Faustino R. Pérez-López

Effects of the Mediterranean diet on longevity and age-related morbid conditions.

OBJECTIVES To delineate the influences of the Mediterranean diet (MD) on human mortality and age-related morbid conditions, principally the metabolic syndrome, hypertension, cardiovascular disease, excess body weight, cancer, poor bone mineralization and rheumatoid arthritis, and neurodegenerative disorders. METHOD Citations were selected from a PubMed search according to their clinical and experimental relevance. RESULTS AND CONCLUSIONS Individuals who adhere to the principles of the traditional MD tend to have a longer life-span. Both men and women who report eating foods closest to the MD are about 10-20% less likely to die over the course of a study of heart disease, cancer or any other cause. The longevity of Mediterranean people has been related to olive oil, and its several microcomponents of antioxidant potential, present in all MD variants. The prevalence of the metabolic syndrome may be reduced by a MD. The MD is significantly inversely associated with both systolic and diastolic blood pressure. It also has benefits in relation to the prevention of cardiovascular events, reduces the risk of mortality after myocardial infarction, and reduces peripheral arterial disease. The risk of obesity decreases with increasing adherence to the traditional MD. The MD also has a preventive effect on cancer, through its antiproliferative and pro-apoptotic effects, mostly due to the components of virgin olive oil and vegetables. There is some evidence of the benefits of the MD in relation to bone metabolism, rheumatoid arthritis, and neurodegenerative age-related diseases (cognitive deficit, Alzheimers disease, Parkinsons disease).

Depressive disorders and the menopause transition

AIM Depressive disorders and symptoms are common among middle-aged women. The effects of hormones on depression remain unclear. This review aims to clarify the nature of depressive disorders during the menopause transition as well as their links with climacteric syndrome, sexuality, cardiovascular risk and cognitive function. MATERIAL AND METHODS The recent literature on depressive disorders and menopause is reviewed. RESULTS AND CONCLUSIONS Women are more vulnerable than men to depressive disorders. Endocrine influences have been postulated but differences in, for example, coping style and response to stress may also contribute to the gender difference in the prevalence of depressive disorders. Gender differences in socialization may lead to higher rates of depression in women. There are data top suggest that menopause and depression are associated, although there is not a common clear causative factor. Women with climacteric symptoms (hot flushes, night sweats, vaginal dryness and dyspareunia) are more likely to report anxiety and/or depressive symptoms. Bothersome vasomotor symptoms could be associated with sleep disturbances, which in turn can increase reports of anxiety and depressive symptoms. Biopsychosocial and partner factors have a significant influence on middle-aged womens sexuality and depressive disorders, and most antidepressants can have a negative effect on sexual response. Lastly, studies have consistently shown that women with high levels of depressive symptoms are at greater cardiovascular risk and have poorer cognitive function than non-depressed women. At present, a direct relationship between psychiatric symptoms and hormonal changes such as estrogen decrease has not been clearly found. Stress, educational level, ethnicity, socioeconomic factors and partner status may influence the prevalence and clinical course of both menopause symptoms and depressive disorders. Since in many cases depression is a lifelong condition, and is associated with severe comorbid conditions, further studies are needed to improve the early diagnosis of depression; it may be advisable to monitor a womans mental health during the menopause transition to prevent a depressive disorder having long-term negative consequences.

Gender differences in cardiovascular disease: hormonal and biochemical influences.

Objective: Atherosclerosis is a complex process characterized by an increase in vascular wall thickness owing to the accumulation of cells and extracellular matrix between the endothelium and the smooth muscle cell wall. There is evidence that females are at lower risk of developing cardiovascular disease (CVD) as compared to males. This has led to an interest in examining the contribution of genetic background and sex hormones to the development of CVD. The objective of this review is to provide an overview of factors, including those related to gender, that influence CVD. Methods: Evidence analysis from PubMed and individual searches concerning biochemical and endocrine influences and gender differences, which affect the origin and development of CVD. Results: Although still controversial, evidence suggests that hormones including estradiol and androgens are responsible for subtle cardiovascular changes long before the development of overt atherosclerosis. Conclusion: Exposure to sex hormones throughout an individual’s lifespan modulates many endocrine factors involved in atherosclerosis.

Vitamin D and aging: beyond calcium and bone metabolism.

BACKGROUND Low serum 25-hydroxyvitamin D (25[OH]D) levels are common and may be associated with morbidity and mortality (and indeed with frailty more generally). This association is not restricted to the links between vitamin D and calcium and bone metabolism. OBJECTIVE To review the influences of vitamin D on the aging process other than those related to bone and calcium. Its effect on mortality is also assessed. METHODS The PubMed database was searched for English-language articles relating to vitamin D, using the following MeSH terms: vitamin D, mortality, cardiovascular diseases, and frailty. In addition, searches were carried out with Google. RESULTS Although some of the reported results have proved controversial, overall the evidence seems to support an association between low serum 25[OH]D levels and mortality rates (all-cause and cardiovascular). Frailty is a condition frequently associated with low serum 25[OH]D levels. CONCLUSION The aging process and mortality are associated with low vitamin D levels. Prospective controlled trials are warranted to determine whether vitamin D supplements can increase longevity and reduce the incidence of certain conditions.

First-trimester maternal serum 25-hydroxyvitamin D3 status and pregnancy outcome

To determine the pregnancy outcome as a function of the first‐trimester serum 25‐hydroxyvitamin D3 [25(OH)D] status and to compare the 25(OH)D levels in the first and third trimesters.

Vitamin D: the secosteroid hormone and human reproduction.

Vitamin D is a secosteroid with an endocrine mechanism of action which is sequentially synthesized in humans in the skin, liver and kidneys. The active hormone, 1α,25-dihydrocholecalciferol [1,25(OH)2D3], is often considered only in terms of its role in controlling calcium and phosphorus homeostasis. However, cumulative evidence points to the presence of vitamin D receptors in many tissues. The present article summarizes key points regarding the participation of vitamin D in pregnancy and breastfeeding. During pregnancy, sufficient vitamin D concentrations are needed not only to address the growing demand for calcium on the part of the fetus, but also to participate in fetal growth, development of the nervous system, lung maturation and fetal immune system function. Hypovitaminosis D has been related to the development of diabetes, pre-eclampsia and fetal neurological disorders. During pregnancy and lactation, calcium from the maternal skeleton is mobilized, with a rise in bone turnover and a reduction in bone mass. It is advisable for pregnant and nursing women to maintain adequate levels of vitamin D, through small doses of solar exposure to facilitate natural formation of the hormone or by ingesting appropriate vitamin supplements. Further studies are needed to clarify the many gaps in knowledge and elucidate the role of vitamin D in the context of reproduction. Confirmation of experimental observations relating to the risks of hypovitaminosis D would have important public health implications.

Obesity is related to increased menopausal symptoms among Spanish women.

Objective. To assess the metabolic syndrome (METS) and its components in postmenopausal women using updated diagnostic criteria and explore their relation to menopausal symptom severity. Method. Medical records of the first visit of 574 postmenopausal Caucasian Spanish women attending a menopause clinic were retrospectively reviewed. Recorded information included general demographic data, type of menopause, menopausal symptom intensity (Kupperman index) and baseline hormonal and metabolic parameters. METS was established if three or more of the following criteria were met: body mass index (BMI) >28.8 kg/m2, fasting glycaemia >100 mg/dL, high-density lipoprotein cholesterol (HDL-C) <50 mg/dL, triglycerides ≥150 mg/dL and blood pressure ≥130/85 mmHg. Results Mean ± SD age of the whole cohort was 49.9 ± 6.1 years, 66% had natural menopause and 38.9% were obese. In all, 23.1% met diagnostic criteria for METS who were significantly older and displayed higher rates of being married, obesity and abnormal glucose, triglyceride, HDL-C, low-density lipoprotein cholesterol and blood pressure values, when compared with those without the syndrome. The mean Kupperman index score for the whole sample was 26.4 ± 10.6, with 73.8% displaying moderate to severe scores (20 or more). Logistic regression analysis determined that obesity and marriage status were independent risk factors related to more severe menopausal symptoms (Kupperman index scores of 20 or more). Conclusion. Although METS was observed in a lower frequency than previous reports, obesity was associated with more severe menopausal symptoms among postmenopausal Spanish women.

Vitamin D metabolism and cardiovascular risk factors in postmenopausal women

OBJECTIVES The purpose of this review is to focus on the association of vitamin D and cardiovascular risk factors in postmenopausal women. METHODS Review of the relevant literature and results from recent clinical studies as well as critical analysis of published results concerning the association of vitamin D and cardiovascular risk factors in postmenopausal women obtained from both a PubMed and individual searches. RESULTS AND DISCUSSION Both basic science and clinical studies support the protective role of vitamin D on cardiovascular health, although there are controversial results in the literature. Hypovitaminosis D is associated with disturbed glucose metabolism and pancreatic beta-cell dysfunction, lipoprotein alterations, hypertension, overweight and obesity. The evidence highlights the importance of improving vitamin D status in the general population for the prevention of adverse long-term health risks, including cardiovascular health. The optimal vitamin D dose remains to be determined. However, correction of low vitamin D itself does not guarantee the prevention of these conditions.

Iodine and thyroid hormones during pregnancy and postpartum

Iodine is a trace element essential for synthesis of the thyroid hormones, triiodothyronine and thyroxine. These hormones play a vital role in the early growth and development stages of most organs, especially the brain. The World Health Organization (WHO) has declared that, after famine, iodine deficiency is the most avoidable cause of cerebral lesions including different degrees of mental retardation and cerebral paralysis. The main function of iodine in vertebrates is to interact with the thyroid hormones. During pregnancy sufficient quantities of iodine are required to prevent the appearance of hypothyroidism, trophoblastic and embryonic or fetal disorders, neonatal and maternal hypothyroidism, and permanent sequelae in infants. Thyroid hormone receptors and iodothyronine deiodinases are present in placenta and central nervous tissue of the fetus. A number of environmental factors influence the epidemiology of thyroid disorders, and even relatively small abnormalities and differences in the level of iodine intake in a population have profound effects on the occurrence of thyroid abnormalities. The prevalence of disorders related to iodine deficit during pregnancy and postpartum has increased. Iodine supplementation is an effective measure in the case of pregnant and lactating women. However, it is not implemented and the problem is still present even in societies with theoretically advanced health systems. During pregnancy and postpartum, the WHO recommends iodine intake be increased to at least 200 μg/day. Side-effects provoked by iodine supplementation are rare during pregnancy at the recommended doses.

EMAS position statement: management of uterine fibroids.

INTRODUCTION Uterine fibroids (also termed leiomyomas or myomas) are the most common tumors of the female reproductive tract. AIM The aim of this position statement is to provide and critically appraise evidence on the management of women with uterine fibroids. METHODS Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow up patients to document stability in size and growth. Fibroid-associated symptoms include heavy menstrual bleeding and pain or pelvic discomfort. The association between infertility and fibroids increases with age. Fibroids do not increase the risk of malignant uterine disease and leiomyosarcomas are extremely rare (less than one in 1000). It is unknown at present whether leiomyosarcoma represents de novo growth or malignant transformation from benign uterine fibroids. Treatment options for symptomatic fibroids include pharmacologic, surgical and radiologically guided interventions. The range of medical treatments allows flexible management of fibroid-related symptoms; the options include tranexamic acid, non-steroidal anti-inflammatory drugs, contraceptive steroids, gonadotropin-releasing hormone analogs, antiprogesterone, and selective progesterone receptor modulators. However, these medical options do not remove the tumors and symptoms may return when treatment is stopped. Surgical and radiologically guided procedures may be tailored to age, general health, and individual patient wishes. Hysterectomy is the most effective treatment, although in some cases myomectomy may be sufficient to control symptoms. Alternatives to surgery include uterine artery embolization, myolysis and ablation by high-intensity focused ultrasound (guided with magnetic resonance imaging or ultrasound). The choice of treatment depends on fibroid size, the underlying symptoms and their severity and the womans desire for subsequent fertility and pregnancy, as well as efficacy and need for repeated interventions.