Spanish Mediterranean Population Research Articles

Timing of Meals and Sleep in the Mediterranean Population: The Effect of Taste, Genetics, Environmental Determinants, and Interactions on Obesity Phenotypes.

Circadian rhythms regulate the sleep-wake and feeding-fasting cycles. Sleep and feeding constitute a complex cycle that is determined by several factors. Despite the importance of sleep duration and mealtimes for many obesity phenotypes, most studies on dietary patterns have not investigated the contribution of these variables to the phenotypes analyzed. Likewise, they have not investigated the factors related to sleep or mealtimes. Thus, our aims were to investigate the link between taste perception and eating/sleep patterns and to analyze the effect of the interactions between sleep/meal patterns and genetic factors on obesity phenotypes. We conducted a cross-sectional analysis on 412 adults from the Mediterranean population. We measured taste perception (bitter, sweet, salty, sour, and umami) and assessed sleep duration and waketime. The midpoint of sleep and social jetlag was computed. From the self-reported timing of meals, we estimated the eating window, eating midpoint, and eating jetlag. Adherence to the Mediterranean diet was measured with a validated score. Selected polymorphisms in the TAS2R38, CLOCK, and FTO genes were determined, and their associations and interactions with relevant phenotypes were analyzed. We found various associations between temporal eating, sleep patterns, and taste perception. A higher bitter taste perception was associated with an earlier eating midpoint (p = 0.001), breakfast time (p = 0.043), dinner time (p = 0.009), waketime (p < 0.001), and midpoint of sleep (p = 0.009). Similar results were observed for the bitter taste polymorphism TAS2R38-rs713598, a genetic instrumental variable for bitter perception, increasing the causality of the associations. Moreover, significant gene-sleep interactions were detected between the midpoint of sleep and the TAS2R38-rs713598 (p = 0.032), FTO-rs9939609 (p = 0.037), and CLOCK-rs4580704 (p = 0.004) polymorphisms which played a role in determining obesity phenotypes. In conclusion, our study provided more information on the sleep and mealtime patterns of the general Spanish Mediterranean population than on their main relationships. Moreover, we were able to show significant associations between taste perception, specifically bitter taste; sleep time; and mealtimes as well as an interaction between sleep time and several genetic variants linked to obesity phenotypes. However, additional research is needed to better characterize the causality and mechanisms behind these associations.

Vitamin D deficiency in solid-organ transplant recipients from a Spanish Mediterranean population.

Solid-organ transplant recipients (SOTRs) are at risk of developing vitamin D deficiency, mainly caused by reduced sunlight exposure with subsequent low vitamin D synthesis in the skin. To analyse whether SOTRs from a Spanish Mediterranean region were vitamin D-deficient. This was a cross-sectional, descriptive and observational study in a transplantation-specialized Dermatological Unit from a Mediterranean area to determine the calcidiol levels of a cohort of 78 consecutively attending patients not receiving vitamin D supplements. Serum 25(OH)D3 levels were determined and clinical characteristics were collected. Logistic regression analysis was used to analyse variables associated with dichotomized 25(OH)D3 levels (≤ or >10ng/mL). The cohort comprised 30 lung, 29 kidney and 19 liver transplant recipients. Mean calcidiol was 18±9ng/mL. Deficiency of 25(OH)D3 was present in 19% of patients, while 68% had insufficient levels and 13% had sufficient levels. Following multivariate logistic regression analysis, the season of blood sampling remained the only predictor of deficient 25(OH)D3 levels. Despite living in a mid-latitude country with sunny weather, our SOTR population was at high risk of developing hypovitaminosis D, especially in autumn/winter. Avoiding sun exposure is important to prevent skin cancer, but careful monitoring of vitamin D status is recommended, with supplementation if hypovitaminosis D is detected.

Relationship between blood glucose levels and cardiovascular risk in the Spanish Mediterranean population.

Diabetes is associated with an increased prevalence of cardiovascular disease. Impaired fasting glucose (IFG) is an intermediate clinical situation between normal glucose levels and type 2 diabetes. The aim of this study is to determine how fasting glucose concentrations affect different cardiovascular risk scales. A descriptive study was conducted with 59,041 Mediterranean Spanish workers. IFG was determined using the American Diabetes Association (ADA) and the World Health Organization (WHO) criteria. Different indicators of cardiovascular risk were analyzed: body mass index, waist circumference, waist-to-height ratio, blood pressure, lipid parameters, atherogenic indices, metabolic syndrome, and various scales of cardiovascular risk such as REGICOR, DORICA, SCORE, Heart Age, and Vascular Age. All cardiovascular scales showed statistically significant differences between the IFG group and the normal glucose group. In all cases, values were worse in the IFG group; furthermore, men exhibited more unfavorable levels of cardiovascular risk factors than women. Higher odds ratio values were present in employees with metabolic syndrome according to ATP III criteria (9.42, 95% CI: 8.56-10.37 using WHO criteria and 9.25, 95% CI: 8.67-9.87 using ADA criteria).Conclusions: IFG increases cardiovascular risk whether using classical scales (REGICOR, SCORE, and metabolic syndrome) or other less studied scales (atherogenic indices, Heart Age, and Vascular Age).

Incidence and survival rates for malignant salivary gland tumors.

The aims of this study were to determine the incidence of malignant salivary gland tumors (MSGTs) in a specific in Spanish Mediterranean population, evaluate oncological outcomes, and identify prognostic factors for survival. Overall survival and disease-free survival rates were calculated for 23 patients with MSGTs who were treated in our department during 2004-2012. In the recruitment population of the reference hospital, annual incidence per 100,000 inhabitants was estimated, with corresponding 95% confidence intervals (CIs). The mean annual incidence of MSGTs was 0.91 new cases per 100,000 inhabitants (95% CI, 0.14-2.83). The most common histological type was squamous cell carcinoma (34.8%). Overall survival ranged from 2 to 120 months (mean 70.5 months). The 5-year overall survival rate was 52.5%, and the 5-year disease-free survival rate was 50%. The mean disease-free interval was 73.9 months (95% CI 47.1-100.7). Metastatic spread, tumor stage, perineural invasion, a submaxillary location, tumor size, histological grade, positive lymph node status, and presence of positive surgical resection margins were the most important factors in patient survival. Our results are consistent with those of other studies in relation to disease incidence but differ somewhat with respect to histological type. (J Oral Sci 58, 67-73, 2016).

Psychiatric Status across Body Mass Index in a Mediterranean Spanish Population.

BackgroundMental and body weight disorders are among the major global health challenges, and their comorbidity may play an important role in treatment and prevention of both pathologies. A growing number of studies have examined the relationship between psychiatric status and body weight, but our knowledge is still limited.ObjectiveThe present study aims to investigate the cross-sectional relationships of psychiatric status and body mass index (BMI) in Málaga, a Mediterranean city in the South of Spain.Materials and MethodsA total of 563 participants were recruited from those who came to his primary care physician, using a systematic random sampling, non-proportional stratified by BMI categories. Structured clinical interviews were used to assess current Axes-I and II mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). BMI was calculated as weight (Kg) divided by square of height in meters (m2). Logistic regression was used to investigate the association between BMI and the presence of any mental disorder. BMI was introduced in the models using restricted cubic splines.ResultsWe found that high BMI values were directly associated with mood and adjustment disorders, and low BMI values were directly associated with avoidant and dependent personality disorders (PDs). We observed an inverse relationship between low BMI values and cluster A PDs. There were not significant relationships between anxiety or substance-related disorders and BMI.ConclusionPsychiatric status and BMI are related in a Mediterranean Spanish population. A multidisciplinary approach to both pathologies becomes increasingly more necessary.

Basic concepts of Mediterranean lifestyle and their impacts in the genomic aspects.

The Mediterranean lifestyle has traditionally been associated with a healthier life pattern, less prone to chronic illnesses, especially cardiovascular diseases. Among the different lifestyle variables, the concept of the Mediterranean diet (MedDiet) stands out as the healthiest aspect of the Mediterranean lifestyle. Moreover, although big differences in diet can be observed between the various countries on the Mediterranean coast, the Mediterranean lifestyle is also characterized by greater physical activity, mainly consisting of frequent walks encouraged by the warm and pleasant climate in comparison to central and northern Europe. So-called social support is also greater in the Mediterranean lifestyle with a closer and stronger family network and friends proving to be beneficial for health. However, there is great controversy about the Mediterranean siesta, mealtimes and sleep patterns. With regard to the MedDiet and despite the heterogeneity in the MedDiet definition, there is a commonly recognized pattern of consumption characterized by: a) high consumption of vegetables, fruits, cereals, legumes, nuts, and olive oil; b) moderate to high fish consumption; c) low consumption of red meats, and meat products; d) poultry and dairy products in moderate to small amounts and. There also seems to be a pattern of alcoholic and alcohol-free beverage consumption that varies depending on age. Environmental factors mainly contribute to this Mediterranean lifestyle, although genetic influences also interact. It is known that there are genetic variants that are associated with the intake of certain foodstuffs and among them the most relevant gene is the lactase gene (LCT) and its association with milk consumption. Thus, single nucleotide polymorphisms (SNPs) in the minichromosome maintenance complex component 6 (MCM6) gene are associated with differential transcriptional activation of the promoter of the neighboring lactase (LCT) gene and, thereby, influence lactase persistence (LP) in adulthood. The rs4988235 SNP, located at -13910 bp upstream from the LCT gene (-13910C>T) within intron 13 of the MCM6, has been the most studied SNP in relation to LP, milk intake and obesity-related diseases. Curiously, there is a north/south gradient in the prevalence of this gene variant, LP being less prevalent in the Mediterranean countries. Fruit, vegetable, sweets, sugared drinks, bitter drinks, etc. have been associated with variations in the different genes related to taste perception. There is increasingly detailed knowledge on the genes associated with the perception of sweet, bitter, sour, umami and salty tastes and their association with both food consumption, and the different health/disease phenotypes are being investigated. We have found associations between the perception of different tastes and the degree of adherence to the MedDiet. Moreover, diet itself may explain why certain gene variants are more prevalent in some countries than in others, as in the case of mutations in the MTHFR gene, which are more prevalent in Mediterranean countries than in northern Europe. In contrast, mutations in the APOE (E4 allele) are more frequent in northern Europe than in Mediterranean countries. To better understand these gene-diet interactions and their impact on the intermediate and final phenotypes of cardiovascular disease, we shall review several results from the PREDIMED (PREvencion con DIeta MEDiterranea) study. We have detected interesting gene-diet interactions in which greater adherence to the MedDiet, or to some of its typical foods, is able to reverse the adverse effects that the risk alleles have on the specific phenotypes.Although in nutrigenetics, the interactions of SNP candidates with total liquid intake in the diet are less well known and difficult to study, there are classic examples in monogenic diseases that point to their importance. Outstanding among these examples is that of cystinuria, an autosomic recessive genetic disorder characterized by an impairment in the transport of cystine, ornithine, lysine, and arginine. Of these, only cystine is insoluble enough to cause stone formation. It can lead to significant morbidity in affected patients due to the often large and recurrent resulting kidney stones. Incidence of cystinuria in the Spanish Mediterranean population is high and has a specific genetic pattern. Mutations in the amino acid exchanger System b(0,+), the two subunits of which are encoded by SLC3A1 and SLC7A9, predominantly underlie this disease. Our group showed a low prevalence of mutations in the SLC3A1 gene and a higher prevalence of mutations in the SLC7A9 gene, in contrast to that found in other countries. However, the wide variation of phenotypical traits suggests that further investigation into other genetic and/

Age-related characteristics of cutaneous melanoma in a Spanish Mediterranean population.

Melanoma is considered a heterogeneous tumor with genetic and environmental factors involved in its pathogenesis. The impact of these factors varies depending on age. The aim of this study was to characterize the epidemiological, phenotypic, and histological features of patients with melanoma according to three age groups: ≤40, 41-65, and >65years. A total of 1122 consecutive patients with invasive melanoma definitively treated in our institution since January 2000 were selected from our melanoma database. Epidemiological, phenotypic, and histological data were retrieved and analyzed as a function of age. Female patients predominated in the younger age group. The location of cutaneous malignant melanoma differed with age. In the younger and middle age groups, tumors presented mainly on the trunk, while in the older group they were mainly found on the head/neck. Signs of actinic damage such as actinic keratoses, solar lentigines, or other skin tumors increased with age, while genetic factors such as family history of melanoma or a high number of common melanocytic nevi were more frequent in the younger group. Our results suggest that melanoma development in younger patients is the result of genetic factors, particularly related to multiple nevi, whereas in older patients environmental factors such as severe chronic sun exposure play a major role.

Dairy product consumption and risk of type 2 diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk.

The possible effects of dairy consumption on diabetes prevention remain controversial. The aim of this study was to investigate the association between the dairy consumption and type 2 diabetes (T2D) risk in an elderly Mediterranean population at high cardiovascular risk. We prospectively followed 3,454 non-diabetic individuals from the PREDIMED study. Dairy consumption was assessed at baseline and yearly using food frequency questionnaires and categorized into total, low-fat, whole-fat, and subgroups: milk, yogurt, cheeses, fermented dairy, concentrated full fat, and processed dairy. Hazard ratios (HRs) were calculated using Cox proportional hazards regression models. During a median follow-up of 4.1 years, we documented 270 incident T2D cases. After multivariate adjustment, total dairy product consumption was inversely associated with T2D risk [0.68 (95% CI 0.47-0.98); P-trend = .040]. This association appeared to be mainly attributed to low-fat dairy; the multivariate HRs (95% CIs) comparing the highest versus the lowest tertile consumption were 0.65 (0.45-0.94) for low-fat dairy products and 0.67 (0.46-0.95) for low-fat milk (both P-trend <.05). Total yogurt consumption was associated with a lower T2D risk [HR 0.60 (0.42-0.86); P-trend = .002]. An increased consumption of total low-fat dairy and total yogurt during the follow-up was inversely associated with T2D; HRs were 0.50 (0.29-0.85), 0.44 (0.26-0.75), and 0.55 (0.33-0.93), respectively. Substituting one serving/day of a combination of biscuits and chocolate and whole grain biscuits and homemade pastries for one serving/day of yogurt was associated with a 40 and 45% lower risk of T2D, respectively. No significant associations were found for the other dairy subgroups (cheese, concentrated full fat, and processed dairy products). A healthy dietary pattern incorporating a high consumption of dairy products and particularly yogurt may be protective against T2D in older adults at high cardiovascular risk.

Weight status and psychological distress in a Mediterranean Spanish population: a symmetric U-shaped relationship.

Psychological disorders in people with extreme weight (low weight or obesity) should be taken into consideration by health professionals in order to practice an effective treatment to these patients. This study evaluates the association between body mass index (BMI) and psychological distress in 563 inhabitants of Málaga (South of Spain). Participants were classified in four categories of BMI: Underweight (BMI <18.5 Kg/m2), Normal weight (BMI 18.5–24.99 Kg/m2), Overweight (BMI 25.0–29.99 Kg/m2) and Obesity (BMI >30 Kg/m2). Psychological distress was measured with the Spanish version of the Derogatis’ Symptoms Checklist Revised (SCL-90-R). We observed a symmetric U-shaped relationship between weight status and psychological distress in all SCL-90-R dimensions (p for quadratic trend <0.001) for both men and women. Participants with extreme weight showed the worst psychological status, and participants with normal weight exhibited the best. We found no statistically significant differences between underweight and obese participants in 9 of the 10 SCL-90-R dimensions analyzed among men, and in 8 of the 10 dimensions among women. Underweight and obese participants showed no gender differences in psychological distress levels. Psychological treatment of Mediterranean people with extreme weight, should consider underweight and obese patients at the same level of psychological distress.

Fruit and vegetable intake and vitamins C and E are associated with a reduced prevalence of cataract in a Spanish Mediterranean population

BackgroundCataract is among the major causes of vision impairment and blindness worldwide. Epidemiological studies support the role of antioxidants in the etiology of cataract, but the evidence for one specific antioxidant over another is inconsistent. Few studies have examined the association of cataract with fruit and vegetable intake with inconclusive results. In the present study, the relationship between cataract and fruit and vegetable intake and dietary and blood levels of carotenoids, vitamins C and E were examined in a Spanish Mediterranean population.MethodsThe present work is an analysis of data from 599 elderly ( ≥ 65 years) participants from the Spanish segment of the EUREYE study. This is a European multi-center cross-sectional population-based study. Cataract was diagnosed using a slit-lamp examination and defined as any lens opacity in either eye or evidence of its removal (cataract extraction). Energy-adjusted intake of fruit and vegetables and antioxidant vitamins was estimated using a semi-quantitative food frequency questionnaire. Plasma concentrations of vitamin C were analyzed by a colorimetric method and carotenoids and α-tocopherol by a HPLC method. The associations between cataract and quartiles of fruit and vegetable intake and plasma antioxidants were investigated using logistic regression models.ResultsOf the 599 elderly recruited, 433 (73%) had cataract or cataract extraction, 54% were women and 46% were men. After adjustments, increasing quartiles of combined fruit and vegetable intake were associated with decreasing reduction of odds of cataract or cataract extraction, (P for trend = 0.008). Increasing quartiles of dietary intakes from 107 mg/d of vitamin C showed a significant decreasing association with prevalence of cataract or cataract extraction (P for trend = 0.047). For vitamin E, a protective association was found from intakes from 8 mg/d, but no linear trend was observed across quartiles of intake (P for trend = 0.944).ConclusionsHigh daily intakes of fruit and vegetables and vitamins C and E were associated with a significantly decreased of the prevalence of cataract or cataract surgery. This study reinforces the WHO recommendations on the benefits of diets rich in fruit and vegetables.

Shifting from glucose diagnosis to the new HbA1c diagnosis reduces the capability of the Finnish Diabetes Risk Score (FINDRISC) to screen for glucose abnormalities within a real-life primary healthcare preventive strategy

BackgroundTo investigate differences in the performance of the Finnish Diabetes Risk Score (FINDRISC) as a screening tool for glucose abnormalities after shifting from glucose-based diagnostic criteria to the proposed new hemoglobin (Hb)A1c-based criteria.MethodsA cross-sectional primary-care study was conducted as the first part of an active real-life lifestyle intervention to prevent type 2 diabetes within a high-risk Spanish Mediterranean population. Individuals without diabetes aged 45-75 years (n = 3,120) were screened using the FINDRISC. Where feasible, a subsequent 2-hour oral glucose tolerance test and HbA1c test were also carried out (n = 1,712). The performance of the risk score was calculated by applying the area under the curve (AUC) for the receiver operating characteristic, using three sets of criteria (2-hour glucose, fasting glucose, HbA1c) and three diagnostic categories (normal, pre-diabetes, diabetes).ResultsDefining diabetes by a single HbA1c measurement resulted in a significantly lower diabetes prevalence (3.6%) compared with diabetes defined by 2-hour plasma glucose (9.2%), but was not significantly lower than that obtained using fasting plasma glucose (3.1%). The FINDRISC at a cut-off of 14 had a reasonably high ability to predict diabetes using the diagnostic criteria of 2-hour or fasting glucose (AUC = 0.71) or all glucose abnormalities (AUC = 0.67 and 0.69, respectively). When HbA1c was used as the primary diagnostic criterion, the AUC for diabetes detection dropped to 0.67 (5.6% reduction in comparison with either 2-hour or fasting glucose) and fell to 0.55 for detection of all glucose abnormalities (17.9% and 20.3% reduction, respectively), with a relevant decrease in sensitivity of the risk score.ConclusionsA shift from glucose-based diagnosis to HbA1c-based diagnosis substantially reduces the ability of the FINDRISC to screen for glucose abnormalities when applied in this real-life primary-care preventive strategy.

Association of the European Lactase Persistence Variant (LCT-13910 C&gt;T Polymorphism) with Obesity in the Canary Islands

BackgroundEuropean lactose tolerance genotype (LCT -13910 C>T, rs4988234) has been positively associated to body mass indexes (BMI) in a meta-analysis of 31,720 individuals of northern and central European descent. A strong association of lactase persistence (LP) with BMI and obesity has also been traced in a Spanish Mediterranean population. The aim of this study was to analyze a potential association of LP compared to lactase non-persistence (LNP) with BMI in inhabitants of the Canary Islands of Spain using Mendelian randomization.MethodsA representative, randomly sampled population of adults belonging to the Canary Islands Nutrition Survey (ENCA) in Spain, aged 18–75 years (n = 551), was genotyped for the LCT – 13910 C>T polymorphism. Milk consumption was assessed by a validated questionnaire. Anthropometric variables were directly measured. WHO classification of BMI was used.ResultsLP individuals were significantly more obese than LNP subjects (χ2 = 10.59; p<0.005). LP showed in a multivariate linear regression analysis showed a positive association of LP with BMI compared to LNP, (β = 0.96; 95% CI: 0.08–1.85, p = 0.033). In a multinomial logistic regression analysis normal range weight LP subjects showed an odds ratio for obesity of 2.41; 95%CI 1.39–418, (p = 0.002) compared to LNP.ConclusionsThe T-13910 of the allele LCT-13910 C>T polymorphism is positively associated with BMI. LP increases significantly the risk to develop obesity in the studied population. The LCT-13910 C>T polymorphism stands proxy for the lifetime exposure pattern, milk intake, that may increase susceptibility to obesity and to obesity related pathologies.

Body Adiposity Index Utilization in a Spanish Mediterranean Population: Comparison with the Body Mass Index

BackgroundBody fat content and fat distribution or adiposity are indicators of health risk. Several techniques have been developed and used for assessing and/or determining body fat or adiposity. Recently, the Body Adiposity Index (BAI), which is based on the measurements of hip circumference and height, has been suggested as a new index of adiposity. The aim of the study was to compare BAI and BMI measurements in a Caucasian population from a European Mediterranean area and to assess the usefulness of the BAI in men and women separately.Research Methodology/Principal FindingsA descriptive cross-sectional study was conducted in a Caucasian population. All participants in the study (1,726 women and 1,474 men, mean age 39.2 years, SD 10.8) were from Mallorca (Spain). Anthropometric data, including percentage of body fat mass obtained by Bioelectrical Impedance Analysis, were determined. Body Mass Index (BMI) and BAI were calculated. BAI and BMI showed a good correlation (r = 0.64, p<0.001). A strong correlation was also found between BAI and the % fat determined using BIA (r = 0.74, p<0.001), which is even stronger than the one between BMI and % fat (r = 0.54, p<0.001). However, the ROC curve analysis showed a higher accuracy for BMI than for the BAI regarding the discriminatory capacity.ConclusionThe BAI could be a good tool to measure adiposity due, at least in part, to the advantages over other more complex mechanical or electrical systems. Probably, the most important advantage of BAI over BMI is that weight is not needed. However, in general it seems that the BAI does not overcome the limitations of BMI.

A Risk Score to Predict Type 2 Diabetes Mellitus in an Elderly Spanish Mediterranean Population at High Cardiovascular Risk

IntroductionTo develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk.Materials and MethodsA diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC).ResultsThe PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples.DiscussionWe identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire.

Meat and fish consumption in a high cardiovascular risk Spanish Mediterranean population

High saturated fat consumption, mostly from red meat and sausage meat has been associated with an increase in cardiovascular risk (CVR) in contrast to the effect of high fish consumption. To get to know the frequency of meat and fish consumption in an elderly high Mediterranean population, their correlations with adherence to the Mediterranean diet (MD) and their association with intermediate CVR phenotypes. A cross-sectional study was carried out on 945 people (67.4±6.2 years old) with high CVR recruited in primary care centres of Valencia, and participating in the PREDIMED study. The frequency of meat and fish consumption was determined through a validated questionnaire. We analyzed clinical, biochemical and anthropometric variables using standard methods. Mean red meat consumption was high (7.4±4.7 times/week), being higher in men than in women (P=0.031) and was associated with greater weight (P=0.001) and prevalence of obesity (P=0.025). Fish consumption was also high (4.5±2.6 time/week) and was associated with lower concentrations of fasting plasma glucose (P=0.016) as well as with lower prevalence of diabetes (P=0.017). Red meat consumption in this high CVR population is very high and far from the recommendations of MD, needing, therefore, to be reduced. Fish consumption is closer to the recommendations and should be maintained.

Consistente asociación del polimorfismo rs7903146 en el gen TCF7L2 con mayor riesgo de diabetes en población mediterránea española

Introduction Type 2 diabetes (T2D) can induce the expression of cell adhesion molecules (ICAM, VCAM) and cytokines (IL-6 and CRP). Possibly related to these mechanisms, the transcription factor 7-like 2 (TCF7L2) gene has been associated with T2D in distinct populations, but there are few data for the Mediterranean population. Our objective was to study the association of this gene with T2D and inflammation markers in a population at high cardiovascular risk. Methods We included 1,001 high cardiovascular risk participants in the PREDIMED-Valencia study. Fasting blood glucose and plasma lipid concentrations were determined. Plasma concentrations of IL-6, CRP, VCAM and ICAM were also determined in a random subsample. The rs7903146 (C > T) polymorphism in the TCF7L2 gene was analyzed. Results The prevalence of T2D was 47.4%. The frequency of genotypes was 38.1% for CC, 47.7% for CT and 14.3% for TT (the allelic frequency of the T allele was 0.381). We found statistically significant differences in fasting plasma glucose concentrations depending on the TCF7L2 genotype (CC: 117.3 ± 37.8; CT: 124.1 ± 41.1; TT: 128.7 ± 45.2 mg/dl; p = 0.011). T allele carriers had an increased risk of T2D (OR = 1.37; 95% CI: 1.05-1.80; p = 0.022) compared with CC individuals. The T allele was also associated with higher concentrations of VCAM (CC: 914.3 ± 355.4; CT: 1147.0 ± 422.6; TT: 1258.1 ± 447.3 ng/ml; p = 0.001). No statistically significant differences were found for the other markers of inflammation. Conclusion Consistent with the results obtained in other European populations, this study found that the T allele of the rs7903146 polymorphism in the TCF7L2 gene is associated with an increased risk of T2D in a Mediterranean Spanish population.

The 1258 G>A polymorphism in the neuropeptide Y gene is associated with greater alcohol consumption in a Mediterranean population

Neuropeptide Y (NPY) is a neurotransmitter widely distributed in the central nervous system. Several studies have demonstrated that increases of NPY are associated with reduced alcohol intake and anxiety manifestations. The Leu7Pro polymorphism in the NPY has been associated with alcohol consumption, but evidence is scarce. In the Spanish Mediterranean population, this variant is not polymorphic. Thus, our aim is to identify novel functional variants in the NPY and to investigate the impact of these markers and others previously described on alcohol consumption in this population. A total of 911 subjects (321 men and 590 women) from the Spanish Mediterranean population were recruited. Alcohol consumption, and demographic and lifestyle variables were measured. Nucleotide sequence determination and SNP analyses were carried out. Only one exonic SNP was detected by direct sequencing (1258 G>A or rs9785023; allele frequency 0.47). From the intronic markers chosen (483 A>G or rs13235938, 2517 A>G or rs4722342, and 7065 A>G or rs4722343), only the two latter ones were polymorphic (allele frequencies 0.46 and 0.04, respectively), and none of them were associated with alcohol consumption. However, the 1258 G>A SNP was associated (recessive pattern) with higher alcohol intake. This association was particularly relevant in men with high alcohol intake (59.1 ± 5.0 g/day in AA as opposed to 40.6 ± 7.5 in the G carriers, P = .022) and women with moderate alcohol intake (7.3 ± 5.5 g/day in AA as opposed to 4.6 ± 3.9 g/day in G carriers, P = .048). The 1258 G>A polymorphism in the NPY is associated with higher alcohol consumption in the Mediterranean population.

Specific Characteristics of Sudden Death in a Mediterranean Spanish Population

Most of the data reported on sudden cardiac death has been from studies of Anglo-Saxon patients. We conducted a study to ascertain the relation between sudden death (SD) and some epidemiologic, clinical, and biochemical parameters and to assess the coronary histopathologic aspects of subjects in a Spanish population who had died suddenly. A total of 204 subjects (86% men), aged 12 to 80 years (mean 54 ± 15), who had died from out-of-hospital natural SD were evaluated. Only 15% of subjects had been previously diagnosed with heart disease. Pathologic evidence of underlying cardiovascular disease was found in 90% of cases, with coronary heart disease (CHD) the most frequent (58%). The CHD was acute coronary thrombosis in 41% and a stable plaque with luminal narrowing of ≥75% in 59%. An old myocardial infarction was found in 31% of the SD victims. Cardiac hypertrophy was found in 48%, with no relation between the presence of cardiac hypertrophy and CHD. Patients with stable plaques had a greater heart weight than did those with acute coronary thrombosis (p = 0.02). Male gender, older age, smoking, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio of ≥3 were associated with CHD. A greater percentage of patients with an eroded and/or ruptured plaque than patients with a stable plaque were smokers. Only smoking and a low-density lipoprotein/high-density lipoprotein cholesterol ratio of ≥3 were associated with an eroded and/or ruptured plaque. In conclusion, compared with the findings from studies of Anglo-Saxon patients, a lower incidence of CHD and acute coronary thrombosis and a greater incidence of cardiac hypertrophy were found in SD victims of a Mediterranean Spanish population.

Effects of C282Y, H63D, and S65C HFE gene mutations, diet, and life-style factors on iron status in a general Mediterranean population from Tarragona, Spain

Mutations in the HFE gene result in iron overload and can produce hereditary hemochromatosis (HH), a disorder of iron metabolism characterized by increased intestinal iron absorption. Dietary quality, alcoholism and other life-style factors can increase the risk of iron overload, especially among genetically at risk populations. Polymorphisms of the HFE gene (C282Y, H63D and S65C) were measured together with serum ferritin (SF), transferrin saturation (TS) and hemoglobin, to measure iron status, in randomly-selected healthy subjects living in the Spanish Mediterranean coast (n = 815; 425 females, 390 males), 18 to 75 years of age. The intake of dietary components that affect iron absorption was calculated from 3-day dietary records. The presence of C282Y/H63D compound heterozygote that had a prevalence of 2.8% in males and 1.2% in females was associated with an elevated TS and SF. No subject was homozygous for C282Y or S65C. The C282Y heterozygote, H63D heterozygote and homozygote and H63D/S65C compound heterozygote genotypes were associated with increased TS relative to the wild type in the general population. These genotypes together with the alcohol and iron intake increase the indicators of iron status, while calcium intake decreases them. We did not observe any affect of the S65C heterozygote genotype on these levels. All the HFE genotypes except for the S65C heterozygote together with the alcohol, iron and calcium intake affect the indicators of iron status. The C282Y/H63D compound heterozygote genotype has the higher phenotypic expression in our Spanish Mediterranean population.

Melanoma primario múltiple

IntroductionThe risk of multiple melanoma is estimated to be between 1 % and 8 %, with the majority of studies being carried out on North American populations. Our objective was to determine the risk and the clinical-pathological features of multiple primary melanoma in a Spanish Mediterranean population. Material and methodsWe performed a retrospective study of the medical records and the database of the Melanoma Unit of Hospital de Bellvitge, Barcelona, Spain, between 1988 and 2005. ResultsWe found 25 cases of multiple primary melanoma among 934 patients studied, representing a risk of 2.6 % in our population of melanoma patients. In 50 % of cases, the second melanoma appeared during the first year of follow-up. These subsequent lesions occurred at a different site from the initial lesion in 58 % of cases. In the majority of cases, lesions in a single patient showed similar cytological and architectural features. However, we did observe marked interindividual variability in the histology of multiple primary melanomas. ConclusionAlthough the risk of a second melanoma in our population appears to be lower than in North American populations, it is not negligible. Melanoma patients must therefore be followed up for life, not only for the risk of metastases but also for the risk of a new primary tumor. Complete examination of the skin must be performed at each visit.