Esther López-García

Coffee Consumption and Coronary Heart Disease in Men and Women A Prospective Cohort Study

Background— We examined the association between long-term habitual coffee consumption and risk of coronary heart disease (CHD). Methods and Results— We performed a prospective cohort study with 44 005 men and 84 488 women without history of cardiovascular disease or cancer. Coffee consumption was first assessed in 1986 for men and in 1980 for women and then repeatedly every 2 to 4 years; the follow-up continued through 2000. We documented 2173 incident cases of coronary heart disease (1449 nonfatal myocardial infarctions and 724 fatal cases of CHD) among men and 2254 cases (1561 nonfatal myocardial infarctions and 693 fatal cases of CHD) among women. Among men, after adjustment for age, smoking, and other CHD risk factors, the relative risks (RRs) of CHD across categories of cumulative coffee consumption (<1 cup/mo, 1 cup/mo to 4 cups/wk, 5 to 7 cups/wk, 2 to 3 cups/d, 4 to 5 cups/d, and ≥6 cups/d) were 1.0, 1.04 (95% confidence interval 0.91 to 1.17), 1.02 (0.91 to 1.15), 0.97 (0.86 to 1.11), 1.07 (0.88 to 1.31), and 0.72 (0.49 to 1.07; P for trend=0.41); among women, the RRs were 1.0, 0.97 (0.83 to 1.14), 1.02 (0.90 to 1.17), 0.84 (0.74 to 0.97), 0.99 (0.83 to 1.17), and 0.87 (0.68 to 1.11; P for trend=0.08). Stratification by smoking status, alcohol consumption, history of type 2 diabetes mellitus, and body mass index gave similar results. Similarly, we found no effect when the most recent coffee consumption was examined. RRs for quintiles of caffeine intake varied from 0.97 (0.84 to 1.10) in the second quintile to 0.97 (0.84 to 1.11) in the highest quintile (P for trend=0.82) in men and from 1.02 (0.90 to 1.16) to 0.97 (0.85 to 1.11; P for trend=0.37) in women. Conclusions— These data do not provide any evidence that coffee consumption increases the risk of CHD.

The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis

BACKGROUND The effect of coffee and caffeine on blood pressure (BP) and cardiovascular disease (CVD) in hypertensive persons is uncertain. OBJECTIVE The objective was to summarize the evidence on the acute and longer-term effects of caffeine and coffee intake on BP and on the association between habitual coffee consumption and risk of CVD in hypertensive individuals. DESIGN A systematic review and meta-analysis of publications identified in a PubMed and EMBASE search up to 30 April 2011 was undertaken. Data were extracted from controlled trials on the effect of caffeine or coffee intake on BP change and from cohort studies on the association between habitual coffee consumption and CVD. RESULTS In 5 trials, the administration of 200-300 mg caffeine produced a mean increase of 8.1 mm Hg (95% CI: 5.7, 10.6 mm Hg) in systolic BP and of 5.7 mm Hg (95% CI: 4.1, 7.4 mm Hg) in diastolic BP. The increase in BP was observed in the first hour after caffeine intake and lasted ≥3 h. In 3 studies of the longer-term effect (2 wk) of coffee, no increase in BP was observed after coffee was compared with a caffeine-free diet or was compared with decaffeinated coffee. Last, 7 cohort studies found no evidence of an association between habitual coffee consumption and a higher risk of CVD. CONCLUSIONS In hypertensive individuals, caffeine intake produces an acute increase in BP for ≥3 h. However, current evidence does not support an association between longer-term coffee consumption and increased BP or between habitual coffee consumption and an increased risk of CVD in hypertensive subjects.

Selected eating behaviours and excess body weight: a systematic review.

The relationship between obesity and the intake of macronutrients and specific foods is uncertain. Thus, there is growing interest in some eating behaviours because they may reflect the joint effect of several foods and nutrients and, thus, increase the likelihood of finding a link to obesity. This study examined the association between selected eating behaviours and excess weight in the general population throughout a systematic review of publications written in English, Spanish or Portuguese identified in a PubMed search up to 31 December 2010. We included 153 articles, 73 of which have been published since 2008. Only 30 studies had a prospective design; of these, 15 adjusted for sociodemographic variables, physical activity and energy or food intake. Moreover, definitions of eating behaviours varied substantially across studies. We found only small or inconsistent evidence of a relationship between excess weight and skipping breakfast, daily eating frequency, snacking, irregular meals, eating away from home, consumption of fast food, takeaway food intake, consumption of large food portions, eating until full and eating quickly. In conclusion, this review highlights the difficulty in measuring human behaviour, and suggests that a more systematic approach is needed for capturing the effects of eating behaviours on body weight.

Justificación y métodos del estudio sobre nutrición y riesgo cardiovascular en España (ENRICA)

INTRODUCTION AND OBJECTIVES The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity. METHODS A cross-sectional survey of 11,991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first home visit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older. DISCUSSION The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093).

Relation between body weight and health-related quality of life among the elderly in Spain

OBJECTIVE: This study examines the relation between body weight and the physical and mental components of health-related quality of life (HRQL) in the population aged 60 y and over in Spain.RESEARCH METHODS AND PROCEDURES: Cross-sectional study covering 3605 subjects, representative of the noninstitutionalised Spanish population aged 60 y and over. Information was collected through home-based personal interview and measurement of blood pressure and anthropometric variables. Logistic regression was used to examine the relation of suboptimal HRQL (score<100) on each SF-36 questionnaire scale with body mass index (BMI) and waist circumference. Separate regression models were constructed for each sex and adjusted for sociodemographic variables, tobacco and alcohol consumption, physical activity, arterial hypertension and diagnosed chronic disease.RESULTS: Mean age of the study population was 70.9 y for men and 72.2 y for women. The percentage of overweight subjects was 48.5% in men and 39.8% in women, and of obese subjects, 31.9 and 41.1% respectively. Men registered a better HRQL than women on most of the SF-36 scales. Compared to normal-weight subjects (BMI: 18.5–24.9 kg/m2), frequency of suboptimal physical functioning was higher among obese subjects (BMI≥30 kg/m2), both male (OR: 1.91; 95% CI: 1.22–3.00) and female (OR: 2.58; 95% CI: 1.59–4.19). The aspects of physical functioning most affected were bending, kneeling or stooping, climbing stairs and strenuous effort. Male, though not female, obesity was nonetheless associated with a better HRQL on the SF-36 mental scales. Frequencies of suboptimal scores for overweight persons (BMI: 25–29.9 kg/m2) were similar to those for normal-weight subjects on most of the SF-36 scales. Results proved similar for subjects in both the 60–74 and 75-and-over age groups, and also when waist circumference was used as the measure of obesity (>102 cm in men and >88 cm in women).CONCLUSIONS: Obese men and women showed worse physical functioning than normal-weight persons. This occurred irrespective of whether subjects were over or under 74 y of age, or whether obesity was measured by BMI or waist circumference, and was not explained by unhealthy lifestyles or obesity-related chronic disease.

Coffee Consumption and Risk of Stroke in Women

Background— Data on the association between coffee consumption and risk of stroke are sparse. We assessed the association between coffee consumption and the risk of stroke over 24 years of follow-up in women. Methods and Results— We analyzed data from a prospective cohort of 83 076 women in the Nurses’ Health Study without history of stroke, coronary heart disease, diabetes, or cancer at baseline. Coffee consumption was assessed first in 1980 and then repeatedly every 2 to 4 years, with follow-up through 2004. We documented 2280 strokes, of which 426 were hemorrhagic, 1224 were ischemic, and 630 were undetermined. In multivariable Cox regression models with adjustment for age, smoking status, body mass index, physical activity, alcohol intake, menopausal status, hormone replacement therapy, aspirin use, and dietary factors, the relative risks (RRs) of stroke across categories of coffee consumption (<1 cup per month, 1 per month to 4 per week, 5 to 7 per week, 2 to 3 per day, and ≥4 per day) were 1, 0.98 (95% CI, 0.84 to 1.15), 0.88 (95% CI, 0.77 to 1.02), 0.81 (95% CI, 0.70 to 0.95), and 0.80 (95% CI, 0.64 to 0.98) (P for trend=0.003). After further adjustment for high blood pressure, hypercholesterolemia, and type 2 diabetes, the inverse association remained significant. The association was stronger among never and past smokers (RR for ≥4 cups a day versus <1 cup a month, 0.57; 95% CI, 0.39 to 0.84) than among current smokers (RR for ≥4 cups a day versus <1 cup a month, 0.97; 95% CI, 0.63 to 1.48). Other drinks containing caffeine such as tea and caffeinated soft drinks were not associated with stroke. Decaffeinated coffee was associated with a trend toward lower risk of stroke after adjustment for caffeinated coffee consumption (RR for ≥2 cups a day versus <1 cup a month, 0.89; 95% CI, 0.73 to 1.08; P for trend=0.05). Conclusions— Long-term coffee consumption was not associated with an increased risk of stroke in women. In contrast, our data suggest that coffee consumption may modestly reduce risk of stroke.

Valores de referencia de la versión española del Cuestionario de Salud SF-36 en población adulta de más de 60 años

Fundamento Y Objetivo El Cuestionario de Salud SF-36 es el mas usado en la bibliografia internacionalpara medir la calidad de vida relacionada con la salud. Los valores de referencia del cuestionario sonnecesarios para interpretar sus resultados en estudios clinicos y poblacionales. Un estudio realizadoen 1996 proporciono dichos valores para la poblacion espanola, pero no se desagregaron por edad enlos sujetos de 75 y mas anos, a pesar de que el estado de salud cambia al envejecer en los que, cadadia con mas frecuencia, superan dicha edad. Ademas, el estado de salud de los ancianos de los paisesdesarrollados ha mejorado en los ultimos anos. Por ello, el objetivo de este trabajo ha sido obtenerlos valores de referencia del Cuestionario de Salud SF-36 en el ano 2001 para la poblacion espanolaen grupos quinquenales de edad en el intervalo de 60 a 85 y mas anos. Sujetos Y Metodo Estudio transversal en una muestra de 3.949 personas representativas de la poblacionespanola no institucionalizada de 60 y mas anos de edad. El Cuestionario de Salud SF-36 secompleto mediante entrevista personal en los domicilios. Se calcularon medidas de tendencia centraly de dispersion, y los percentiles de las puntuaciones de las 8 escalas del cuestionario, segun la edady el sexo. Ademas se examino la consistencia o fiabilidad interna de cada escala mediante el coeficientealfa de Cronbach. Resultados Los sujetos refirieron las puntuaciones mas elevadas para las escalas de rol emocional(media [DE]: 84,8 [32,9]), funcion social (79,2 [28,0]) y rol fisico (73,3 [41,1]). Los valores mediosde todas las escalas fueron superiores (mejor salud percibida) en los varones que en las mujeres (p Conclusiones Estos resultados complementan los del estudio de 1996 y favoreceran la interpretacionde los valores del Cuestionario de Salud SF-36 en estudios clinicos y poblacionales en personas de 60y mas anos en Espana. Background and Objective The SF-36 Health Survey questionnaire is the most widely used instrumentto measure health-related quality of life. Reference measures are needed to interpret its results in clinicaland population studies. In 1996, a study provided population-based norms for Spain, but thesewere not disaggregated by age in subjects aged 75 years and over, even though health status changeswith aging among those who overpass such age. Moreover, health status in elderly people from developedcountries has improved over the last years. This study obtains population-based norms for theSpanish version of the SF-36 Health Survey in five-year age-groups for those aged 60 to 85 and over. Subjects and Method Cross-sectional survey on a sample of 3,949 non-institutionalised subjects representativeof the Spanish population aged 60 years and over. Information on the SF-36 Health Survey wasobtained through house-hold personal interviews. Central position and dispersion statistics, as well aspercentiles, were calculated for each of the eight SF-36 scales by age and sex. Cronbachs alpha coefficientswere calculated to assess the internal reliability of each scale. Results Subjects reported higher scores for emotional role (mean [SD] 84.8 [32.9]), social functioning(79.2 [28.0]) and physical role (73.3 [41.1]). For all scales, mean scores were higher (better perceivedhealth) among men than women (p Conclusions These results extend those obtained in 1996 and facilitate the interpretation of the SF-36Health Survey values in clinical and population studies in the Spanish population aged 60 years andolder.

Relationship between obesity, hypertension and diabetes, and health-related quality of life among the elderly.

Background The purpose of this study was to study the cumulative effects of cardiovascular risk factors on all the health-related quality of life dimensions among the elderly in this era of epidemic obesity and diabetes. Design and methods The population-based study covered 3567 participants, representative of the Spanish non-institutionalized population aged 60 years and above. Data were gathered from home-based interviews and from the measurements of blood pressure and other anthropometric variables. Multiple linear regression was used to examine the relationships between health-related quality of life, on each scale of the SF-36 questionnaire, and obesity (waist circumference > 102 cm in men and >88cm in women), hypertension (blood pressure ≥ 140/90 mmHg), and known diabetes, after adjusting for sociodemographic and lifestyle factors. Results Patients with obesity, hypertension, and diabetes, or a combination of these factors were, in general, associated with a worse health-related quality of life, on both the physical and the mental scales, than those without these factors, though statistical significance (P<0.05) was only attained for some relationships. Obesity in women (−2.9 to −6.7 points, according to the scale) and diabetes in men (−6.1 to −16.4 points, according to the scale) were the factors most closely and significantly associated with diminished health-related quality of life. Women who had all three factors showed the maximum decline in health-related quality of life (−10.2 to −17.7 points, according to the scale). Conclusions Obesity in old women and diabetes in old men are the most decisive factors adversely affecting the health-related quality of life. The association with worse health-related quality of life is especially marked (greater than additive) in women with all three factors, thereby rendering them a group that calls for special study and attention.

Usual sleep duration and cognitive function in older adults in Spain

The few studies that have examined the association between usual sleep duration and cognitive function have shown conflicting results. This cross‐sectional study examined the association between sleep duration and cognitive function among 3212 people, representative of the non‐institutionalized population aged 60 years and over in Spain. Sleep duration was self‐reported, and cognitive function was measured with the Mini‐Examen Cognoscitivo (MEC), a version of the Mini‐Mental State Examination that has been validated in Spain. Linear regression, with adjustment for the main confounders, was used to obtain mean differences in the MEC between the categories of sleep duration (≤5, 6, 7, 8, 9, 10, ≥11 h day−1). The MEC score decreased progressively (became worse) across sleep categories from 7 to ≥11 h (P for linear trend <0.001). People who slept for ≥11 h had a significantly lower MEC score than those who slept for 7 h (mean difference −1.48; 95% confidence interval −2.12 to −0.85). This difference in the MEC was similar to that observed for a 10‐year increase in age. The results did not vary significantly by sex (P for interaction >0.05). No association was observed between short sleep duration (<7 h) and cognitive function. We conclude that long sleep duration is associated with poorer cognitive function in older adults from the general population.

Mediterranean Diet and Risk of Frailty in Community-Dwelling Older Adults

BACKGROUND AND OBJECTIVE Low intake of certain micronutrients and protein has been associated with higher risk of frailty. However, very few studies have assessed the effect of global dietary patterns on frailty. This study examined the association between adherence to the Mediterranean diet (MD) and the risk of frailty in older adults. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study with 1815 community-dwelling individuals aged ≥60 years recruited in 2008-2010 in Spain. MEASUREMENTS At baseline, the degree of MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS) score and the Mediterranean Diet Score, also known as the Trichopoulou index. In 2012, individuals were reassessed to detect incident frailty, defined as having at least 3 of the following criteria: exhaustion, muscle weakness, low physical activity, slow walking speed, and weight loss. The study associations were summarized with odds ratios (OR) and their 95% confidence interval (CI) obtained from logistic regression, with adjustment for the main confounders. RESULTS Over a mean follow-up of 3.5 years, 137 persons with incident frailty were identified. Compared with individuals in the lowest tertile of the MEDAS score (lowest MD adherence), the OR (95% CI) of frailty was 0.85 (0.54-1.36) in those in the second tertile, and 0.65 (0.40-1.04; P for trend = .07) in the third tertile. Corresponding figures for the Mediterranean Diet Score were 0.59 (0.37-0.95) and 0.48 (0.30-0.77; P for trend = .002). Being in the highest tertile of MEDAS was associated with reduced risk of slow walking (OR 0.53; 95% CI 0.35-0.79) and of weight loss (OR 0.53; 95% CI 0.36-0.80). Lastly, the risk of frailty was inversely associated with consumption of fish (OR 0.66; 95% CI 0.45-0.97) and fruit (OR 0.59; 95% CI 0.39-0.91). CONCLUSIONS Among community-dwelling older adults, an increasing adherence to the MD was associated with decreasing risk of frailty.