Seguimiento Universidad De Navarra Cohort Research Articles

Association between overall quality of macronutrients and incidence of overweight and obesity in the SUN (Seguimiento Universidad de Navarra) cohort.

no previous large prospective studies have assessed the global quality of macronutrients in association with the risk of overweight/obesity. to prospectively assess the association of an overall macronutrient quality index (MQI) with weight change and the incidence of overweight/obesity in the Seguimiento Universidad de Navarra (SUN) cohort. the diet of 9,344 Spanish university graduates (mean age: 36.5 [SD, 11.1]) was assessed through a validated 136-item food frequency questionnaire. The MQI was calculated as the sum of the Carbohydrate Quality Index, the Fat Quality Index, and the Healthy Plate Protein Quality Index. Participants were classified into groups according to MQI. Incident overweight/obesity was defined if follow-up questionnaires indicated BMI was ≥ 25 kg/m2. Multiple linear regression models and Cox proportional hazard models were used to assess the average yearly weight change and the risk of overweight/obesity over follow-up time. 2,465 cases of incident overweight/obesity were identified (median follow-up: 10.7 years). Increasing MQI was significantly associated with lower annual weight gain (g): ß coefficient: -99.0, (95 % CI: -173.6 to -24.5) in the Q4 vs Q1, p for trend = 0.007. In the fully adjusted model the incidences of overweight/obesity in Q4 and Q1 were 21.7 % (431 cases) and 29.3 % (954 cases), respectively. The adjusted HR was 0.87 (95 % CI, 0.77-0.98, p for trend = 0.036). When we used repeated analyses updating the MQI after 10 years of follow-up, results remained similar. a significant inverse association between a multidimensional MQI and the risk of overweight/obesity was found in this Mediterranean cohort of adults.

The risk of incident depression when assessed with the Lifestyle and Well-Being Index

ObjectivesNovel findings indicate links between unhealthy lifestyles and depression based on active inflammatory processes. Thus, identifying participants with poor habits could reveal differences in trends of incident depression. This study aimed to examine the association between an objective lifestyle assessment, as measured by the Lifestyle and Well-Being Index (LWB-I), and incident depression in healthy participants of a Spanish cohort. Study designThis was a longitudinal analysis of a subsample of 10,063 participants from the Seguimiento Universidad de Navarra cohort study. MethodsGroup comparisons and Cox proportional hazard models were conducted using the LWB-I, which categorizes the sample into groups with healthy and unhealthy lifestyles and well-being. The main outcome was incident depression as well as secondary outcomes. ResultsThose classified to the transition category of LWB-I were associated with a hazard ratio of 0.67 (95% confidence interval: 0.52–0.87), and those in the excellent category showed a hazard ratio of 0.44 (95% confidence interval: 0.33–0.58), which in both groups reflects a significantly lower risk of incident depression compared with the group including those classified in the poor LWB-I level. Moreover, the available sensitivity analyses concerning time of depression diagnosis or antidepressant treatment further supported the role of nutrition and physical activity on incident depression. Interestingly, throughout the follow-up, incident depression was inversely related to healthier daily habits as measured by the LWB-I. ConclusionsA global assessment of lifestyles such as the LWB-I provides valuable insight into the complex relationship between lifestyle factors and their link to depression risk.

Association between an oxidative balance score and mortality: a prospective analysis in the SUN cohort

PurposeWe aimed to prospectively investigate the association of an overall oxidative balance score (OBS) with all-cause death and cause-specific mortality among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of Spanish graduates.MethodsUsing baseline information on 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures—vitamins C and E, β-carotenes, selenium, zinc, heme iron, polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity—we constructed an equally weighted OBS categorized into quartiles, with higher scores representing greater antioxidant balance. Cox proportional hazards models were fitted to evaluate the association between the OBS and mortality.ResultsA total of 18,561 participants (mean [SD] age, 38.5 [12.4] years; 40.8% males) were included in the analysis. During a median follow-up of 12.2 years (interquartile range 8.3–14.9), 421 deaths were identified, including 80 deaths from cardiovascular disease (CVD), 215 from cancer, and 126 from other causes. After adjustment for potential confounders, the hazard ratios and 95% confidence interval (CIs) between the highest quartile (predominance of antioxidants) vs. the lowest quartile (reference category) were 0.35 (95% CI 0.22–0.54, P-trend < 0.001) for all-cause mortality, 0.18 (95% CI 0.06–0.51, P-trend = 0.001) for CVD mortality, 0.35 (95% CI 0.19–0.65, P-trend = 0.002) for cancer mortality, and 0.45 (95% CI 0.20–1.02, P-trend = 0.054) for other-cause mortality.ConclusionOur findings suggest a strong inverse association between the OBS and all-cause, CVD, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk.Study registry numberDynamic Mediterranean Prospective Cohort: the SUN Project; NCT02669602. https://clinicaltrials.gov/ct2/show/NCT02669602. https://proyectosun.es

Healthful and unhealthful provegetarian food patterns and micronutrient intake adequacy in the SUN cohort.

To investigate the association between different versions of a provegetarian food pattern (FP) and micronutrient inadequacy. Cross-sectional analysis. Dietary intake was assessed at baseline through a validated 136-item FFQ. Participants were classified according to groups of different versions of a provegetarian FP: overall, healthful and unhealthful. The prevalence of inadequate intake of vitamins B1, B2, B3, B6, B12, C, A, D, E, folic acid, Zn, I, Se, Fe, Ca, K, P, Mg and Cr was evaluated using the estimated average requirement (EAR) cut-point method and the probabilistic approach. Logistic regression analyses were conducted to estimate the probability of failing to meet EAR for either ≥ 3 or ≥ 6 micronutrients. Seguimiento Universidad de Navarra (SUN) cohort. 17 825 Spanish adults. Overall, subjects in the highest group of the unhealthful provegetarian FP had the highest prevalence of inadequate dietary intake for every vitamin and mineral, compared to those in the lowest group. The adjusted OR of failing to meet ≥ 3 EAR (highest v. lowest group) was 0·65 (0·54, 0·69) for the overall, 0·27 (0·24, 0·31) for the healthful and 9·04 (7·57, 10·4) for the unhealthful provegetarian FP. A higher adherence to an overall and healthful provegetarian FP was inversely associated with the risk of failing to meet EAR values, whereas the unhealthful version was directly associated with micronutrient inadequacy. Provegetarian FP should be well planned, prioritising nutrient-dense plant foods and minimising ultra-processed and unhealthy ones.

Joint association of the Mediterranean diet and smoking with all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort

ObjectivesAlthough low-quality diets and smoking are independently associated with higher mortality risk, a joint analysis of both risk factors in relation to mortality has not been sufficiently studied. The aim of this study was to explore the effect modification between level of adherence to a Mediterranean dietary pattern (MedDiet) and smoking status on all-cause, cancer, and cardiovascular mortality. MethodsWe conducted a prospective analysis to assess the association between diet and smoking status in the SUN (Seguimiento Universidad de Navarra) cohort study. Deaths were confirmed by review of the National Death Index. Participants were classified into six categories according to the MedDiet (adherence/non-adherence) and their exposure to smoking (never/former/current smoker). Multivariate-adjusted Cox regression models were fitted to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for mortality. During a mean follow-up of 11.5 y (SD 4.5), we observed 18 948 participants (mean age 38.4 y; SD 12.4) and 431 deaths (51.3% cancer deaths). ResultsA higher risk for death was found among smokers with a low adherence to the MedDiet (HR, 2.20; 95% CI, 1.45–3.34) compared with never smokers with high adherence to the MedDiet. The P value for supra-multiplicative effect modification was not statistically significant, meaning that the effect of both factors is multiplicative. A higher risk for premature death from cancer was found in smokers and in those non-adherent with the MedDiet. ConclusionSmoking and poor adherence to the MedDiet exerted a multiplicative effect in increasing all-cause mortality and cancer-related mortality in a Spanish population of university graduates.

Sedentary behaviors and risk of depression in the Seguimiento Universidad de Navarra cohort: the SUN Project

The study aimed to prospectively examine the association between different sedentary behaviors and the risk of depression. We included 12,691 Spanish university graduates (mean age: 36.7 year; SD: 11.5), participants of the Seguimiento Universidad de Navarra cohort (the SUN Project), initially free of depression who were followed-up for a median of 10.9 years. Based on items presented in our baseline questionnaire, time spent in four sedentary behaviors (hours/day) were evaluated: overall sitting time; TV-viewing; computer use; and driving. Participants were classified as incident cases of depression if they reported a physician diagnosis of depression in at least one of the follow-up assessments conducted after the first two years of follow-up. Cox regression models were used to assess the relationship between sedentary behaviors and depression. A total of 560 incident cases of depression were identified during follow-up. We found no significant association between overall sitting time, TV-viewing or driving and risk of depression. On the other hand, computer use was directly associated with the risk of developing depression during the follow-up (p-value for trend = 0.020), with the participants in the highest quartile of computer use (3.64 to 10 hours/week) having a higher risk of developing depression (HR = 1.33; 95%CI: 1.05-1.70) than those in the lowest quartile (0 to 0.25 hours/week) after adjusting for potential confounders. Prolonged use of computer was independently associated with an increased risk of developing depression among young middle-aged adult university graduates from a Spanish cohort.

The Mediterranean Lifestyle and the Risk of Depression in Middle-Aged Adults

BackgroundRecent evidence has indicated a greater number of protective factors are associated with a greater decreased risk for depression and depressive symptoms compared with individual factors alone. Moreover, adherence to healthy modifiable lifestyle behaviors may lower the risk of depression regardless of underlying genetic risk. ObjectivesWe longitudinally evaluated the association of the Mediterranean lifestyle (MEDLIFE) with the risk of depression. MethodsWe prospectively analyzed data from 15,279 participants (6089 men and 9190 women, mean age 37 y) in the Seguimiento Universidad de Navarra cohort. The MEDLIFE index is composed of 28 items on food consumption, dietary habits, physical activity, rest, social habits, and conviviality, each of which was assigned 0 or 1 point. Final scores ranged from 0 to 28 points and were categorized into quartiles of MEDLIFE adherence. Cox proportional regression models determined the association of total MEDLIFE adherence, each item, and block with incident depression. ResultsAfter a mean follow-up of 11.7 y, 912 (6%) incident cases of depression were reported. The mean ± SD final score for MEDLIFE adherence was 11.9 ± 2.7 points. The multivariable model showed that compared with the first quartile, the second and third quartiles of MEDLIFE adherence were significantly associated with a decreased relative risk for incident depression (HR: 0.82; 95% CI: 0.69, 0.96 and HR: 0.74; 95% CI: 0.61, 0.89, respectively). The fourth quartile did not show a statistically significant association with incident depression (HR: 0.89; 95% CI: 0.73, 1.09). ConclusionsMEDLIFE adherence may decrease the risk of depression in a Spanish cohort of university graduates. Given no clear association was observed among the highest MEDLIFE adherence, future studies are warranted to better understand the nature of this association. Evidence on MEDLIFE, beyond the Mediterranean diet, may contribute toward more effective prevention strategies for depression.

Association Between an Oxidative Balance Score and Mortality: A Prospective Analysis in the SUN Cohort

ObjectivesWhether oxidative balance impacts mortality risk requires accounting not only for dietary patterns but also for lifestyle exposures. We aimed to investigate the association between an overall oxidative balance with all-cause, cardiovascular, and cancer mortality risk among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of middle-aged Spanish graduate students. MethodsUsing baseline information from 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures — vitamins C and E, betacarotenes, minerals (Se, Zn, heme-Fe), polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity — we constructed an oxidative balance score (OBS) categorized in equal-weighting quartiles, with higher scores meaning greater antioxidant balance. Cox proportional hazards models were fitted to evaluate the association between the OBS and mortality risk. Cases were ascertained through consultation of the National Death Index. ResultsA total of 19,083 participants (mean [SD] age, 38.5 [12.4] years; 59.2% females) were included in the analysis. During a median follow-up of 12.2 years (interquartile range, 8.1–14.9), 421 deaths were identified, including 80 cardiovascular (CV) deaths and 215 cancer deaths. After adjustment for potential confounders, the hazard ratio between the highest quartile (predominance of antioxidant) vs. the lowest quartile (reference category) was 0.43 (95% confidence interval [CI], 0.29–0.66, P-trend < 0.001) for all-cause mortality; 0.19 (95% CI 0.07–0.50, P-trend = 0.012) for CV mortality; 0.47 (95% CI 0.26–0.84, P-trend = 0.012) for cancer mortality. The antioxidant balance of dietary exposures and lifestyle exposures contributed towards reducing mortality risk, however, the individual effects were smaller than the combination of both exposures, suggesting the utility of the OBS to reflect the synergistic effect between the individual components. ConclusionsOur findings suggest a strong inverse association between OBS score and decreased all-cause, CV, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk. Funding SourcesInstituto de Salud Carlos III, FEDER, Navarra Regional Government and University of Navarra.

Association between ideal cardiovascular health and telomere length in participants older than 55 years old from the SUN cohort

Introduction and objectivesTelomeres are noncoding regions located at the end of chromosomes and their shortening has been associated with risk factors and cardiovascular disease. The aim of this study was to evaluate the association between ideal cardiovascular health (Life's simple 7) and the odds of having short telomeres in a subsample of participants older than 55 years from the Seguimiento Universidad de Navarra (SUN) study. MethodsWe included 886 participants older than 55 years (645 men and 241 women). Telomere length was measured using a real-time quantitative polymerase chain reaction. Cardiovascular health score was defined by the American Heart Association as a composite score of 7 key risk factors (smoking status, physical activity, diet, body mass index, blood pressure, total cholesterol, and fasting blood glucose) with 0 to 2 points for each factor. We categorized this score in tertiles as poor (0-9 points), intermediate (10-11 points) and ideal (12-14 points). The odds of having short telomeres was defined as telomere length below the 20th percentile. ResultsIndividuals with higher ideal cardiovascular health had a lower prevalence of having short telomeres (adjusted OR, 0.60; 95%CI, 0.34-1.05; P trend=.052). This association was statistically significant in men (adjusted OR, 0.37; 95%CI, 0.17-0.83; P trend=.025) but not in women. ConclusionsAn inverse association between cardiovascular health score and short telomeres was found especially for men older than 55 years in the SUN population.The SUN project was registered at ClinicalTrials.gov (Identifier: NCT02669602).

Dietary calcium, vitamin D, and breast cancer risk in women: findings from the SUN cohort.

Epidemiological evidence concerning the relationship between calcium and vitamin D intake and breast cancer (BC) is inconclusive. Moreover, the association according to menopausal status remains unclear. We aimed to assess whether total intakes from dietary and supplemental sources of calcium and vitamin D were associated with the incidence of BC in a Mediterranean cohort. We prospectively evaluated the association between intakes of calcium and vitamin D and BC risk among 10,812 women in the Seguimiento Universidad de Navarra (SUN) Project, a Spanish cohort of university graduates. During a mean follow-up of 10.7years, 101 incident BC cases were confirmed. Evidence of a non-linear association between total calcium intake and BC risk was found (Pnon-linearity = 0.011) with risk reductions associated with higher intake up to approximately 1400mg/day. Moderate intake [Tertile 2 (T2)] of total calcium was associated with lower overall BC risk [HR for T2 vs. Tertile 1 (T1): 0.55; 95% CI 0.33-0.91] and also among postmenopausal women (HRT2 vs. T1 = 0.38; 95% CI 0.16-0.92). Intake of vitamin D was not associated with BC risk. Our findings suggest an L-shaped association between total calcium intake and BC incidence. Moderate calcium intake may be associated with lower BC risk among overall and postmenopausal women, but not among premenopausal women. No evidence for any association between vitamin D intake and BC was found. Adherence to current guidelines recommendations for calcium intake may help to reduce BC risk.

A three-dimensional dietary index (nutritional quality, environment, and price) and reduced mortality: a prospective study in the Seguimiento Universidad de Navarra cohort

BackgroundSeveral healthy diet indices have been associated with mortality risk. However, the ideal diet should not only be healthy but also environmentally friendly and affordable. This study aimed to determine if a new Sustainable Diet Index (SDI), which takes into account the nutritional quality, environmental impacts, and market price of diets, was associated with all-cause and cause-specific mortality. MethodsUsing data from the Seguimiento Universidad de Navarra Project, a prospective cohort study of Spanish university graduates, the study included 15 492 participants (median age 34 years, IQR 27–45) recruited between Dec 1, 1999, and March 31, 2014 who were followed-up for a median of 10 years (IQR 7–14). Cox regression was used to determine the relationship of SDI and its components with all-cause and cause-specific mortality risk, where high values of SDI represent high nutritional quality, low environmental impacts, and low market price. Hazard ratios (HRs) with adjustment for several confounders were calculated. The weights for the foods contributing to the SDI were assessed with multiple regression analyses and variability with nested regression analyses. FindingsThe highest quartile of the SDI scores was associated with a 59% relative reduction in all-cause mortality (HR 0·41, 95% CI 0·23–0·75) and a 79% reduction in cardiovascular mortality (0·21, 0·05–0·85). The nutritional index was itself statistically associated with a reduction in all-cause mortality, but not the environmental impact index and the market price. Nevertheless, a diet only focused on the nutritional quality would be less eco-friendly and more expensive than an overall sustainable diet. SDI was positively correlated with beans and potato consumption but negatively correlated with red meat intake. Red and processed meats, fatty dairy products, and fish consumption accounted for most of the variability in the SDI. InterpretationDietary patterns accounting not only for nutritional quality of the food but also the environmental impact and affordability could still provide health benefits. Such sustainable diets are rich in minimally processed plant-based foods and low in some animal-sourced products. FundingThe Seguimiento Universidad de Navarra Project has received funding from the Spanish Government—Instituto de Salud Carlos III, and the European Regional Development Fund (CIBEROBN, PI17/01795).

Macronutrient Quality and All-Cause Mortality in the SUN Cohort.

No previous study has assessed the relationship between overall macronutrient quality and all-cause mortality. We aimed to prospectively examine the association between a multidimensional macronutrient quality index (MQI) and all-cause mortality in the SUN (Seguimiento Universidad de Navarra) (University of Navarra Follow-Up) study, a Mediterranean cohort of middle-aged adults. Dietary intake information was obtained from a validated 136-item semi-quantitative food-frequency questionnaire. We calculated the MQI (categorized in quartiles) based on three quality indexes: the carbohydrate quality index (CQI), the fat quality index (FQI), and the healthy plate protein source quality index (HPPQI). Among 19,083 participants (mean age 38.4, 59.9% female), 440 deaths from all causes were observed during a median follow-up of 12.2 years (IQR, 8.3–14.9). No significant association was found between the MQI and mortality risk with multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest quartile of 0.79 (95% CI, 0.59–1.06; Ptrend = 0.199). The CQI was the only component of the MQI associated with mortality showing a significant inverse relationship, with HR between extreme quartiles of 0.64 (95% CI, 0.45–0.90; Ptrend = 0.021). In this Mediterranean cohort, a new and multidimensional MQI defined a priori was not associated with all-cause mortality. Among its three sub-indexes, only the CQI showed a significant inverse relationship with the risk of all-cause mortality.

An Active Lifestyle Is Associated with Better Cognitive Function Over Time in APOE ɛ4 Non-Carriers.

Available evidence on the association of physical activity (PA) or sedentary behavior with cognitive decline is inconclusive. To assess the association between an active lifestyle score and leisure-time physical activity (LTPA) and changes in cognitive function in the Seguimiento Universidad de Navarra (SUN) prospective cohort. Cognitive function was evaluated in a subsample of 806 participants of the SUN cohort study using the validated Telephone Interview for Cognitive Status-modified (STICS-m) questionnaire at baseline and after 6 years. LTPA was evaluated with a previously validated 17-item self-administered questionnaire and with information on sedentary lifestyles. We also calculated a multidimensional 8-item PA score. Multivariable linear regression analysis evaluated the association between PA and changes in cognitive function and its interaction by APOE genotype. Mean age of participants was 66 (SD 5.3) years and 69.7% were male. When stratifying by APOE variants, no significant associations between the active lifestyle score or LTPA and changes in cognitive performance over time were found among APOE ɛ4 carriers. However, we observed that a higher adherence to an active lifestyle (high versus low PA score β= 0.76 95% CI 0.15,1.36; p trend = 0.011) and a high LTPA (Q4 versus Q1 β= 0.63; 95% CI -0.01,1.26; p trend = 0.030) were associated with more favorable changes in cognitive function over time among APOE ɛ4 non-carriers with statistically significant interactions in both cases (p for interaction = 0.042 for PA score, and p = 0.039 for LTPA). The results of the present study suggest that an active lifestyle is associated with a better status of cognitive function over time only among APOE ɛ4 non-carriers.

Pregestational BMI and higher offspring's risk of overweight/obesity in smoker and non-smoker mothers.

To assess the association between pregestational BMI and offspring's risk of overweight/obesity after accounting for the most important confounders, especially maternal smoking habit. Prospective cohort study. The Seguimiento Universidad de Navarra (SUN) study is a prospective cohort of Spanish graduates with more than 22 000 participants nationwide. Recruitment started in 1999, and it is permanently open. Data on diet, lifestyle and clinical diagnoses are collected at baseline and every 2 years. Women from the SUN cohort who reported at least one pregnancy during follow-up (n 3496) were invited to this study. Among them, 1527 agreed to participate and completed an additional more detailed online questionnaire on their pregnancy history and their offspring's nutritional status. After excluding 165 children, we analysed data of 2791 participants born to 1485 mothers and observed that each 5 kg/m2 increase in pregestational BMI was associated with a 0·22 (95 % CI 0·15, 0·29) higher z-score in offspring's BMI and higher risk of overweight/obesity (multivariable-adjusted relative risk (RR) 1·57 (95 % CI 1·39, 1·77)) in childhood or adolescence. Furthermore, we observed stronger association in children born to smoker mothers (RR 1·91; 95 % CI 1·48, 2·46) than from non-smoker mothers (RR 1·51; 95 % CI 1·31, 1·73) (Pfor interaction = 0·02). We found a synergistic interaction between pregestational BMI and maternal smoking habit on offspring's z-score of the BMI and in their risk of overweight/obesity. Although further research is needed to analyse dose-response relationships, these findings reinforce the importance of promoting healthy lifestyles in pregnant women in order to prevent childhood obesity.

The Association Between the Mediterranean Lifestyle Index and All-Cause Mortality in the Seguimiento Universidad de Navarra Cohort

Overall lifestyle patterns rather than individual factors may exert greater reductions on chronic disease risk and mortality. The objective is to study the association between a Mediterranean lifestyle index and all-cause and cause-specific mortality. Investigators analyzed data from 20,494 participants in the Seguimiento Universidad de Navarra cohort in 2019. The Mediterranean lifestyle index is composed of 28 items on food consumption, dietary habits, physical activity, rest, and social interactions that score 0 or 1 point; scores theoretically could range from 0 to 28 points. After a median follow-up of 12.1 years, 407 deaths were observed. In the multivariable-adjusted model, high adherence (>14 points) to the Mediterranean lifestyle was associated with a 41% relative reduction in all-cause mortality (hazard ratio=0.59, 95% CI=0.42, 0.83) compared with low adherence (3-10 points, p<0.001 for trend). For each additional point, the multivariable hazard ratios for all-cause mortality were 0.95 (95% CI=0.89, 1.02) for food consumption; 1.00 (95% CI=0.92, 1.08) for dietary habits; and 0.73 (95% CI=0.66, 0.80) for physical activity, rest, social habits, and conviviality. Significant interaction with age at last contact (p<0.001) suggested a lower risk for each additional point among participants aged ≥50 years (hazard ratio=0.50, 95% CI=0.34, 0.74), whereas no association was found for participants aged <50 years (hazard ratio=1.15, 95% CI=0.54, 2.44). Adherence to a Mediterranean lifestyle may reduce the risk of mortality in a Spanish cohort of university graduates. Inverse associations were found for the overall Mediterranean lifestyle score and lifestyle block, whereas no associations were observed for the dietary blocks. Future research should consider the Mediterranean lifestyle beyond the Mediterranean diet in different populations for the promotion of healthy longevity. This study is registered at www.clinicaltrials.gov NCT02669602.

Mediterranean diet, Dietary Approaches to Stop Hypertension, and Pro-vegetarian dietary pattern in relation to the risk of basal cell carcinoma: a nested case-control study within the Seguimiento Universidad de Navarra (SUN) cohort

The association of dietary pattern with the risk of basal cell carcinoma (BCC) is little understood and has scarcely been investigated. We assessed the association of several complete dietary patterns [Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Pro-vegetarian dietary pattern] with the risk of BCC, conducting a nested case-control study (4 controls for each case). Cases and controls were selected from the SUN (Seguimiento Universidad de Navarra) cohort using risk set sampling. Cases were identified among subjects free of skin cancer at baseline but who later reported a physician-made BCC diagnosis during the follow-up period. In the cohort we identified 101 incident cases of BCC. In multivariable-adjusted conditional logistic regression analyses, better adherence to the Mediterranean diet (highest compared with lowest quintile) was associated with a 72% relative reduction in the odds of BCC (OR: 0.28; 95% CI: 0.10, 0.77; Ptrend=0.014); the DASH diet was associated with a 68% RR reduction (OR: 0.32; 95% CI: 0.14, 0.76; Ptrend=0.013) for the comparison between extreme quintiles. No association was found between a Pro-vegetarian dietary pattern and BCC. Higher fruit consumption (highest compared with lowest quintile, OR: 0.27; 95% CI: 0.11, 0.64; Ptrend<0.001) and low-fat dairy products (OR: 0.39; 95% CI: 0.16, 0.92; Ptrend=0.014) were associated with a lower BCC risk. Our results suggest that Mediterranean and DASH dietary patterns may be associated with a lower risk of BCC, but confirmatory studies are required.

Healthful and unhealthful provegetarian food patterns and the incidence of breast cancer: Results from a Mediterranean cohort.

Provegetarian diets, also known as predominantly plant-based (but not vegetarian or vegan) or plant-forward diets, have been associated with health benefits. However, a distinction is needed between high- and low-quality provegetarian dietary patterns (PVGs). We sought to examine potential associations between PVG indices and breast cancer (BC) incidence. We assessed 10 812 women in the Seguimiento Universidad de Navarra cohort. We calculated an overall PVG pattern from a validated semi-quantitative food-frequency questionnaire as proposed by Martínez-Gonzalez etal, assigning positive scores (based on quintiles) to plant foods and reversing the quintile scores for animal foods. Participants were categorized according to tertiles of the overall score. We also calculated a healthful PVG (hPVG) and unhealthful PVG (uPVG) as proposed by Satija et al. RESULTS: After a median of 11.5 years of follow-up, 101 incident BC cases, confirmed by medical records, were observed. A significant inverse association with BC (comparing tertile 2 vs. tertile 1, HR= 0.55; 95% confidence interval, 0.32-0.95) was identified for a modest overall PVG, but not for hPVG and uPVG separately. Nevertheless, the highest tertile was not associated with BC. In this large prospective cohort study, a moderate adherence to a PVG might decrease the risk of BC. Further studies should replicate and expand these results to other racial, ethnic, and socioeconomic groups.

Lifestyle-Related Factors and Total Mortality in a Mediterranean Prospective Cohort

Lifestyle-related habits have a strong influence on morbidity and mortality worldwide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors. Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were followed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours per week. During a median follow-up of 10.8 years, 407 deaths were documented. In the multivariable adjusted analysis, the highest category of adherence to the score (7-10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0-3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88). Adherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority.

Dietary fiber intake and mortality in a Mediterranean population: the “Seguimiento Universidad de Navarra” (SUN) project

To prospectively assess the association of dietary fiber intake (from different dietary sources) with all-cause mortality in a Mediterranean cohort. We assessed 19,703 participants of the SUN (Seguimiento Universidad de Navarra) cohort (mean follow-up: 10.1years). A validated 136-item FFQ was administered at baseline. We used Cox proportional hazards models adjusted for multiple socio-demographic, anthropometric, lifestyle factors, and prevalent conditions at baseline. We observed 323 deaths during 198,341 person-years of follow-up. A significantly inverse linear trend in Cox models was observed for the association of total dietary fiber intake and all-cause mortality after adjustment for confounders (p for trend 0.017). Each additional intake of 5g/1000kcal of dietary fiber was associated with a 9% relative reduction in all-cause mortality risk (HR 0.91, 95% CI 0.84-0.99). Considering separate dietary sources in separate models, a significant inverse trend was apparent for fiber derived from vegetables (p for trend 0.001), but it was non-significant for fiber derived from fruit, legumes, cereals, or other sources. Soluble fiber was significantly inversely associated with all-cause mortality in the fully adjusted model (p for trend 0.007), and insoluble fiber was marginally significant (p for trend 0.08). A higher intake of total dietary fiber, and particularly fiber from vegetables, was related to a reduced all-cause mortality in our Mediterranean cohort. Dietary messages to increase the consumption of dietary patterns rich in fiber-rich foods should be broadly disseminated to decrease the alarming rate of chronic diseases and its derived mortality.

1590P - Body shape trajectories and risk of breast cancer: Results from the SUN study project

Background: Obesity is a well-known risk factor for some types of cancer including post-menopausal breast cancer. Nevertheless, the influence of adiposity over life course on cancer risk remains poorly understood. The objective of this study was to assess body shape trajectories in early and middle life in relation to subsequent risk of breast cancer in a Mediterranean cohort. Methods: We used a group-based modelling approach to assess body shape trajectories from age 5 to 40 years, among 10679 women from the SUN cohort study from 1999 to 2014. Four distinct body shape trajectories were identified (lean-heavy increase, medium-stable, medium-heavy increase and heavy-stable). Cox regression models were used to estimate the hazard ratio (HR) for breast cancer according to the assigned body shape trajectory. Results: Among 106,537 women-years of follow-up a total of 133 probable incident cases of breast cancer were identified (70 of these cases were confirmed). When compared to those in the medium-stable category, women who were lean and had a marked increase (lean-heavy increase category) showed a subsequent higher risk of probable breast cancer (HR = 1.55, 95%CI 1.05-2.29). When stratifying according to menopausal status, there was a higher risk of probable postmenopausal breast cancer for women in the lean-heavy increase category (HR = 2.0, 95%CI 1.06- 3.80) compared to the medium-stable group. The statistical power was reduced and significance was lost when we considered only confirmed cases.Table: 1590POverall breast cancerPremenopausal breast cancerPostmenopausal breast cancerProbable casesCases / woman-yearsHR (95% CI)Cases / woman-yearsHR (95% CI)Cases / woman-yearsHR (95% CI)Lean-heavy increase43 / 183601.55 (1.05-2.29)13/124561.34 (0.69-2.61)21/54742.0 (1.06-3.80)Medium-stable65 / 570611 (ref.)28/466021 (ref.)19/93431 (ref.)Medium-heavy increase22 / 237380.81 (0.50-1.32)12/200480.93 (0.46-1.87)7/32811.03 (0.43-2.47)Heavy -stable3 / 73780.55 (0.17-1.76)Confirmed casesLean-heavy increase20/ 184531.22 (0.70-2.13)8/124561.14 (0.49-2.67)9/54741.32 (0.54-3.26)Medium-stable37/ 572101 (ref.)18/466021 (ref.)11/93431 (ref.)Medium-heavy increase13/ 238110.86 (0.45-1.62)8/200480.88 (0.37- 2.10)4/32810.24 (0.39-4.0) Open table in a new tab Hazard ratio (HR) and 95% confidence interval (95% CI) of breast cancer according to body shape trajectory in the SUN Project, 1999-2016. Adjusted for potential confounders and age as underlying time variable. Conclusions: This is the first Mediterranean cohort to suggest that a marked increase in body shape from age 5 to 40 years is associated with a higher risk of breast cancer, especially for postmenopausal women, indicating a role for lifetime adiposity in breast carcinogenesis. Legal entity responsible for the study: The Seguimiento Universidad de Navarra (SUN) Project. Funding: Spanish Government-Instituto de Salud Carlos III, the European Regional Development Fund, the Navarra Regional Government and the University of Navarra. Disclosure: All authors have declared no conflicts of interest.