Estudio epidemiológico del estimador de grasa corporal CUN-BAE y su implicación en diversos problemas de salud. Gripe, hipertensión, diabetes, síndrome metabólico y cáncer colorrectal = Epidemiological Study of the Body Fat Estimator CUN-BAE and its Implication in Different Health Conditions (Influenza, Hypertension, Diabetes, Metabolic Syndrome and Colorectal Cancer)

259 p.La obesidad y el sobrepeso son problemas relevantes de Salud Pública. Es bien sabido que el exceso de grasa corporal (GC) se asocia con factores de riesgo cardiometabólico, algunos tipos de cáncer y otras causas principales de muerte. Sin embargo, casi el 40% de las muertes y de los años de vida ajustados por discapacidad que se atribuyen a un alto índice de masa corporal (IMC) se produjeron en individuos no obesos (IMC <30 kg / m2). En la población general, las medidas más frecuentemente utilizadas para definir el exceso de GC son el IMC y la circunferencia de la cintura (CC). Probablemente el IMC no esté captando la compleja biología de la GC; ya que los sujetos con un peso corporal normal según el IMC, pero con un alto %GC presentan un riesgo significativamente mayor de desarrollar enfermedades cardiometabólicas, cáncer y mortalidad. En este sentido, un método antropométrico alternativo que merece especial consideración es el índice CUN-BAE (Clínica Universidad de Navarra - Estimador de Adiposidad Corporal). Este estimador del %GC se basa en el IMC, el sexo y la edad en sujetos caucásicos para tratar de realizar una mejor predicción de la GC en adultos. El CUN-BAE podría ayudar a identificar a las personas con un IMC normal pero metabólicamente no saludables. Esta Tesis Doctoral está dedicada al estudio epidemiológico de la capacidad predictiva del CUN-BAE asociada a diversos problemas de salud y su relación con el IMC y la CC en la población adulta española. Así pues, los objetivos de la presente Tesis Doctoral son: 1) facilitar la translación a la práctica clínica del CUN-BAE utilizando una escala de colores; 2) comparar la relación entre el CUN-BAE, IMC y CC; 3) estimar la asociación del CUN-BAE con enfermedades transmisibles (gripe) y condiciones de salud crónicas (hipertensión, diabetes, síndrome metabólico), así como cuantificar la carga de enfermedad atribuida al %GC; 4) evaluar la contribución neta del CUN-BAE, independientemente de los componentes de su ecuación IMC, edad y sexo, en la asociación con condiciones cardiometabólicas; 5) estimar la asociación del CUN-BAE e IMC con el riesgo de cáncer colorrectal por sexo y localización anatómica del tumor. Metodológicamente, esta tesis se ha realizado utilizando datos de tres proyectos científicos: el estudio MCC-España, el estudio "Factores de riesgo de hospitalización por gripe A (H1N1)" y el estudio ENRICA. Además, utilizamos diferentes estrategias analíticas (p.e. correlación de Pearson, índice kappa, regresión logística condicional, no condicional y el uso de modelos mixtos; splines cúbicos, fracción atribuible poblacional (AFp), criterio de información de Akaike). Por consiguiente, como resultado principal y conclusiones de este trabajo podemos destacar el hecho de que: 1) la representación del CUN-BAE en una escala colorimétrica podría facilitar su uso clínico; 2) la correlación del CUN-BAE con el IMC y la CC es moderada, si bien mejora por sexo y edad; 3) el exceso de GC, medido por el CUN-BAE, se asocia con un aumento de la hospitalización por gripe A (H1N1), además el IMC podría estar subestimando la AFp de adiposidad en la hospitalización por gripe; 4) el CUN-BAE se asoció más fuertemente con la hipertensión, la diabetes y el síndrome metabólico que el IMC y el CC; 5) el CUN-BAE aporta información cardiometabólica más allá de los componentes de su ecuación: sexo, edad e IMC; y 6) la diferencia en la asociación entre el %GC y el riesgo de cáncer colorrectal en hombres y mujeres, puede no estar relacionada con su estimación por el IMC o el CUN-BAE

A Comparative Study on Feature Selection for a Risk Prediction Model for Colorectal Cancer

[EN]Background and objective: Risk prediction models aim at identifying people at higher risk of developing a target disease. Feature selection is particularly important to improve the prediction model performance avoiding overfitting and to identify the leading cancer risk (and protective) factors. Assessing the stability of feature selection/ranking algorithms becomes an important issue when the aim is to analyze the features with more prediction power. Methods: This work is focused on colorectal cancer, assessing several feature ranking algorithms in terms of performance for a set of risk prediction models (Neural Networks, Support Vector Machines (SVM), Logistic Regression, k-Nearest Neighbors and Boosted Trees). Additionally, their robustness is evaluated following a conventional approach with scalar stability metrics and a visual approach proposed in this work to study both similarity among feature ranking techniques as well as their individual stability. A comparative analysis is carried out between the most relevant features found out in this study and features provided by the experts according to the state-of-the-art knowledge. Results: The two best performance results in terms of Area Under the ROC Curve (AUC) are achieved with a SVM classifier using the top-41 features selected by the SVM wrapper approach (AUC=0.693) and Logistic Regression with the top-40 features selected by the Pearson (AUC=0.689). Experiments showed that performing feature selection contributes to classification performance with a 3.9% and 1.9% improvement in AUC for the SVM and Logistic Regression classifier, respectively, with respect to the results using the full feature set. The visual approach proposed in this work allows to see that the Neural Network-based wrapper ranking is the most unstable while the Random Forest is the most stable. Conclusions: This study demonstrates that stability and model performance should be studied jointly as Random Forest turned out to be the most stable algorithm but outperformed by others in terms of model performance while SVM wrapper and the Pearson correlation coefficient are moderately stable while achieving good model performance. © 2019 Elsevier B.V. All rights reservedS

El reto de profesionalizar la salud pública

Somos profesionales de la salud pública, aunque nuestras familias siguen sin saber a qué nos dedicamos. No es lo contrario de la salud privada: es la salud de y para toda la población. Dada la complejidad que esta definición entraña y la confusión semántica inherente al adjetivo “público”, los profesionales de la salud pública nos enfrentamos con frecuencia al reto de tener que justificar nuestra existencia.N

High adherence to the Western, Prudent, and Mediterranean dietary patterns and risk of gastric adenocarcinoma: MCC-Spain study

BACKGROUND: The influence of dietary habits on the development of gastric adenocarcinoma is not clear. The objective of the present study was to explore the association of three previously identified dietary patterns with gastric adenocarcinoma by sex, age, cancer site, and morphology. METHODS: MCC-Spain is a multicase-control study that included 295 incident cases of gastric adenocarcinoma and 3040 controls. The association of the Western, Prudent, and Mediterranean dietary patterns-derived in another Spanish case-control study-with gastric adenocarcinoma was assessed using multivariable logistic regression models with random province-specific intercepts and considering a possible interaction with sex and age. Risk according to tumor site (cardia, non-cardia) and morphology (intestinal/diffuse) was evaluated using multinomial regression models. RESULTS: A high adherence to the Western pattern increased gastric adenocarcinoma risk [odds ratiofourth_vs._first_quartile (95% confidence interval), 2.09 (1.31; 3.33)] even at low levels [odds ratiosecond_vs._first_quartile (95% confidence interval), 1.63 (1.05; 2.52)]. High adherence to the Mediterranean dietary pattern could prevent gastric adenocarcinoma [odds ratiofourth_vs._first_quartile (95% confidence interval), 0.53 (0.34; 0.82)]. Although no significant heterogeneity of effects was observed, the harmful effect of the Western pattern was stronger among older participants and for non-cardia adenocarcinomas, whereas the protective effect of the Mediterranean pattern was only observed among younger participants and for non-cardia tumors. CONCLUSION: Decreasing the consumption of fatty and sugary products and of red and processed meat in favor of an increase in the intake of fruits, vegetables, legumes, olive oil, nuts, and fish might prevent gastric adenocarcinoma.The study was supported by the “Acción Transversal del Cáncer,” approved by the Spanish Ministry Council on 11 October 2007, by the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), by the Instituto de Salud Carlos III grants, co-funded by FEDER funds: a way to build Europe-PI08/1770 (to M. Kogevinas), PI09/0773 (to J. Llorca), PI09/1286 (to V. Martín), PI09/1903 (to R. Peiró), PI09/2078 (to F.J. Caballero), PI09/1662 (to J.J. Jiménez-Moleón), PI11/01403 (to N. Aragonés), and PI12/00150 (to B. Pérez-Gómez), by the Fundación Marqués de Valdecilla grant API 10/09 (to J. Llorca), by Catalan Government DURSI grant 2014SGR647 (to V. Moreno) and 2014SGR756 (to S. de Sanjose), by the Junta de Castilla y León Grant LE22A10-2 (to V. Martín), by the Consejería de Salud of the Junta de Andalucía Grant 2009-S0143 (to J. Alguacil), by the Conselleria de Sanitat of the Generalitat Valenciana grant AP061/10 (to R. Peiró), by the Regional Government of the Basque Country, by the Consejería de Sanidad de la Región de Murcia, by the Fundación Caja de Ahorros de Asturias, by the University of Oviedo, by the Spanish Association Against Cancer (AECC) Scientific Foundation, and by the Spanish Ministry of Economy and Competitiveness Juan de la Cierva de Incorporación Grant IJCI-2014-20900 (to A. Castelló). None of the sponsors intervened in any stage of the research.S

Adherence to the Western, Prudent and Mediterranean dietary patterns and breast cancer risk: MCC-Spain study

Objective To externally validate the previously identified effect on breast cancer risk of the Western, Prudent and Mediterranean dietary patterns. Study design MCC-Spain is a multicase-control study that collected epidemiological information on 1181 incident cases of female breast cancer and 1682 control cases from 10 Spanish provinces. Three dietary patterns derived in another Spanish case-control study were analysed in the MCC-Spain study. These patterns were termed Western (high intakes of fatty and sugary products and red and processed meat), Prudent (high intakes of low-fat dairy products, vegetables, fruits, whole grains and juices) and Mediterranean (high intake of fish, vegetables, legumes, boiled potatoes, fruits, olives, and vegetable oil, and a low intake of juices). Their association with breast cancer was assessed using logistic regression models with random province-specific intercepts considering an interaction with menopausal status. Risk according to tumour subtypes ? based on oestrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) receptors (ER+/PR+&HER2-; HER2+; ER-/PR-&HER2-) ? was evaluated with multinomial regression models. Main outcome measures Breast cancer and histological subtype. Results Our results confirm most of the associations found in the previous case-control study. A high adherence to the Western dietary pattern seems to increase breast cancer risk in both premenopausal women (OR4thvs.1stquartile(95%CI):1.68(1.02;2.79); OR1SD-increase(95%CI): 1.19(1.01;1.40)) and postmenopausal women (OR4thvs.1stquartile(95%CI):1.48(1.07;2.05); OR1SD-increase(95%CI): 1.14(1.01;1.28)). While high adherence to the Prudent pattern did not show any effect on breast cancer, the Mediterranean dietary pattern seemed to be protective, but only among postmenopausal women (OR4thvs.1stquartile (95%CI):0.72(95% CI 0.53;0.98); p-int = 0.075). There were no significant differences by tumour subtype. Conclusion Dietary recommendations based on a departure from the Western dietary pattern in favour of the Mediterranean diet could reduce breast cancer risk in the general population.The study was funded by Carlos III Institute of Health grants (PI12/00488, PI12/00265, PI12/00715, PI12/01270, PI09/00773 and PI08/1770), by the Spanish Ministry of Economy and Competitiveness (IJCI-2014-20900) and by Consejería de Salud de la Junta de Andalucía (PI-0571- 2009 and PI-0306-2011) competitive calls including peer review for scientific quality. Additional funding was provided by the Spanish Federation of Breast Cancer Patients (FECMA: EPY 1169- 10), the Association of Women with Breast Cancer from Elche (AMACMEC:EPY 1394/15), the Marqués de Valdecilla foundation (grant API 10/09), ) and by Acción Transversal del Cancer, approved by the Spanish Ministry Council on October 11, 2007. None of the funders played any role in conducting research or writing the paper

Comparison of body mass index (BMI) with the CUN-BAE body adiposity estimator in the prediction of hypertension and type 2 diabetes

Background Obesity is a world-wide epidemic whose prevalence is underestimated by BMI measurements, but CUN-BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) estimates the percentage of body fat (BF) while incorporating information on sex and age, thus giving a better match. Our aim is to compare the BMI and CUN-BAE in determining the population attributable fraction (AFp) for obesity as a cause of chronic diseases. Methods We calculated the Pearson correlation coefficient between BMI and CUN-BAE, the Kappa index and the internal validity of the BMI. The risks of arterial hypertension (AHT) and diabetes mellitus (DM) and the AFp for obesity were assessed using both the BMI and CUN-BAE. Results 3888 white subjects were investigated. The overall correlation between BMI and CUN-BAE was R2 = 0.48, which improved when sex and age were taken into account (R2 > 0.90). The Kappa coefficient for diagnosis of obesity was low (28.7 %). The AFp was 50 % higher for DM and double for AHT when CUN-BAE was used. Conclusions The overall correlation between BMI and CUN-BAE was not good. The AFp of obesity for AHT and DM may be underestimated if assessed using the BMI, as may the prevalence of obesity when estimated from the percentage of BF

Editorial decisions: highlighting the role of systematic reviews

En 2014, el doctor Gerard Urrútia del Centro Cochrane Iberoamericano - Institut d'Investigació Biomèdica Sant Pau, escribió unas líneas editoriales para la Revista Española de Nutrición Humana y Dietética1 en las que ponía en valor la necesidad de "incrementar el rigor científico tanto en la producción de estudios científicos, que proporcionen las bases para una toma de decisiones bien fundamentada, como en su divulgación mediante publicaciones científicas de calidad" en el ámbito de la nutrición y la dietética. Asimismo vaticinaba que "cabría esperar, por una parte, un creciente interés en la producción de revisiones sistemáticas por parte de profesionales de nuestro medio, también entre dietistas y nutricionistas, y por otra, una mayor calidad y, por tanto, utilidad e impacto de las revisiones publicadas en las revistas españolas e iberoamericanas"