Alejandro Fernández-Montero

Prospective study of changes in sugar-sweetened beverage consumption and the incidence of the metabolic syndrome and its components: the SUN cohort.

The incidence of the metabolic syndrome (MetS) is increasing and lifestyle behaviours may play a role. The aim of the present study was to prospectively assess the association between changes in the consumption of sugar-sweetened beverages (SSB) and the incidence of the MetS and its components in a Spanish cohort of university graduates. We included 8157 participants initially free of the MetS and followed up during at least 6 years. SSB consumption was collected by a FFQ previously validated in Spain. The change in SSB consumption was calculated as the difference between SSB consumption at a 6-year follow-up and baseline consumption. The MetS was defined according to the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institutes new definition of the MetS that had harmonised previous definitions. The associations between changes in SSB intake and the MetS were examined using multiple logistic regression. We observed 361 incident cases of the MetS. Participants who increased their consumption of SSB (upper v. lower quintile) had a significantly higher risk of developing the MetS (adjusted OR 2·2, 95 % CI 1·4, 3·5; P for trend = 0·003). Similarly, they presented a significantly higher risk of developing high blood pressure (adjusted OR 1·6, 95 % CI 1·3, 2·1), central obesity (adjusted OR 2·3, 95 % CI 1·9, 2·7), hypertriacylglycerolaemia (adjusted OR 1·7, 95 % CI 1·1, 2·6) or impaired fasting glucose (adjusted OR 1·6, 95 % CI 1·1, 2·2). In conclusion, an increase in SSB consumption was associated with a higher risk of developing the MetS and other metabolic disorders after 6 years of follow-up in a Mediterranean cohort of university graduates.

Validación de los componentes del síndrome metabólico autodeclarados en un estudio de cohortes

OBJECTIVES To assess the accuracy of self-reported data needed to constitute the metabolic syndrome in the University of Navarra Follow-Up [Seguimiento Universidad de Navarra (SUN)] cohort. METHODS The SUN project is a multi-purpose prospective cohort, formed by more than 20,000 university graduates, followed-up using surface mail questionnaires every 2 years. In a sample of 287 cohort participants, self-reported data on the criteria needed to define the metabolic syndrome (waist circumference, blood pressure, triglycerides, high-density lipoprotein-cholesterol and glucose) were compared with the same biometric data obtained by blood tests or measured by trained medical staff. Intra-class correlation coefficients with 95% confidence intervals (95% CI), relative mean error and agreement limits according to the method proposed by Bland and Altman were calculated for each variable studied. RESULTS High intraclass correlations were found for the values of waist circumference (r=0.86, 95% CI: 0.80-0.90) and triglycerides (r=0.71, 95%CI: 0.61-0.79). Moderate intraclass correlations were found (between 0.46 and 0.63) for the other factors. Relative mean errors were always<2.5%, and >91% of values were within the limits of agreement for all variables. CONCLUSIONS The results suggest that self-declared data on the criteria of metabolic syndrome obtained in the SUN cohort, though with some caution, are sufficiently accurate to be used in epidemiological studies.

Triglyceride–glucose index (TyG index) in comparison with fasting plasma glucose improved diabetes prediction in patients with normal fasting glucose: The Vascular-Metabolic CUN cohort

AIMS We evaluated the potential role of the triglyceride-glucose index (TyG index) as a predictor of diabetes in a White European cohort, and compared it to fasting plasma glucose (FPG) and triglycerides. METHODS 4820 patients of the Vascular-Metabolic CUN cohort (VMCUN cohort) were examined and followed up for 8.84years (±4.39). We performed a Cox proportional hazard ratio with repeated-measures analyses to assess the risk of developing type 2 diabetes across quartiles of FPG, triglycerides and the TyG index (ln[fasting triglycerides (mg/dl)×fasting plasma glucose (mg/dl)/2]), and plotted a receiver operating characteristics (ROC) curve for discrimination. RESULTS There were 332 incident cases of type 2 diabetes involving 43,197.32person-years of follow-up. We observed a progressively increased risk of diabetes in subjects with TyG index levels of 8.31 or more. Among those with normal fasting glucose at baseline, <100mg/dl, subjects with the TyG index in the fourth quartile were 6.87 times more likely to develop diabetes (95% CI, 2.76-16.85; P for trend<0.001), as compared with the bottom quartile. The areas under the ROC curves (95% CI) were 0.75 (0.70-0.81) for TyG index, 0.66 (0.60-0.72) for FPG and 0.71 (0.65-0.77) for TG, in subjects with normal fasting glucose (p=0.017). CONCLUSIONS Our data suggest that the TyG index is useful for the early identification of individuals at risk of type 2 diabetes. The TyG index seems to be a better predictor than FPG or triglycerides of the potential development of type 2 diabetes in normoglycemic patients.

Nut consumption and incidence of metabolic syndrome after 6-year follow-up: the SUN (Seguimiento Universidad de Navarra, University of Navarra Follow-up) cohort.

OBJECTIVE To assess the long-term relationship between tree nut consumption and the risk of developing metabolic syndrome (MetS). DESIGN Nut consumption was collected using a validated 136-item FFQ. The MetS was defined according to the International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute harmonizing definition. The association between nut consumption and MetS was assessed with logistic regression models adjusting for potential confounders. We compared the incidence of MetS between extreme categories of nut intake (> or = 2 servings/week v. never/almost never) after 6 years of follow-up. SETTING The SUN Project (Seguimiento Universidad de Navarra, University of Navarra Follow-up) is a prospective cohort study, formed of Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. Nut consumption and MetS information was collected by self-reported data. SUBJECTS Participants (n 9887) initially free of MetS or diabetes and followed up for a minimum of 6 years were included. RESULTS We observed 567 new cases of MetS during follow-up. Participants who consumed nuts > or = 2 servings/week presented a 32% lower risk of developing MetS than those who never/almost never consumed (adjusted OR = 0.68, 95% CI 0.50, 0.92). The inverse association was stronger among participants who were health professionals. CONCLUSIONS Nut consumption was significantly associated with lower risk of developing MetS after a 6-year follow-up period in a cohort of Spanish graduates.

The TyG index may predict the development of cardiovascular events

Cardiovascular disease (CVD) is the worldwide leading cause of morbidity and mortality. An early risk detection of apparently healthy people before CVD onset has clinical relevance in the prevention of cardiovascular events. We evaluated the association between the product of fasting plasma glucose and triglycerides (TyG index) and CVD.

Validation of metabolic syndrome using medical records in the SUN cohort

BackgroundThe objective of this study was to evaluate the validity of self reported criteria of Metabolic Syndrome (MS) in the SUN (Seguimiento Universidad de Navarra) cohort using their medical records as the gold standard.MethodsWe selected 336 participants and we obtained MS related data according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF). Then we compared information on the self reported diagnosis of MS and MS diagnosed in their medical records. We calculated the proportion of confirmed MS, the proportion of confirmed non-MS and the intraclass correlation coefficients for each component of the MS.ResultsFrom those 336 selected participants, we obtained sufficient data in 172 participants to confirm or reject MS using ATP III criteria. The proportion of confirmed MS was 91.2% (95% CI: 80.7- 97.1) and the proportion of confirmed non-MS was 92.2% (95% CI: 85.7-96.4) using ATP III criteria. The proportion of confirmed MS using IDF criteria was 100% (95% CI: 87.2-100) and the proportion of confirmed non-MS was 97.1% (95% CI: 85.1-99.9). Kappa Index was 0.82 in the group diagnosed by ATP III criteria and 0.97 in the group diagnosed by IDF criteria. Intraclass correlation coefficients for the different component of MS were: 0.93 (IC 95%:0.91- 0.95) for BMI; 0.96 (IC 95%: 0.93-0.98) for waist circumference; 0.75 (IC 95%: 0.66-0.82) for fasting glucose; 0.50 (IC 95%:0.35-0.639) for HDL cholesterol; 0.78 (IC 95%: 0.70-0.84) for triglycerides; 0.49 (IC 95%:0.34-0.61) for systolic blood pressure and 0.55 (IC 95%: 0.41-0.65) for diastolic blood pressure.ConclusionsSelf-reported MS based on self reported components of the SM in a Spanish cohort of university graduates was sufficiently valid as to be used in epidemiological studies.

The impact of computer use in myopia progression: a cohort study in Spain.

OBJECTIVE Many subjects, especially highly educated subjects, are increasingly exposed to computer use. This exposure might represent an explanation for the growing rates of myopia. METHODS We assessed 17,217 Spanish university graduates from the SUN project, an open-recruitment cohort. Their mean age was 38.5 years (SD 12.1), and their mean time of exposure to computers was 14.3h/week (SD 14.6). We estimated multivariable-adjusted odds ratios (OR) for the risk of myopia development and/or progression (≥0.5 diopters) according to baseline exposure to computer and to changes in exposure. RESULTS The age and sex-adjusted OR comparing >40 h/week of exposure versus<10h/week was 1.34 (95% confidence interval (CI): 1.12-1.60). This association remained essentially unchanged after additional adjustments. Comparing participants who increased their exposure to computers, versus those with no change, the age and sex-adjusted OR was 1.49 (1.34-1.66). This result was unchanged after additional adjustments. CONCLUSIONS To our knowledge this is the first large longitudinal assessment in young adults, showing that exposure to computer use is associated with myopia development or progression in a cohort of Spanish university graduates. Further studies are needed to confirm these epidemiological findings.

Applied nutritional investigationNut consumption and 5-y all-cause mortality in a Mediterranean cohort: The SUN project

OBJECTIVE The aim of this study was to assess the association between nut consumption and all-cause mortality after 5-y follow-up in a Spanish cohort. METHODS The SUN (Seguimiento Universidad de Navarra, University of Navarra Follow-up) project is a prospective cohort study, formed by Spanish university graduates. Information is gathered by mailed questionnaires collected biennially. In all, 17 184 participants were followed for up to 5 y. Baseline nut consumption was collected by self-reported data, using a validated 136-item semi-quantitative food frequency questionnaire. Information on mortality was collected by permanent contact with the SUN participants and their families, postal authorities, and the National Death Index. The association between baseline nut consumption and all-cause mortality was assessed using Cox proportional hazards models to adjust for potential confounding. Baseline nut consumption was categorized in two ways. In a first analysis energy-adjusted quintiles of nut consumption (measured in g/d) were used. To adjust for total energy intake the residuals method was used. In a second analysis, participants were categorized into four groups according to pre-established categories of nut consumption (servings/d or servings/wk). Both analyses were adjusted for potential confounding factors. RESULTS Participants who consumed nuts ≥2/wk had a 56% lower risk for all-cause mortality than those who never or almost never consumed nuts (adjusted hazard ratio, 0.44; 95% confidence intervals, 0.23-0.86). CONCLUSION Nut consumption was significantly associated with a reduced risk for all-cause mortality after the first 5 y of follow-up in the SUN project.

Clinical Features of Smokers With Radiological Emphysema But Without Airway Limitation

Background: The clinical characteristics of patients with emphysema but without airway limitations remain unknown. The goal of this study was to compare the clinical features of current and former smokers without airflow limitation who have radiologic emphysema on chest CT scans vs a control group of current and ex‐smokers without emphysema. Methods: Subjects enrolled had anthropometric characteristics recorded, provided a medical history, and underwent low‐dose chest CT scanning. The following parameters were also evaluated: pulmonary function tests including diffusion capacity for carbon monoxide (Dlco), the modified Medical Research Council dyspnea score, COPD assessment test (CAT), and 6‐min walk test (6MWT). A comparison was conducted between those with and without CT‐confirmed emphysema. Results: Of the 203 subjects, 154 had emphysema, and 49 did not. Adjusted group comparisons revealed that a higher proportion of patients with emphysema according to low‐dose chest CT scanning had an abnormal Dlco value (< 80%) (46% vs 19%; P = .02), a decrease in percentage of oxygen saturation > 4% during the 6MWT (8.5% vs 0; P = .04), and an altered quality of life (CAT score ≥ 10) (32% vs 14%; P = .01). A detailed analysis of the CAT questionnaire items revealed that more patients with emphysema had a score ≥ 1 in the “chest tightness” (P = .05) and “limitation when doing activities at home” (P < .01) items compared with those with no emphysema. They also experienced significantly more exacerbations in the previous year (0.19 vs 0.04; P = .02). Conclusions: A significant proportion of smokers with emphysema according to low‐dose chest CT scanning but without airway limitation had alterations in their quality of life, number of exacerbations, Dlco values, and oxygen saturation during the 6MWT test.

Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis

OBJECTIVES To investigate the long-term effectiveness of voice therapy in vocal outcomes of patients with unilateral vocal fold paralysis (UVFP) and vocal productions of patients with long-standing treatment-naïve UVFP treated with voice therapy. STUDY DESIGN Prospective observational study. METHODS A voice therapy protocol was applied individually in three stages. Fifteen sessions were scheduled twice a week in 70 patients with UVFP. Forty-seven patients were treated within a year of the diagnosis (group 1). The remaining patients had delayed therapy (at least 1 year after diagnosis) (group 2). Multidisciplinary assessment included nasofibroscopy, videostroboscopy, acoustic and aerodynamic parameters, and perception of voice impairment measures. A subgroup of the 70 patients (n = 32) was reassessed after 1 year of follow-up. RESULTS Our voice therapy protocol significantly improved voice productions and perception of voice impairment in group 1 (P < 0.0001). Patients in group 2 experienced less hoarseness and had improved perception of voice impairment (P = 0.007). The improvement was long lasting and persisted at 1 year of follow-up in both groups. CONCLUSIONS Voice therapy is effective in patients with UVFP and its benefits are sustained over time. Early referral for voice therapy seems to be associated with greater benefit, but quality of life also improves for patients despite delayed treatment.