranean Diet (MD) pattern can preserve or improve lung function. Our purpose is to evaluate the effect of increased MD adherence on lung function in smokers. A multicenter, parallel, cluster-randomized, controlled clinical trial is proposed. A total of 566 active smokers (>10 packs-year), aged 25-75 years will be included, without previous respiratory disease and who sign an informed consent to participate. Twenty Primary Care Centres in Tarragona (Spain) will be randomly assigned to a control or an intervention group (1:1). All participants will receive advice to quit smoking, and the intervention group, a nutritional intervention (2 years) designed to increase MD adherence by: (1) annual visit to deliver personalized nutritional education, (2) annual telephone contact to reinforce the intervention, and (3) access to an online dietary blog. We will evaluate (annually for 2 years): pulmonary function by forced spirometry and MD adherence by a 14-item questionnaire and medical tests (oxidation, inflammation and consumption biomarkers). In a statistical analysis by intention-to-treat basis, with the individual smoker as unit of analysis, pulmonary function and MD adherence in both groups will be compared; logistic regression models will be applied to analyze their associations. We hope to observe an increased MD adherence that may prevent the deterioration of lung function in smokers without previous respiratory disease. This population may benefit from a dietary intervention, together with the recommendation of smoking cessation

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Effectiveness of a Motivational Nutritional Intervention through Social Networks 2.0 to Increase Adherence to the Mediterranean Diet and Improve Lung Function in Active Smokers: The DIET Study, a Randomized, Controlled and Parallel Clinical Trial in Primary Care

Background: Diet can help preserve lung function in smokers, as well as aid individuals who avoid smoking. This study aimed to evaluate the effectiveness of a nutritional intervention, using the Social Networks 2.0 tool, to increase adherence to the Mediterranean diet (MD) and improve lung function in smokers without prior respiratory disease. Methods: A randomized controlled parallel design was used. The participants were assigned to either the intervention or control group. Data from representative smokers without respiratory disease (n = 77) aged 18–70 years were analyzed. The participants completed a validated semi-quantitative food-frequency questionnaire, and their adherence to the diet was evaluated by using the questionnaire called the Mediterranean Diet Adherence Score (MEDAS, with 14 items), which considers ≥9 points to indicate high adherence. The lung function was assessed by spirometry. Associations among variables were determined by logistic regression. Results: A comparison of the variables at the end of the study between the control and intervention groups showed that the intervention significantly increased adherence to the MD based on the MEDAS questionnaire (0.69 (2.1) vs. 2.05 (2.03); p = 0.009). Specifically, the consumption of fruits was increased after two years in both groups; however, a more significant increase was detected in the intervention group (121 (178) vs. 12.7 (167) in the control group; p-value = 0.008). In the unadjusted analysis, the intervention only showed a statistical significant increase in the score of adherence to the MD (β: 1.36; 95% CI 0.35; 2.3; p = 0.009), and this increase was maintained after adjusting for age and sex (β: 1.15; 95% CI 0.05; 2.2; p = 0.040) and after adjusting for various sociodemographic, lifestyle and anthropometric variables (β: 1.17; 95% CI 0.02; 2.31; p = 0.046). The pulmonary function parameters improved more in the intervention group; however, no significant differences were observed between the two groups. Conclusions: A nutritional intervention based on a dietetic-nutritional education program resulted in a significant increase in adherence to the MD. However, some evidence suggests that an MD dietary intervention can improve lung function, but in our study, we were not able to demonstrate this. Further research is needed to obtain more robust data and confirm a possible benefit of the program before it can be extended to general practice

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective