Effectiveness of the physical activity intervention program in the PREDIMED-Plus study: a randomized controlled trial

Background: The development and implementation of effective physical activity (PA) intervention programs is challenging, particularly in older adults. After the first year of the intervention program used in the ongoing PREvención con DIeta MEDiterránea (PREDIMED)-Plus trial, we assessed the initial effectiveness of the PA component. Methods: PREDIMED-Plus is an ongoing randomized clinical trial including 6874 participants randomized to an intensive weight-loss lifestyle intervention based on an energy-restricted Mediterranean diet (MedDiet), physical activity promotion and behavioral support and to a control group using MedDiet recommendations but without calorie restriction or PA advice. Body mass index (BMI) and waist circumference (WC) are measured by standard clinical protocols. Duration and intensity of PA is self-reported using the validated REGICOR Short Physical Activity Questionnaire. The primary endpoint of the PREDIMED-Plus trial is a combined cardiovascular outcome: myocardial infarction (acute coronary syndromes with positive troponin test), stroke, or cardiovascular mortality. The present study involved secondary analysis of PA data (n = 6059; mean age 65 ± 4.9 years) with one-year changes in total, light, and moderate-to-vigorous PA within and between intervention groups as the outcome. Generalized estimating equation models were fitted to evaluate time trends of PA, BMI, and WC within groups and differences between intervention and control groups. Results: After 12 months, average daily MVPA increased by 27.2 (95%CI 5.7;48.7) METs-min/day and 123.1 (95%CI 109. 7–136.6) METs-min/day in the control and intervention groups, respectively. Total-PA, light-PA, and MVPA increased significantly (p < 0.01) in both groups. A significant (p < 0.001) time*intervention group interaction was found for Total-PA and MVPA, meaning the PA trajectory over time differed between the intervention and control groups. Age, sex, education level, and BMI did not moderate the effectiveness of the PA intervention. BMI and WC decreased significantly with increasing MVPA, compared with participants who reported no changes in MVPA.Conclusion: After one year of follow-up, the PREDIMED-Plus PA intervention has been effective in increasing daily PA in older adult

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Association of physical activity with cardiovascular risk factors and all-cause mortality in older Spanish individuals

Among older adults, there is limited evidence on the prospective associations of physical activity (PA) with cardiovascular risk factors and mortality. This thesis aimed to: i) Analyse the prospective associations of leisure-time physical activity (LTPA) with body mass index (BMI), waist circumference (WC), and incidence of obesity. ii) Assess the independent and joint associations of LTPA and adherence to the Mediterranean diet (MedDiet) with all-cause mortality. iii) Determine the association between changes in PA and changes in the inflammatory profile. iv) Assess the effectiveness of a 1-year PA intervention. This thesis used data from two Spanish trials: the PREDIMED and the PREDIMED-Plus studies. We found that increasing total and MVPA were inversely associated with surrogate markers of fat, the inflammatory profile, and incidence of general and abdominal obesity. High adherence to the MedDiet, together with high levels of PA (total, light and MVPA), were associated with the lowest risk of all-cause mortality. The PA intervention was effective in increasing total and MVPA and decreasing surrogate markers of fat. The findings that light PA was inversely associated with the incidence of general obesity and all-cause mortality, and that increases in moderate PA were associated with decreases in the inflammatory profile, are relevant because these intensities of PA provides a feasible option for older adults.En adultos mayores, la evidencia sobre las asociaciones prospectivas de la actividad física (AF) con factores de riesgo cardiovascular y mortalidad es limitada. El objetivo de esta tesis fue: i) Analizar las asociaciones prospectivas de la actividad física durante el tiempo libre (AFTL) con el índice de masa corporal (IMC), la circunferencia de cintura (CC), y la incidencia de obesidad. ii) Estudiar las asociaciones independientes y conjuntas de la AFTL y la adherencia a la dieta Mediterránea (DM) con la mortalidad por todas las causas. iii) Determinar la asociación entre cambios en la AF y cambios en el perfil inflamatorio. iv) Evaluar la efectividad de una intervención con AF de un año de duración. Los datos de esta tesis provienen de dos ensayos clínicos realizados en España: el estudio PREDIMED y el estudio PREDIMED–Plus. Los aumentos en la AF total y en la AF moderada-intensa estuvieron inversamente asociados con marcadores de grasa corporal, con el perfil inflamatorio, y con la incidencia de obesidad abdominal y general. Una alta adherencia a la DM, en conjunto con altos niveles de AF (total, ligera y moderada-intensa), estuvieron asociados con un riesgo de mortalidad por todas las causas bajo. La intervención con AF aumentó la AF total y moderada-intensa y disminuyó los marcadores de grasa. Los hallazgos que mostraron que la AF ligera estaba inversamente asociada con la incidencia de obesidad general y mortalidad por todas las causas, y que aumentos en la actividad física moderada estuvieron asociados con disminuciones en el perfil inflamatorio, son relevantes, porque estas intensidades de AF proporcionan una opción factible para muchos adultos mayores

Flexibilidad de isquiotibiales : una comparación entre masaje tendioso versus técnicas de energía muscular en individuos sanos

Tesis (Kinesiología)La flexibilidad es un elemento básico para una óptima función corporal. Dentro de la musculatura del cuerpo humano los isquiotibiales (IQT) son uno de los grupos musculares con mayor predisposición a sufrir acortamientos. Existen diversas técnicas para aumentar la flexibilidad en los IQT. El presente estudio tiene por objetivo general comparar la efectividad de las Técnicas de Energía Muscular (TEM) versus Masaje tendinoso (MT), utilizadas para aumentar la flexibilidad de los IOT en hombres sanos. Los objetivos específicos son corroborar la efectividad de las TEM y del MT para aumentar la flexibilidad de los IQT, y además, determinar cuál técnica tiene mayores efectos al minuto 1, 3, 6 y 1 O después de ser aplicada. El presente estudio es de tipo cuantitativo, explicativo y cuasiexperimental. La muestra (n = 30) pertenece a estudiantes universitarios varones, con edades comprendidas entre 19 y 23 años (Edad promedio = 21 años, Estatura promedio = 1,70 mt.), los cuales presentaban los criterios de inclusión para participar de forma voluntaria en este estudio. Se evaluó la flexibilidad de la musculatura lsquiotibial de una extremidad inferior (El) escogida al azar. Luego de la evaluación, se aplicó un protocolo de Inducción Miofascial (IM) seguido de una de las dos técnicas (TEM MT) y se volvió a medir la flexibilidad al minuto 1, 3, 6 y 1 O. Una semana después, se volvió a medir la flexibilidad de los isquiotibiales de la misma extremidad inferior y se aplicó el mismo protocolo de IM seguido esta vez de la otra técnica, y se midió la flexibilidad al minuto 1, 3, 6 y 1 O. Para evaluar la flexibilidad se utilizó un goniómetro, y además se diseñó un dispositivo de madera, con la finalidad de facilitar la estabilización lumbo-pélvica para disminuir posibles compensaciones. Se consideró acortamiento de lsquiotibiales un ángulo poplíteo menor a 160°, evaluada por el Test de extensión pasiva de rodilla. Utilizando t de student, se buscó determinar la existencia de diferencias entre ambas técnicas en relación a la cantidad de aumento de flexibilidad y a la duración de esta en los IOT. Los resultados obtenidos demuestran que ambas técnicas son eficaces y producen un aumento significativo de la flexibilidad de los IOT, siendo las TEM las que presentan mayor efectividad.The flexibility is a basic element far an optima! corporal function. Within the different muscles of the human body the hamstring are one of the muscle groups with greater predisposition to undergo shortening. Diverse techniques exist to increase the flexibility in the hamstring. The general purpose of this study is to compare the efficacy of TEM versus TM used to improve the flexibility of the hamstring muscle group in healthy male subjects. The specific objectives are to corroborate the effectiveness of TEM and TM to improve the flexibility of the hamstring muscle group, and in addition, to determine which technique has majors effects at 1, 3, 6 and 1 O minutes after being applied. This study is quasiexperimental, explanatory and quantitative type. The sample (n = 30) belongs to male university students, with ages between 19 and 23 years old (Mean age = 21 years old, Mean Stature = 1,70cm.), which presented the inclusion criteria to participate voluntarily in this study. The flexibility of the hamstrings in one lower extremity was chosen randomly. After the evaluation, the subjects received a protocol of Miofascial induction plus a protocol of one of the two techniques (TEM or MT), followed by a measurement of the flexibility of the hamstrings at 1, 3, 6 and 1 O minutes later. One week later, the flexibility of the hamstring in the same lower extremity of the subject was measured, after this evaluation it was applied the same protocol of miofascial induction, followed this time by a protocol of the other technique, when finalizing the protocol the flexibility was evaluated at 1, 3, 6 and 1 O minutes later. Hamstring flexibility was quantified by a goniometer, also a wood device was designed in arder to facilitate the lumbopelvic stabilization to reduce possible compensations. Shortening hamstrings was considered by < 160° popliteal angle in the PKE Test. The results demonstrate that both techniques are effective, being the TEM the one that present more duration in the flexibility gain after minute 10

Prospective Association of Maternal Educational Level with Child's Physical Activity, Screen Time, and Diet Quality

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children's lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child's physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child's socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child's screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children.This work was supported by a grant from Instituto de Salud Carlos III FEDER, (PI11/01900).Centro de Investigación Biomédica en Red Epidemiologia y Salud Publica (CIBERESP) is an initiativeof the Instituto de Salud Carlos III (ISCIII) of Spain, which is financed by the European RegionalDevelopment Fund (ERDF), “A way to make Europe”/“Investing in your future” (CB06/03). Itis supported by the official funding agency for biomedical research of the Spanish government,ISCIII, Spain

Prospective association of maternal educational level with childs physical activity, screen time, and diet quality

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children's lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child's physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child's socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child's screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children

Prospective association of maternal educational level with child's physical activity, screen time, and diet quality

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children's lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child's physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child's socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child's screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children

Prospective associations between maternal and child diet quality and sedentary behaviors

As the most likely primary caregivers, mothers are an integral part of children's social influence and are therefore greatly involved in shaping their children's behaviors. The objectives were to determine the prospective associations between maternal and child diet quality and sedentary behaviors. This study, within the framework of a community-based intervention study, included 1130 children aged 8-10 years and their mothers. The study was carried out during two academic years (2012/2014) with a mean follow-up of 15 months. Exposure and outcome variables were measured at baseline and follow-up, respectively. Diet quality was assessed by the KIDMED questionnaire and the short Diet Quality Screener, respectively. Sedentary behaviors were determined by standardized questions of sedentary behaviors. Maternal consumption of fruits, vegetables, fish, legumes, pasta/rice, dairy products, nuts and baked goods were positively associated (p < 0.05) with the corresponding child behavior. Multiple linear regression models adjusted for sex, age, maternal education and intervention group revealed significant cross-sectional (p < 0.005) and prospective (p < 0.01) associations between maternal and child overall diet quality and sedentary behaviors. Maternal diet quality and sedentary behaviors were predictive for these lifestyle behaviors in children

Validation of a Parent-Reported Physical Activity Questionnaire by Accelerometry in European Children Aged from 6 to 12 Years Old

Validated physical activity (PA) questionnaires are crucial for collecting information in large epidemiological studies during childhood. Thus, this study analyzed the validity of a parent-reported PA questionnaire based on the Children’s Leisure Activities Study Survey by accelerometry in European children aged from 6 to 12 years old. We used data from 230 children of the Human Early-Life Exposome and Infancia y Medio Ambiente projects. Mean differences between moderate-to-vigorous PA (MVPA) reported by the questionnaire and the accelerometer were calculated (min/day), and its associated factors were explored by multiple robust linear regression. The agreement between methods was examined using a Bland–Altman plot. The concurrent validity of assessing MVPA was analyzed by cohort-adjusted Spearman’s partial correlations. ROC curve analysis was also used to explore the questionnaire’s capability to identify active children based on the World Health Organization guidelines. A moderate correlation was found between parent-reported and accelerometer MVPA (rho = 0.41, p < 0.001). The child’s sex (girl) was statistically associated with the mean MVPA difference between methods. However, this questionnaire accurately identified physically active children (area under the curve = 83.8% and 82.7% for boys and girls, cut-points = 68.6 and 45.4 min/day in MVPA, respectively). Consequently, this questionnaire is suitable for classifying active children in order to monitor public health interventions regarding PA

Validity of prognostic models of critical COVID-19 is variable. A systematic review with external validation

Data de publicació electrònica: 02-05-2023Objectives: To identify prognostic models which estimate the risk of critical COVID-19 in hospitalized patients and to assess their validation properties. Study design and setting: We conducted a systematic review in Medline (up to January 2021) of studies developing or updating a model that estimated the risk of critical COVID-19, defined as death, admission to intensive care unit, and/or use of mechanical ventilation during admission. Models were validated in two datasets with different backgrounds (HM [private Spanish hospital network], n = 1,753, and ICS [public Catalan health system], n = 1,104), by assessing discrimination (area under the curve [AUC]) and calibration (plots). Results: We validated 18 prognostic models. Discrimination was good in nine of them (AUCs ≥ 80%) and higher in those predicting mortality (AUCs 65%-87%) than those predicting intensive care unit admission or a composite outcome (AUCs 53%-78%). Calibration was poor in all models providing outcome's probabilities and good in four models providing a point-based score. These four models used mortality as outcome and included age, oxygen saturation, and C-reactive protein among their predictors. Conclusion: The validity of models predicting critical COVID-19 by using only routinely collected predictors is variable. Four models showed good discrimination and calibration when externally validated and are recommended for their use