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      Lifestyle factors and visceral adipose tissue: Results from the PREDIMED-PLUS study

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          Abstract

          Background

          Visceral adipose tissue (VAT) is a strong predictor of cardiometabolic health, and lifestyle factors may have a positive influence on VAT depot. This study aimed to assess the cross-sectional associations between baseline levels of physical activity (PA), sedentary behaviours (SB) and adherence to the Mediterranean diet (MedDiet) with VAT depot in older individuals with overweight/obesity and metabolic syndrome.

          Methods

          Baseline data of the PREDIMED-Plus study including a sample of 1,231 Caucasian men and women aged 55–75 years were used. Levels of leisure-time PA (total, light, and moderate-to-vigorous, in METs·min/day) and SB (total and TV-viewing, in h/day) were evaluated using validated questionnaires. Adherence to the MedDiet was evaluated using a 17-item energy-restricted MedDiet (erMedDiet) screener. The chair-stand test was used to estimate the muscle strength. VAT depot was assessed with DXA-CoreScan. Multivariable adjusted linear regression models were used to evaluate the association between lifestyle factors and VAT. For the statistics we had used multiadjusted linear regression models.

          Results

          Total leisure-time PA (100 METs·min/day: β -24.3g, -36.7;-11.9g), moderate-to-vigorous PA (β -27.8g, 95% CI -40.8;-14.8g), chair-stand test (repeat: β -11.5g, 95% CI -20.1;-2.93g) were inversely associated, and total SB (h/day: β 38.2g, 95% CI 14.7;61.7) positively associated with VAT. Light PA, TV-viewing time and adherence to an erMedDiet were not significantly associated with VAT.

          Conclusions

          In older adults with overweigh/obesity and metabolic syndrome, greater PA, muscle strength, and lower total SB were associated with less VAT depot. In this study, adherence to an erMedDiet was not associated with lower VAT.

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          Most cited references 43

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          Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity.

          A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.
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            2011 Compendium of Physical Activities: a second update of codes and MET values.

            The Compendium of Physical Activities was developed to enhance the comparability of results across studies using self-report physical activity (PA) and is used to quantify the energy cost of a wide variety of PA. We provide the second update of the Compendium, called the 2011 Compendium. The 2011 Compendium retains the previous coding scheme to identify the major category headings and specific PA by their rate of energy expenditure in MET. Modifications in the 2011 Compendium include cataloging measured MET values and their source references, when available; addition of new codes and specific activities; an update of the Compendium tracking guide that links information in the 1993, 2000, and 2011 compendia versions; and the creation of a Web site to facilitate easy access and downloading of Compendium documents. Measured MET values were obtained from a systematic search of databases using defined key words. The 2011 Compendium contains 821 codes for specific activities. Two hundred seventeen new codes were added, 68% (561/821) of which have measured MET values. Approximately half (317/604) of the codes from the 2000 Compendium were modified to improve the definitions and/or to consolidate specific activities and to update estimated MET values where measured values did not exist. Updated MET values accounted for 73% of all code changes. The Compendium is used globally to quantify the energy cost of PA in adults for surveillance activities, research studies, and, in clinical settings, to write PA recommendations and to assess energy expenditure in individuals. The 2011 Compendium is an update of a system for quantifying the energy cost of adult human PA and is a living document that is moving in the direction of being 100% evidence based.
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              Adherence to a Mediterranean diet and survival in a Greek population.

              Adherence to a Mediterranean diet may improve longevity, but relevant data are limited. We conducted a population-based, prospective investigation involving 22,043 adults in Greece who completed an extensive, validated, food-frequency questionnaire at base line. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean-diet scale that incorporated the salient characteristics of this diet (range of scores, 0 to 9, with higher scores indicating greater adherence). We used proportional-hazards regression to assess the relation between adherence to the Mediterranean diet and total mortality, as well as mortality due to coronary heart disease and mortality due to cancer, with adjustment for age, sex, body-mass index, physical-activity level, and other potential confounders. During a median of 44 months of follow-up, there were 275 deaths. A higher degree of adherence to the Mediterranean diet was associated with a reduction in total mortality (adjusted hazard ratio for death associated with a two-point increment in the Mediterranean-diet score, 0.75 [95 percent confidence interval, 0.64 to 0.87]). An inverse association with greater adherence to this diet was evident for both death due to coronary heart disease (adjusted hazard ratio, 0.67 [95 percent confidence interval, 0.47 to 0.94]) and death due to cancer (adjusted hazard ratio, 0.76 [95 percent confidence interval, 0.59 to 0.98]). Associations between individual food groups contributing to the Mediterranean-diet score and total mortality were generally not significant. Greater adherence to the traditional Mediterranean diet is associated with a significant reduction in total mortality. Copyright 2003 Massachusetts Medical Society
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                Author and article information

                Affiliations
                [1 ] Balearic Islands Health Research Institute (IdISBa), University Hospital Son Espases, Palma de Mallorca, Spain
                [2 ] CIBER Pathophysiology of Obesity and Nutrition (CIBEROBN), Health Institute Carlos III (ISCIII), Madrid, Spain
                [3 ] Department of Nutrition, Food Sciences and Physiology, Center for Nutrition Research, University of Navarra (UNAV), Pamplona, Spain
                [4 ] Human Nutrition Unit, University Hospital of Sant Joan de Reus, Department of Biochemistry and Biotechnology, Pere Virgili Institute for Health Research, Rovira i Virgili University, Reus, Spain
                [5 ] Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
                [6 ] Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
                [7 ] Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
                [8 ] CIBER Diabetes and Metabolic Diseases (CIBERdem), Health Institute Carlos III (ISCIII), Madrid, Spain
                [9 ] Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
                [10 ] Primary Care, Health Service of Navarra-Osasunbidea, Pamplona, Spain
                [11 ] Division of Preventive Medicine, University of León, León, Spain
                [12 ] Lipids and Cardiovascular Epidemiology Research Unit, Municipal Institute of Medical Research (IMIM), Barcelona, Spain
                [13 ] Madrid Institute for Advanced Studies (IMDEA) Food Institute, Madrid, Spain
                University of Cordoba, SPAIN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ¶ A complete list of the PREDIMED-Plus trial investigators is provided as Supporting Information ( S1 Text).

                Contributors
                Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Funding acquisition, Role: Investigation, Role: Methodology, Role: Resources, Role: Validation, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
                ORCID: http://orcid.org/0000-0002-2947-1338, Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Funding acquisition, Role: Investigation, Role: Methodology, Role: Resources, Role: Supervision, Role: Validation, Role: Visualization, Role: Writing – original draft, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                ORCID: http://orcid.org/0000-0001-5041-0778, Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Project administration, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Investigation, Role: Resources, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                ORCID: http://orcid.org/0000-0002-4389-1777, Role: Data curation, Role: Funding acquisition, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                ORCID: http://orcid.org/0000-0003-2700-7459, Role: Data curation, Role: Funding acquisition, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                Role: Data curation, Role: Funding acquisition, Role: Methodology, Role: Validation, Role: Visualization, Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 January 2019
                2019
                : 14
                : 1
                30682078 6347417 10.1371/journal.pone.0210726 PONE-D-18-28856
                © 2019 Galmes-Panades et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Counts
                Figures: 0, Tables: 3, Pages: 15
                Product
                Funding
                Funded by: CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn) and Instituto de Salud Carlos III (ISCIII)
                Award ID: PI13/00462, PI13/01090, PI13/02184, PI14/00853, PI14/00728, PI14/01919, PI16/00501, PI16/00381, PI16/01522, PI17/00525, PI17/00532, PI17/00215, PI17/00926
                Funded by: funder-id http://dx.doi.org/10.13039/501100003741, Institució Catalana de Recerca i Estudis Avançats;
                Award ID: 340918
                Funded by: Recercaixa
                Award ID: 2013ACUP00194
                Funded by: SEMERGEN
                Award ID: SEMERGEN
                Funded by: International Nut & Dried Fruit Council – FESNAD (2014-2015)
                Award ID: 201302
                Funded by: funder-id http://dx.doi.org/10.13039/100004325, AstraZeneca;
                Award ID: T2D 2017
                Award Recipient :
                Funded by: Spanish Ministry of Economy, Industry and Competitiveness
                Award ID: FJCI-2015-24058
                Award Recipient : ORCID: http://orcid.org/0000-0002-2947-1338
                This work was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects leaded by J.S.-S. and J.Vi., including the following projects: PI13/00462, PI13/01090, PI13/02184, PI14/00853, PI14/00728, PI14/01919, PI16/00501, PI16/00381, PI16/01522, PI17/00525, PI17/00532, PI17/00215, PI17/00926 and the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus [J.S.-S.]; the European Research Council (Advanced Research Grant 2013-2018; grant number 340918); the Recercaixa (grant number 2013ACUP00194) [J.S.-S.]; the SEMERGEN grant; International Nut & Dried Fruit Council – FESNAD (Long-term effects of an energy-restricted Mediterranean diet on mortality and cardiovascular disease 2014 –2015, No. 201302) [Miguel A. Martinez-Gonzalez]; the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 [D.R.]; Juan de la Cierva-formación research grant (FJCI-2015-24058) of the Spanish Ministry of Economy, Industry and Competitiveness [J.K.]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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                Custom metadata
                There are restrictions on the availability of data for the PREDIMED-Plus study, due to the signed consent agreements around data sharing, which only allow access to external researchers for research following the project purposes. Requestors wishing to access the PREDIMED-Plus trial data used in this study can request it to the PREDIMED-Plus trial Steering Committee: predimed_plus_scommittee@ 123456googlegroups.com .

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