Joan Fernández-Ballart

Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain

The aim of the present study was to assess reproducibility and relative validity of a self-administered FFQ used in the PREDIMED Study, a clinical trial for primary prevention of CVD by Mediterranean diet in a population at high cardiovascular risk. The FFQ was administered twice (FFQ1 and FFQ2) to explore reproducibility at 1 year. Four 3 d dietary records (DR) were used as reference to explore validity; participants therefore recorded their food intake over 12 d in the course of 1 year. The degree of misclassification in the FFQ was also evaluated by a contingency table of quintiles comparing the information from the FFQ2 and the DR. A total of 158 men and women (aged 55-80 years) were asked not to modify their dietary habits during the study period. Reproducibility for food groups, energy and nutrient intake, explored by the Pearson correlation coefficient (r) ranged 0.50-0.82, and the intraclass correlation coefficient (ICC) ranged from 0.63 to 0.90. The FFQ2 tended to report higher energy and nutrient intake than the DR. The validity indices of the FFQ in relation to the DR for food groups and energy and nutrient intake ranged (r) from 0.24 to 0.72, while the range of the ICC was between 0.40 and 0.84. With regard to food groups, 68-83 % of individuals were in the same or adjacent quintile in both methods, a figure which decreased to 55-75 % for energy and nutrient intake. We concluded that FFQ measurements had good reproducibility and a relative validity similar to those of FFQ used in other prospective studies.

Regulation of Serum Paraoxonase Activity by Genetic, Nutritional, and Lifestyle Factors in the General Population

BACKGROUND Paraoxonase may protect lipoproteins and cell membranes from peroxidation, and alterations in the activity of this enzyme have been associated with some chronic diseases. Serum paraoxonase appears to be mainly under genetic control, but some studies suggest that environmental factors may also modulate its activity. The aim of the present study was to investigate whether diet and lifestyle affect serum paraoxonase activity. METHODS We studied a population-based sample of 388 individuals (194 women and 194 men; age range, 18-75 years) and assessed their daily dietary intake using a 3-day estimated food record. The variables studied included serum paraoxonase activity, paraoxonase polymorphisms at positions 55 and 192, age, gender, smoking status, physical exercise, body mass index, energy consumption, nutrient intake (total lipids, saturated fatty acids, beta-carotenes, vitamins C and E), and serum lipid concentrations. RESULTS Multiple linear regression analysis showed that only genetic polymorphisms, serum cholesterol, HDL-cholesterol concentrations, and cigarette smoking were significant predictors of serum paraoxonase activity. HDL-cholesterol concentrations were also related to body mass index, daily energy consumption, and saturated fatty acid intake. CONCLUSIONS The between-individual variability of serum paraoxonase activity is regulated mainly by genetic determinants. Although HDL-cholesterol and tobacco smoking may contribute to the modulation of this enzyme, the other nutritional and lifestyle factors do not seem to play a significant role.

Adherence to the Mediterranean diet and risk of metabolic syndrome and its components

BACKGROUND AND AIMS The role of diet in the aetiology of metabolic syndrome (MetS) is not well understood. The aim of the present study was to evaluate the relationship between adherence to the Mediterranean diet (MedDiet) and MetS. METHODS AND RESULTS A cross-sectional study was conducted with 808 high cardiovascular risk participants of the Reus PREDIMED Centre. MetS was defined by the updated National Cholesterol and Education Program Adult Treatment Panel III criteria. An inverse association between quartiles of adherence to the MedDiet (14-point score) and the prevalence of MetS (P for trend<0.001) was observed. After adjusting for age, sex, total energy intake, smoking status and physical activity, participants with the highest score of adherence to the MedDiet (>/=9 points) had the lowest odds ratio of having MetS (OR [95% CI] of 0.44 [0.27-0.70]) compared to those in the lowest quartile. Participants with the highest MedDiet adherence had 47 and 54% lower odds of having low HDL-c and hypertriglyceridemia MetS criteria, respectively, than those in the lowest quartile. Some components of the MedDiet, such as olive oil, legumes and red wine were associated with lower prevalence of MetS. CONCLUSION Higher adherence to a Mediterranean diet is associated with a significantly lower odds ratio of having MetS in a population with a high risk of cardiovascular disease.

Association between a healthy lifestyle and general obesity and abdominal obesity in an elderly population at high cardiovascular risk

BACKGROUND Diet, smoking and physical activity are important modifiable lifestyle factors that can influence body weight and fat accumulation. We assessed the relationship between lifestyle and obesity risk in a baseline analysis of the PREDIMED study, a randomized dietary primary prevention trial conducted in Spain. METHODS 7000 subjects at high cardiovascular risk were assessed cross-sectionally. A healthy lifestyle pattern (HLP) was determined using a score including: adherence to the Mediterranean diet, moderate alcohol consumption, expending ≥200 kcal/day in leisure-time physical activity, and non-smoking. RESULTS Inverse linear trends were observed between the HLP-score and body-mass-index (BMI) or waist circumference (p<0.001). The BMI and waist circumference of participants with a HLP-score=4 were, respectively, 1.3 kg/m(2) (95% CI: 0.9 to 1.7) and 4.3 cm (3.1 to 5.4) lower than those of subjects with an HLP≤1. The odds ratios of general obesity and abdominal obesity for an HLP score of 4 compared to an HPL score≤1 were 0.50 (0.42 to 0.60) and 0.51 (0.41 to 0.62), respectively. CONCLUSION A combination of four healthy lifestyle behaviors was associated with a lower prevalence of general obesity and abdominal obesity in Mediterranean elderly subjects at high cardiovascular risk.

Further evidence that hyperhomocysteinemia and methylenetetrahydrofolate reductase C677T and A1289C polymorphisms are not risk factors for schizophrenia

It has been suggested that total plasma homocysteine (tHcy) concentrations and methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms are risk factors for schizophrenia. We conducted a case-control study to investigate whether tHcy levels and MTHFR C677T and A1298C variants are associated with schizophrenia, giving special consideration to confounding factors. Logistic regression analysis showed that neither tHcy nor MTHFR polymorphisms were associated with schizophrenia. Homozygosity for MTHFR C677T was associated with higher tHcy concentrations in control and schizophrenia groups (P<0.01), which was mainly driven by the male group. The A1298C variant did not show any association with tHcy concentrations. In conclusion, these results do not confirm an independent relationship of tHcy and MTHFR genotype with risk of schizophrenia.

The apolipoprotein AV gene and diurnal triglyceridaemia in normolipidaemic subjects

Abstract The newly recognised apolipoprotein (apo) AV gene (APOAV) has been linked to fasting plasma triglyceride (TG) concentrations with some polymorphisms associated with elevated fasting TGs. Since fasting plasma TGs are mainly determined by the hepatic production of TG-rich particles (very low density lipoprotein; VLDL), and fasting TGs are the major determinants of postprandial lipaemia, we have evaluated the effects of an APOAV polymorphism on postprandial triglyceridaemia, which is largely determined by the intestinal production and clearance of chylomicrons. For this purpose, diurnal capillary triglyceridaemia (reflecting postprandial lipaemia) was determined in a cohort of 88 healthy volunteers (48 males and 40 females) in relation with a −1131T>C variant in the promoter of APOAV. Thirteen of these subjects (7 males and 6 females) were carriers of the −1131C allele, which has been associated with higher fasting plasma TG levels. The carriers had higher fasting capillary TG concentrations, although plasma TGs were not significantly different from non-carriers in this cohort. Surprisingly, total diurnal triglyceridaemia calculated as the area under the capillary TG curve was similar in carriers compared to non-carriers but after correction for fasting capillary TG levels, incremental diurnal triglyceridaemia was significantly lower in carriers (1.74 (5.27) mmol/h/l) than in non-carriers (4.91 (4.90) mmol/h/l; p = 0.036). The same trends were found for both males and females when analysed separately. Since dietary intake, which is a major determinant of incremental diurnal triglyceridaemia, did not differ between the two groups, we believe that these differences are at least partly explained by the APOAV. In summary, the APOAV assessed by means of the −1131T>C variant seemed to have a paradoxical effect on postprandial lipaemia when compared to fasting TG levels.

How anxiety levels during pregnancy are linked to personality dimensions and sociodemographic factors

We evaluated the development of anxiety, from the pre-conception stage to the postpartum stage, in 96 women who wanted to have children. Anxiety levels were assessed with the State-Anxiety Inventory Questionnaire for Adults (STAI). Personality dimensions (from the Eysenck Personality Questionnaire for Adults, EPQ-A) and sociodemographic variables were related with the anxiety levels. There were no statistical differences in State or Trait Anxiety during the period we studied. Neuroticism was significantly linked to anxiety levels. Older expectant mothers had significantly lower levels of anxiety at the pre-conception stage. We suggest that support offered at this stage would enhance the health of the mother and her new-born baby.

Predictors of depression at eighteen: A 7-year follow-up study in a Spanish nonclinical population

Abstract. This study prospectively examined predicting factors and depressive antecedents of depression in early adulthood and determined differences by sex. 199 adolescents aged 11–12 from the general community were followed up annually for 4 years and reassessed at 18 years of age. Sociodemographic data, depressive symptomatology, anxiety level, personality dimensions, self-esteem, academic aptitude and pubertal development were reported throughout this period and tested as possible risk variables of depression. At 18, depression was diagnosed using ICD-10 criteria. Of the cases of major depression (MDD) at eighteen, 30 % had been diagnosed as MDD between 12 and 14 years of age. Of the cases of MDD at eighteen, 80 % had had depressive symptomatology between the ages of 11 and 14. Subclinical scores in the Childrens Depression Inventory (CDI) were early indicators of long-term risk. Gender differences were found in the risk pattern; depressive symptoms were more significant in girls than in boys. In boys, early anxious symptomatology was a significant predictor. This study reports cross-cultural data that support a continuity of depression from adolescence to young adulthood.

Chapter 5 – Homocysteine in Pregnancy

The aim of this review is to evaluate the evidence for and against fasting plasma total homocysteine (tHcy) as a biomarker/risk factor of impaired reproductive function before and during pregnancy. Apart from nutritional and lifestyle factors, tHcy is also influenced by physiological factors specific to pregnancy such as hemodilution, increased glomerular filtration rate, and endocrinological changes. These lead to a considerable reduction under normal circumstances in tHcy by midpregnancy. Stimulating excess endogenous homocysteine production before and during pregnancy in animal experiments and adding exogenous homocysteine to cell cultures result in the impairment of reproductive and developmental processes from preconception throughout pregnancy and during subsequent development of the offspring. Different studies have confirmed that elevated tHcy is a risk factor for subfertility, congenital developmental defects, preeclampsia, and intrauterine growth retardation. There is conflicting evidence that elevated tHcy is a risk factor for miscarriage, gestational diabetes, premature rupture of the membranes, placental abruption, and offspring with Down syndrome. Prospective, sufficiently powered, studies from preconception/early pregnancy are required to determine whether tHcy is a risk factor for these pregnancy complications.

Onset of puberty at eight years of age in girls determines a specific tempo of puberty but does not affect adult height

Aims: To analyse the effect of early puberty (onset between 7.5 and 8.5 y) on pubertal growth and adult height in girls, and the implications of this effect for the age limit for normal onset of puberty. Methods: Longitudinal study in Reus (Spain) of 32 girls with early puberty until they reached adult height. Data from these girls were compared with longitudinal data from girls (116) from the same population with normal onset at 10 (n= 37), 11 (n= 47), 12 (n= 19) and 13 (n= 13) y. We analysed height, target height, adult height, pubertal height increase, duration of pubertal growth, age at menarche and time to menarche. Results: The adult height of girls with early puberty (160.9 ± 5.4 cm) was similar to that of girls with onset at later ages (p= not significant). In these girls, puberty lasted 5.4 ± 0.7 y and the mean growth during puberty was 31.1 ± 3.5 cm. As the age of onset of puberty increases, the duration of puberty and mean growth during puberty progressively decreased (p < 0.001). Girls with early puberty reached menarche at a mean age of 10.9 ± 1.0 y, 3.2 ± 0.9 y after onset of puberty, and this time span was greater than in the other groups.