Intensive Weight-Loss Lifestyle Intervention Using Mediterranean Diet and COVID-19 Risk in Older Adults: Secondary Analysis of PREDIMED-Plus Trial

OBJECTIVES

We tested the effects of a weight-loss intervention encouraging energy-reduced MedDiet and physical activity (PA) in comparison to ad libitum MedDiet on COVID-19 incidence in older adults.

DESIGN

Secondary analysis of PREDIMED-Plus, a prospective, ongoing, multicentre randomized controlled trial.

SETTING

Community-dwelling, free-living participants in PREDIMED-Plus trial.

PARTICIPANTS

6,874 Spanish older adults (55-75 years, 49% women) with overweight/obesity and metabolic syndrome.

INTERVENTION

Participants were randomised to Intervention (IG) or Control (CG) Group. IG received intensive behavioural intervention for weight loss with an energy-reduced MedDiet intervention and PA promotion. CG was encouraged to consume ad libitum MedDiet without PA recommendations.

MEASUREMENTS

COVID-19 was ascertained by an independent Event Committee until December 31, 2021. COX regression models compared the effect of PREDIMED-Plus interventions on COVID-19 risk.

RESULTS

Overall, 653 COVID-19 incident cases were documented (IG:317; CG:336) over a median (IQR) follow-up of 5.8 (1.3) years (inclusive of 4.0 (1.2) years before community transmission of COVID-19) in both groups. A significantly lowered risk of COVID-19 incidence was not evident in IG, compared to CG (fully-adjusted HR (95% CI): 0.96 (0.81,1.12)).

CONCLUSIONS

There was no evidence to show that an intensive weight-loss intervention encouraging energy-reduced MedDiet and PA significantly lowered COVID-19 risk in older adults with overweight/obesity and metabolic syndrome in comparison to ad libitum MedDiet. Recommendations to improve adherence to MedDiet provided with or without lifestyle modification suggestions for weight loss may have similar effects in protecting against COVID-19 risk in older adults with high cardiovascular risks.

Mediterranean diet and the risk of COVID-19 in the 'Seguimiento Universidad de Navarra' cohort

BACKGROUND & AIMS

A potential protection against COVID-19 by a high-quality dietary pattern is to be expected given the biological plausibility supporting the beneficial effects of an adequate dietary intake on the immune system. However, knowledge on the relationship between long-term maintained healthy dietary patterns, such as the Mediterranean diet, and the risk of SARS-CoV-2 infection is still sparse. We longitudinally assessed this association in a well-known Mediterranean cohort.

METHODS

We assessed 9,677 participants from the SUN Project, a prospective cohort of middle-aged university graduates in Spain. We inquired about a positive result in a COVID-19 diagnostic test during the months of February to December 2020. After excluding health professionals (HP), 5,194 participants were included in the statistical analyses (mean age: 52.6, SD: 12.4; 55.2% women). Food habits were assessed at baseline using a previously validated semiquantitative 136-item food frequency questionnaire. Adherence to the Mediterranean diet (cumulative average of 2 repeated measurements 10 years apart) was assessed using the 0-to-9 Mediterranean Diet Score (MDS). We used multivariable logistic regression models to estimate odds ratios and 95% confidence intervals for incident COVID-19 according to the MDS.

RESULTS

Among 5,194 non-HP participants, 122 reported to have received a positive COVID-19 diagnostic test. Participants with intermediate adherence to the Mediterranean diet (3 < MDS ≤ 6) had a significantly lower odds of developing COVID-19 (multivariable-adjusted OR = 0.50, 95% CI: 0.34-0.73), and those with the highest adherence (MDS > 6) exhibited the lowest risk (multivariable-adjusted OR = 0.36, 95% CI: 0.16-0.84, p for trend < 0.001) as compared with participants with MDS ≤ 3. This inverse association remained robust within subgroups and in sensitivity analyses. Notwithstanding, no significant associations were observed for health professionals (p for interaction = 0.06).

CONCLUSION

In conclusion, better adherence to the Mediterranean diet may be associated with a lower risk of COVID-19. Our results are applicable only to persons who are not health professionals.

O-218 Single-cell RNA sequencing reveals that Ashermańs syndrome is caused by chronic inflammation that induces differential molecular and cellular cartography in the human endometrium

Study question

What is the differential cellular, transcriptomic and immunological differences of the human endometrium in AS versus healthy patients at single cell resolution?

Summary answer

The epithelial fraction is decreased, the myeloid and lymphoid cell lineages increased with an altered inflammation, inhibition of angiogenesis and EM abnormal remodeling.

What is known already

Asherman’s Syndrome (AS) is an acquired pathological condition, defined by the presence of intrauterine adhesions (IUAs) causing the uterine walls to adhere to one another resulting in menstrual abnormalities, pelvic pain, infertility, recurrent miscarriage, and abnormal placentation. However, the underlaying cellular, transcriptomic and immunological mechanisms at the single-cell level that occur in AS have not been investigated. 

Study design, size, duration

Single cell RNA-seq (scRNA-seq) was performed on 41,854 cells corresponding to endometrial biopsies from a total of 7 individuals with severe AS (AFS classification 1998). These patients were involved in a phase I/II, prospective, non-randomized, uncontrolled, multicenter, interventional clinical trial authorized by the Spanish Medicines Agency (AEMPS)(2016-003973-23). Control healthy endometrium was represented by 68,026 cell transcriptomes from our previous work (Wang et al. 2020). 

Participants/materials, setting, methods

Seven patients were included. Ultrasound and hysteroscopies were performed in mid secretory phase. Endometrial specimens were digested with collagenase and filtered. Epithelial cells were digested with trypsin and red blood cells removed. After MACS live enrichment, cells were loaded onto ChromiumNext GEM (10xGenomics). Libraries were sequenced in a Novaseq, and reads processed with CellRanger. Quality filtering, normalization, clustering and differential expression analysis were applied from ‘Seurat’ package. Functional enrichment analysis was computed using ‘escape’ package.

Main results and the role of chance

In total 109,880 cell transcriptomes were compared and found changes in cell population ratios in two specific cell types. First, the epithelial fraction was decreased in AS compared to healthy condition (26.53% vs 45.7%, respectively) specifically the epithelium representing the opening of the window of implantation (WOI) (0.25% vs 2.01%respectively), and the ciliated epithelium (0.84% vs 6.12%, respectively). Second, the myeloid and lymphoid cell lineages, which are much more abundant in AS samples. Macrophages (1.97% vs 0.24%, respectively), CD8+ T cells (3.71% vs 1.34%, respectively), and CD8- T cells (2.28% vs 0.55%, respectively).

In addition, there was a different transcriptomic composition represented by three differential linked clusters related to AS condition. First, a unique stromal cluster labelled as stromal_ACTA2 that express genes related to contractile functions (ACTA2, MYH11, DES). Second, a specific AS epithelium cluster closely related to antigen processing and presentation of HLA class II family genes. Third, a KRT8 ACTA2 cluster composed by genes related to collagen (COL3A1 and COL1A1) and IGFBP5.

Enrichment analysis performed with ssGSEA revealed the functional impact of the AS condition identifying an increase in different GO terms related to tissue damage, pro-inflammatory processes, inhibition of angiogenesis.

Limitations, reasons for caution

Despite these promising results, this is an study in progress to be completed with 10 patients 

Wider implications of the findings

These findings describe for the first time the pathophysiology of AS at single cell level with the functional involvement of inflammation, fibrosis, and defective angiogenesis in this pathological condition. 

Trial registration number

Eudra CT 2016-003975-23

Fat Quality Index and Risk of Cardiovascular Disease in the Sun Project

OBJECTIVES

To examine the association between a dietary fat quality index (FQI), and the risk of incident cardiovascular events or deaths in the Seguimiento Universidad de Navarra (SUN) cohort.

DESIGN

Longitudinal analysis during 10.1 years of median follow-up. Cox models were used to estimate adjusted hazard ratios (HR) of incident cardiovascular diseases (CVD) according to tertiles of FQI and of different fat subtypes.

SETTING

University of Navarra, Spain.

PARTICIPANTS

19,341 middle-aged adults.

MEASUREMENTS

Fat intake was measured with a validated food-frequency questionnaire. The FQI was calculated according to the ratio: (monounsaturated+polyunsaturated) / (saturated+trans fatty acids).

RESULTS

We observed 140 incident cases of CVD. No association was found for FQI (HR=0.94, 95 %CI 0.61-1.47 for the highest vs the lowest tertile, p for trend=0.884). No significant associations were found for different dietary fat subtypes on CVD risk. The results suggest no clear association between a higher FQI and a higher amount of energy from fat and incidence of CVD (p for interaction: 0.259 and p for trend only among participants with a percentage of energy from fat ≥35% of total energy: 0.272).

CONCLUSION

In this Mediterranean cohort, the FQI was not associated with cardiovascular events. A "heart-healthy diet" should focus its attention on dietary fat sources and should use an overall dietary pattern approach, rather than limiting the focus on fat subtypes. More research is needed to validate dietary advice on specific fatty acids intake or saturated fatty acids replacements for reducing CVD risk.

Substitution of water or fresh juice for bottled juice and type 2 diabetes incidence: The SUN cohort study

BACKGROUND AND AIMS

The relationship between juice consumption and type 2 diabetes (T2D) has not been widely evidenced. Our aims were to prospectively evaluate the associations with T2D incidence of: 1) isovolumetric substitution of a water serving/day for one of fruit juice (different types), and of fresh fruit juice for its bottled version; 2) consumption of total, fresh or bottled juice; 3) energy intake from juices.

METHODS AND RESULTS

We followed 17,518 adults without T2D at baseline. Beverage consumption was assessed at baseline through a validated food-frequency questionnaire. The outcome was T2D incidence, according to American Diabetes Association's criteria. During a median follow-up of 10.2 years, 142 incident cases of T2D were identified. In substitution models, the substitution of water for bottled juice was associated with a lower T2D incidence, and also if the replacement was done by fresh juice, or especially fresh orange juice [HR 0.75 (95% CI 0.57-0.99), 0.65 (95% CI 0.43-0.98) and 0.56 (95% CI 0.34-0.92); respectively]. Each additional serving/day of bottled juice was directly associated with T2D incidence [HR 1.33 (95% CI 1.01-1.75)]. No significant association was observed for energy coming for bottled juice [HR 1.74 (95% CI 0.94-3.20)].

CONCLUSION

Our results suggest that isovolumetric substitution of water or fresh juice for bottled juice was inversely associated with T2D incidence in a long-term prospective study. Thus, these substitutions could be useful to tackle the diabetes epidemic.

Association between a dietary carbohydrate index and cardiovascular disease in the SUN (Seguimiento Universidad de Navarra) Project

BACKGROUND AND AIMS

Beyond the quantity of carbohydrate intake, further research is needed to know the relevance of carbohydrate quality following operational indices. No previous longitudinal study has assessed the association between an index for quality of dietary carbohydrate intake and the risk of cardiovascular disease (CVD). Here, we examined the association between a carbohydrate quality index (CQI) and the risk of CVD.

METHODS AND RESULTS

We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 17,424 middle-aged adults from Spain. The CQI was defined by four criteria: dietary fiber intake, glycemic index, whole-grain/total-grain carbohydrate ratio, and solid/total carbohydrate ratio. We observed 129 incident cases of CVD during 10.1 y of median follow-up. An inverse association for CQI was found (hazard ratio = 0.44, 95% confidence interval (CI): 0.25-0.78 for the highest versus the lowest tertile, p for trend = 0.008). Participants in the highest tertile of the whole-grain/total-grain carbohydrate ratio had 47% lower risk of CVD (95% CI: 0.33-0.85, p for trend = 0.008). Participants with higher baseline CQI and higher baseline energy from carbohydrates had the lowest risk of CVD.

CONCLUSION

In this Mediterranean cohort, a better quality of dietary carbohydrates measured by the CQI, showed a significant inverse association with the incidence of CVD. Specially, a higher proportion of carbohydrates from whole grains was strongly inversely associated with CVD. "Heart-healthy" diets should be focused not only on carbohydrate quantity but also on a multidimensional assessment of the type and quality of carbohydrates.

Association between dietary intakes of PCBs and the risk of obesity: the SUN project

BACKGROUND

Polychlorinated biphenyls (PCB) are persistent organic pollutants (POP) that are consumed because of their bioaccumulation through the food chain. Recent studies have suggested the implication of POPs in the development of metabolic diseases such as type 2 diabetes and obesity. However, this relationship is not entirely consistent, and has not been investigated in longitudinal studies. The purpose of this study was to prospectively examine the association between dietary intake of PCBs and the incidence of obesity in the Seguimiento Universidad de Navarra (SUN) Project.

METHODS

Our study included 12 313 participants without obesity at baseline, who were followed-up for a median of 8.1 years. Dietary intakes of PCBs, expressed as WHO toxic equivalents, were assessed at baseline through a 136-item semiquantitative food-frequency questionnaire. The published concentration levels of PCBs measured in samples of food consumed in Spain were used to estimate intakes. Multivariable Cox regression models were fitted to estimate HRs and 95% CI for incident obesity.

RESULTS

During follow-up, we observed 621 incident cases of obesity. After adjustment for total energy intake and additional adjustment for potential confounders, participants in the fifth quintile of PCBs intake were at higher risk of becoming obese (adjusted HR: 1.58; (95% CI 1.21 to 2.06)) compared to those in the first quintile. The linear trend test was statistically significant (p<0.001).

CONCLUSIONS

Dietary intake of PCBs as estimated using a food frequency questionnaire was associated with a higher incidence of obesity. Nevertheless, further longitudinal studies are needed to confirm our results.

[A study of clinical response to antibiotic treatment in subjects with chronic bacterial prostatitis]

A study was carried out on the clinical response to antibiotics in 105 patients with chronic bacterial prostatitis. Two groups of patients were compared in a retrospective study. The results of rectal examination, ultrasound scan, microbiological analysis, and response to different antibiotic therapy regimens were compared. There was a high incidence of perineal-testicular pain and sexual potency reduction; prostate congestion and pain on rectal examination were frequently reported. All the patients had positive microbial cultures, with Gram-negative microorganisms being predominantly isolated. Following the administration of different antibiotic therapy regimens, symptoms either disappeared or diminished, irrespective of whether positive cultures remained. A poorer clinical response was observed in patients with positive prostate ultrasound and rectal examination, and with isolated Gram-negative bacilli. No differences were observed between either group in clinical response to different antimicrobial regimens.

Rapid molecular analysis of the haemagglutinin gene of human influenza A H3N2 viruses isolated in spain from 1996 to 2000

A simple molecular technique was used for the rapid preliminary genetic characterization of human influenza A H3N2 viruses isolated in Spain from 1996 to 2000. Subtyping, based on RT-PCR, was followed by subtype-specific restriction enzyme fragment length polymorphism (RFLP) analyses of an amplified region of the HA1 domain of the H3 haemagglutinin (HA) gene to distinguish variants differentiated by common amino acid substitutions in HA1. The approach was tested using 135 Spanish H3N2 isolates and included nucleotide sequencing and phylogenetic analyses of a region of the HA1 domain of 41 representative isolates. The viruses were distinguished by haemagglutination inhibition (HI) assays into two antigenically discernible groups, the A/Wuhan/359/95-like and A/Sydney/5/97-like viruses. The results of PCR-RFLP analysis allowed a finer classification into five genetic variant subgroups, corresponding to those distinguished by phylogenetic analyses. This rapid, simple and variant-specific procedure could, therefore, be used to rapidly screen clinical specimens prior to more detailed antigenic and genetic analyses.

Intra-sellar salivary gland-like pleomorphic adenoma arising within the wall of a Rathke's cleft cyst

Salivary gland rests occur in the posterior lobe of the pituitary gland near or often communicating with the Rathke's cleft or its cystic subdivisions, and are usually incidental autopsy findings. They are attributed to the oropharyngeal development of the Rathke's pouch and may rarely give rise to salivary gland-like tumors in the sella. We present a pleomorphic adenoma, a rare tumor of the sellar region, that has not been previously recognized in association with Rathke's cleft cyst. It occurred in a 44-year-old man who presented with hypopituitarism and reduced vision. Magnetic resonance imaging showed a sellar mass with suprasellar extension which was totally removed. It consisted of segments of a cyst wall lined by focally ciliated columnar of cuboid epithelium containing goblet cells. An eosinophilic granular material with cholesterol clefts represented the contents of the cyst. Within its wall there was a tumor with ductal structures and non-ductal varied cellular components including hypercellular areas of spindle and ovoid cells forming interlacing fascicles. Individual cells appeared to float in abundant mucinous material. The appearances were those of a salivary gland pleomorphic adenoma arising within the wall of a Rathke's cleft cyst. The myoepithelial nature of non-ductal tumor cells was confirmed with immunocytochemistry. The existence of seromucous glands communicating with the Rathke's cleft remnants, explains the concomitant occurrence of the tumor and the cyst. This rare neoplasm from salivary gland rest should be considered in the differential diagnosis of unusual sellar and suprasellar tumors.

Bed mobility task performance in older adults

Difficulty in transferring, the ability to rise in and out of a bed and chair, is a common problem in older adults, particularly those residing in skilled nursing facilities. Focusing on one aspect of transferring, rising from supine to sitting position, we devised a set of bed mobility tasks to test key arm, leg, and trunk movements that likely contribute to successful rising from bed. Healthy young controls (YC, n=22, mean age 23), and older adults (aged 60 and over) either residing independently in congregate housing (CH, n=29, mean age 84) or undergoing rehabilitation in a skilled nursing facility (SNF, mean age 77) were assessed in the time to rise from supine to sitting and in the ability or inability to perform 16 other bed mobility tasks. Trunk function-related tasks, specifically those requiring trunk elevation and trunk balance, were most difficult for the SNF, followed by CH, and then YC. Tasks focusing on trunk flexion strength (sit up arms crossed, bilateral heel raise) and lateral trunk strength/balance were the most difficult for both SNF and CH, although there was minimal difference in the percent unable to complete each task. The major CH-SNF differences occurred in trunk elevation tasks where the upper limb was important in facilitating trunk elevation (sit up with head of bed elevation with use of arms, sit up with the use of a trapeze, or sit up with use of arms from a flat bed position). These findings suggest that to improve frail older adult performance on bed mobility tasks, and specifically in rising from supine to sitting, training should move beyond improving trunk function (i.e., trunk strength). There should be an additional focus, either through therapy or bed design modifications, on how upper limb movements and positioning can be used to assist in trunk elevation.

Sequence and characterization of a sperm-specific histone H1-like protein of Mytilus californianus

The major protein fraction of the protamine-like PL-II* (phi 2B) from the sperm of Mytilus californianus has been sequenced and characterized. Immunological and sequence analyses unequivocally show that this protein is indeed a member of the histone H1 family. Along with proteins of the histone H1 class, the protein also shows cross-reactivity and sequence identity, in its NH2-terminal region, with the major protamine-like protein component of Mytilus sperm: PL-III (phi 1), of smaller molecular mass. Indeed it is the unusual repetitive sequence motif of the NH2-terminal domain of PL-II* that bestows to this protein its protamine-like nature. Fourier-transform infrared spectroscopy spectroscopy indicates that the protein contains considerable secondary structure: 18% alpha-helix, 21% beta-sheet, 39% turns and bends, 22% random coil. At the higher levels of structure, PL-II* exhibits ionic strength-dependent folding which is indistinguishable from that of histone H5, as monitored by fluorescence anisotropy.

Post-translational cleavage of a histone H1-like protein in the sperm of Mytilus

Starting with total RNA from spermatogenic cells of Mytilus trossulus and using random priming, we have cloned and sequenced the c-DNAs corresponding to two variants of the sperm-specific protein PLII* (phi 2B). DNA sequencing in conjunction with mass spectrometry and protein sequence data have allowed us to establish that of the three sperm-specific proteins present in the sperm of Mytilus (PL-II*(phi 2B), PL-III (phi 1), PL-IV (phi 3)), the first and the last one are the result of post-translational cleavage of a common precursor. This common precursor is a member of the histone H1 family, and it exhibits inter- and intraspecific microheterogeneity.

Microheterogeneity and interspecific variability of the nuclear sperm proteins from Mytilus

We have used acetic acid-urea-triton (AUT) gel electrophoresis and ionic exchange chromatography in order to analyze the interspecific variability and microheterogeneity pattern of the protamine-like (PL) proteins of the sperm of 4 different species of the bivalve mollusc, Mytilus. We have found that based upon these 2 criteria, it is possible to unambiguously distinguish each species from the rest. We have thus been able to corroborate the identity of M. trossulus. We have also analyzed the amino acid composition of some of the PL components for each different species. In the case of the PL-II* fraction, we have analyzed the composition of its major protein subcomponents.