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1. Nutrient adequacy and diet quality in a Mediterranean population with metabolic syndrome: A cross-sectional study

Author

Cristina Bouzas, Josep A. Tur, Clotilde Vázquez, Montserrat Fitó, Nerea Becerra-Tomás, Josep Vidal, Rebeca Fernández-Carrión, J. Alfredo Martínez, M. Dolors Zomeño, Jordi Salas-Salvadó, Pilar Matía, Francisco J. Tinahones, Jose Lopez-Miranda, M. Angeles Zulet, Emilio Ros, Javier Díez-Espino, Josep Basora, Ramon Estruch, Miguel Delgado-Rodríguez, Lluis Serra-Majem, Manuela Abbate, Estefanía Toledo, José Lapetra, Miguel Ángel Martínez-González, Antonio Garcia-Rios, Dora Romaguera, Ángel M. Alonso-Gómez, Maria del Mar Bibiloni, Juan Carlos Cenoz, Lidia Daimiel, Vicente Martín, Dolores Corella, Jesús Vioque, Xavier Pintó, Alberto Asensio, Helmut Schröder, Aurora Bueno-Cavanillas, and Julia Wärnberg

Subjects
0301 basic medicine, Male, Mediterranean diet, Population, Physiology, Nutritional Status, 030209 endocrinology & metabolism, Overweight, Critical Care and Intensive Care Medicine, Diet, Mediterranean, Diabetes, Diet quality, Mediterranean diet, Nutrient adequacy, Pre-diabetes, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Surveys and Questionnaires, medicine, Humans, Micronutrients, education, Geriatric Assessment, Aged, Metabolic Syndrome, education.field_of_study, 030109 nutrition & dietetics, Nutrition and Dietetics, Nutrient adequacy, business.industry, Diabetes, Middle Aged, medicine.disease, Micronutrient, Obesity, Cross-Sectional Studies, Nutrition Assessment, Dietary Reference Intake, Spain, Patient Compliance, Female, medicine.symptom, Metabolic syndrome, Pre-diabetes, business, Diet quality
Abstract

Background & aims: Few studies have compared micronutrient intake and fulfilment of average requirements (EAR) in non-diabetic, pre-diabetic and diabetic adults at high cardiovascular risk. We assessed these variables in a large sample of participants in the PREDIMED-PLUS randomized trial of primary cardiovascular prevention with diet and physical activity. Design: Baseline assessment of nutritional adequacy in n = 5792 men and women, aged 55-75 years, with overweight/obesity and some metabolic syndrome features. Methods: Participants were categorised as non-diabetic (n = 2390), pre-diabetic (n = 1322) or diabetic (n = 2080) by standard criteria. Food and nutrient intake were assessed using a validated food frequency questionnaire. Micronutrients examined were vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine. The proportion of micronutrient inadequacy was evaluated using the EAR or adequate intake (AI) cut-offs. Diet quality was also determined using a 17-item energy-restricted Mediterranean diet (MedDiet) questionnaire. Results: Compared to non-diabetic participants, those with pre-diabetes had lower intakes of total carbohydrates (CHO) and higher intakes of total fat and saturated fatty acids (SFA) and were more likely to be below EAR for folic, while diabetic participants had lower intakes of total CHO and higher intakes of protein, total fat, monounsaturated fatty acids, SFA and cholesterol and were less likely to be below EAR for vitamins B2, and B6, Ca, Zn and iodine. Diabetic participants disclosed higher adherence to the MedDiet than the other two groups. Conclusions: Older Mediterranean individuals with metabolic syndrome and diabetes had better nutrient adequacy and adherence to the MedDiet than those with pre-diabetes or no diabetes. (C) 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Published
2020

2. Dietary inflammatory index and all-cause mortality in large cohorts: The SUN and PREDIMED studies

Author

L. Parra, Luis V. García, Cinta Valls-Pedret, Patricia Guillem-Saiz, Josep A. Tur, María P. Portillo, J. Vila, Estefanía Toledo, R. Martí Massó, E. de la Cruz, José I. González, J. de Irala, L. Garcia-Pérez, Simona Giardina, J.A. Cabeza-Beunza, I. Bautista Castaño, R. Osma, Alejandro Diaz, Ana Jover, M. Mata, Laura Quiles, Elena Martinez, T. Macua-Martínez, T. Elcarte-Lopez, Daniel Muñoz-Aguayo, Andrés Díaz-López, I. Duaso, Christopher Papandreou, L. Mellado, Manuel Leal, Carlos Ferreira, M.L. Garcés Ducar, M.J. Férnandez Rodríguez, I. Falcón Sanabria, P. Pascual-Pascual, L. Mengual, M.T. Martín, V. Velasco García, C. Simón García, G. Mestres, R. Benítez Pont, M. Ginard, Manuel Ortega-Calvo, L. Fernández Urzainqui, Susana Munuera, A. Fernandez Montero, James R. Hébert, E. Maestre, J. Amat, Miquel Fiol, Antonio García-Rodríguez, M. Vivó, Ernest Vinyoles, A. Ramos, B. Macías Gutiérrez, A. Casi, F. Artal-Moneva, M.A. Rodríguez, I. González-Monje, I. Maldonado Díaz, José V. Sorlí, Miguel-Angel Muñoz, Josep Basora-Gallisà, Dolores Corella, J. Gil Zarzosa, J. Alvarez-Pérez, M.A. Rovira, Mònica Bulló, Maira Bes-Rastrollo, P. Iglesias, N. Tort, Adriano Marçal Pimenta, S. Sánchez-Navarro, J. San Vicente, Pilar Buil-Cosiales, José Alfredo Martínez, E. Gutierrez, A. Proenza, Cristina Razquin, Paola Quifer-Rada, J. Marrugat, A.J. Santana Santana, Olga Castañer, Javier Rekondo, F. Trias, Magí Farré, J.M. Lozano-Rodriguez, Carlos Muñoz-Bravo, Marta Evelia Aparicio García, G. Mena, Leticia Miró-Moriano, Anna Tresserra-Rimbau, Z. Vazquez Ruiz, S. Tello, P. Baby, M.J. Ariz-Arnedo, J. García, M. Donazar, Emili Corbella, Jordi Salas-Salvadó, J. Fernandez-Crehuet, C. Simón, J.M. Baena, C. Murillo, Amelia Marti, A. Brau, H. Schröder, Rafael Balanza, C. Iglesias, R. Pedret, C. Oreja-Arrayago, J. Clos, R. Villanueva Moreno, V. Pascual, C. Lopez del Burgo, Raquel Pimienta González, Mercè Serra-Mir, Luis Forga, Helmut Schröder, Alex Medina-Remón, Javier Díez-Espino, C. de Juan, M. Amorós, M.D. Martínez-Mazo, D. Godoy, Olga Portolés, L. Quinzavos, Nancy Babio, Nerea Becerra-Tomás, J. Altirriba, P. Martínez, Carolina Donat-Vargas, N. Rosique Esteban, P. Villanueva, Ramon Estruch, Albert Goday, M. Tafalla, Alfredo Gea, R. de la Torre, F. Martin, B. Sanjulián, Ana García-Arellano, Y. García, Alvaro Alonso, P. Román, M. García-Valdueza, M.T. Barrio Lopez, N. Ibarrola, Marisa Guillén, Francisco Javier Basterra-Gortari, M. Liroz, Joan Fernández-Ballart, I. Bobe, F. Paris, P. Pascual Pascual, E. Manzano, Ricardo Gómez-Huelgas, F. Sarmiendo de la Fe, José Lapetra, R. Navajas, J. García Roselló, E. Sanz, F. Fiol, A. Baca Osorio, A.I. Castellote-Bargalló, J.V. Extremera-Urabayen, Carmen Sayón-Orea, I. Montull, Xavier Corbella, Sebastián Cervantes, T. del Hierro, Nitin Shivappa, E. Solis, Jorge M. Núñez-Córdoba, I. Zazpe Garcıa, A. Parra-Osés, Rosa Casas, Francisco Guillén-Grima, A. Altés, F.J. Giménez, Itziar Salaverria, M.C. Yuste, Carolina Ortega-Azorín, A. Carratalá-Calvo, E. Vargas López, F. Bestard, Eva M. Asensio, Paula Carrasco, T. Cervello, J.J. Sánchez Luque, Raul Ramallal, A. Isach, Ariadna Rovira, Juan Carlos Martínez-González, M. Oller, Francesc Francés, Lluis Serra-Majem, Montse Cofán, J.M. Santos-Lozano, Julia Wärnberg, C. Arroyo-Azpa, I. Sarasa, E. Díez Benítez, Guiem Frontera, J. Rekondo, Manuel Serrano-Martínez, Ana Pérez-Heras, Emilio Ros, I. Felipe, C. Domínguez-Espinaco, Carmen Saiz, M.I. Santamaría, Francisca Lahortiga, E. Figuerido-Garmendia, I. Pla, J. Benavent, Marta Guasch-Ferré, J.A. Tabar-Sarrias, P. Hernandez, X. Pintó-Salas, Rafel M. Prieto, C. Valero-Barceló, Albert Salas-Huetos, A. Loma-Osorio, M.T. Bonet, E. Arina-Vergara, P.A. de la Rosa, C. de la Fuente, J. Basells, Jaime Algorta, R. Segarra, A. Guarner, Rocío Barragán, S. Vaquero Diaz, Roberto Elosua, A. Sánchez Tainta, M. Bianchi Alba, Pilar Roura, Casandra Riera, Ana Galera, N. Molina, P. Cia-Lecumberri, J.A. Munar, Jesús Vizcaíno, J. de Diego Salas, J.M. Esparza-López, R. M. Lamuela-Raventos, A. Ruiz Zambrana, Aleix Sala-Vila, Amelia Marí-Sanchis, L. Coll, A.F. Barcena, Miguel Ángel Martínez-González, J.J. Beunza, Y. Corchado, M.S. Sánchez, Mónica Doménech, J. Toledo-Atucha, E. Goni-Ochandorena, Silvia Canudas, Raquel de Deus Mendonça, M. Cabre, O. Coltell, Miguel Ruiz-Canela, Javier Llorca, M.A. Pages, M.C. López Sabater, Guillermo T. Sáez, S. Francisco, M. Araque, Almudena Sánchez-Villegas, Silvia Carlos, Carmen Cabezas, Dora Romaguera, M. Llauradó, S. Benito Corchon, A. Rico, M.J. Lasanta-Sáez, C. Molina, C. Viñas, Rebeca Fernández-Carrión, M.A. Fernandez, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (España), Centro Nacional de Investigaciones Cardiovasculares (España), European Commission, Ministerio de Ciencia e Innovación (España), Fundación Mapfre, Junta de Andalucía, Generalitat de Catalunya, Generalitat Valenciana, and Diputación Foral de Navarra

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Mediterranean diet, 030209 endocrinology & metabolism, Context (language use), Type 2 diabetes, Diet, Mediterranean, Critical Care and Intensive Care Medicine, Dietary inflammatory index, Body Mass Index, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Humans, Medicine, Obesity, Prospective Studies, Mortality, Prospective cohort study, Randomized Controlled Trials as Topic, Inflammation, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Smoking, Hazard ratio, Middle Aged, medicine.disease, Diet, C-Reactive Protein, Diabetes Mellitus, Type 2, Cohort, Patient Compliance, Cohort studies, Female, business, CRP, Cohort study
Abstract

[Background]: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet. [Objective]: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts., [Design]: We assessed 18,566 participants in the “Seguimiento Universidad de Navarra” (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the “PREvencion con DIeta MEDiterránea” (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality., [Results]: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%–32%, for the highest vs lowest category of DII)., [Conclusion]: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively., Supported by the official funding agency for biomedical research of the Spanish Government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial (RTIC G03/140, to R.E.; RTIC RD 06/0045, to Miguel A. Martínez-González) and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (Proyecto de Investigación (PI) 04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505, PI13/00462, PI13/00615, PI13/01090, PI14/01668, PI14/01798, PI14/01764), Ministerio de Ciencia e Innovación (Recursos y teconologia agroalimentarias(AGL)-2009-13906-C02 and AGL2010-22319-C03 and AGL2013-49083-C3-1- R), Fundación Mapfre 2010, the Consejería de Salud de la Junta de Andalucía (PI0105/2007), the Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (Generalitat Valenciana Ayuda Complementaria (GVACOMP) 06109, GVACOMP2010-181, GVACOMP2011-151), Conselleria de Sanitat y, PI14/01764 AP; Atención Primaria (CS) 2010-AP-111, and CS2011-AP-042), and Regional Government of Navarra (P27/2011).). Drs. Shivappa and Hébert were supported by grant number R44DK103377 from the United States National Institute of Diabetes and Digestive and Kidney Diseases.

Published
2019

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