Francisca Lahortiga-Ramos

Validación del cuestionario Eating Attitudes Test (EAT) como prueba de cribado de trastornos de la conducta alimentaria en la población general

Fundamento y objetivo Validar un punto de corte alternativo de la version espanola del Eating Attitudes Test (EAT-40) para el cribado de casos de trastornos de la conducta alimentaria en la poblacion general. Sujetos y metodo Se administro el cuestionario traducido a una muestra representativa de 2.734 mujeres estudiantes de entre 13 y 22 anos de edad. Se entrevisto a las participantes cuya puntuacion en el cuestionario fue superior a 21 y a una muestra aleatoria del resto. Se estimaron los parametros de validez interna y externa obtenidos con puntos de corte distintos de 30, que es el utilizado habitualmente en el EAT. Resultados La mejor prediccion diagnostica se obtuvo con 21 puntos (sensibilidad del 73,3% y especificidad del 85,1%). El valor predictivo positivo fue del 20% y el valor predictivo negativo, del 98,4%. Conclusiones La mejor prediccion diagnostica del EAT-40 en un entorno no clinico se obtiene con un punto de corte de 21 puntos, algo inferior al recomendado por los autores del cuestionario.

Relationship between adherence to Dietary Approaches to Stop Hypertension (DASH) diet indices and incidence of depression during up to 8 years of follow-up.

OBJECTIVE Our aim was to evaluate the relationship between adherence to different Dietary Approaches to Stop Hypertension (DASH) diet indices and the risk of depression. DESIGN In a prospective study we assessed 14051 participants of a dynamic (permanently ongoing recruitment) prospective cohort (the Seguimiento Universidad de Navarra (SUN) Project), initially free of depression. At baseline, a validated FFQ was used to assess adherence to four previously proposed DASH indices (Dixon, Mellen, Fung and Günther). To define the outcome we applied two definitions of depression: a less conservative definition including only self-reported physician-diagnosed depression (410 incident cases) and a more conservative definition that required both clinical diagnosis of depression and use of antidepressants (113 incident cases). Cox regression and restricted cubic splines analyses were performed. RESULTS After a median follow-up period of 8 years, the multiple-adjusted model showed an inverse association with the Fung DASH score (hazard ratio (HR)=0·76; 95 % CI 0·61, 0·94) when we used the less conservative definition of depression, and also under the more conservative definition (HR=0·63; 95 % CI 0·41, 0·95). We observed a weak inverse association with the Mellen DASH score, but no statistically significant association was found for the other definitions. The restricted cubic splines analyses suggested that these associations were non-linear (U-shaped). CONCLUSIONS Moderate adherence to the DASH diet as operationalized by Fung and Mellen was related to lower depression risk. Since these associations were non-linear, additional prospective studies are required before the results can be generalized and clinical recommendations can be given.

Intake of High-Fat Yogurt, but Not of Low-Fat Yogurt or Prebiotics, Is Related to Lower Risk of Depression in Women of the SUN Cohort Study

BACKGROUND Yogurt and prebiotic consumption has been linked to better health. However, to our knowledge, no longitudinal study has assessed the association of yogurt and prebiotic consumption with depression risk. OBJECTIVE We longitudinally evaluated the association of yogurt and prebiotic consumption with depression risk in a Mediterranean cohort. METHODS The SUN (Seguimiento Universidad de Navarra) Project is a dynamic, prospective cohort of Spanish university graduates. A total of 14,539 men and women (mean age: 37 y) initially free of depression were assessed during a median follow-up period of 9.3 y. Validated food-frequency questionnaires at baseline and after a 10-y follow-up were used to assess prebiotic (fructans and galacto-oligosaccharide) intake and yogurt consumption (<0.5, ≥0.5 to <3, ≥3 to <7, and ≥7 servings/wk). Participants were classified as incident cases of depression when they reported a new clinical diagnosis of depression by a physician (previously validated). Multivariable Cox proportional hazards models were used to calculate HRs and 95% CIs. RESULTS We identified 727 incident cases of depression during follow-up. Whole-fat yogurt intake was associated with reduced depression risk: HR for the highest [≥7 servings/wk (1 serving = 125 g)] compared with the lowest (<0.5 servings/wk) consumption: 0.78 (95% CI: 0.63, 0.98; P-trend = 0.020). When stratified by sex, this association was significant only in women (HR: 0.66; 95% CI: 0.50, 0.87; P-trend = 0.004). Low-fat yogurt consumption was associated with a higher incidence of depression (HR: 1.32; 95% CI: 1.06, 1.65; P-trend = 0.001), although this association lost significance after the exclusion of early incident cases, suggesting possible reverse causation bias. Prebiotic consumption was not significantly associated with depression risk. CONCLUSIONS Our study suggests that high consumption of whole-fat yogurt was related to a lower risk of depression in women of the SUN cohort. No association was observed for prebiotics. Further studies are needed to clarify why the yogurt-depression association may differ by fat content of the yogurt.

Added sugars and sugar-sweetened beverage consumption, dietary carbohydrate index and depression risk in the Seguimiento Universidad de Navarra (SUN) Project.

The association between added sugars or sugar-sweetened beverage consumption and the risk of depression, as well as the role of carbohydrate quality in depression risk, remains unclear. Among 15 546 Spanish university graduates from the Seguimiento Universidad de Navarra (SUN) prospective cohort study, diet was assessed with a validated 136-item semi-quantitative FFQ at baseline and at 10-year follow-up. Cumulative average consumption of added sugars, sweetened drinks and an overall carbohydrate quality index (CQI) were calculated. A better CQI was associated with higher whole-grain consumption and fibre intake and lower glycaemic index and consumption of solid (instead of liquid) carbohydrates. Clinical diagnoses of depression during follow-up were classified as incident cases. Multivariable time-dependent Cox regression models were used to estimate hazard ratios (HR) of depression according to consumption of added sugars, sweetened drinks and CQI. We observed 769 incident cases of depression. Participants in the highest quartile of added sugars consumption showed a significant increment in the risk of depression (HR=1·35; 95 % CI 1·09, 1·67, P=0·034), whereas those in the highest quartile of CQI (upper quartile of the CQI) showed a relative risk reduction of 30 % compared with those in the lowest quartile of the CQI (HR=0·70; 95 % CI 0·56, 0·88). No significant association between sugar-sweetened beverage consumption and depression risk was found. Higher added sugars and lower quality of carbohydrate consumption were associated with depression risk in the SUN Cohort. Further studies are necessary to confirm the reported results.

Psychometric properties of a Spanish version of the Dyadic Adjustment Scale

Abstract The Dyadic Adjustment Scale (DAS) is a self-report instrument measuring marital satisfaction, which has been widely used in different cultures. In Spain, there are to date no studies analysing the psychometric properties of the scale in functional and dysfunctional couples, nor performing independent factor analysis of men and womens data. The objective of this study is to determine some psychometric properties of a Spanish DAS version on a sample of 915 participants: 403 who requested couple therapy, and 512 who did not request therapy. Results support the reliability of the instrument for both subsamples. The confirmatory factor analysis showed a four-factor internal structure that corresponds to the one proposed by the author of the original scale. Furthermore, the Spanish DAS has high discriminant power between both subsamples, and presents as a valid and reliable instrument to measure marital quality in Spanish couples who request couple therapy and those who do not request it.

Satisfacción conyugal y deseo de cambio: un modelo predictivo

espanolSatisfaccion conyugal y deseo de cambio son dos constructos estrechamente relacionados de gran importancia al evaluar la disfuncion conyugal. El objetivo fue evaluar la relacion entre la satisfaccion conyugal y el deseo de cambio. Se estudio una muestra de 435 matrimonios (166 funcionales y 264 disfuncionales) que completaron la Escala de Ajuste Diadico (EAD) y el Cuestionario de Areas de Cambio (ACQ). Los resultados obtenidos muestran que las mujeres desean mas cambios que los hombres. La satisfaccion conyugal, el numero de hijos y los anos de matrimonio predicen el deseo de cambio. En conclusion, hombres y mujeres perciben de manera distinta la relacion conyugal y en esta percepcion influyen variables como el numero de hijos y los anos de matrimonio. EnglishMarital satisfaction and desire for change are closely related constructs, which are very important to measure couple dysfunction. The objective was to determine the eventual relationship between marital satisfaction and desire for change. A sample of 435 couples (166 functional and 264 dysfunctional) completed the Dyadic Adjustment Scale (DAS) and the Areas of Change Questionnaire (ACQ). Results showed that women wanted more changes than men did. The variables marital satisfaction, number of children, and length of marriage were found to predict desire for change. Both men and women have a different perception of their couple relationship and number of children and years of marriage influence their perception.

Self-perceived level of competitiveness, tension, and dependency and lifestyles in the ‘Seguimiento Universidad de Navarra’ cohort study

OBJECTIVE The objective of this study is to assess the differences in lifestyles according to levels of self-perceived competitiveness, psychological tension, and dependency in a Mediterranean cohort of university graduates. STUDY DESIGN Levels of personality traits, food consumption, nutrient intake, eating attitudes, physical activity, sedentary lifestyle, and alcohol and tobacco consumption were assessed through a questionnaire administered at baseline. This was a cross-sectional study in the context of the Seguimiento Universidad de Navarra cohort. Participants are 15,346 Spanish adults. RESULTS Participants with a high level of self-perceived competitiveness consumed more vegetables and fish but less refined grains; they had higher protein intake and healthier eating attitudes. They were more physically active and less likely to be smokers. Participants with a high level of tension or dependency were less physically active, and participants more dependent also had poorer adherence to the Mediterranean diet. CONCLUSIONS Self-perceived personality traits, especially the trait of competitiveness, are likely to be associated with healthier dietary patterns, better nutrient profile, better eating attitudes, physical activity, and less exposure to smoking. The use of short questions about self-perceived levels of competitiveness, psychological tension, and dependency can contribute to add additional information when assessing lifestyles and diet in adults.

Adherence to the Mediterranean dietary pattern and incidence of anorexia and bulimia nervosa in women: The SUN cohort

OBJECTIVE To our knowledge, no study has yet assessed the association between dietary patterns and incidence of eating disorders. This study aimed to assess the association between adherence to the Mediterranean dietary pattern (MDP) and incident risk of anorexia (AN) and bulimia nervosa (BN). METHODS We conducted a prospective cohort study of 11 800 women from the Seguimiento Universidad de Navarra follow-up project. Participants were classified as having incident AN or BN if they were free of AN or BN at baseline and reported a physician-made diagnosis of AN or BN during the follow-up period. Nutritional status, lifestyle, and behavioral variables were investigated and used as covariates. A validated 136-item food frequency questionnaire and the Trichopoulou score were used to assess adherence to the MDP. RESULTS After a median follow-up time of 9.4 y, 100 new cases of AN and BN were identified. The multivariate hazard ratio of AN and BN for the two upper categories of adherence to the MDP were 0.39 (95% CI: 0.20-0.75) and 0.32 (95% CI: 0.14-0.70; Ptrend = 0.021). Inverse dose-response relationships were found for the consumption of cereals and olive oil and marginally for polyunsaturated fatty acid intake. To address reverse causation, multivariable linear regressions were run using a cross-sectional approach between adherence to the MDP and risk of AN and BN at baseline. No difference in adherence was found between participants with and without eating disorders. CONCLUSIONS Our results suggest a potential inverse association between the MDP and the risk of AN and BN. Additional longitudinal studies and trials are needed.