OBJECTIVEDiabetes prevalence and incidence increase among individuals with hypothyroidism but also among those with hyperthyroxinemia, which seems contradictory. Both high free thyroxine (fT4) and high thyroid-stimulating hormone (TSH) are present in the resistance to thyroid hormone syndrome. A mild acquired resistance to thyroid hormone might occur in the general population and be associated with diabetes. We aimed to analyze the association of resistance to thyroid hormone indices (the Thyroid Feedback Quantile-based Index [TFQI], proposed in this work, and the previously used Thyrotroph T4 Resistance Index and TSH Index) with diabetes. RESEARCH DESIGN AND METHODSWe calculated the aforementioned resistance to thyroid hormone indices based on a U.S. representative sample of 5,129 individuals ‡20 years of age participating in the 2007-2008 National Health and Nutrition Examination Survey (NHANES). Also, to approximate TFQI, a U.S.-referenced Parametric TFQI (PTFQI) can be calculated with the spreadsheet formula 5NORM.DIST(fT4_cell_in_pmol_per_L,10.075, 2.155,TRUE)1NORM.DIST(LN(TSH_cell_in_mIU_per_L),0.4654,0.7744,TRUE)21. Outcomes of interest were glycohemoglobin ‡6.5%, diabetes medication, diabetes-related deaths (diabetes as contributing cause of death), and additionally, in a fasting subsample, diabetes and metabolic syndrome. Logistic and Poisson regressions were adjusted for sex, age, and race/ethnicity. RESULTSOdd ratios for the fourth versus the first quartile of TFQI were 1.73 (95% CI 1.32, 2.27) (P trend 5 0.002) for positive glycohemoglobin and 1.66 (95% CI 1.31, 2.10) (P trend 5 0.001) for medication. Diabetes-related death rate ratio for TFQI being above versus below the median was 4.81 (95% CI 1.01, 22.94) (P trend 5 0.015). Further adjustment for BMI and restriction to normothyroid individuals yielded similar results. Per 1 SD in TFQI, odds increased 1.13 (95% CI 1.02, 1.25) for diabetes and 1.16 (95% CI 1.02, 1.31) for metabolic syndrome. The other resistance to thyroid hormone indices showed similar associations for diabetes-related deaths and metabolic syndrome. CONCLUSIONSHigher values in resistance to thyroid hormone indices are associated with obesity, metabolic syndrome, diabetes, and diabetes-related mortality. Resistance to thyroid hormone may reflect energy balance problems driving type 2 diabetes. These indices may facilitate monitoring treatments focused on energy balance.

Objective: To design and develop a questionnaire that can account for an individual's adherence to a Mediterranean lifestyle including the assessment of diet and physical activity patterns, as well as social interaction. Design: The Mediterranean Lifestyle (MEDLIFE) index was created based on the current Spanish Mediterranean food guide pyramid. MEDLIFE is a twenty-eightitem derived index consisting of questions about food consumption (fifteen items), traditional Mediterranean dietary habits (seven items) and physical activity, rest and social interaction habits (six items). Linear regression models and Spearman rank correlation were fitted to assess content validity and internal consistency. Setting: A subset of participants in the Aragon Workers' Health Study cohort (Zaragoza, Spain) provided the data for development of MEDLIFE. Subjects: Participants (n 988) of the Aragon Workers' Health Study cohort in Spain. Results: Mean MEDLIFE score was 11·3 (SD 2·6; range: 0-28), and the quintile distribution of MEDLIFE score showed a significant association with each of the individual items as well as with specific nutrients and lifestyle indicators (intra-validity). We also quantified MEDLIFE correspondence with previously reported diet quality indices and found significant correlations (ρ range: 0·44-

Background Ultra-processed food intake has been associated with chronic conditions and mortality. The aim of this study was to assess the relationship between ultra-processed food intake and incident frailty in community-dwelling older adults. Methods Prospective cohort study with 1,822 individuals aged at least 60 years who were recruited during 2008–2010 in Spain. At baseline, food consumption was obtained using a validated computerized face-to-face dietary history. Ultra-processed foods were identified according to the nature and extent of their industrial processing (NOVA classification). In 2012, incident frailty was ascertained based on Fried’s criteria. Statistical analyses were performed with logistic regression and adjusted for the main potential confounders. Results After a mean follow-up of 3.5 years, 132 cases of frailty were identified. The fully adjusted risks of frailty across increasing quartiles of the percentage of total energy intake from ultra-processed foods were the following: 0.04 (0.02–0.05), 0.05 (0.03–0.07), 0.09 (0.07–0.12), and 0.11 (0.08–0.14). Results were similar when food consumption was expressed as gram per day/body weight. Regarding ultra-processed food groups, the highest versus the lowest tertiles of consumption of yogurts and fermented milks, cakes and pastries, as well as nonalcoholic beverages (instant coffee and cocoa, packaged juices, and other nonalcoholic drinks, excluding soft drinks) were also significantly related to incident frailty. Conclusions Consumption of ultra-processed foods is strongly associated with frailty risk in older adults. Substituting unprocessed or minimally processed foods for ultra-processed foods would play an important role in the prevention of age-related frailty. Trial registration NCT02804672.

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Information on the association between socioeconomic status (SES) throughout life and sarcopenic obesity is scarce, whereas no study has been focused on the association between SES and frail obesity. This analysis estimated the prevalence of sarcopenic obesity and frail obesity, and their associations with SES in older adults. Data were collected in 2012 from 1,765 non-institutionalized individuals aged ≥65 participating in the Seniors-ENRICA study in Spain, by using standardized techniques and equipment. SES throughout life was evaluated with the father’s occupation, participant’s educational level, former own occupation, and current poor housing condition. Overall, 17.2% of participants had sarcopenic obesity, and 4.0% frail obesity. No association was found between SES and sarcopenic obesity. In contrast, the prevalence of frail obesity was higher in those with lower education, having worked in manual job, and currently having poor housing condition. Having ≥1 social disadvantages throughout life was associated with higher prevalence of frail obesity. The prevalence of this disorder increased by 1.49 (95% CI: 1.21–1.85) times for each social disadvantage added. The OR (95% CI) of frail obesity was 3.13 (1.71–5.7) for those having 3 or 4 vs. 0 or 1 social disadvantages, implying a more complex process beginning early in life.

Background Ultra-processed food (UPF) consumption has been associated with higher cardiovascular disease (CVD) and mortality risks. Objectives The aim of this study was to assess the relationship between UPF consumption and incident dyslipidemia in older adults, where evidence is limited. Methods We studied a prospective cohort of 1082 community-dwelling adults in Spain, older than 60 (mean age, 68 ± 6 years old). Participants (52% were women) were recruited between 2008–10 and followed up to 2015. At baseline, food intake data were collected using a validated computerized face-to-face dietary history. UPFs were identified according to the nature and extent of their industrial processing (NOVA classification). Triglycerides, HDL cholesterol, and LDL cholesterol were measured in fasting plasma samples collected at baseline and at follow-up. Statistical analyses were performed with logistic regression adjusted for the main potential confounders. Results Among those free of corresponding dyslipidemia at baseline, and after a follow-up of between 5 to 7 years, 60 (out of 895) developed incident hypertriglyceridemia (≥150 mg/dL), 112 (out of 878) had low HDL cholesterol (<40 in men/<50 mg/dL in women), and 54 (out of 472) had high LDL cholesterol (>129 mg/dL). The mean percentage of UPF consumption was 19% ± 11% of total energy intake. Those in the highest versus the lowest tertile of energy intake from UPFs had more than twice the odds of incident hypertriglyceridemia (OR, 2.66; 95% CI: 1.20–5.90; P-trend, 0.011) or low HDL cholesterol (OR, 2.23; 95% CI: 1.22–4.05; P-trend, 0.012). UPF consumption was not associated with high LDL cholesterol plasma concentrations. Conclusions Although UPF consumption in Spain was low among older adults, high consumption of UPFs was clearly associated with incident dyslipidemia. The increase in CVD risk recently found to be associated with UPF consumption might be mediated by these atherogenic lipid abnormalities.

Background: Ultra-processed food (UPF) consumption, which is increasing worldwide, has recently been associated with an increased risk of death and cardiovascular disease. We aimed to assess whether consumption of UPF is directly associated with subclinical coronary atherosclerosis in middle-aged men. Methods: A computed tomography scan was performed on 1876 men from the Aragon Workers' Health Study, recruited from January 2011 to December 2014, to assess coronary calcium. All participants were free of coronary heart disease. Dietary intake was collected by a validated 136-item semi-quantitative food frequency questionnaire. UPF was defined according to the NOVA classification. Associations between consumption of total energy-adjusted UPF and Coronary Calcium Agatston Score (CACS)-categorized into CACS of 0, > 0 and < 100, and ≥ 100-were cross-sectionally assessed by generalized ordered logistic regression adjusted for main confounders. Results: No coronary calcium was detected in 60.2% of the participants, whereas 10.2% had a CACS ≥ 100. A significant dose-response association was observed between energy-adjusted UPF consumption and the risk of having a CACS ≥ 100, when compared with those in the lowest CACS categories (CACS of 0 together with CACS > 0 and < 100). The fully adjusted ORs (95% CI) of having a CACS ≥ 100 across quartiles of energy-adjusted UPF consumption (approximately 100 g/day in the lowest quartile (ref.) and 500 g/day in the highest) were 1.00 (ref.), 1.50 (0.93, 2.42), 1.56 (0.96, 2.52), and 2.00 (1.26, 3.16), p trend .005. Conclusion: In this middle-aged worker's sample, approximately 500 g/day of UPF consumption was associated with a 2-fold greater prevalence of subclinical coronary atherosclerosis than consuming only 100 g/day, independently of total energy intake and other well-established cardiovascular risk factors.