Pilar Guallar-Castillón

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

BACKGROUND AND OBJECTIVEnLow 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.nnnDESIGN, SETTING, AND PARTICIPANTSnProspective cohort study with 1815 community-dwelling individuals aged ≥60 years recruited in 2008-2010 in Spain.nnnMEASUREMENTSnAt 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.nnnRESULTSnOver 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).nnnCONCLUSIONSnAmong community-dwelling older adults, an increasing adherence to the MD was associated with decreasing risk of frailty.

Health-related quality of life and mental health in the medium-term aftermath of the Prestige oil spill in Galiza (Spain): a cross-sectional study

BackgroundIn 2002 the oil-tanker Prestige sank off the Galician coast. This study analyzes the effect of this accident on health-related quality of life (HRQoL) and mental health in the affected population.MethodsUsing random sampling stratified by age and sex, 2700 residents were selected from 7 coastal and 7 inland Galician towns. Two exposure criteria were considered: a) residential exposure, i.e., coast versus interior; and b) individual exposure-unaffected, slightly affected, or seriously affected-according to degree of personal affectation. SF-36, GHQ-28, HADS and GADS questionnaires were used to assess HRQoL and mental health. Association of exposure with suboptimal scores was summarized using adjusted odds ratios (OR) obtained from logistic regression.ResultsFor residential exposure, the SF-36 showed coastal residents as having a lower likelihood of registering suboptimal HRQoL values in physical functioning (OR:0.69; 95%CI:0.54–0.89) and bodily pain (OR:0.74; 95%CI:0.62–0.91), and a higher frequency of suboptimal scores in mental health (OR:1.28; 95%CI:1.02–1.58). None of the dimensions of the other questionnaires displayed statistically significant differences.For individual exposure, no substantial differences were observed, though the SF-36 physical functioning dimension rose (showed better scores) with level of exposure (91.51 unaffected, 93.86 slightly affected, 95.28 seriously affected, p < 0.001).ConclusionAlmost one and a half years after the accident, worse HRQoL and mental health levels were not in evidence among subjects exposed to the oil-spill. Nevertheless, some of the scales suggest the possibility of slight impact on the mental health of residents in the affected areas.

Role of educational level in the relationship between Body Mass Index (BMI) and health-related quality of life (HRQL) among rural Spanish women

BackgroundThe impact of obesity on health-related quality of life (HRQL) has been little explored in rural areas. The goal of this study is to ascertain the association between obesity and HRQL among Spanish women living in a rural area, and the influence of their educational level.MethodsCross-sectional study with personal interview of 1298 women (aged 18 to 60) randomly selected from the electoral rolls of 14 towns in Galicia, a region in the north-west of Spain. HRQL was assessed using the SF-36 questionnaire. The association between body mass index (BMI) and suboptimal scores in the different HRQL dimensions was summarised using odds ratios (ORs), obtained from multivariate logistic regression models. Separate analyses were conducted for women who had finished their education younger than 16 years old and women with secondary education to assess differences in the relationship between BMI and HRQL according to educational level.ResultsAmong women with primary or lower education, obesity was associated with a higher prevalence of suboptimal values in the following dimensions: Physical functioning (OR: 1.97; 95%CI: 1.22–3.18); Role-physical (OR: 1.81; 95%CI: 1.04–3.14); General health (OR: 1.76; 95%CI: 1.10–2.81); and Role-emotional (OR: 2.52; 95%CI: 1.27–5.03). In women with higher education, physical functioning was the only dimension associated with obesity (OR: 2.02: 95%CI 0.83–4.97).ConclusionThe impact of obesity on womens HRQL is greater among those with a lower educational level. This group registered higher prevalence of obesity and poorer self-perceived health.

Patterns of Alcohol Consumption and Risk of Frailty in Community-dwelling Older Adults

BACKGROUNDnConsumption of moderate-to-heavy amounts of alcohol has been associated with lower risk of cardiovascular disease and diabetes. Although both diseases are main causes of the frailty syndrome, no previous study has assessed the association between alcohol-drinking patterns and risk of frailty in older adults.nnnMETHODSnA prospective cohort study of 2,086 community-dwelling individuals aged 60 and older, recruited in 2008-2010, and followed through 2012, was carried out. Drinking patterns were self-reported at baseline. Moderate drinking was defined as alcohol intake less than 40 g/day for men and less than 24 g/day for women. A Mediterranean drinking pattern was defined as moderate alcohol intake, with wine preference (≥80% of alcohol proceeds from wine) and drinking only with meals. Study participants were followed through 2012 to ascertain incident frailty, defined as ≥2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed. Analyses were performed with logistic regression and adjusted for the main confounders.nnnRESULTSnAfter a mean follow-up of 3.3 (SD = 0.6) years, 292 participants with incident frailty were identified. Compared with nondrinkers, the odds ratio and its 95% confidence interval of frailty was 0.90 (0.65-1.25) for moderate drinkers. The corresponding results were 0.74 (0.48-1.16) for wine versus other beverage preference and 0.53 (0.31-0.92) for drinking only with meals versus only outside meals. Finally, compared with nondrinkers, the odds ratio (95% confidence interval) of frailty was 0.68 (0.47-0.99) for those adhering to the Mediterranean drinking pattern.nnnCONCLUSIONSnCertain drinking patterns, in particular drinking only with meals and the Mediterranean drinking pattern, are associated with a lower risk of frailty in older adults.

Socioeconomic Variation in the Magnitude of the Association between Self-Rated Health and Mortality

PURPOSEnTo assess socioeconomic variation in the association between self-rated health (SRH) and mortality and to determine whether socioeconomic inequalities in SRH and socioeconomic inequalities in mortality differ in magnitude.nnnMETHODSnWe used data from a cohort of Spanish people 60 years of age and older with an 8-year follow-up of mortality. The association between SRH at baseline and mortality was estimated by the age-adjusted relative risk of mortality in people with low, medium, and high education. The measures of health inequalities were the prevalence ratio of poor SRH and the age-adjusted relative risk of mortality according to educational level. The validity of SRH to reflect life-threatening and non-life-threatening health conditions was summarized with the likelihood ratio for poor SRH in each educational category.nnnRESULTSnThe relative risk of mortality according to SRH in subjects with high and low education was 3.24 and 1.62 in men and 2.25 and 1.50 in women, respectively. Inequalities in poor self-rated health were larger than inequalities in mortality: -1.63 versus 1.07 in men and 1.45 versus 1.30 in women. The highest likelihood ratio for SRH was seen in persons with high education in the case of life-threatening conditions, and for those with low education, in the case of non-life-threatening conditions.nnnCONCLUSIONSnSocioeconomic variation in the validity of SRH to reflect life-threatening and non-life-threatening conditions could explain the greater ability of SRH to predict mortality in persons with high education and why inequalities in poor SRH are larger than inequalities in mortality.

Binge Drinking in Spain, 2008–2010

BACKGROUNDnMost alcohol-related research has focused on northern and eastern Europe and the United States. Data on Mediterranean countries point to drinking patterns approaching the sporadic and excessive patterns found in northern and eastern Europe. This is the first study to estimate the prevalence of binge drinking (BD) and the joint distribution of BD, regular heavy alcohol consumption, and alcohol abuse or dependence (AAD) in a nationally representative sample of the adult population of Spain.nnnMETHODSnCross-sectional study conducted in 2008 to 2010 with 9,130 persons aged 18 to 64xa0years. BD was defined as intake of ≥80xa0g of alcohol in men (≥60xa0g in women) during any drinking occasion in the previous month, with ≥3 BD episodes discriminating between frequent and sporadic BD. Regular alcohol consumption was measured with a validated diet history, and the threshold between moderate and heavy drinking was ≥40xa0g of alcohol/d in men (≥24xa0g in women). AAD was defined by a CAGE score ≥2.nnnRESULTSnBD prevalence was 10% (95% confidence interval [CI]: 8.8 to 11.2) in men and 4.2% (95% CI: 3.5 to 4.8) in women, and proved highest among 18- to 24-year-olds (19.5% in men and 10.3% in women). During the latest BD episode, men consumed a mean of 114xa0g of alcohol versus 85.3xa0g in women; spirits accounted for 65.2 and 66.2% of total intake, respectively. The mean number of monthly BD episodes was 2.3 in men and 2 in women. Among binge drinkers, 61% were 18- to 34-year-olds, over 80% had regular moderate drinking, 25% reported frequent BD, and 22.8% reported AAD. In multivariate analyses, sporadic BD and frequent BD were associated with AAD independently of regular alcohol intake.nnnCONCLUSIONSnPrevalence of BD in Spain is moderately high. Prevention interventions should consider that the majority of binge drinkers are young men with regular moderate consumption and no AAD traits.

Alcohol drinking patterns and health-related quality of life reported in the Spanish adult population ☆

OBJECTIVESnTo examine the association between alcohol drinking patterns and health-related quality of life (HRQL).nnnMETHODSnPopulation-based cross-sectional study was conducted in 2008-2010 among 12,715 adult individuals in Spain. HRQL was assessed with the SF-12 questionnaire and alcohol intake with a diet history. The threshold between average moderate drinking and average heavy drinking was ≥ 40 g/day of alcohol in men and ≥ 24 g/day in women. Binge drinking was defined as the intake of ≥ 80 g in men and ≥ 60 g in women at any drinking session during the preceding 30 days. Analyses were performed with linear regression and adjusted for the main confounders.nnnRESULTSnCompared to non-drinkers, all types of average drinkers reported better scores on the SF-12 physical component: β=1.42 (95% confidence interval 1.03 to 1.81) in moderate drinkers and β=1.86 (1.07 to 2.64) in heavy drinkers. In contrast, average alcohol consumption was not associated with the mental component of the SF-12. The number of binge drinking episodes and most types of beverage preference showed no association with physical or mental HRQL.nnnCONCLUSIONSnAlcohol drinkers, including those with heavy drinking, reported better physical HRQL than non-drinkers.

Mediterranean Dietary Patterns and Impaired Physical Function in Older Adults

BackgroundnInformation about nutritional risk factors of functional limitation is scarce. The aim of this study was to examine the association between the Mediterranean diet and risk of physical function impairment in older adults.nnnMethodsnWe used data from 1,630 participants in the Seniors-ENRICA cohort aged ≥60 years. In 2008-2010, adherence to the Mediterranean diet pattern was measured with the Mediterranean Diet Score (MDS) and the Mediterranean Diet Adherence Screener (MEDAS). Study participants were followed up through 2012 to assess incident impairment in agility and mobility as well as impairment in overall physical functioning, defined as a ≥5-point decrease from baseline to follow-up in the physical component summary of the 12-Item Short-Form Health Survey.nnnResultsnOver a median follow-up of 3.5 years, we identified 343 individuals with agility limitation, 212 with mobility limitation, and 457 with decreased overall physical functioning. No association was found between the MDS score and the likelihood of impaired agility or mobility, although a 2-point increment in the MDS score was marginally associated with lower likelihood for decreased overall physical function. Compared to individuals in the lowest tertile of the MEDAS score, those in the highest tertile showed a lower odds of agility limitation (odds ratio: 0.67, 95% confidence interval: 0.48; 0.94, p trend = .02), mobility limitation (odds ratio: 0.69, 95% confidence interval: 0.40; 0.88, p trend = .01), and decreased overall physical functioning (odds ratio: 0.60, 95% confidence interval: 0.45; 0.79, p trend < .001).nnnConclusionsnIn this prospective cohort study, a Mediterranean-style dietary pattern, especially when measured with the MEDAS, was associated with a lower likelihood of physical function impairment in older adults.

The Southern European Atlantic Diet is associated with lower concentrations of markers of coronary risk

OBJECTIVEnThe Southern European Atlantic Diet (SEAD) is the traditional diet of Northern Portugal and Galicia, a region in northwest Spain. The SEAD has been associated with a lower risk of non-fatal acute myocardial infarction, but the mechanisms of this association have not yet been investigated. Thus, we examined the association between the SEAD and numerous biomarkers of coronary risk, blood pressure and anthropometrics.nnnMETHODSnCross-sectional study conducted in 2008-2010 among 10,231 individuals representative of the population aged 18 years and older in Spain. Diet was assessed with a validated computerized diet history. SEAD adherence was measured with an index including 9 food components (fresh fish, cod, red meat and pork products, dairy products, legumes and vegetables, vegetable soup, potatoes, whole-grain bread, and wine), which ranges from 0 (lowest adherence) to 9 (highest adherence). C-reactive protein, uric acid, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, glucose, glycated hemoglobin, insulin, leptin, fibrinogen, were determined in 12-h fasting blood samples, while creatinine and urine albumin were determined in urine.nnnRESULTSnMean SEAD score was 2.9 points (inter-quartile range 2-4 points). Higher SEAD adherence was associated with a lower level of plasma C-reactive protein (adjusted difference in geometric means between the highest and lowest SEAD quartiles -0.2xa0mg/l; p for trend <0.001), plasma triglycerides (-3.4xa0mg/dl; p for trend 0.012), insulin (-0.5xa0mU/l; p for trend <0.001), HOMA-IR (-0.12; p for trend <0.001), urine albumin (-0.8xa0mg/l; p for trend <0.001), urine albumin-creatinine ratio (-0.3xa0mg/g creatinine; p for trend <0.034), and systolic blood pressure (-1.6xa0mm Hg; p for trend <0.001).nnnCONCLUSIONSnThis study identifies possible mediators of the effect of SEAD on myocardial infarction, because SEAD is associated with a lower concentration of markers of inflammation and with reduced triglycerides, insulin, insulin resistance, and systolic blood pressure.

Household physical activity and mortality in older adults: A national cohort study in Spain

OBJECTIVEnTo examine the association between household physical activity (HPA) and all-cause mortality in a cohort of older adults from Spain, and the role of sedentary time on this association.nnnMETHODnProspective cohort study of 2874 individuals aged ≥ 62 years. In 2003, the time spent in HPA and the time spent seated were self-reported. The association of HPA with all-cause mortality through 2011 was assessed with Cox regression.nnnRESULTSnDuring the follow-up, 970 participants died. In men, HPA was inversely associated with the risk of death only among those with longer sitting time (≥ 8 h/d): compared to those who did not do HPA, the mortality hazard ratio (HR) was 0.80 (95% confidence interval (CI): 0.60-1.08) and 0.43 (95% CI: 0.27-0.69) for those who spent >0 to 2h/d and >2h/d in HPA, respectively (P for trend<0.001). In women, sitting time did not modify the study association. Thus, compared to women who spent <2h/d in HPA, the HR for mortality was 0.72 (95% CI: 0.56-0.93) and 0.52 (95% CI: 0.39-0.70) for those who spent >2 to 4h/d, and >4h/d in HPA, respectively (P for trend<0.001).nnnCONCLUSIONnIn women, HPA is associated with reduced mortality regardless of sitting time. HPA may also contribute to longer survival among men with longer sitting time.