Dieta Mediterránea, riesgo cardiovascular y obesidadDieta Mediterránea, riesgo...

www.unav.es/preventiva

Dieta Mediterránea, riesgo cardiovascular y obesidad

http://www.unav.es/preventiva

Miguel A. Martínez-González, Universidad de Navarra


Diseño y métodos

Dieta Mediterránea y diabetes

Dieta Mediterránea y ECV

Dieta Mediterránea y obesidad

El Proyecto SUN (Seguimiento Universidad de Navarra)

Research designs

Source: Martínez JA, Martínez-González MA. Nutrition Research Methodology: the scientific method and nutritional research.

In: Gibney MJ, et al. Introduction to Human Nutrition. The Nutrition Society Textbook series. London: Blackwell Science.

COHORT


Cohorte

prospectiva

dinámica

multipropósito

Comienzo: 1999

Mentores de HSPH:

W Willett, A Ascherio, FB Hu

Graduados universitarios de toda España

Invitación:

Universidad (alumni navarrensis)

Colegios profesionales de diversas provincias

Diseño y métodos


Reclutamiento: Cuestionario basal (Q_0)

Seguimiento (follow-up): Cada 2 años

Q_2

Q_4

Q_6

Q_8

Q_10 (Enero-2010)

Autoreferidos Impreso o por internet

Hasta 5 mailings para seguimiento

Diseño y métodos


1999/01 2002/03 2004/05 2006/07 2008/09 Follow-up

7500 9+

4200 7+

4200 5+

2500 3+

2000 1+

Año entrada

Tasa Retención Global >92%

Reclutamiento y seguimiento


Int J Epidemiol 2006;35:1417-22.

Public Health Nutr 2006;9:127-31.


Información


Participantes según sexo y edad

0

10

20

30

40

50

60

70

<25 y 25-44 y 45-64 y >=65 y

%

Men Women

Segui-Gomez M, de la Fuente C, Vazquez Z, de Irala J, Martinez-Gonzalez MA. Cohort profile: The 'Seguimiento Universidad de Navarra' (SUN) study. Int J Epidemiol 2006;35:1417-22.

19,2

17,6

8,2

3,82,23,5

45,4

MD

Nurses

Pharmacists

Biology

Dieticians

Oth. Health Prof.

Non health Prof.

Int J Epidemiol 2006;35:1417-22.


Métodos

Recogida de datos: actualización datos, personales, control calidad, escaneado, depósito

Análisis estadísticos variados según propósito


¿Auto-declarados? ¿Validez?

Alonso, et al. Validation of self reported diagnosis of

hypertension in a cohort of university graduates in Spain.

BMC Public Health 2005;5:94

% of confirmed cases of HT: 82 % (73 – 93)

% of confirmed cases of not HT: 85 % (72 – 89)

¿Sesgos?


Validación de actividad física

Public Health Nutrition 2005;8;920-7.


Validación de diagnósticos de depresión

BMC Psychiatry 2008;8;43.


0.73 -0.68

(-0.34 to –1.00)

-0.72

(-0.23 to –1.20)

0.52 +0.88

(+0.14 to +1.63)

+1.32

(+0.13 to +2.49)

0.90 -1.12

(-1.69 to –0.54)

-0.97

(-0.32 to –1.61)

0.85 -2.73

(-4.04 to –1.41)

-2.53

(-4.27 to –0.78)

0.33 -1.71

(-2.59 to –0.83)

-1.13

(-1.90 to –0.36)

p Women

Men

Diferencia de IMC (Kg/m2)

declarado-medido)

Diferencia de talla (cm)

(declarado-medido)

Weight difference (Kg)

(reported-measured)

Mean error (BMI)* (%)

Mean error (weight)* (%)

* (declarado-medido)/medido

Correlation coefficient: 0.991 (0.986-0.994)

Bes-Rastrollo M, Pérez Valdivieso JR, Sánchez-Villegas A, Alonso A, Martínez-González MA. Validación del peso e indice de masa corporal auto-declarados de los participantes de una cohorte de graduados universitarios. Rev Esp Obes 2005;3:183-9.

Validacion de peso e IMC


112

114

116

118

120

122

124

126

128

<25 25 to 30 >30

BMI (kg/m2)S

BP

(ad

j. m

ean

, 9

5%

CI)

68

70

72

74

76

78

80

82

<25 25 to 30 >30

BMI (kg/m2)

DB

P (

ad

j. m

ean

, 9

5%

CI)

IMC basal y TA auto-referida (6 años de seguim.)


Cuestionario de Frecuencia Consumo Alim. (136-items) - FFQ


Martin-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernandez-Rodriguez JC, Salvini S, Willett WC.Development and validation of a food frequency questionnaire in Spain. Int J Epidemiol 1993;22:512-9.

Validación-Reproducibilidad del FFQ


Representativeness is a

fallacy that has plagued

epidemiologic studies for

decades. Rothman KJ. Epidemiology. An introduction

Oxford University Press, 2002, p.110.


Low-fat dairy but not whole-fat dairy incidence of HT (SUN Cohort. Alonso, et al AJCN, 2005)

Am J Clin Nutr 2005;82:972-9.


Low-fat dairy but not whole-fat dairy incidence of HT (SUN Cohort. Alonso, et al AJCN, 2005)

Interaction SFA-dairy (only incidence of HT if SFA intake is low) Djoussé et al, Hypertension 2006

Low-fat dairy, but not whole-fat dairy HT risk in the Women Health Study cohort (n=28 000)

Wang et al, Hypertension 2008

Low-fat dairy, but not whole-fat dairy BP Toledo et al, Br J Nutr 2009

Low-fat dairy, but not whole-fat dairy HT risk in the

Rotterdam cohort Engberink et al, AJCN 2009

Am J Clin Nutr 2005;82:972-9.


Diseño y métodos






•1 point if >= sex-specific Median •MUFA/SFA ratio

•Fruits & nuts

•Vegetables

•Cereals

•Legumes

•Fish

•1 point if <= sex-specific Median •Meat & poultry /meat products

•Dairy

•Alcohol: 1 point if •Men: between 10-50 g/d •Women: between 5-25 g/d

Trichopoulou score


n = 13 464 8 084 women and 5 380 men

mean age = 38 yr (SD: 12)

initially free of diabetes

Follow-up: ~59 000 p-yr (mean follow-up: 4.4 yr)

2+ yr: 4130

4+ yr: 4424

6+ yr: 4910

Retention rate: 87%

Mediterranean Food Pattern and diabetes: The SUN Project

Outcome: confirmed cases of type-2 diabetes

(additional questionnaire + medical chart review)


MeDiet (Trichopoulou score) <3 3-6 >6

n 2258 9657 1549

% Male 40 39 45

Age 34 38 43

BMI 23.0 23.5 23.8

% Family history of diabetes 12 14 17

% Personal history hypertension 6 9 14

% Current or ex-smoker 44 51 58

Total energy intake (kcal/d) 2286 2586 2783

Physical activity (METS-h/wk) 24 29 36



0.31

0.49

0.78

0

0,25

0,5

0,75

1

<3 3 to 6 >6

MeDiet score <3 3-6 >6

Total fibre (g/d) 18 29 41

Olive oil (g/d) 12 19 25

Alcohol (g/d) 4 7 10

Meats (g/d) 199 187 154



Trichopoulou Score <3 3-6 >6

Rate/1000 0.88 0.52 0.32

crude IRR 1 (ref.) 0.6 (0.3-1.3) 0.4 (0.1-1.7)

age- & sex-adj. IRR 1 (ref.) 0.41 (0.19-0.87) 0.17 (0.04-0.75)

multivariate adj. IRR* 1 (ref.) 0.40 (0.18-0.90) 0.17 (0.04-0.72)

p for trend = 0.04

*Adjusted for age, sex, years of university education, BMI, energy intake,

physical activity, hours/wk sitting down, smoking, family history of

diabetes and personal history of hypertension.



Mediterranean Diet and Metabolic syndrome: The SUN Project


Odds Ratios for Metabolic Syndrome according to Baseline adherence to MeDiet (SUN cohort, 6-yr follow-up)

MeDiet (Trichopoulou

score)

% Metabolic Syndrome

(incidence)

Age- and sex-adjusted analysis

Multivariate analysis

<=2 (n=535) 2.6 1 (ref.) 1 (ref.)

3 – 5 (n=1523) 2.5 0.76 (0.40, 1.45) 0.80 (0.42, 1.54)

>=6 (n=505) 0.8 0.18 (0.06, 0.56) 0.20 (0.06, 0.63)

P for trend 0.006 0.01

Adjusted for age, gender, smoking, leisure-time physical activity (METS-h/wk), and total energy intake.

Tortosa A, Bes-Rastrollo M, Sanchez-Villegas A, Basterra-Gortari FJ, Núñez-Córdoba JM, Martínez-Gonzalez MA. Mediterranean Diet inversely associated with the incidence of Metabolic Syndrome: the SUN prospective cohort. Diabetes Care 2007


Diseño y métodos





Nutr Metab Cardiov Dis Jan 20. [Epub ahead of print]


15 975

14 129

13 823

13 609 free of CVD

(5483 men & 8126 women)

100 incident CVD Events (73 men & 27 women)

306 out of kcal limits

1 846 without follow-up

214 CVD at

baseline

mean follow-up: 43 months

Mediterranean Diet and CV Disease: The SUN Project

68 AMI or Revasc. 32 Stroke


p for trend = 0.07

Cox model (age): adjusted for smoking (3), sex, family history of CHD, hypertension,

diabetes, aspirin use, dyslipidemia, physical activity (4), BMI (3), and total energy intake.

Martinez-Gonzalez, et al. Nutr Metab Cardiov Dis 2010, Jan 20

1

0,64 0,66

0,41

0

0,2

0,4

0,6

0,8

1

Low (0-2) Low-Mod. (3-4) Mod-High(5-6) High (7-9)

MeDiet

RR

of

CV

DMediterranean Diet and CV Disease: The SUN Project


Mediterranean Diet and CV Disease: The SUN Project

Studies conducted in the US


Diseño y métodos






Mediterranean Diet and obesity: The SUN Project


Mediterranean Diet and obesity: The SUN Project

10 376 participants

Followed-up 5.7 2 y

MeDiet: 6 scores Trichopoulou (0 to 9) Alberti-Fidanza (Med Foods/not Med Foods) Scali (0 to 14)- inverse Sánchez-Villegas (0 to 100) Panagiotakos (0 to 55) Rumawas (0 to 100)

Weight bianually Risk of gaining 3 kg or 5 kg after 2 or 4 y

Incident overweight/obesity (if BMI<25 at onset)

Average yearly weight gain


Baseline, cross-sectional comparisons


0,5

0,75

1

1,25

0 to 3 4 to 5 6 to 9

MeDiet (Trichopoulou)

OR

fo

r g

ain

ing

5+

kg

(9

5%

CI)

Relative Risk (Odds Ratios) of gaining 5+ kg

in 2-y follow-up or in 4-y follow-up

p<0,01

0,5

0,75

1

1,25

0 to 3 4 to 5 6 to 9


OR

fo

r g

ain

ing

5+

kg

(9

5%

CI) p<0,01


0,9

0,5

0,75

1

1,25

0 to 3 4 to 5 6 to 9


HR

fo

r o

ve

rwe

igh

t/o

be

sit

y

(9

5%

CI)

Relative Risk (Hazard Ratios) of incident overweight/obesity during follow-up (baseline BMI<25)

Person-yr 13 911 14 072 8 512 Incident cases 375 412 239

Adjusted for sex, age, baseline BMI, physical activity, sedentary behavior, smoking (never, former, or current smokers), snacking, and total energy intake


0,295

0,238

0,186

0

0,1

0,2

0,3

0,4

Lowest (<4) Mod (4-5) Highest (>5)


Ye

arl

y w

eig

ht

ch

an

ge

(k

g/y

)

dif.= ―0,057

AVERAGE YEARLY WEIGHT CHANGE Longitudinal, crude (unadjusted) comparisons


-0,2

-0,1

0

0,1

0,2

0 to 3 4 to 5 6 to 9


Dif

f. in

ye

arl

y w

eig

ht

ch

an

ge

(9

5%

CI)

-0,2

-0,1

0

0,1

0,2

0 to 3 4 to 5 6 to 9


Dif

f. in

ye

arl

y w

eig

ht

ch

an

ge

(9

5%

CI)

DIFFERENCES IN YEARLY WEIGHT CHANGE Longitudinal, adjusted comparison

p = 0,02 p = 0,04

*Adjusted for sex, age, baseline BMI, physical activity, sedentary

behavior, smoking (never, former, or current smokers), snacking, and

total energy intake


Age-sex Multivariable*

Trichopoulou Score 0.04 0.02

Alberti-Fidanza 0.01 0.02

Scali <0.01 <0.01

Sánchez-Villegas <0.01 0.02

Panagiotakos 0.18 0.30

Rumawas 0.13 0.41

Statistical significance, p for trend values

Adjusted for sex, age, baseline BMI, physical activity, sedentary behavior, smoking (never, former, or current smokers), snacking, and total energy intake


MeDiet & average yearly weight change (6 scores) Multivariable-adjusted*

-0,2

-0,1

0

0,1

0,2

0 to 3 4 to 5 6 to 9

Trichopoulou

-0,2

-0,1

0

0,1

0,2

Lowest Mod-low Mod-high Highest

Alberti-Fidanza

-0,2

-0,1

0

0,1

0,2


Scali

-0,2

-0,1

0

0,1

0,2


Sánchez-Villegas

-0,2

-0,1

0

0,1

0,2

Low Mod. High

Panagiotakos

-0,2

-0,1

0

0,1

0,2

Low Mod. High

Rumawas


-0,3

-0,2

-0,1

0

0,1

0 to 3 4 to 5 6 to 9


Dif

f. i

n y

earl

y w

eig

ht

ch

an

ge (

95

%C

I)

-0,3

-0,2

-0,1

0

0,1

0 to 3 4 to 5 6 to 9


Dif

f. i

n y

earl

y w

eig

ht

ch

an

ge (

95

%C

I)

Effect modification (interaction) according to previous weight gain Multivariable-adjusted*

p<0,01


Proyecto SUN Dpt. Medicina Preventiva y S. Pública

Universidad de Navarra

Nunez-Cordoba JM, Tortosa A, de la Fuente-Arrillaga C, Bes-Rastrollo M, Martinez-Gonzalez MA,

Benito S, Beunza JJ, Vazquez Z, Basterra-Gortari FJ.

¡Muchas gracias!

Dieta Mediterránea, riesgo cardiovascular y obesidadDieta Mediterránea, riesgo...

Documents

Transcript of Dieta Mediterránea, riesgo cardiovascular y obesidadDieta Mediterránea, riesgo...