Asociación entre la severidad de las alteraciones de la conducta alimentaria y el patrón dietético: estudio comparativo en escolares de primaria y secundaria

Objetivos: Valorar si los diferentes grados de severidad de los trastornos de la Conducta Alimentaria (TCA) conllevan cambios alimentarios con trascendencia nutricional o son cuadros conductuales con escasa repercusión sobre el desarrollo desde edades tempranas previas a la adolescencia. Estudiar en qué medida factores antropométricos y psicosociales participan en el proceso de desarrollo de los TCA desde la pradolescencia.Material y Métodos: Se basó en dos estudios transversales con diseño en doble fase. En la primera fase se han cribado a 1522 escolares de primaria o preadolescentes y a 3122 escolares de secundaria o adolescentes. En la segunda fase se estudiaron a 259 sujetos de primaria (129 de riesgo y 130 controles) y a 425 sujetos de secundaria (217 de riesgo y 208 controles). Se determinó, en cada grupo de edad, los sujetos con Trastornos de la Conducta Alimentaria No Especificados.Se administraron el Children Eating Atittudes Test (ChEAT), el Eating Atittudes Test (EAT) y Youth's Inventory-IV. Se confirmaron los diagnósticos de TCA mediante la Entrevista de Diagnóstico para Niños y Adolescentes (en los preadolescentes) y el Schedules for Clinical Assesment in Neuropsychiatry (en los adolescentes). Se determinó el consumo alimentario de 3 días no consecutivos (incluyendo uno no festivo). Se aplicó la técnica de Goldberg para validar la estimación de la ingesta energética referida. Se determinaron los patrones alimentarios mediante análisis factorial (método de componentes principales), el sobrepeso y la obesidad mediante los puntos de corte de Cole y col. y la insatisfacción corporal (IC) a través del Body Areas Satisfaction Test. Se analizaron los datos con el paquete estadístico SPSS 13.0.Resultados: Las mujeres consumen menos energía a mayor severidad de los TCA y esta restricción es más evidente en la adolescencia. Los nutrientes que presentan mayor riesgo nutricional son calcio, fósforo, hierro y folatos. Existen diferencias en el patrón alimentario según la severidad de los TCA y de la edad. En ambos sexos y en los dos grupos de edad, la frecuencia de exceso de peso y de masa grasa aumenta significativamente a mayor severidad de los TCA. Las chicas que tienen riesgo de padecer un TCA y que presentan mayor IMC manifiestan más IC. En las chicas adolescentes del grupo de riesgo, factores socioculturales y emocionales está asociados a la IC.Conclusiones: Las mujeres consumen menos energía y nutrientes a mayor severidad de los TCA, siendo significativo en las mujeres adolescentes. La restricción se debe a los lípidos en las preadolescentes, mientras que en las adolescentes se debe a los tres macronutrientes de forma proporcional. Tanto en la preadolescencia como en la adolescencia, el mayor IMC y la menor satisfacción corporal están asociados negativamente con la ingesta energética sólo en el sexo femenino y principalmente cuando existe riesgo de TCA.Objectives: To evaluate whether differing grades of severity of eating disorders (ED) bring about changes in feeding of nutritional importance or whether they are behavioural conditions with little repercussion on development from early ages prior to adolescence.To study to what extent anthropometrical and psycho-social factors participate in the process of development of ED from pre-adolescence. Material and Methods: Two transversal studies with two phases were performed. During the first phase 1522 primary or pre-adolescent school children were screened and 3122 secondary or adolescent school children. During the second phase 259 primary school subjects (129 at risk and 130 controls) and 425 secondary school subjects (217 at risk and 208 controls). Subjects with unspecified eating disorders were identified in each age group.The Children Eating Attitudes Test (ChEAT), Eating Attitudes Test (EAT) and Youth's Inventory-IV tests were performed. ED diagnoses were confirmed using the diagnostic interview for children and adolescents (in preadolescents) and the Schedules for Clinical Assessment in Neuropsychiatry (in adolescents). 3 nonconsecutive day's food intake was recorded (including a weekday). The Goldberg test was used to validate the estimation of energy intake. Feeding patterns were determined using factorial analysis (method of principal components), overweight and obesity using Cole et al's cut-off points and body dissatisfaction (BD) using the Body Areas Satisfaction Test. Data was analysed using the SPPS statistical package (version 13.0). Results: ED of greater severity was associated with lower energy intake in girls and this was more evident during adolescence. Calcium, phosphorous, iron and folates are the most susceptible nutrients to deficiency. Differences in feeding patterns were observed according to severity of the ED and age. In both sexes and in both age groups the frequency of excess weight and fat mass increased significantly with greater severity of ED. Girls at risk of ED and with greater BMI showed greater BD. In the risk group of adolescent girls, socio-cultural and emotional factors were associated with BD.Conclusions: Greater severity of ED was associated with less energy and nutrient intake in girls and this was significant in adolescents. While the restriction is of lipid origin in preadolescents, the three macronutrients are equally restricted in adolescents. In both preadolescence and adolescence, greater BMI and less body satisfaction are negatively associated with energy intake only in girls and mainly in situations of ED risk

Adopting a High-Polyphenolic Diet Is Associated with an Improved Glucose Profile: Prospective Analysis within the PREDIMED-Plus Trial

The prevalence of diabetes is experiencing an increasing trend, and in 2019 it was the ninth leading cause of death in the world. Additionally, individuals with diabetes are more likely to suffer from other noncommunicable diseases such as heart attacks, strokes, or kidney disease. The expectations for the forthcoming years are not encouraging since the prevalence of diabetes has been increasing over the past decades. Nevertheless, type-2 diabetes (T2D), the most prevalent type, can be prevented by modifying harmful behavioral risk factors such as smoking, an unhealthy diet, sedentarism, and alcohol abuse [1]. In the search for the best dietary pattern to prevent or stop the progression of T2D, plant-based diets such as Mediterranean-style, vegetarian or vegan diets have been studied in several prospective observational studies and clinical trials [2]. Healthy plant-based diets are based on the consumption of large amounts of whole grains, fruits, vegetables, legumes, and nuts, as well as healthy fats such as extra virgin olive oil, which are associated with a lower risk of developing cardiovascular disease and T2D [3]. A trait all these foods have in common is a richness in polyphenols, bioactive plant secondary metabolites with a vast structural diversity. According to their structure, polyphenols are classified into two main groups: flavonoids and non-flavonoids. Polyphe nols in the flavonoid group share the C6-C3-C6 structure and can be divided into the following subgroups: flavones, flavonols, theaflavins, catechins, proanthocyanidins (poly meric forms), flavanones, anthocyanidins, and isoflavones, whereas the non-flavanoids are classified as phenolic acids, lignans, and stilbenes [4]. Protective effects of polyphenols against the incidence and complications of T2D are supported by mechanistic studies conducted in animals [5] as well as clinical and epidemiological studies [6], although the available evidence is still limited and inconsistent. Furthermore, no previous study has examined the association between changes in the intake of all polyphenolic groups and subgroups and T2D-related parameters in a population with or at high-risk of T2D. The aim of the present work was to determine whether changing to a high polyphenol diet is associated with an improved glucose profile. Due to the heterogeneity of polyphenols in terms of bioavailability and metabolism, they were studied in separate groups

Vitamin D Intake and the Risk of Colorectal Cancer: An Updated Meta-Analysis and Systematic Review of Case-Control and Prospective Cohort Studies

Obesity, a sedentary lifestyle, high red meat consumption and alcohol, and tobacco are considered the driving factors behind colorectal cancer (CRC) worldwide. Both diet and lifestyle are recognized to play an important role in the prevention of CRC. Forty years later, the vitamin D-cancer hypothesis is considered consistent. However, the relationship between low vitamin D intake and CRC is still controversial. The aim of this meta-analysis is to determine the associations between Vitamin D intake and CRC. MEDLINE-PubMed and Cochrane databases were searched up to May 2020 for studies evaluating the association between vitamin D intake (from foods and supplements) and CRC. Two reviewers, working independently, screened all titles and abstracts to identify the studies that met the inclusion criteria (case-control or prospective cohort (PC) studies published in English). Data were pooled by the generic inverse variance method using a random or fixed effect model. Heterogeneity was identified using the Cochran Q-test and quantified by the I2 statistic. A total of 31 original studies were included for the quantitative meta-analysis, comprising a total 47.540 cases and 70.567 controls in case-control studies, and a total of 14.676 CRC-incident cases (out of 808.130 subjects in PC studies) from 17 countries. A significant 25% lower risk was reported comparing the highest vs. the lowest dietary vitamin D consumption and CRC risk (odds ratio (95% confidence interval): 0.75 (0.67; 0.85)) in case-control studies, whereas a non-significant association was reported in case of prospective studies (hazard ratio (95% confidence interval): 0.94 (0.79; 1.11). The present meta-analysis demonstrates that high dietary vitamin D is associated to CRC prevention. However, larger and high-quality prospective studies and clinical trials are warranted to confirm this association. View Full-Text Keywords: vitamin D intake; meta-analysis; systematic review; colorectal cancer; incidence; case-control; prospectiv

Glycemic Dysregulations Are Associated With Worsening Cognitive Function in Older Participants at High Risk of Cardiovascular Disease: Two-Year Follow-up in the PREDIMED-Plus Study

Introduction: Type 2 diabetes has been linked to greater cognitive decline, but other glycemic parameters such as prediabetes, diabetes control and treatment, and HOMA-IR and HbA1c diabetes-related biomarkers have shown inconsistent results. Furthermore, there is limited research assessing these relationships in short-term studies. Thus, we aimed to examine 2-year associations between baseline diabetes/glycemic status and changes in cognitive function in older participants at high risk of cardiovascular disease. Methods: We conducted a 2-year prospective cohort study (n=6,874) within the framework of the PREDIMED-Plus study. The participants (with overweight/obesity and metabolic syndrome; mean age 64.9 years; 48.5% women) completed a battery of 8 cognitive tests, and a global cognitive function Z-score (GCF) was estimated. At baseline, participants were categorized by diabetes status (no-diabetes, prediabetes, and <5 or ≥5-year diabetes duration), and also by diabetes control. Furthermore, insulin resistance (HOMA-IR) and glycated hemoglobin (HbA1c) levels were measured, and antidiabetic medications were recorded. Linear and logistic regression models, adjusted by potential confounders, were fitted to assess associations between glycemic status and changes in cognitive function. Results: Prediabetes status was unrelated to cognitive decline. However, compared to participants without diabetes, those with ≥5-year diabetes duration had greater reductions in GCF (β=-0.11 (95%CI -0.16;-0.06)], as well as in processing speed and executive function measurements. Inverse associations were observed between baseline HOMA-IR and changes in GCF [β=-0.0094 (95%CI -0.0164;-0.0023)], but also between HbA1c levels and changes in GCF [β=-0.0085 (95%CI -0.0115, -0.0055)], the Mini-Mental State Examination, and other executive function tests. Poor diabetes control was inversely associated with phonologic fluency. The use of insulin treatment was inversely related to cognitive function as measured by the GCF [β=-0.31 (95%CI -0.44, -0.18)], and other cognitive tests. Conclusions: Insulin resistance, diabetes status, longer diabetes duration, poor glycemic control, and insulin treatment were associated with worsening cognitive function changes in the short term in a population at high cardiovascular risk

Prospective associations between a priori dietary patterns adherence and kidney function in an elderly Mediterranean population at high cardiovascular risk

Purpose To assess the association between three diferent a priori dietary patterns adherence (17-item energy reduced Mediterranean Diet (MedDiet), Trichopoulou-MedDiet and Dietary Approach to Stop Hypertension (DASH)), as well as the Protein Diet Score and kidney function decline after one year of follow-up in elderly individuals with overweight/obesity and metabolic syndrome (MetS). Methods We prospectively analyzed 5675 participants (55–75 years) from the PREDIMED-Plus study. At baseline and at one year, we evaluated the creatinine-based estimated glomerular fltration rate (eGFR) and food-frequency questionnaires derived dietary scores. Associations between four categories (decrease/maintenance and tertiles of increase) of each dietary pattern and changes in eGFR (ml/min/1.73m2 ) or≥10% eGFR decline were assessed by ftting multivariable linear or logistic regression models, as appropriate. Results Participants in the highest tertile of increase in 17-item erMedDiet Score showed higher upward changes in eGFR (β: 1.87 ml/min/1.73m2 ; 95% CI: 1.00–2.73) and had lower odds of≥10% eGFR decline (OR: 0.62; 95% CI: 0.47–0.82) compared to individuals in the decrease/maintenance category, while Trichopoulou-MedDiet and DASH Scores were not associated with any renal outcomes. Those in the highest tertile of increase in Protein Diet Score had greater downward changes in eGFR (β: − 0.87 ml/min/1.73m2 ; 95% CI: − 1.73 to − 0.01) and 32% higher odds of eGFR decline (OR: 1.32; 95% CI: 1.00–1.75). Conclusions Among elderly individuals with overweight/obesity and MetS, only higher upward change in the 17-item erMedDiet score adherence was associated with better kidney function after one year. However, increasing Protein Diet Score appeared to have an adverse impact on kidney health. Trial Registration Number: ISRCTN89898870 (Data of registration: 2014)

White blood cell counts as risk markers of developing metabolic syndrome and its components in the Predimed study.

Background The Metabolic Syndrome (MetS) is a cluster of metabolic abnormalities that includes hyperglucemia, hypertension, dyslipidemia and central obesity, conferring an increased risk of cardiovascular disease. The white blood cell (WBC) count has been proposed as a marker for predicting cardiovascular risk. However, few prospective studies have evaluated the relationship between WBC subtypes and risk of MetS. Methods Participants were recruited from seven PREDIMED study centers. Both a baseline cross-sectional (n = 4,377) and a prospective assessment (n = 1,637) were performed. Participants with MetS at baseline were excluded from the longitudinal analysis. The median follow-up was 3.9 years. Anthropometric measurements, blood pressure, fasting glucose, lipid profile and WBC counts were assessed at baseline and yearly during the follow-up. Participants were categorized by baseline WBC and its subtype count quartiles. Adjusted logistic regression models were fitted to assess the risk of MetS and its components. Results Of the 4,377 participants, 62.6% had MetS at baseline. Compared to the participants in the lowest baseline sex-adjusted quartile of WBC counts, those in the upper quartile showed an increased risk of having MetS (OR, 2.47; 95%CI, 2.03-2.99; P-trend<0.001). This association was also observed for all WBC subtypes, except for basophils. Compared to participants in the lowest quartile, those in the top quartile of leukocyte, neutrophil and lymphocyte count had an increased risk of MetS incidence. Leukocyte and neutrophil count were found to be strongly associated with the MetS components hypertriglyceridemia and low HDL-cholesterol. Likewise, lymphocyte counts were found to be associated with the incidence of the MetS components low HDL-cholesterol and high fasting glucose. An increase in the total WBC during the follow-up was also associated with an increased risk of MetS. Conclusions Total WBC counts, and some subtypes, were positively associated with MetS as well as hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, all components of MetS

Waist-to-Height Ratio and Cardiovascular Risk Factors in Elderly Individuals at High Cardiovascular Risk

IntroductionSeveral anthropometric measurements have been associated with cardiovascular disease, type-2 diabetes mellitus and other cardiovascular risk conditions, such as hypertension or metabolic syndrome. Waist-to-height-ratio has been proposed as a useful tool for assessing abdominal obesity, correcting other measurements for the height of the individual. We compared the ability of several anthropometric measurements to predict the presence of type-2 diabetes, hyperglycemia, hypertension, atherogenic dyslipidemia or metabolic syndrome.Materials and MethodsIn our cross-sectional analyses we included 7447 Spanish individuals at high cardiovascular risk, men aged 55–80 years and women aged 60–80 years, from the PREDIMED study. Logistic regression models were fitted to evaluate the odds ratio of presenting each cardiovascular risk factor according to various anthropometric measures. The areas under the receiver-operating characteristic curve (AUC) were used to compare the predictive ability of these measurements.ResultsIn this relatively homogeneous cohort with 48.6% of type-2 diabetic individuals, the great majority of the studied anthropometric parameters were significantly and positively associated with the cardiovascular risk factors. No association was found between BMI and body weight and diabetes mellitus. The AUCs for the waist-to-height ratio and waist circumference were significantly higher than the AUCs for BMI or weight for type-2 diabetes, hyperglycemia, atherogenic dyslipidemia and metabolic syndrome. Conversely, BMI was the strongest predictor of hypertension.ConclusionsWe concluded that measures of abdominal obesity showed higher discriminative ability for diabetes mellitus, high fasting plasma glucose, atherogenic dyslipidemia and metabolic syndrome than BMI or weight in a large cohort of elderly Mediterranean individuals at high cardiovascular risk. No significant differences were found between the predictive abilities of waist-to-height ratio and waist circumference on the metabolic disease

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

Effect of mediterranean-diet on metabolic syndrome status in the predimed study

Trabajo presentado en el X lntemational Conference Mediterranean Diet, celebrado en Barcelona (España) del 02 al 03 de abril de 2014