Roberto Pastor-Barriuso

Instituto de Salud Carlos III, Madrid, Madrid, Spain

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Publications (47)281.07 Total impact

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    ABSTRACT: The association of egg consumption with subclinical coronary atherosclerosis remains unknown. Our aim was to examine the association between egg consumption and prevalence of coronary artery calcium (CAC). Cross-sectional study of 23,417 asymptomatic adult men and women without a history of cardiovascular disease (CVD) or hypercholesterolemia, who underwent a health screening examination including cardiac computed tomography for CAC scoring and completed a validated food frequency questionnaire at the Kangbuk Samsung Hospital Total Healthcare Centers, South Korea (March 2011-April 2013). The prevalence of detectable CAC (CAC score > 0) was 11.2%. In multivariable-adjusted models, CAC score ratio (95% confidence interval [CI]) comparing participants eating ≥ 7 eggs/wk to those eating < 1 egg/wk was 1.80 (1.14-2.83; P for trend = 0.003). The multivariable CAC score ratio (95% CI) associated with an increase in consumption of 1 egg/day was 1.54 (1.11-2.14). The positive association seemed to be more pronounced among participants with low vegetable intake (P for interaction = 0.02) and those with high BMI (P for interaction = 0.05). The association was attenuated and no longer significant after further adjustment for dietary cholesterol. Egg consumption was associated with an increased prevalence of subclinical coronary atherosclerosis and with a greater degree of coronary calcification in asymptomatic Korean adults, which may be mediated by dietary cholesterol. The association was particularly pronounced among individuals with low vegetable intake and those with high BMI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 08/2015; 241(2). DOI:10.1016/j.atherosclerosis.2015.05.036 · 3.97 Impact Factor
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    ABSTRACT: To evaluate the association between brachial-ankle pulse wave velocity (baPWV), a convenient, non-radiating, readily available measurement of arterial stiffness, and coronary artery calcium (CAC), a reliable marker of coronary atherosclerosis, in a large sample of young and middle-aged asymptomatic adults; and to assess the incremental value of baPWV for detecting prevalent CAC beyond traditional risk factors. Cross-sectional study of 15,185 asymptomatic Korean adults who voluntarily underwent a comprehensive health screening program including measurement of baPWV and CAC. BaPWV was measured using an oscillometric method with cuffs placed on both arms and ankles. CAC burden was assessed using a multi-detector CT scan and scored following Agatston's method. The prevalence of CAC > 0 and CAC > 100 increased across baPWV quintiles. The multivariable-adjusted odds ratios (95% CI) for CAC > 0 comparing baPWV quintiles 2-5 versus quintile 1 were 1.06 (0.87-1.30), 1.24 (1.02-1.50), 1.39 (1.15-1.69) and 1.60 (1.31-1.96), respectively (P trend < 0.001). Similarly, the relative prevalence ratios for CAC > 100 were 1.30 (0.74-2.26), 1.59 (0.93-2.71), 1.74 (1.03-2.94) and 2.59 (1.54-4.36), respectively (P trend < 0.001). For CAC > 100, the area under the ROC curve for baPWV alone was 0.71 (0.68-0.74), and the addition of baPWV to traditional risk factors significantly improved the discrimination and calibration of models for detecting prevalent CAC > 0 and CAC > 100. BaPWV was independently associated with the presence and severity of CAC in a large sample of young and middle-aged asymptomatic adults. BaPWV may be a valuable tool for identifying apparently low-risk individuals with increased burden of coronary atherosclerosis. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Atherosclerosis 08/2015; 241(2). DOI:10.1016/j.atherosclerosis.2015.05.031 · 3.97 Impact Factor
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    ABSTRACT: The relation between glycemic index, glycemic load, and subclinical coronary atherosclerosis is unknown. The aim of the study was to evaluate the associations between energy-adjusted glycemic index, glycemic load, and coronary artery calcium (CAC). This study was cross-sectional analysis of 28,429 asymptomatic Korean men and women (mean age 41.4 years) without a history of diabetes or cardiovascular disease. All participants underwent a health screening examination between March 2011 and April 2013, and dietary intake over the preceding year was estimated using a validated food frequency questionnaire. Cardiac computed tomography was used for CAC scoring. The prevalence of detectable CAC (CAC score >0) was 12.4%. In multivariable-adjusted models, the CAC score ratios (95% confidence intervals) comparing the highest to the lowest quintile of glycemic index and glycemic load were 1.74 (1.08 to 2.81; p trend = 0.03) and 3.04 (1.43 to 6.46; p trend = 0.005), respectively. These associations did not differ by clinical subgroups, including the participants at low cardiovascular risk. In conclusion, these findings suggest that high dietary glycemic index and glycemic load were associated with a greater prevalence and degree of CAC, with glycemic load having a stronger association. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Cardiology 05/2015; DOI:10.1016/j.amjcard.2015.05.005 · 3.43 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the association of diabetes and diabetes treatment with risk of postmenopausal breast cancer. Histologically confirmed incident cases of postmenopausal breast (N = 916) cancer were recruited from 23 Spanish public hospitals. Population-based controls (N = 1094) were randomly selected from primary care center lists within the catchment areas of the participant hospitals. ORs (95 % CI) were estimated using mixed-effects logistic regression models, using the recruitment center as a random effect term. Breast tumors were classified into hormone receptor positive (ER+ or PR+), HER2+ and triple negative (TN). Diabetes was not associated with the overall risk of breast cancer (OR 1.09; 95 % CI 0.82-1.45), and it was only linked to the risk of developing TN tumors: Among 91 women with TN tumors, 18.7 % were diabetic, while the corresponding figure among controls was 9.9 % (OR 2.25; 95 % CI 1.22-4.15). Regarding treatment, results showed that insulin use was more prevalent among diabetic cases (2.5 %) as compared to diabetic controls (0.7 %); OR 2.98; 95 % CI 1.26-7.01. They also showed that, among diabetics, the risk of developing HR+/HER2- tumors decreased with longer metformin use (ORper year 0.89; 95 % CI 0.81-0.99; based on 24 cases and 43 controls). This study reinforces the need to correctly classify breast cancers when studying their association with diabetes. Given the low survival rates in women diagnosed with TN breast tumors and the potential impact of diabetes control on breast cancer prevention, more studies are needed to better characterize this association.
    Acta Diabetologica 04/2015; DOI:10.1007/s00592-015-0756-6 · 3.68 Impact Factor
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    ABSTRACT: In Spain, cervical cancer prevention is based on opportunistic screening, due to the disease's traditionally low incidence and mortality rates. Changes in sexual behaviour, tourism and migration have, however, modified the probability of exposure to human papilloma virus among Spaniards. This study thus sought to evaluate recent cervical cancer mortality trends in Spain. We used annual female population figures and individual records of deaths certified as cancer of cervix, reclassifying deaths recorded as unspecified uterine cancer to correct coding quality problems. Joinpoint models were fitted to estimate change points in trends, as well as the annual (APC) and average annual percentage change. Log-linear Poisson models were also used to study age-period-cohort effects on mortality trends and their change points. 1981 marked the beginning of a decline in cervical cancer mortality (APC1981-2003: -3.2; 95%CI:-3.4;-3.0) that ended in 2003, with rates reaching a plateau in the last decade (APC2003-2012: 0.1; 95%CI:-0.9; 1.2). This trend, which was observable among women aged 45-46 years (APC2003-2012:1.4; 95%CI:-0.1;2.9) and over 65 years (APC2003-2012:-0.1; 95%CI:-1.9;1.7), was clearest in Spain's Mediterranean and Southern regions. The positive influence of opportunistic screening is not strong enough to further reduce cervical cancer mortality rates in the country. Our results suggest that the Spanish Health Authorities should reform current prevention programmes and surveillance strategies in order to confront the challenges posed by cervical cancer.
    BMC Cancer 04/2015; 15(1):287. DOI:10.1186/s12885-015-1306-x · 3.32 Impact Factor
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    ABSTRACT: Purpose: To examine the longitudinal association between age and intraocular pressure (IOP) in a large sample of Korean men and women. Methods:We conducted a prospective cohort study of274,064young and middle age Korean adultswith normal fundoscopic findingsfollowed from January 1, 2002 to Feb 28, 2010.Health exams were scheduled annually or biennially. At each visit, IOP was measured in both eyes with automated noncontact tonometers. The longitudinal change in IOP with agewas evaluated using three-level mixed models for longitudinal paired-eye data accounting for correlations between pairedeyes and repeated measurements over time. Results:In fully adjusted models, the average longitudinal change in IOP per one-yearincrease in age was -0.065mm Hg (95% CI -0.068 to -0.063), with markedsex differences (P<0.001). In men, the average annual IOP change was -0.093 mm Hg (95% CI -0.096 to -0.091) throughout follow-up. In women, the average annual IOP change was -0.006 mm Hg (95% CI -0.010 to -0.003), with a relatively flat association in the middle-age range of 30-59 years and more marked annual decreases at younger and older ages. Conclusions: IOP was inversely associated with age in a large cohort of Korean adults attending health screening visits. For men, this inverse association was observed throughout the entire age range, while for women it was evident only in younger (<30 year of age) and older (≥60 years of age) women, with no association in women aged 30 to 59.Further research is needed to better understand the underlying mechanisms and to reconsider cutoffs for defining high IOP by age and sex groups in Asian populations.
    Investigative Ophthalmology &amp Visual Science 09/2014; 55(10). DOI:10.1167/iovs.14-14151 · 3.66 Impact Factor
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    ABSTRACT: Objective-Overt and subclinical hypothyroidism are risk factors for atherosclerosis. It is unclear whether thyroid hormone levels within the normal range are also associated with atherosclerosis measured by coronary artery calcium (CAC). Approach and Results-We conducted a cross-sectional study of 41 403 apparently healthy young and middle-aged men and women with normal thyroid hormone levels. Free thyroxin, free triiodothyronine, and thyroid-stimulating hormone levels were measured by electrochemiluminescent immunoassay. CAC score was measured by multidetector computed tomography. The multivariable adjusted CAC ratios comparing the highest versus the lowest quartile of thyroid hormones were 0.74 (95% confidence interval, 0.60-0.91; P for trend <0.001) for free thyroxin, 0.81 (0.66-1.00; P for trend=0.05) for free triiodothyronine, and 0.78 (0.64-0.95; P for trend=0.01) for thyroid-stimulating hormone. Similarly, the odds ratios for detectable CAC (CAC >0) comparing the highest versus the lowest quartiles of thyroid hormones were 0.87 (0.79-0.96; P for linear trend <0.001) for free thyroxin, 0.90 (0.82-0.99; P for linear trend=0.02) for free triiodothyronine, and 0.91 (0.83-1.00; P for linear trend=0.03) for thyroid-stimulating hormone. Conclusions-In a large cohort of apparently healthy young and middle-aged euthyroid men and women, low-normal free thyroxin and thyroid-stimulating hormone were associated with a higher prevalence of subclinical coronary artery disease and with a greater degree of coronary calcification.
    Arteriosclerosis Thrombosis and Vascular Biology 07/2014; 34(9). DOI:10.1161/ATVBAHA.114.303889 · 5.53 Impact Factor
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    ABSTRACT: Background: Overt and subclinical hypothyroidism are associated with higher levels of serum creatinine and with increased risk of chronic kidney disease (CKD). The prospective association between thyroid hormones and kidney function in euthyroid individuals, however, is largely unexplored. Methods: We conducted a prospective cohort study in 104 633 South Korean men and women who were free of CKD and proteinuria at baseline and had normal thyroid hormone levels and no history of thyroid disease or cancer. At each annual or biennial follow-up visit, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxin (FT4) levels were measured by radioimmunoassay. The study outcome was incident CKD, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) based on the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Results: After a median follow-up of 3.5 years, 1032 participants developed incident CKD. There was a positive association between high-normal levels of TSH and increased risk of incident CKD. In fully-adjusted models including baseline eGFR, the hazard ratio comparing the highest vs the lowest quintiles of TSH was 1.26 [95% confidence interval (CI) 1.02 to 1.55; P for linear trend = 0.03]. In spline models, FT3 levels below 3 pg/ml were also associated with increased risk of incident CKD. There was no association between FT4 levels and CKD. Conclusions: In a large cohort of euthyroid men and women, high levels of TSH and low levels of FT3, even within the normal range, were modestly associated with an increased risk of incident CKD.
    International Journal of Epidemiology 07/2014; 43(5). DOI:10.1093/ije/dyu126 · 9.20 Impact Factor
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    ABSTRACT: Although oral cavity, pharyngeal, oesophageal and gastric cancers share some risk factors, no comparative analysis of mortality rate trends in these illnesses has been undertaken in Spain. This study aimed to evaluate the independent effects of age, death period and birth cohort on the mortality rates of these tumours. Specific and age-adjusted mortality rates by tumour and sex were analysed. Age-period-cohort log-linear models were fitted separately for each tumour and sex, and segmented regression models were used to detect changes in period- and cohort-effect curvatures. Among men, the period-effect curvatures for oral cavity/pharyngeal and oesophageal cancers displayed a mortality trend that rose until 1995 and then declined. Among women, oral cavity/pharyngeal cancer mortality increased throughout the study period whereas oesophageal cancer mortality decreased after 1970. Stomach cancer mortality decreased in both sexes from 1965 onwards. Lastly, the cohort-effect curvature showed a certain degree of similarity for all three tumours in both sexes, which was greater among oral cavity, pharyngeal and oesophageal cancers, with a change point in evidence, after which risk of death increased in cohorts born from the 1910-1920s onwards and decreased among the 1950-1960 cohorts and successive generations. This latter feature was likewise observed for stomach cancer. While the similarities of the cohort effects in oral cavity/pharyngeal, oesophageal and gastric tumours support the implication of shared risk factors, the more marked changes in cohort-effect curvature for oral cavity/pharyngeal and oesophageal cancer could be due to the greater influence of some risk factors in their aetiology, such as smoking and alcohol consumption. The increase in oral cavity/pharyngeal cancer mortality in women deserves further study.
    BMC Cancer 04/2014; 14(1):254. DOI:10.1186/1471-2407-14-254 · 3.32 Impact Factor
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    Roberto Pastor-Barriuso, Gonzalo López-Abente
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    ABSTRACT: In contrast to other haematological cancers, mortality from non-Hodgkin's lymphoma and multiple myeloma increased dramatically during the second half of the 20th century in most developed countries. This widespread upward trend remains controversial, as it may be attributable either to progressive improvements in diagnosis and certification or to increasing exposures to little-known but relevant risk factors. To assess the relative contribution of these factors, we analysed the independent effects of age, death period, and birth cohort on haematological cancer mortality rates in Spain across the period 1952-2006. Weighted joinpoint regression analyses were performed to detect and estimate changes in period and cohort curvatures. Although mortality rates were consistently higher among men, trends across periods and cohorts were virtually identical in both sexes. There was an early period trend reversal in the 1960s for Hodgkin's disease and leukaemia, which was delayed to the 1980s for multiple myeloma and the 1990s for non-Hodgkin's lymphoma. Birth cohort patterns showed a first downturn for generations born in the 1900s and 1910s for all haematological cancers, and a second trend reversal for more recent cohorts born in the 1950s and 1960s for non-Hodgkin's lymphoma and leukaemia. The sustained decline in Hodgkin's disease mortality and the levelling off in leukaemia seem to be driven by an early period effect linked to improvements in disease treatment, whereas the steep upward trends in non-Hodgkin's lymphoma and multiple myeloma mortality in Spain are more likely explained by a cohort effect linked to better diagnosis and death certification in the elderly. The consistent male excess mortality across all calendar periods and age groups points to the importance of possible sex-related genetic markers of susceptibility in haematological cancers.
    BMC Cancer 04/2014; 14(1):250. DOI:10.1186/1471-2407-14-250 · 3.32 Impact Factor
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    ABSTRACT: Context: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear. Objective: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints. Design: Prospective cohort study from January 1, 2002 to December 31, 2009. Participants: 212,456 middle age South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline. Exposures: Free thyroxin (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) levels were measured by radioimmunoassay. Main outcomes: Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records. Results: After a median follow-up of 4.3 years, 730 participants died (335 cancer deaths and 112 cardiovascular deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% CI 0.63 to 0.95, comparing the highest vs. lowest quartile of FT4; P for linear trend = 0.01), and FT3 was inversely associated cancer mortality (HR = 0.62, 95% CI 0.45 to 0.85; P for linear trend = 0.001). TSH was not associated with mortality endpoints. Conclusions: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.
    The Journal of Clinical Endocrinology and Metabolism 04/2014; 99(7):jc20133832. DOI:10.1210/jc.2013-3832 · 6.31 Impact Factor
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    ABSTRACT: World-wide controversy continues to surround the question of whether exposure to ionising radiations arising from nuclear power plants and radioactive fuel cycle facilities could increase the risk of cancer. The objective was to analyse cancer mortality in towns close to Spanish nuclear power plants and radioactive fuel cycle facilities by reference to their history of exposure to artificial radiation generated by such emissions. An ecological cancer mortality study was conducted to know the effect of artificial radiation, estimated taken into account the magnitude of emissions, in towns ≤30 km of any installation. A model of atmospheric and aquatic dispersion of radionuclides was used. As reference, towns within a 50–100 km radius were matched with exposed by socio-demographic characteristics. For analysis purposes, log-linear Poisson models were fitted. The cumulative effective dose was the measure of exposure. Mortality rates ratios were calculated for each tumour site. Natural radiation and socio-demographic matching variables were included in the models, with ‘installation’ as a random effects term. The estimated cumulative artificial radiation dose was below 350 μSv for all sites. For nuclear power plants overall, analysis showed no positive association with increases in the cumulative dose. In the joint analysis of radioactive fuel cycle facilities, however, mortality was observed to rise with increases in the estimated radiation dose in the case of lung, bone and colorectal cancer, and in breast cancer among women. These results would not appear to be due to exposure arising from the operation of the installations, since were not reproduced around installations of the same type.
    International journal of Environmental Science and Technology 02/2014; 11(1). DOI:10.1007/s13762-013-0223-2 · 1.79 Impact Factor
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    ABSTRACT: A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011--2015 and 2016--2020 in Spain. Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions. Pleural cancer deaths increased across the study period, rising from 491 in 1976--1980 to 1,249 in 2006--2010. Predictions for the five-year period 2016--2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality. The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040.
    BMC Cancer 11/2013; 13(1):528. DOI:10.1186/1471-2407-13-528 · 3.32 Impact Factor
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    Javier Virues-Ortega, Flávia M Julio, Roberto Pastor-Barriuso
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    ABSTRACT: The intervention program for autism known as Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) is considered an emerging practice for autism. In the present study we used state-of-the-art meta-analytical procedures to examine the pooled clinical effects of TEACCH in a variety of outcomes. A total of 13 studies were selected for meta-analysis totaling 172 individuals with autism exposed to TEACCH. Standardized measures of perceptual, motor, adaptive, verbal and cognitive skills were identified as treatment outcomes. We used inverse-variance weighted random effects meta-analysis supplemented with quality assessment, sensitivity analysis, meta-regression, and heterogeneity and publication bias tests. The results suggested that TEACCH effects on perceptual, motor, verbal and cognitive skills were of small magnitude in the meta-analyzed studies. Effects over adaptive behavioral repertoires including communication, activities of daily living, and motor functioning were within the negligible to small range. There were moderate to large gains in social behavior and maladaptive behavior. The effects of the TEACCH program were not moderated by aspects of the intervention such as duration (total weeks), intensity (hours per week), and setting (home-based vs. center-based). While the present meta-analysis provided limited support for the TEACCH program as a comprehensive intervention, our results should be considered exploratory owing to the limited pool of studies available.
    Clinical psychology review 07/2013; 33(8):940-953. DOI:10.1016/j.cpr.2013.07.005 · 7.18 Impact Factor
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    ABSTRACT: Little is known about the dose-response relationship between physical activity and health benefits among young people. Our objective was to analyse the association between the frequency of undertaking moderate-to-vigorous physical activity (MVPA) and the self-reported health status of the adolescent population. Cross-sectional study. All regions of Spain. Students aged 11-18 years participating in the Spanish Health Behaviour in School-aged Children survey 2006. A total of 375 schools and 21 188 students were selected. The frequency of undertaking MVPA was measured by a questionnaire, with the following four health indicators: self-rated health, health complaints, satisfaction with life and health-related quality of life. Linear and logistic regression models were used to analyse the association, adjusting for potential confounding variables and the modelling of the dose-response relationship. As the frequency of MVPA increased, the association with health benefits was stronger. A linear trend (p<0.05) was found for self-rated health and health complaints in males and females and for satisfaction with life among females; for health-related quality of life this relationship was quadratic for both sexes (p<0.05). For self-reported health and health complaints, the effect was found to be of greater magnitude in males than in females and, in all scales, the benefits were observed from the lowest frequencies of MVPA, especially in males. A protective effect of MVPA was found in both sexes for the four health indicators studied, and this activity had a gradient effect. Among males, health benefits were detected from very low levels of physical activity and the magnitude of the relationship was greater than that for females.
    BMJ Open 05/2013; 3(5). DOI:10.1136/bmjopen-2013-002644 · 2.06 Impact Factor
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    ABSTRACT: The Gail model for predicting the absolute risk of invasive breast cancer has been validated extensively in US populations, but its performance in the international setting remains uncertain. We evaluated the predictive accuracy of the Gail model in 54,649 Spanish women aged 45-68 years who were free of breast cancer at the 1996-1998 baseline mammographic examination in the population-based Navarre Breast Cancer Screening Program. Incident cases of invasive breast cancer and competing deaths were ascertained until the end of 2005 (average follow-up of 7.7 years) through linkage with population-based cancer and mortality registries. The Gail model was tested for calibration and discrimination in its original form and after recalibration to the lower breast cancer incidence and risk factor prevalence in the study cohort, and compared through cross-validation with a Navarre model fully developed from this cohort. The original Gail model overpredicted significantly the 835 cases of invasive breast cancer observed in the cohort (ratio of expected to observed cases 1.46, 95 % CI 1.36-1.56). The recalibrated Gail model was well calibrated overall (expected-to-observed ratio 1.00, 95 % CI 0.94-1.07), but it tended to underestimate risk for women in low-risk quintiles and to overestimate risk in high-risk quintiles (P = 0.01). The Navarre model showed good cross-validated calibration overall (expected-to-observed ratio 0.98, 95 % CI 0.92-1.05) and in different cohort subsets. The Navarre and Gail models had modest cross-validated discrimination indexes of 0.542 (95 % CI 0.521-0.564) and 0.544 (95 % CI 0.523-0.565), respectively. Although the original Gail model cannot be applied directly to populations with different underlying rates of invasive breast cancer, it can readily be recalibrated to provide unbiased estimates of absolute risk in such populations. Nevertheless, its limited discrimination ability at the individual level highlights the need to develop extended models with additional strong risk factors.
    Breast Cancer Research and Treatment 02/2013; 138(1). DOI:10.1007/s10549-013-2428-y · 4.20 Impact Factor
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    ABSTRACT: INTRODUCTION: It is not clear whether high mammographic density (MD) is equally associated with all subtypes of breast cancer (BC). We investigated the association between MD and subsequent BC, considering invasiveness, means of detection, pathologic subtype and the time elapsed since mammographic exploration and BC diagnosis. METHODS: BC cases occurring in the population of women who attended screening from 1997 through 2004 in Navarre, a Spanish region with a fully consolidated screening program, were identified via record-linkage with the Navarre Cancer Registry (N=1,172). Information was extracted from the records of their first attendance at screening in that period. For each case, we randomly selected four controls, matched by screening round, year of birth, and place of residence. Cases were classified according to invasiveness (ductal carcinoma in situ (DCIS) versus invasive tumors), pathologic subtype (considering hormonal receptors and HER2), and type of diagnosis (screen-detected versus interval cases). MD was evaluated by a single, experienced radiologist using a semiquantitative scale. Data on BC risk factors were obtained by the screening program in the corresponding round. The association between MD and tumor subtype was assessed using conditional logistic regression. RESULTS: MD was clearly associated with subsequent BC. The odds ratio (OR) for the highest MD category (MD>75%) compared to the reference category (MD<10%) was similar for DCIS (OR=3.47; 95%CI=1.46-8.27) and invasive tumors (OR=2.95; 95%CI=2.01-4.35). The excess risk was particularly high for interval cases (OR=7.72; 95%CI=4.02-14.81) in comparison to screened detected tumors (OR=2.17; 95%CI=1.40-3.36). Sensitivity analyses excluding interval cases diagnosed in the first year after MD assessment or immediately after an early recall to screening yielded similar results. No differences were seen regarding pathologic subtypes. The excess risk associated with MD persisted for at least 7-8 years after mammographic exploration. CONCLUSIONS: Our results confirm that MD is an important risk factor for all types of breast cancer. High breast density strongly increases the risk of developing an interval tumor and this excess risk is not completely explained by a possible masking effect.
    Breast cancer research: BCR 01/2013; 15(1):R9. DOI:10.1186/bcr3380 · 5.88 Impact Factor
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    ABSTRACT: BACKGROUND: Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. METHODS: Data were obtained from a survey on a probabilistic sample of residents aged >=65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy. RESULTS: The final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82). The strongest risk factor was number of diseases, with an adjusted rate ratio (RR) of 1.32 (95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR = 2.56 [95% CI, 1.32-4.94]); antidepressant use (RR = 2.32 [95% CI, 1.22-4.40]); arrhythmias (RR = 2.00 [95% CI, 1.05-3.81]); and polypharmacy (RR = 1.07 [95% CI, 0.95-1.21], for each additional medication). The attributable fraction for number of diseases (with reference to those with <= 1 condition) was 84% (95% CI, 45-95%). CONCLUSIONS: Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy.Virtual slides: The virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337.
    BMC Geriatrics 01/2013; 13(1):6. DOI:10.1186/1471-2318-13-6 · 2.00 Impact Factor
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    ABSTRACT: Human biomonitoring (HBM), defined as the measurement of concentrations of chemicals or of their metabolites in human biological matrices, is considered the method of choice for determining internal exposures in individuals. HBM is part of environmental exposure surveillance systems in several countries. In 2007, the Ministry of Agriculture, Food and Environment promoted BIOAMBIENT.ES project, a national-level HBM study on environmental pollutants carried out in Spain to estimate levels of heavy metals, persistent organic pollutants, and other substances on the Spanish active workforce. BIOAMBIENT.ES is a nationwide cross-sectional study, with a stratified cluster sampling designed to cover all geographical areas, sex and occupational sectors, and aimed to obtain a representative sample of the Spanish workforce. Participants were recruited among people residing in Spain for 5 years or more, which underwent their annual occupational medical check-up in the health facilities of the Societies for Prevention of IBERMUTUAMUR, MUTUALIA, MC-PREVENCIÓN, MUGATRA, UNIMAT PREVENCIÓN, and PREVIMAC (March 2009-July 2010). A total of 1,892 subjects fulfilled the criteria for inclusion, donated biological samples (1,880 blood, 1,770 urine, and 577 hair) and completed a short self-administrated epidemiological questionnaire on environmental and lifestyle-related exposures. Additionally, clinical information from participant's health exams was obtained. This project will provide a first overview of the body burden of selected pollutants in a representative sample of the Spanish-occupied population. This information will be useful to establish reference values of the studied population and, eventually, to evaluate temporal trends and the effectiveness of environmental and health policies.
    Environmental Science and Pollution Research 11/2012; 20(2). DOI:10.1007/s11356-012-1320-3 · 2.76 Impact Factor
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    ABSTRACT: Evidence that selenium affects the risk of type-2 diabetes is conflicting, with observational studies and a few randomized trials showing both lower and higher risk linked to the level of selenium intake and status. We investigated the effect of selenium supplementation on the risk of type-2 diabetes in a population of relatively low selenium status as part of the UK PRECISE (PREvention of Cancer by Intervention with SElenium) pilot study. Plasma adiponectin concentration, a recognised independent predictor of type-2 diabetes risk and known to be correlated with circulating selenoprotein P, was the biomarker chosen. In a randomized, double-blind, placebo-controlled trial, five hundred and one elderly volunteers were randomly assigned to a six-month intervention with 100, 200 or 300 µg selenium/d as high-selenium or placebo yeast. Adiponectin concentration was measured by ELISA at baseline and after six months of treatment in 473 participants with one or both plasma samples available. Mean (SD) plasma selenium concentration was 88.5 ng/g (19.1) at baseline and increased significantly in the selenium-treatment groups. In baseline cross-sectional analyses, the fully adjusted geometric mean of plasma adiponectin was 14% lower (95% CI, 0-27%) in the highest than in the lowest quartile of plasma selenium (P for linear trend = 0.04). In analyses across randomized groups, however, selenium supplementation had no effect on adiponectin levels after six months of treatment (P = 0.96). These findings are reassuring as they did not show a diabetogenic effect of a six-month supplementation with selenium in this sample of elderly individuals of relatively low selenium status. Controlled-Trials.com ISRCTN25193534.
    PLoS ONE 09/2012; 7(9):e45269. DOI:10.1371/journal.pone.0045269 · 3.53 Impact Factor

Publication Stats

2k Citations
281.07 Total Impact Points

Institutions

  • 2003–2015
    • Instituto de Salud Carlos III
      • • Area of Environmental Epidemiology and Cancer
      • • Center National of Epidemiology (CNE)
      Madrid, Madrid, Spain
  • 2011
    • University of Surrey
      • Faculty of Health and Medical Sciences
      Guildford, ENG, United Kingdom
  • 2006–2009
    • Johns Hopkins Bloomberg School of Public Health
      • • Department of Epidemiology
      • • Department of Environmental Health Sciences
      Baltimore, MD, United States
  • 2005–2006
    • Johns Hopkins Medicine
      • • Department of Epidemiology
      • • Welch Center for Prevention, Epidemiology and Clinical Research
      Baltimore, MD, United States