Coffee consumption and the risk of depression in a middle-aged cohort: the SUN project

Coffee is one of the most widely consumed drinks around the world, while depression is considered the major contributor to the overall global burden of disease. However, the investigation on coffee consumption and depression is limited and results may be confounded by the overall dietary pattern. We assessed the relationship between coffee intake and the risk of depression, controlling for adherence to the Mediterranean diet. We studied 14,413 university graduates of the Seguimiento Universidad de Navarra' (SUN) cohort, initially free of depression. We evaluated coffee consumption using a validated food-frequency questionnaire (FFQ). Incident depression cases were adjudicated only if the participant met two criteria simultaneously: (a) validated physician-diagnosed depression together with (b) new onset of habitual antidepressant use. Both criteria were needed; participants meeting only one of them were not classified as cases. Participants who drank at least four cups of coffee per day showed a significantly lower risk of depression than participants who drank less than one cup of coffee per day (HR: 0.37 (95% CI 0.15-0.95)). However, overall, we did not observe an inverse linear dose-response association between coffee consumption and the incidence of depression (p for trend = 0.22)

Healthy lifestyle and incidence of metabolic syndrome in the SUN cohort

We assessed the relationship between a healthy lifestyle and the subsequent risk of developing metabolic syndrome. The "Seguimiento Universidad de Navarra" (SUN) Project is a prospective cohort study, focused on nutrition, lifestyle, and chronic diseases. Participants (n = 10,807, mean age 37 years, 67% women) initially free of metabolic syndrome were followed prospectively for a minimum of 6 years. To evaluate healthy lifestyle, nine habits were used to derive a Healthy Lifestyle Score (HLS): Never smoking, moderate to high physical activity (>20 MET-h/week), Mediterranean diet (>= 4/8 adherence points), moderate alcohol consumption (women, 0.1-5.0 g/day; men, 0.1-10.0 g/day), low television exposure (1 h/day, and working at least 40 h/week. Metabolic syndrome was defined according to the harmonizing definition. The association between the baseline HLS and metabolic syndrome at follow-up was assessed with multivariable-adjusted logistic regressions. During follow-up, we observed 458 (4.24%) new cases of metabolic syndrome. Participants in the highest category of HLS adherence (7-9 points) enjoyed a significantly reduced risk of developing metabolic syndrome compared to those in the lowest category (0-3 points) (adjusted odds ratio (OR) = 0.66, 95% confidence interval (CI) = 0.47-0.93). Higher adherence to the Healthy Lifestyle Score was associated with a lower risk of developing metabolic syndrome. The HLS may be a simple metabolic health promotion tool

Relación entre una escala de estilo de vida saludable y el riesgo de enfermedades crónicas en la cohorte SUN

Las enfermedades crónicas,definidas como aquellas que requieren atención médica continua o limitan las actividades de la vida diaria o ambas, constituyen la causa de muerte más frecuente en el mundo y representan más de la mitad de la carga global de enfermedad,con una tendencia en aumento. Son el resultado de una combinación de factores genéticos,fisiológicos, ambientales y comportamiento. La hipertensión arterial, la diabetes y la depresión mayor son unas de las enfermedades crónicas prevenibles más importantes,con un alto impacto económico y social.Comparten factores de riesgo relacionados con el estilo de vida,que interactúan de forma compleja y pueden afectar positiva o negativamente a la salud.Incidir sobre estos factores modificables es la mejor opción coste-efectiva para el control de estas enfermedades y se puede lograr, en gran parte,a través de un estilo de vida saludable (EVS). Los objetivos generales del trabajo fueron analizar la asociación entre una escala combinada de estilo de vida saludable y la incidencia de nuevos diagnósticos clínicos de enfermedades crónicas incluyendo hipertensión, diabetes mellitus tipo 2, depresión y mortalidad por todas las causas en la cohorte Seguimiento Universidad de Navarra (SUN). El estudio SUN es una cohorte prospectiva, multipropósito y dinámica.El reclutamiento de los participantes comenzó en 1999 y sigue abierto actualmente.El cuestionario basal recoge información sobre variables antropométricas, sociodemográficas y de estilo de vida.El seguimiento de los participantes se realiza mediante cuestionarios de seguimiento enviados cada 2 años por correo postal con un sobre a franquear a destino o por vía electrónica. Para valorar la adhesión a un EVS se utilizó una escala previamente asociada con menor riesgo de eventos cardiovasculares en nuestra cohorte.Esta escala construida con los datos recogidos en el cuestionario basal, se calculó dando un punto a cada participante por cada uno de los siguientes hábitos:no fumar, actividad física moderada-alta (>20 MET-h/semana), dieta Mediterránea (≥4/8 puntos de adhesión), bajo IMC (≤22 kg/m2), consumo de alcohol moderado (mujeres 0,1-5,0 g/d; hombres 0,1-10,0 g/d; excluyendo abstemios),baja exposición a televisión (<2 h/d), no beber alcohol en atracones (≤5 bebidas alcohólicas por día en cualquier ocasión), dormir una breve siesta (<30 min/d), estar con amigos (>1 h/d) y trabajar al menos 40 h/semana. Se ajustaron modelos de regresión de Cox para evaluar el riesgo de hipertensión, diabetes tipo 2, depresión y mortalidad por todas las causas durante el seguimiento según la adherencia a la escala de EVS. Se calcularon HR y sus IC del 95%, utilizando como referencia la categoría con las puntuaciones de estilo de vida más bajas.Se incluyó la edad como variable de tiempo subyacente y los modelos de Cox se estratificaron por deciles de edad y por 5 categorías de años calendario según la fecha de ingreso en la cohorte. Tras ajustar por múltiples posibles factores de confusión, observamos que un mayor número de factores de estilo de vida saludable se asoció de forma estadísticamente significativa con un menor riesgo de hipertensión,diabetes, depresión y mortalidad por todas las causas.Los participantes en la categoría más alta de adhesión a la escala de EVS mostraron una reducción relativa del 46% del riesgo de hipertensión arterial, del 46% del riesgo de diabetes tipo 2, del 32% del riesgo de depresión y un 60% menor riesgo de mortalidad por todas las causas; en comparación con la categoría más baja de adhesión a la escala.Por tanto,estos hallazgos enfatizan la importancia de promover hábitos saludables como piedra angular en la atención médica y la promoción de la salud en general,más allá de los factores de riesgo tradicionales.Esta escala podría servir como herramienta práctica para capacitar a las personas a adquirir un mayor auto-control sobre su salud

Lifestyle-Related Factors and Total Mortality in a Mediterranean Prospective Cohort

Introduction: Lifestyle-related habits have a strong influence on morbidity and mortality world- wide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors. Methods: Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were fol- lowed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours per week. Results: During a median follow-up of 10.8 years, 407 deaths were documented. In the multivari- able adjusted analysis, the highest category of adherence to the score (7−10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0−3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88). Conclusions: Adherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority. Am J Prev Med 2020;59(2):e59−e67. © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved

Lifestyles and the risk of depression in the “Seguimiento Universidad de Navarra” cohort

Background: Lifestyles are involved in the pathogenesis of depression and many of these factors can be modified for the potential prevention of depression. Our aim was to assess the association between a healthy-lifestyle score, that includes some less-studied lifestyle indicators, and the risk of depression. Methods: We followed 14,908 participants initially free of any history of depression in the “Seguimiento Universidad de Navarra” (SUN) cohort. Information was collected biennially from 1999 to December 2016. We calculated a healthy-lifestyle score (0–10 points), previously associated with cardioprotection, by giving one point to each of the following components: never smoking, physical activity (> 20 METs-h/ week), Mediterranean diet adherence ( 4 points), healthy body mass index ( 22 kg/m2 ), moderate alcohol consumption (women 0.1–5 g/d; men 0.1–10 g/d of ethanol), avoidance of binge drinking (never more than 5 alcoholic drinks in a row), low television exposure ( 2 h/d), short afternoon nap ( 30 min/ day), time spent with friends (>1 h/d) and working at least 40 h/week. Results: During a median follow-up of 10.4 years, we observed 774 new cases of major depression among participants initially free of depression. The highest category (8–10 factors) showed a significant inverse association with a 32% relative risk reduction for depression compared to the lowest category (0–3 factors) (multivariable-adjusted hazard ratio: 0.68; 95% CI:0.49-0.95) (p for trend = 0.010). Conclusions: Adopting a healthy-lifestyle was associated with a lower risk of incident depression in the SUN cohort. This index, including ten simple healthy lifestyle habits, may be useful for a more integrative approach to depression prevention

Low dietary magnesium and overweight/obesity in a Mediterranean population: a detrimental synergy for the development of hypertension. The SUN Project

Hypertension is the strongest independent modifiable risk factor for cardiovascular disease. We aimed to investigate the association of magnesium intake with incident hypertension in a Mediterranean population, and the potential modification of this association by body mass index (BMI). We assessed 14,057 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (67.0% women) initially free of hypertension. At baseline, a validated 136-item food frequency questionnaire was administered. We used Cox models adjusted for multiple socio-demographic, anthropometric, and lifestyle factors, and prevalent conditions present at baseline. Among a mean 9.6 years of follow-up we observed 1406 incident cases of medically diagnosed hypertension. An inverse association in multivariable-adjusted models was observed for progressively higher magnesium intake up to 500 mg/d vs. intake 27 kg/m(2). Lean participants with magnesium intake 200 mg/d also had a higher risk of incident hypertension. Adherence to the Mediterranean diet did not modify these associations. In conclusion, dietary magnesium intake < 200 mg/d was independently associated with a higher risk of developing hypertension in a Mediterranean cohort, stronger for overweight/obese participants. Our results emphasize the importance of encouraging the consumption of magnesium-rich foods (vegetables, nuts, whole cereals, legumes) in order to prevent hypertension

Use of non-steroidal anti-inflammatory drugs, aspirin and the risk of depression: The "Seguimiento Universidad de Navarra (SUN)" cohort.

Background: The potential effect of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to prevent depression remains largely unknown, in spite of the implication of inflammation in depression. This study aimed to investigate whether the habitual intake of aspirin and other NSAIDs was prospectively associated with a reduction in the observed incidence of depression. Methods: A dynamic cohort including 22,564 Spanish university graduates (mean age: 37 years) initially free of depression was followed during an average of 8.7 years. Exposure to NSAIDs was assessed with specific repeated questionnaires throughout follow-up, starting in the 2-year follow-up questionnaire. Incident cases of depression were defined as either a new validated medical diagnosis of depression or reporting the initiation of habitual use of antidepressants. Results: We identified 772 incident cases of depression. Regular intake of aspirin and other NSAIDs was not associated with depression risk. Only in secondary sensitivity analyses using a definition of the outcome with higher specificity (a validated medical diagnosis of depression), an inverse association of aspirin with depression was found [HR (95%CI): 0.20 (0.04–0.87)]. However, these results were non-significant after adjustment for multiple testing. Limitations: A possible underestimation of incident depression and a limited ability to detect all possible residual confounding. Conclusions: Regular use of NSAIDs was not associated with the incidence of depression. Further longitudinal controlled studies are necessary to clarify a potential role of aspirin use in depression risk