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

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

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

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

Anthropometric variables as mediators of the association of changes in diet and physical activity with inflammatory profile

Data de publicació electrònica: 08-03-2021Background: Mechanisms underlying the associations of high levels of physical activity (PA) and adherence to the Mediterranean Diet (MedDiet) with a better inflammatory profile remain unclear. Our objective was to assess the mediating role of changes in body mass index (BMI) and waist circumference (WC), as markers of body fat in the association of changes in PA and adherence to the MedDiet, with changes in the inflammatory profile. Methods: This study included 489 adults, aged 55 to 75 years, from the PREDIMED-Plus multi-centre lifestyle intervention trial. An inflammatory score was calculated, based on 8 blood biomarkers: high-sensitivity C-reactive protein, interleukin 6, interleukin 8, interleukin 18, monocyte chemo-attractant protein-1, C-peptide, leptin, and regulated on activation, normal T-cell expressed and secreted chemokine (RANTES). Biomarkers, levels of PA, score of MedDiet adherence, BMI and WC were measured at baseline and at one-year follow-up. Linear regression models were fitted according to the Baron and Kenny framework for mediation analysis. Results: Changes in BMI and WC mediated the association of both changes in PA and changes in the MedDiet adherence with the inflammatory score. BMI mediated 26% of the association of changes in total PA with the inflammatory profile, and 27% of the association of changes in the MedDiet, while WC mediated 13% and 12% of these associations, respectively. Conclusion: In older adults at high cardiovascular risk, increasing PA levels and adherence to a MedDiet during 1 year were associated with a lower inflammatory score, which was partly mediated by a reduction in body fat.Background: Mechanisms underlying the associations of high levels of physical activity (PA) and adherence to the Mediterranean Diet (MedDiet) with a better inflammatory profile remain unclear. Our objective was to assess the mediating role of changes in body mass index (BMI) and waist circumference (WC), as markers of body fat in the association of changes in PA and adherence to the MedDiet, with changes in the inflammatory profile. Methods: This study included 489 adults, aged 55 to 75 years, from the PREDIMED-Plus multi-centre lifestyle intervention trial. An inflammatory score was calculated, based on 8 blood biomarkers: high-sensitivity C-reactive protein, interleukin 6, interleukin 8, interleukin 18, monocyte chemo-attractant protein-1, C-peptide, leptin, and regulated on activation, normal T-cell expressed and secreted chemokine (RANTES). Biomarkers, levels of PA, score of MedDiet adherence, BMI and WC were measured at baseline and at one-year follow-up. Linear regression models were fitted according to the Baron and Kenny framework for mediation analysis. Results: Changes in BMI and WC mediated the association of both changes in PA and changes in the MedDiet adherence with the inflammatory score. BMI mediated 26% of the association of changes in total PA with the inflammatory profile, and 27% of the association of changes in the MedDiet, while WC mediated 13% and 12% of these associations, respectively. Conclusion: In older adults at high cardiovascular risk, increasing PA levels and adherence to a MedDiet during 1 year were associated with a lower inflammatory score, which was partly mediated by a reduction in body fat