Manuel Moñino

Association between dietary fibre intake and fruit, vegetable or whole-grain consumption and the risk of CVD: results from the PREvención con DIeta MEDiterránea (PREDIMED) trial

Prospective studies assessing the association between fibre intake or fibre-rich food consumption and the risk of CVD have often been limited by baseline assessment of diet. Thus far, no study has used yearly repeated measurements of dietary changes during follow-up. Moreover, previous studies included healthy and selected participants who did not represent subjects at high cardiovascular risk. We used yearly repeated measurements of diet to investigate the association between fibre intake and CVD in a Mediterranean cohort of elderly adults at high cardiovascular risk. We followed-up 7216 men (55-80 years) and women (60-80 years) initially free of CVD for up to 7 years in the PREvención con DIeta MEDiterránea study (registered as ISRCTN35739639). A 137-item validated FFQ was repeated yearly to assess diet. The primary end point, confirmed by a blinded ad hoc Event Adjudication Committee, was a composite of cardiovascular death, myocardial infarction and stroke. Time-dependent Coxs regression models were used to estimate the risk of CVD according to baseline dietary exposures and to their yearly updated changes. We found a significant inverse association for fibre (P for trend=0·020) and fruits (P for trend=0·024) in age-sex adjusted models, but the statistical significance was lost in fully adjusted models. However, we found a significant inverse association with CVD incidence for the sum of fruit and vegetable consumption. Participants who consumed in total nine or more servings/d of fruits plus vegetables had a hazard ratio 0·60 (95 % CI 0·40, 0·96) of CVD in comparison with those consuming <5 servings/d.

Is complying with the recommendations of sodium intake beneficial for health in individuals at high cardiovascular risk? Findings from the PREDIMED study

BACKGROUND Excess sodium intake is associated with high blood pressure, a major risk factor for cardiovascular disease (CVD). It is unknown whether decreasing sodium intake to <2300 mg/d has an effect on CVD or all-cause mortality. OBJECTIVE The objective was to assess whether reductions in sodium intake to <2300 mg/d were associated with either an increased or a decreased risk of fatal and nonfatal CVD and all-cause mortality. DESIGN This observational prospective study of the PREvención con DIeta MEDiterránea (PREDIMED) trial included 3982 participants at high CVD risk. Sodium intake was evaluated with a validated food-frequency questionnaire and categorized as low (<1500 mg/d), intermediate (≥1500 to ≤2300 mg/d), high (>2300 to ≤3400 mg/d), or very high (>3400 mg/d). Subsequently, 1-y and 3-y changes in sodium intake were calculated. Multivariate relative risks were assessed by using Cox proportional hazards ratios. Marginal structural models with inverse probability weighting were used to test the effect of changes in sodium intake and the Mediterranean diet (MedDiet). RESULTS We documented 125 CVD events and 131 deaths after a 4.8-y median follow-up. Sodium intake <2300 mg/d was associated with a lower risk of all-cause mortality: 48% (HR: 0.52; 95% CI: 0.30, 0.91; P = 0.02) and 49% (HR: 0.51; 95% CI: 0.26, 0.98; P = 0.04) after 1 and 3 y, respectively. Increasing sodium intake after 1 y was associated with a 72% (HR: 1.72; 95% CI: 1.01, 2.91; P = 0.04) higher risk of CVD events. The incidence rate of CVD was reduced for those who reduced their sodium intake and were randomly assigned to MedDiet interventions [4.1/10,000 (95% CI: 3.1, 8.0) compared with 4.4/10,000 (95% CI: 2.7, 12.4) person-years; P = 0.002]. CONCLUSIONS Decreasing sodium intake to <2300 mg/d was associated with a reduced risk of all-cause mortality, whereas increasing the intake to >2300 mg/d was associated with a higher risk of CVD. Our observational data suggest that sodium intake <2300 mg/d was associated with an enhanced beneficial effect of the MedDiet on CVD. These results should be interpreted with caution, and other confirmatory studies are necessary.

Consumo de zumos de frutas en el marco de una alimentación saludable: Documento de Postura del Comité Científico "5 al día"

Resumen El presente articulo es la adaptacion a las normas de publicacion de la revista A ctividad D ietetica del Documento de Postura del Comite Cientifico “5 al dia” respecto del consumo de zumos de frutas en el marco de una alimentacion saludable. La postura fue aprobada en la V Reunion del Comite Cientifico, celebrada en Madrid el 4 de abril de 2009. La controversia suscitada en torno a los criterios y parametros para evaluar los zumos de frutas y/o de hortalizas, dentro del propio Comite Cientifico “5 al dia”, ha promovido la creacion de este documento de postura para evaluar, justificar y consensuar la incorporacion de los zumos a las recomendaciones de consumo de frutas u hortalizas promovidas desde la Asociacion “5 al dia”, asi como las declaraciones de consumo permitidas.

Incorporación del dietista-nutricionista en el Sistema Nacional de Salud (SNS): Declaración de Postura de la Asociación Española de Dietistas-Nutricionistas (AEDN)

Resumen El presente documento tiene como objetivo justificar la incorporacion del dietista-nutricionista en los equipos multidisciplinarios de atencion primaria, especializada y de salud publica que dispensan atencion sanitaria integrada segun su papel especifico en la promocion, la prevencion, el tratamiento y la rehabilitacion de enfermedades prevalentes en Espana, y con ello benefician a la salud individual y colectiva de los ciudadanos y ciudadanas.

Association between Access to Public Open Spaces and Physical Activity in a Mediterranean Population at High Cardiovascular Risk

Background: Regular physical activity is an important preventive factor of cardiovascular disease. Proximity and density of public open spaces are important modifying factors on the practice of physical activity. This article explores the cross-sectional relationship between access to public open spaces (POS) and leisure time physical activity (LTPA) in elderly participants at high cardiovascular risk from PREDIMED-Baleares. Method: 428 elderly subjects at high cardiovascular risk, participating in the PREDIMED trial, from Palma de Mallorca (Spain) were assessed using Geographic Information Systems, and access to POS was determined. The quantity and intensity of LTPA was calculated using the Minnesota Leisure-Time Physical Activity Questionnaire. In order investigate the association between access to POS and LTPA, generalized linear regression models were used. Results: Better access to POS was not consistently associated with total LTPA. Only distance to the nearest park showed a borderline significant positive associated with total LTPA and moderate-vigorous LTPA but was not associated with light LTPA. Conclusions: Although living near POS was not associated to total LTPA, higher levels of moderate-vigorous LTPA were associated to distances to the nearest park. Future work should be conducted on a larger sample size, integrating a longitudinal design, and greater heterogeneity in POS access and introducing objective measures of physical activity.

Criterios y parámetros básicos para la evaluación de alimentos candidatos a incluirlos en las recomendaciones de consumo de frutas y hortalizas “5 al día”: el Documento Director

Resumen Establecer un consenso para las recomendaciones de raciones de consumo de frutas y hortalizas frescas, desecadas o deshidratadas, asi como de productos elaborados a partir de dichos alimentos es un objetivo y una prioridad de la Asociacion para la Promocion del Consumo de Frutas y Hortalizas “5 al dia”. El Comite Cientifico de “5 al dia”, creado en octubre de 2005 como organo asesor en materias de alimentacion, nutricion y dietetica, ha elaborado el Documento Director en el que se han revisado y consensuado los criterios y parametros basicos que deben tenerse en cuenta para evaluar y valorar todos los alimentos candidatos a ser incluidos en las recomendaciones de consumo de frutas y hortalizas “5 al dia” en Espana. Sin menoscabo de realizar una evaluacion caso a caso, la aplicacion del Documento Director por parte de la asociacion facilita la seleccion de alimentos enmarcados en el mensaje “5 al dia”, segun criterios legales, tecnologicos, nutricionales, alimentarios y de promocion de la salud. El presente articulo es una adaptacion del Documento Director para ser publicado en la revista Actividad Dietetica.