Seguimiento Universidad De Navarra Project Research Articles

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

Associations between overall, healthful, and unhealthful low-fat dietary patterns and breast cancer risk in a Mediterranean cohort: The SUN project

ObjectivesDietary patterns may have a greater influence on human health than individual foods or nutrients, and they are also of substantial interest in the field of breast cancer prevention. Beyond the adequate balance of macronutrients, evidence indicates that the quality of macronutrient sources may play an important role in health outcomes. We sought to examine the relationship between healthful and unhealthful low-fat dietary patterns in relation to breast cancer. MethodsWe used observational data from a Mediterranean cohort study (the Seguimiento Universidad de Navarra project). We prospectively followed 10 930 middle-aged women initially free of breast cancer during a median follow-up of 12.1 y. We calculated an overall, an unhealthful, and a healthful low-fat diet score, based on a previously validated 136-item food frequency questionnaire and grouped participants into tertiles. Incident breast cancer—overall and stratified by menopausal status—was the primary outcome. It was self-reported by participants and confirmed based on medical reports or consultation of the National Death Index. We used multivariable Cox regression models adjusted for potential confounders. ResultsDuring 123 297 person-years of follow-up, 150 cases of incident breast cancer were confirmed. No significant associations were observed for overall or premenopausal breast cancer. For postmenopausal women, we observed a significant association for moderate adherence to the unhealthful low-fat dietary score and postmenopausal breast cancer (comparing tertile 2 to tertile 1; hazard ratio = 2.18; 95% confidence interval, 1.15–4.13). ConclusionsIn conclusion, no clear associations were observed, although more research is needed to address the association between an unhealthful dietary pattern and postmenopausal breast cancer risk.

Increased Adiposity Appraised with CUN-BAE Is Highly Predictive of Incident Hypertension. The SUN Project.

Overweight and obesity are growing worldwide and strongly associated with hypertension. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index is proposed as an optimal indicator of body fatness. We aimed to investigate the association of body fat as captured by the CUN-BAE index with incident hypertension in a Mediterranean population. We assessed 15,950 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (63.7% women) initially free of hypertension. Participants completed follow-up questionnaires biennially. A validated 136-item food-frequency questionnaire was administered at baseline. We used Cox models adjusted for multiple confounders. Among 12.3 years of median follow-up (interquartile range: 8.3, 15.0 years), 2160 participants reported having received a diagnosis of hypertension. We observed a strong direct association between progressively higher the CUN-BAE index at baseline and incident hypertension during follow-up in multivariable-adjusted models for men and women, even after further adjustment for BMI ≥ 30 kg/m2, showing a significant association also in non-obese participants. For each 2-unit increase in the CUN-BAE index, hypertension risk increased by 27% and 29% in men and women, respectively. The results remained significant when considering longitudinal repeated measures of changes in body fat assessed with the CUN-BAE index among the different biennial follow-up questionnaires. Our results emphasize the importance of reducing and maintaining a low body fat to prevent hypertension.

Asociación entre salud cardiovascular ideal y longitud telomérica en una población de edad avanzada de la cohorte SUN

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).

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).

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).

Dairy Consumption and Incidence of Breast Cancer in the 'Seguimiento Universidad de Navarra' (SUN) Project.

Dairy products might influence breast cancer (BC) risk. However, evidence is inconsistent. We sought to examine the association between dairy product consumption—and their subtypes—and incident BC in a Mediterranean cohort. The SUN (“Seguimiento Universidad de Navarra”) Project is a Spanish dynamic ongoing cohort of university graduates. Dairy product consumption was estimated through a previously validated 136-item food frequency questionnaire (FFQ). Incident BC was reported in biennial follow-up questionnaires and confirmed with revision of medical records and consultation of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression models. Among 123,297 women-years of follow-up (10,930 women, median follow-up 12.1 years), we confirmed 119 incident BC cases. We found a nonlinear association between total dairy product consumption and BC incidence (p nonlinear = 0.048) and a significant inverse association for women with moderate total dairy product consumption (HRQ2vs.Q1 = 0.49 (95% CI 0.28–0.84); HRQ3vs.Q1 = 0.49 (95% CI 0.29–0.84) ptrend = 0.623) and with moderate low-fat dairy product consumption (HRQ2vs.Q1 = 0.58 (95% CI 0.35–0.97); HRQ3vs.Q1 = 0.55 (95% CI 0.32–0.92), p trend = 0.136). In stratified analyses, we found a significant inverse association between intermediate low-fat dairy product consumption and premenopausal BC and between medium total dairy product consumption and postmenopausal BC. Thus, dairy products, especially low-fat dairy products, may be considered within overall prudent dietary patterns.

Low Dietary Magnesium and Overweight/Obesity in a Mediterranean Population: A Detrimental Synergy for the Development of Hypertension. The SUN Project.

Hypertension is the strongest independent modifiable risk factor for cardiovascular disease. We aimed to investigate the association of magnesium intake with incident hypertension in a Mediterranean population, and the potential modification of this association by body mass index (BMI). We assessed 14,057 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (67.0% women) initially free of hypertension. At baseline, a validated 136-item food frequency questionnaire was administered. We used Cox models adjusted for multiple socio-demographic, anthropometric, and lifestyle factors, and prevalent conditions present at baseline. Among a mean 9.6 years of follow-up we observed 1406 incident cases of medically diagnosed hypertension. An inverse association in multivariable-adjusted models was observed for progressively higher magnesium intake up to 500 mg/d vs. intake < 200 mg/d, which was greater among those with a BMI > 27 kg/m2. Lean participants with magnesium intake < 200 mg/d vs. >200 mg/d also had a higher risk of incident hypertension. Adherence to the Mediterranean diet did not modify these associations. In conclusion, dietary magnesium intake < 200 mg/d was independently associated with a higher risk of developing hypertension in a Mediterranean cohort, stronger for overweight/obese participants. Our results emphasize the importance of encouraging the consumption of magnesium-rich foods (vegetables, nuts, whole cereals, legumes) in order to prevent hypertension.

Higher adherence to an empirically derived Mediterranean dietary pattern is positively associated with telomere length: the Seguimiento Universidad de Navarra (SUN) project.

Telomere integrity is influenced by oxidative stress. Also, inflammation-related factors, including nutritional factors, could modulate telomere integrity. The relationship between a posteriori-derived dietary patterns and telomere length (TL) has been scarcely investigated. Thus, our objective was to examine the association between empirically derived dietary patterns ascertained through principal component analysis (PCA) and TL in an older adult Spanish population. A total of 886 older adults (>55 years old; 645 males and 241 females) from the Seguimiento Universidad de Navarra (SUN) cohort were included in the study. TL was measured by monochrome multiplex real-time quantitative PCR. Age-adjusted TL was used for all analyses. Dietary patterns were identified by PCA based on thirty predefined candidate food groups collected from a validated 136-food items frequency questionnaire. Generalised linear models were fitted to obtain β-coefficients and their 95 % CI evaluating differences in TL between each of the four upper quintiles of adherence to dietary patterns and the lowest quintile. Sensitivity analyses by rerunning all multiple linear models under different stratifications were performed to evaluate the robustness of our results. Two major dietary patterns were empirically identified, Western dietary pattern (WDP) and Mediterranean dietary pattern (MDP). After adjustment for potential confounders, longer TL was found among subjects in the highest quintile of MDP (β = 0·064; 95 % CI 0·004, 0·123). The WDP showed no significant association with TL. In conclusion, higher adherence to a posteriori-derived MDP was independently associated with longer telomeres in an older adult Spanish population of the SUN project.

Association of carbohydrate quality and all-cause mortality in the SUN Project: A prospective cohort study

Emerging evidence supports shifting the focus from carbohydrate quantity to carbohydrate quality to obtain greater health benefits. We investigated the association of carbohydrate quality with all-cause mortality using a single, multidimensional carbohydrate quality index (CQI) designed to account for multiple characteristics of carbohydrate quality. A prospective study was conducted among 19,083 participants in the Seguimiento Universidad de Navarra (SUN) Project, a Mediterranean cohort of middle-aged university graduates. The CQI was based on four dimensions: high total dietary fiber intake, low glycemic index, high whole-grain carbohydrate: total grain carbohydrate ratio, and high solid carbohydrate: total carbohydrate ratio. During 12.2 years of median follow-up, 440 deaths were identified. We found an inverse association between the CQI and all-cause mortality. The multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest tertile of the CQI was 0.70 (95% CI, 0.53-0.93; Ptrend=0.018). However, each individual dimension of the CQI was not independently associated with lower mortality risk, with HR (95% CI) between extreme tertiles as follows: 0.77 (0.52-1.14; Ptrend=0.192) for high fiber intake; 0.81 (0.59-1.12; Ptrend=0.211) for low glycemic index; 0.87 (0.69-1.11; Ptrend=0.272) for high whole-grain carbohydrate: total-grain carbohydrate ratio; and 0.81 (0.61-1.07; Ptrend=0.139) for high solid carbohydrate: total carbohydrate ratio. Our analyses remained similar after using repeated measurements of diet with updated nutritional exposures after a ten-year follow-up. The CQI as a whole, but none of its individual dimensions, was associated with lower mortality. The CQI seems to comprehensively capture the combined effects of quality domains.

Adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research Recommendations and Breast Cancer in the SUN Project.

A proportion of breast cancer cases are attributable to combined modifiable risk factors. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) has recently updated the recommendations for cancer prevention and a standard scoring system has been published. The aim of this study was to evaluate the association between compliance with the 2018 WCRF/AICR cancer prevention recommendations (Third Expert Report) and the risk of breast cancer in the SUN (“Seguimiento Universidad de Navarra”) prospective cohort. Spanish female university graduates, initially free of breast cancer, were included (n = 10,930). An 8-item score to measure compliance to the recommendations was built: body fat, physical activity, consumption of wholegrains/vegetables/fruit/beans, “fast foods”, red/processed meat consumption, sugar-sweetened drinks consumption, alcohol intake, and breastfeeding. A stratified analysis was conducted according to menopausal status. A non-significant inverse association was observed for overall breast cancer. The inverse association became statistically significant for post-menopausal breast cancer after multivariable adjustment (hazard ratio for > 5 vs. ≤ 3 points = 0.27; 95% CI: 0.08-0.93). The results suggested that the possible inverse association with breast cancer was attributable to the combined effects of the different nutritional and lifestyle components.

Ultra-processed food consumption and the risk of short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project

Telomere length (TL) is a marker of biological age that may be affected by dietary factors through oxidation and inflammation mechanisms. In addition, ultra-processed food (UPF) consumption has increased worldwide and it has been associated with the risk of developing several diseases. We aimed to evaluate the association between UPF consumption and the risk of having short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project. This is a cross-sectional study of 886 participants (645 men and 241 women) aged 57-91 y recruited from the SUN Project (Spain, 1999-2018). TL was measured from saliva samples by real-time qPCR at baseline and UPF consumption was collected using a validated 136-item FFQ and classified according to the NOVA system. We evaluated the association between consumption of energy-adjusted UPF categorized into quartiles (low, medium-low, medium-high, and high consumption) and the risk of having short telomeres (<20th percentile) using logistic regression models. Those participants with the highest UPF consumption had almost twice the odds of having short telomeres compared with those with the lowest consumption (adjusted OR: 1.82; 95% CI: 1.05, 3.22; P-trend=0.03). A higher consumption of UPF (>3 servings/d) was associated with higher risk of having shorter telomeres in an elderly Spanish population of the SUN Project.This trial was registered at clinicaltrials.gov as NCT02669602.

Dimensions of leisure-time physical activity and risk of depression in the \u201cSeguimiento Universidad de Navarra\u201d (SUN) prospective cohort

BackgroundAn inverse association between total leisure-time physical activity (LTPA) and depression has been previously documented in the scientific literature. Our objective was to prospectively assess the association of LTPA with the risk of depression, focusing on several dimensions of LTPA (intensity, duration and type).MethodsThe SUN (Seguimiento Universidad de Navarra) project is a prospective cohort study formed by Spanish university graduates. A total of 15,488 adults (40.2% men, mean age 37 ± 12 years) initially free of depression were assessed. A report of a validated medical diagnosis of depression or the habitual use of antidepressants (any of both) were considered as incident cases of depression. LTPA was estimated through previously validated self-reported questionnaires. Participants were classified following Physical Activity recommendations from the World Health Organization, and according to the intensity, duration and type of LTPA. Cox proportional hazards regression models were run, adjusted for demographic, lifestyle, and dietary factors, to estimate adjusted hazard ratios (HR) of depression and 95% confidence intervals (CI).ResultsDuring 163,059 person-years of follow-up we registered 870 incident cases of depression. Participants with higher total LTPA (METs-h/wk) and higher duration of LTPA (hours/wk) exhibited a lower risk of depression HR = 0.84 (95% CI: 0.72–0.99) and HR = 0.83 (0.70–0.99) respectively, whereas intensity of LTPA (MET) did not show any association with depression.ConclusionParticipants with higher LTPA had a lower risk of depression. The inverse association was stronger for total LPTA time than for its intensity. Higher duration of LTPA should be encouraged to prevent depression.

Abstract P5-08-04: Physical activity, sedentary behaviour, and risk of breast cancer: Results from the SUN (‘Seguimiento Universidad de Navarra’) project

Abstract BACKGROUND: Breast cancer is the leading type of cancer in women worldwide. Some factors, like leisure-time physical activity (LTPA), have been inversely associated with the risk of breast cancer. Nevertheless, evidence on the influence of sedentary lifestyles, LTPA, and their combined exposure on breast cancer risk is still limited. We aimed to assess sedentary behavior and recreational PA in relation to subsequent risk of breast cancer in a Mediterranean cohort. METHODS: The SUN Project is a Spanish dynamic prospective cohort of university graduates initiated in 1999. The baseline assessment included a validated questionnaire on LTPA and sedentary habits. Participants completed biennial follow-up questionnaires, which inquired about medical diagnosis of breast cancer. Self-reported information was confirmed with medical reports; self-reported cases pending confirmation were added to confirmed cases and together they were labeled as "probable cases". For our analyses, we included 10,812 women, with a median follow-up of 11.8 years. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for breast cancer according to 3 categories of weekly METs-hours of LTPA (low: 0-6, medium: 6.1-16.5, high &amp;gt;16.5), h/d of TV watching (&amp;lt;1h, 1-2 h, &amp;gt;2 h) and an 8-item PA Score (low:&amp;lt;2, medium-low:2-3, medium-high:4-5, high:6-8). We first fitted models for overall breast cancer incidence and then separate analyses according to menopausal status at diagnosis. RESULTS: Mean baseline age of our participants was 34.7 years (SD: 10.6 years). Among 115,802 women-years of follow-up, we identified 190 probable incident cases of breast cancer, out of which we confirmed 101. In multivariable-adjusted analyses, women in the highest category of LTPA showed a significantly lower risk of breast cancer (HR=0.55; 95% CI: 0.34-0.89) compared to women in the lowest category. Women watching &amp;gt;2 h/d of TV had a significantly higher risk of breast cancer (HR=1.71; 95% CI:1.05-2.78) compared to women who watched &amp;lt;1h/d of TV. Women in the highest category of the PA Score (6-8 points) showed a significant decrease in breast cancer risk compared to the lowest PA Score (&amp;lt;2 points) group (HR=0.34; 95% CI: 0.15-0.79). Results were consistent when we considered probable breast cancer cases. CONCLUSION: In this Mediterranean cohort, women in the highest leisure-time PA categories showed a significant decrease in breast cancer risk. More than 2 h/day of TV watching was associated with a higher risk of breast cancer development. The harmful effect of TV watching persisted despite the practice of &amp;gt;6 MET-h/week of PA. Hazard ratio (HR) and 95% confidence interval (95% CI) of breast cancer according to levels of LTPA.MET-h/week categoriesLow (0-6)Medium (6.1-16.5)High (&amp;gt;16.5)Cases/ Women-years31/2359032/3963238/52580Multivar. adjusted1 (ref)0.61 (0.37 - 1.00)0.55 (0.34 - 0.89)Hours/day of TV watching&amp;lt; 1 hour1-2 hours&amp;gt;2 hoursCases/ Women-years30/3546930/4484241/35491Multivar. adjusted1 (ref)0.92 (0.55 - 1.54)1.71 (1.05 - 2.78)Joint classificationMET&amp;gt;6MET&amp;gt;6MET&amp;lt;6MET&amp;lt;6TV&amp;lt;2hTV&amp;gt;2hTV&amp;lt;2hTV&amp;gt;2hCases/ Women-years42/6471728/2749518/1559413/7996Multivar. adjusted1 (ref)1.77 (1.09 - 2.88)1.73 (0.99 - 3.03)3.05(1.61 - 5.77)Physical Activity ScoreLow (&amp;lt;2)Medium-Low (2-3)Medium-High (4-5)High (6-8)Cases/ Women-years17/1276637/4542538/426249/14986Multivar. adjusted1 (ref)0.58 (0.32 - 1.03)0.59 (0.33 - 1.06)0.34 (0.15 - 0.79) Citation Format: Rodrigo Sánchez-Bayona, Itziar Gardeazabal, Cesar Ignacio Fernandez-Lazaro, Miguel Angel Martinez-Gonzalez, Andrea Romanos-Nanclares, Ismael Alvarez-Alvarez, Alfredo Gea, Marta Santisteban, Estefanía Toledo. Physical activity, sedentary behaviour, and risk of breast cancer: Results from the SUN (‘Seguimiento Universidad de Navarra’) project [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-08-04.

Phenolic Acid Subclasses, Individual Compounds, and Breast Cancer Risk in a Mediterranean Cohort: The SUN Project

BackgroundBiological and epidemiological evidence supports an inverse association of phenolic acids with obesity-related chronic diseases. However, no previous study has prospectively evaluated the relationship between subclasses and individual compounds of phenolic acids and the risk of postmenopausal breast cancer, one of the most important and prevalent obesity-related cancer sites. ObjectiveThis study examined associations between subclasses of phenolic acids, including hydroxycinnamic and hydroxybenzoic acids intake, and risk of breast cancer. DesignThe Seguimiento Universidad de Navarra (SUN) Project is a dynamic, permanently open prospective cohort which started in 1999. Participants/settingParticipants were 10,812 middle-aged women. All of them were university graduates. Main outcome measuresUsual diet was assessed at baseline and after 10 years of follow-up with a 136-item food frequency questionnaire. Phenolic acid intake was calculated by matching food consumption with the Phenol-Explorer database on phenolic acids content of each reported food item. Statistical analysis performedParticipants were classified according to tertiles of subclasses or individual compounds of phenolic acids. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios and 95% CIs for breast cancer incidence. ResultsOver an average of 11.8 years of follow-up, 101 incident cases of breast cancer were confirmed. After multivariable adjustment, an inverse association between hydroxycinnamic acids intake and breast cancer was observed (hazard ratio third tertile vs first tertile 0.37, 95% CI 0.16 to 0.85; P for trend=0.029) among postmenopausal women. Specifically, chlorogenic acids (3-, 4-, and 5- caffeoylquinic acids) showed the strongest inverse association (hazard ratio third tertile vs first tertile 0.33, 95% CI 0.14 to 0.78; P for trend=0.012). ConclusionsA higher intake of hydroxycinnamic acids, especially from chlorogenic acids—present in coffee, fruits, and vegetables—was associated with a lower incidence of breast cancer among postmenopausal women. Future observational studies are needed to corroborate these results.

Coffee consumption and breast cancer risk in the SUN project.

Breast cancer prevalence is growing worldwide. Many factors, such as diet and lifestyle could be determinants of the incidence of breast cancer. Coffee has been extensively studied in relation to several chronic diseases because of its multiple effects in health maintenance and its elevated consumption. We studied the relationship between coffee intake and breast cancer risk in the SUN (Seguimiento Universidad de Navarra) prospective cohort. We evaluated 10,812 middle-aged, Spanish female university graduates from the SUN Project, initially free of breast cancer. Coffee consumption was assessed with a 136-item validated food-frequency questionnaire (FFQ). Incident breast cancer cases were confirmed by a trained oncologist using medical records and by consultation of the National Death Index. We fitted Cox regression models to assess the relationship between baseline categories of coffee consumption and the incidence of breast cancer during follow-up. We stratified the analysis by menopausal status. During 115,802 person-years of follow-up, 101 new cases of breast cancer were confirmed. Among postmenopausal women, more than 1 cup of coffee per day was associated with a lower incidence of breast cancer (HR 0.44; 95% confidence interval: 0.21, 0.92) in the fully adjusted model, compared to women who consumed one cup of coffee or less per day. We observed no significant differences in regard to premenopausal women. Even though the number of cases was low, slight indications of an inverse association between coffee consumption and breast cancer risk among postmenopausal women were observed. Further longitudinal studies are warranted to confirm this finding.

Paper-Based Versus Web-Based Versions of Self-Administered Questionnaires, Including Food-Frequency Questionnaires: Prospective Cohort Study.

BackgroundWeb-based questionnaires allow collecting data quickly, with minimal costs from large sample groups and through Web-based self-administered forms. Until recently, there has been a lack of evidence from large-scale epidemiological studies and nutrition surveys that have evaluated the comparison between traditional and new technologies to measure dietary intake.ObjectiveThis study aimed to compare results from the general baseline questionnaire (Q_0) and the 10-year follow-up questionnaire (Q_10) in the Seguimiento Universidad de Navarra (SUN) prospective cohort, obtained from different subjects, some of whom used a paper-based version, and others used a Web-based version. Both baseline and 10-year assessments included a validated 136-item semiquantitative food-frequency questionnaire (FFQ), used to collect dietary intake.MethodsThe SUN project is a prospective cohort study (with continuous open recruitment and many participants who were recently recruited). All participants were university graduates. Participants who completed the validated FFQ at baseline (FFQ_0, n=22,564) were selected. The variables analyzed were classified into 6 groups of questions: (1) FFQ (136 items), (2) healthy eating attitudes (10 items), (3) alcohol consumption (3 items), (4) physical activity during leisure time (17 items), (5) other activities (24 items), and (6) personality traits (3 items). Multiple linear and logistic regression models were used to assess the adjusted differences between the mean number of missing values and the risk of having apparently incorrect values for FFQ items or mismatches and inconsistencies in dietary variables.ResultsOnly 1.5% (339/22564) and 60.71% (6765/11144) participants reported their information using the Web-based version for Q_0 and Q_10, respectively, and 51.40 % (11598/22564) and 100.00% (11144/11144) of participants who completed the Q_0 and Q_10, respectively, had the option of choosing the Web-based version. Sociodemographic, lifestyle, health characteristics, food consumption, and energy and nutrient intakes were similar among participants, according to the type of questionnaire used in Q_10. Less than 0.5% of values were missing for items related to healthy eating attitudes, alcohol consumption, and personality traits in the Web-based questionnaires. The proportion of missing data in FFQ, leisure time physical activity, and other activities was higher in paper-based questionnaires than Web-based questionnaires. In Web-based questionnaires, a high degree of internal consistency was found when comparing answers that should not be contradictory, such as the frequency of fruit as dessert versus total fruit consumption and the frequency of fried food consumptions versus oil consumption.ConclusionsIncorporating a Web-based version for a baseline and 10-year questionnaire has not implicated a loss of data quality in this cohort of highly educated adults. Younger participants showed greater preference for Web-based questionnaires. Web-based questionnaires were filled out to a greater extent and with less missing items than paper-based questionnaires. Further research is needed to optimize data collection and response rate in Web-based questionnaires.

Total polyphenol intake and breast cancer risk in the Seguimiento Universidad de Navarra (SUN) cohort.

Polyphenols are a wide family of phytochemicals present in diverse foods. They might play a role in cancer development and progression. In vivo and in vitro studies have suggested beneficial properties and potential mechanisms. We aimed to evaluate the association between total and main classes of polyphenol intake and breast cancer (BC) risk in the Seguimiento Universidad de Navarra project - a prospective Mediterranean cohort study. We included 10 713 middle-aged, Spanish female university graduates. Polyphenol intake was derived from a semi-quantitative FFQ and matching food consumption data from the Phenol-Explorer database. Women with self-reported BC were asked to return a copy of their medical report for confirmation purposes; death certificates were used for fatal cases. Cox models were fitted to estimate multivariable-adjusted hazard ratios (HR) and 95 % CI for the association between tertiles (T) of polyphenol intake and BC. After 10·3 years of median follow-up, 168 probable incident BC cases were identified, out of which 100 were confirmed. We found no association between polyphenol intake and the overall BC risk. Nevertheless, we observed a significant inverse association between total polyphenol intake and BC risk for postmenopausal women, either for probable or only for confirmed cases (HRT3 v. T1 0·31 (95 % CI 0·13, 0·77; Ptrend=0·010)). Also, phenolic acid intake was inversely associated with postmenopausal BC. In summary, we observed no significant association between total polyphenol intake and BC risk. Despite a low number of incident BC cases in our cohort, higher total polyphenol intake was associated with a lower risk of postmenopausal BC.

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.

Potato Consumption Does Not Increase Blood Pressure or Incident Hypertension in 2 Cohorts of Spanish Adults

Background: Potatoes have a high glycemic load but also antioxidants, vitamins, and minerals. It is unclear what mechanisms are involved in relation to their effect on blood pressure (BP) and hypertension.Objectives: This study aimed to assess the association between potato consumption, BP changes, and the risk of hypertension in 2 Spanish populations.Methods: Separate analyses were performed in PREDIMED (PREvención con DIeta MEDiterránea), a multicenter nutrition intervention trial of adults aged 55-80 y, and the SUN (Seguimiento Universidad de Navarra) project, a prospective cohort made up of university graduates and educated adults with ages (means ± SDs) of 42.7 ± 13.3 y for men and 35.1 ± 10.7 y for women. In PREDIMED, generalized estimating equations adjusted for lifestyle and dietary characteristics were used to assess changes in BP across quintiles of total potato consumption during a 4-y follow-up. Controlled BP values (systolic BP <140 mm Hg and diastolic BP <90 mm Hg) during follow-up were also assessed. For SUN, multivariate-adjusted HRs for incident hypertension during a mean 6.7-y follow-up were calculated.Results: In PREDIMED, the total potato intake was 81.9 ± 40.6 g/d. No overall differences in systolic or diastolic BP changes were detected based on consumption of potatoes. For total potatoes, the mean difference in change between quintile 5 (highest intake) and quintile 1 (lowest intake) in systolic BP after multivariate adjustment was -0.90 mm Hg (95% CI: -2.56, 0.76 mm Hg; P-trend = 0.1) and for diastolic BP was -0.02 mm Hg (95% CI: -0.93, 0.89 mm Hg; P-trend = 0.8). In SUN, the total potato consumption was 52.7 ± 33.6 g/d, and no significant association between potato consumption and hypertension incidence was observed in the fully adjusted HR for total potato consumption (quintile 5 compared with quintile 1: 0.98; 95% CI: 0.80, 1.19; P-trend = 0.8).Conclusions: Potato consumption is not associated with changes over 4 y in blood pressure among older adults in Spain or with the risk of hypertension among Spanish adults. This trial was registered at www.controlled-trials.com as ISRCTN35739639.