GRUP DE RECERCA EN MEDICINA INTERNA

Hospital Clínic de Barcelona (Barcelona)

Director: Ramón Estruch Riba, Consultor Sènior. Servei de Medicina Interna, Hospital Clínic

RESTRUCH@clinic.ub.es

(+34) 932 27 93 65

(+34) 932 27 93 65

Actualització fitxa tècnica del grup: setembre 2017

MEMBRES DEL GRUP INVESTIGADOR

Ramón Estruch Riba, Consultor Sènior. Servei de Medicina Interna. Hospital Clínic de Barcelona, a/e: RESTRUCH@clinic.ub.es

Rosa Mª Casas , Investigadora Doctoral, CiberObn, a/e: rcasas1@clinic.ub.es

Mónica Domenech, Investigadora Doctoral, IDIBAPS, a/e: mdomen@clinic.ub.es

Ana Mª Ruiz, Estudiant pre-doctoral. Laboratori. CiberObn, a/e: amruiz@clinic.ub.es

Conxa Viñas, Nutricionista , CiberObn, a/e: cvinas@clinic.ub.es

Sara Castro, Nutricionista- Estudiant pre-doctoral, IDIBAPS, a/e: scastro@clinic.ub.es

Irene Roth, Nutricionista- Estudiant pre-doctoral, IDIBAPS, a/e: roth@clinic.ub.es

Margarida Ribó, Nutricionista- Estudiant pre-doctoral, IDIBAPS, a/e: mribo@sportdiet.org

Marina Sadurní, Nutricionista, IDIBAPS, a/e: sadurni@clinic.ub.es

María Gual, Infermera, IDIBAPS, a/e: gual@clinic.ub.es

Miguel Camafort, Metge Consultor, Hospital Clínic de Barcelona, a/e: camafort@clinic.ub.es

Cristina Sierra, Metge Consultor, Hospital Clínic de Barcelona, a/e: csierra@clinic.ub.es

Emilio Sacanella, Metge Consultor, Hospital Clínic de Barcelona, a/e: esacane@clinic.ub.es

Ferran Masanés, Metge Consultor, Hospital Clínic de Barcelona, a/e: fmasanes@clinic.ub.es

Margarita Navarro, Metge Consultor, Hospital Clínic de Barcelona, a/e: navarrol@clinic.ub.es

Alfons López Soto, Metge Consultor, Hospital Clínic de Barcelona, a/e: alopez@clinic.ub.es

Ricardo Arturo Losno, Metge pre-doctoral, Hospital Clínic de Barcelona, a/e: ralosno@clinic.ub.es

(Actualització de l’apartat: 08/09/2017)

ACTIVITATS I CAPACITATS DEL GRUP DE RECERCA

L’equip d’investigació de Medicina Interna, actualment anomenat de Risc Cardiovascular, Nutrició i Envelliment, es va formar fa més de 20 anys i està inclòs dins dels grups d’investigació de l’Institut Biomèdic August Pi i Sunyer (IDIBAPS), lligat a l’Hospital Clínic i a la Universitat de Barcelona. L’IP del grup és el Dr. Ramón Estruch, Consultor Sènior del Servei de Medicina Interna de l’Hospital Clínic (Barcelona), Professor Associat a la Facultat de Medicina de la Universitat de Barcelona. També és IP del grup és membre de l’ Advisory Board of the European Research on Alcoholism Board (ERAB) de la Unió Europea i President del consell científic de la Fundació dieta mediterrània.

Ha publicat més de 300 articles amb un índex d’impacte total superior a 360. Ha participat en nombrosos projectes d’investigació. La seva experiència i activitat investigadora es centra en la investigació dels efectes de la dieta mediterrània sobre l’enfermetat cardiovascular i càncer, efectes del consum del vi, cervesa, oli d’oliva, fruits secs, tomàquet i cacao sobre la pressió arterial, perfil lipídic, metabolisme de la glucosa, estrès oxidatiu i inflamació.

El grup ha publicat més de 150 treballs de recerca en revistes com New England Journal of Medicine, Annals of Internal Medicine, JAMA, Lancet, Archives of Medicine, Annals of Neurology y Archives of Neurology, American Journal of Clinical Nutrition i Journal of Nutrition. Així mateix, ha obtingut ajuts per la recerca del FIS, CICYT, Universitat de Barcelona, CIRIT, INIA, Comité Conjunto Hispano – Norteamericano (USA), Alcoholic Beverage Medical Research Foundation de California, NIH iComunitat Econòmica Europea.

Tots els estudis s’ han realitzat en col·laboració amb universitats e institucions estrangeres como: Columbia University a Nova York, Loma Linda University a Califòrnia, Harvard School of Public Health a Massachusetts, Human Nutrition Research Centre a Tufts University, Massachusetts, Estats Units i Mario Negri Sud, Santa Maria d’Imbaro, Itàlia.

LÍNIES DE RECERCA

Línia: Efectes de la Dieta Mediterrània sobre la prevenció de la enfermetat cardiovascular, càncer i enfermetats neurodegeneratives.
Investigador principal: Ramon Estruch Riba

Línia: Efectes de la Dieta Mediterrània sobre els factors clàssics i novells de risc vascular
Investigador principal: Ramon Estruch Riba

Línia: Efectes del vi, oli d’oliva, fruits secs, tomàquet i del cacao sobre el perfil lipidic, estrès oxidatiu i els biomarcadors relacionats amb arteriosclerosi.
Investigadors principals: Ramon Estruch Riba / Emilio Sacanella

Línia: Efectes del consum crònic de l’alcohol sobre el sistema cardiovascular, fetge i sistema nerviós.
Investigador principal: Ramon Estruch Riba

Línia: Mecanismes dels efectes protectors del consum moderat de vi i cervesa: efectes sobre la expressió i funció de les molècules d’ adhesió i quimiocines relacionades amb el desenvolupament de l’aterosclerosi.
Investigador principal: Ramon Estruch Riba

Línia: Efectes dels diferents tipus de begudes alcohòliques sobre el sistema immune
Investigador principal: Ramon Estruch Riba

Línia: Avaluació del gruix íntima-mèdia (IMT) de l’artèria caròtide i placa per ecografia en: a) persones amb un alt risc cardiovascular; b) prediabetis; c) persones grans sanes. Associacions amb factors de risc convencionals i emergents i biomarcadors dietètics, incloent-hi àcids grassos insaturats i fitosterols en sang. Influència de la dieta en la vulnerabilitat de les plaques d’ateroma de les caròtides avaluada mitjançant una RMN.
Investigador principal: Ramon Estruch Riba

MILLORS PUBLICACIONS DEL GRUP (DARRERS 2 ANYS)

Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, Fiol M, Gómez-Gracia E, Arós F, Lapetra J, Serra-Majem L, Pintó X, Buil-Cosiales P, Sorlí JV, Muñoz MA, Basora-Gallisá J, Lamuela-Raventós RM, Serra-Mir M, Ros E; PREDIMED Study Investigators.
Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: A prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial.
The Lancet Diabetes and Endocrinology. 2016; 4(8):666-76.
PMID: 27283479

Abstract:
BACKGROUND: Because of the high density of fat, high-fat diets are perceived as likely to lead to increased bodyweight, hence health-care providers are reluctant to recommend them to overweight or obese individuals. We assessed the long-term effects of ad libitum, high-fat, high-vegetable-fat Mediterranean diets on bodyweight and waist circumference in older people at risk of cardiovascular disease, most of whom were overweight or obese.
METHODS: PREDIMED was a 5 year parallel-group, multicentre, randomised, controlled clinical trial done in primary care centres affiliated to 11 hospitals in Spain. 7447 asymptomatic men (aged 55-80 years) and women (aged 60-80 years) who had type 2 diabetes or three or more cardiovascular risk factors were randomly assigned (1:1:1) with a computer-generated number sequence to one of three interventions: Mediterranean diet supplemented with extra-virgin olive oil (n=2543); Mediterranean diet supplemented with nuts (n=2454); or a control diet (advice to reduce dietary fat; n=2450). Energy restriction was not advised, nor was physical activity promoted. In this analysis of the trial, we measured bodyweight and waist circumference at baseline and yearly for 5 years in the intention-to-treat population. The PREDIMED trial is registered with ISRCTN.com, number ISRCTN35739639.
FINDINGS: After a median 4·8 years (IQR 2·8-5·8) of follow-up, participants in all three groups had marginally reduced bodyweight and increased waist circumference. The adjusted difference in 5 year changes in bodyweight in the Mediterranean diet with olive oil group was -0·43 kg (95% CI -0·86 to -0·01; p=0·044) and in the nut group was -0·08 kg (-0·50 to 0·35; p=0·730), compared with the control group. The adjusted difference in 5 year changes in waist circumference was -0·55 cm (-1·16 to -0·06; p=0·048) in the Mediterranean diet with olive oil group and -0·94 cm (-1·60 to -0·27; p=0·006) in the nut group, compared with the control group.
INTERPRETATION: A long-term intervention with an unrestricted-calorie, high-vegetable-fat Mediterranean diet was associated with decreases in bodyweight and less gain in central adiposity compared with a control diet. These results lend support to advice not restricting intake of healthy fats for bodyweight maintenance.

Casas R, Sacanella E, Urpí-Sardà M, Corella D, Castañer O, Lamuela-Raventos RM, Salas-Salvadó J, Martínez-González MA, Ros E, Estruch R.
Long-Term Immunomodulatory Effects of a Mediterranean Diet in Adults at High Risk of Cardiovascular Disease in the PREvención con DIeta MEDiterránea (PREDIMED) Randomized Controlled Trial.
J Nutr. 2016 Sep;146(9):1684-93.
PMID: 27440261

Abstract:
BACKGROUND: The Mediterranean diet (MedDiet) has demonstrated short-term anti-inflammatory effects, but little is known about its long-term immunomodulatory properties.
OBJECTIVE: Our goal was to assess the long-term effects of the MedDiet on inflammatory markers related to atherogenesis in adults at high risk of cardiovascular disease (CVD) compared with the effects of a low-fat diet (LFD).
METHODS: We randomly assigned 165 high-risk participants (one-half men; mean age: 66 y) without overt CVD to 1 of 3 diets: a MedDiet supplemented with extra-virgin olive oil, a MedDiet supplemented with nuts, or an LFD. Follow-up data were collected at 3 and 5 y. Repeated-measures ANOVA, adjusted for potential confounding variables, was used to evaluate changes in diet adherence, CVD risk factors, and inflammatory variables.
RESULTS: The 2 MedDiet groups achieved a high degree of adherence to the intervention, and the LFD group had reduced energy intake from fat by 13% by 5 y. Compared with baseline, at 3 and 5 y, both MedDiet groups had significant reductions of ≥16% in plasma concentrations of high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor α, and monocyte chemoattractant protein 1 (P ≤ 0.04), whereas there were no significant changes in the LFD group. The reductions in CD49d and CD40 expressions in T lymphocytes and monocytes at 3 y were ≥16% greater in both MedDiet groups than were the changes in the LFD group (P < 0.001) at 3 y. Compared with baseline, at 3 y, the MedDiet groups had increased HDL-cholesterol (≥8%) and decreased blood pressure (>4%) and total cholesterol, LDL-cholesterol, and triglyceride (≥8%) concentrations. At 5 y, concentrations of glucose (13%) and glycated hemoglobin (8%) had increased with the LFD.
CONCLUSIONS: The MedDiet participants had lower cellular and plasma concentrations of inflammatory markers related to atherosclerosis at 3 and 5 y. This anti-inflammatory role of the MedDiet could explain in part the long-term cardioprotective effect of the MedDiet against CVD. This trial was registered at controlled-trials.com as ISRCTN35739639.

Medina-Remón A, Casas R, Tressserra-Rimbau A, Ros E, Martínez-González MA, Fitó M, Corella D, Salas-Salvadó J, Lamuela-Raventos RM, Estruch R; PREDIMED Study Investigators.
Polyphenol intake from a Mediterranean diet decreases inflammatory biomarkers related to atherosclerosis: a substudy of the PREDIMED trial.
Br J Clin Pharmacol. 2017;83(1):114-128.
PMID: 27100393

Abstract:
High dietary polyphenol intake is associated with reduced all-cause mortality and a lower incidence of cardiovascular events. However, the mechanisms involved are not fully understood. The aim of the present substudy of the PREvención con DIetaMEDiterránea (Prevention with Mediterranean diet; PREDIMED) trial was to analyse the relationship between polyphenol intake measured by total urinary polyphenol excretion (TPE), and circulating inflammatory biomarkers and cardiovascular risk factors in elderly individuals. A substudy of 1139 high-risk participants was carried out within the PREDIMED trial. The subjects were randomly assigned to a low-fat control diet or to two Mediterranean diets, supplemented with either extra-virgin olive oil or nuts. Dietary intake, anthropometric data, clinical and laboratory assessments, including inflammatory biomarkers, and urinary TPE were measured at baseline and after the one-year intervention. Participants in the highest tertile of changes in urinary TPE (T3) showed significantly lower plasma levels of inflammatory biomarkers [vascular cell adhesion molecule 1 (VCAM-1) (-9.47 ng ml-1 ), intercellular adhesion molecule 1 (-14.71 ng ml-1 ), interleukin 6 (-1.21 pg ml-1 ), tumour necrosis factor alpha (-7.05 pg ml-1 ) and monocyte chemotactic protein 1 (-3.36 pg ml-1 )] than those inthe lowest tertile (T1, P < 0.02; all). A significant inverse correlation existed between urinary TPE and the plasma concentration of\VCAM-1 (r = -0.301; P < 0.001). In addition, systolic and diastolic blood pressure (BP) decreased and plasma high-density lipoprotein cholesterol increased in parallel with increasing urinary TPE (T3 vs. T1) (P < 0.005 and P = 0.004, respectively). Increases in polyphenol intake measured as urinary TPE are associated with decreased inflammatory biomarkers, suggesting a dose-dependent anti-inflammatory effect of polyphenols. In addition, high polyphenol intake improves cardiovascular risk factors- mainly BP and the lipid profile.

Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martínez-González MA, Martínez-Lapiscina EH, Fitó M, Pérez-Heras A, Salas-Salvadó J, Estruch R, Ros E.
Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial.
JAMA Intern Med. 2015;175(7):1094-103.
PMID: 25961184

Abstract:
IMPORTANCE: Oxidative stress and vascular impairment are believed to partly mediate age-related cognitive decline, a strong risk factor for development of dementia. Epidemiologic studies suggest that a Mediterranean diet, an antioxidant-rich cardioprotective dietary pattern, delays cognitive decline, but clinical trial evidence is lacking.
OBJECTIVE: To investigate whether a Mediterranean diet supplemented with antioxidant-rich foods influences cognitive function compared with a control diet.
DESIGN, SETTING, AND PARTICIPANTS: Parallel-group randomized clinical trial of 447 cognitively healthy volunteers from Barcelona, Spain (233 women [52.1%]; mean age, 66.9 years), at high cardiovascular risk were enrolled into the Prevención con Dieta Mediterránea nutrition intervention trial from October 1, 2003, through December 31, 2009. All patients underwent neuropsychological assessment at inclusion and were offered retesting at the end of the study.
INTERVENTIONS: Participants were randomly assigned to a Mediterranean diet supplemented with extravirgin olive oil (1 L/wk), a Mediterranean diet supplemented with mixed nuts (30 g/d), or a control diet (advice to reduce dietary fat).
MAIN OUTCOMES AND MEASURES: Rates of cognitive change over time based on a neuropsychological test battery: Mini-Mental State Examination, Rey Auditory Verbal Learning Test (RAVLT), Animals Semantic Fluency, Digit Span subtest from the Wechsler Adult Intelligence Scale, Verbal Paired Associates from the Wechsler Memory Scale, and the Color Trail Test. We used mean z scores of change in each test to construct 3 cognitive composites: memory, frontal (attention and executive function), and global.
RESULTS: Follow-up cognitive tests were available in 334 participants after intervention (median, 4.1 years). In multivariate analyses adjusted for confounders, participants allocated to a Mediterranean diet plus olive oil scored better on the RAVLT (P = .049) and Color Trail Test part 2 (P = .04) compared with controls; no between-group differences were observed for the other cognitive tests. Similarly adjusted cognitive composites (mean z scores with 95% CIs) for changes above baseline of the memory composite were 0.04 (-0.09 to 0.18) for the Mediterranean diet plus olive oil, 0.09 (-0.05 to 0.23; P = .04 vs controls) for the Mediterranean diet plus nuts, and -0.17 (-0.32 to -0.01) for the control diet. Respective changes from baseline of the frontal cognition composite were 0.23 (0.03 to 0.43; P = .003 vs controls), 0.03 (-0.25 to 0.31), and -0.33 (-0.57 to -0.09). Changes from baseline of the global cognition composite were 0.05 (-0.11 to 0.21; P = .005 vs controls) for the Mediterranean diet plus olive oil, -0.05 (-0.27 to 0.18) for the Mediterranean diet plus nuts, and -0.38 (-0.57 to -0.18) for the control diet. All cognitive composites significantly (P < .05) decreased from baseline in controls.
CONCLUSIONS AND RELEVANCE: In an older population, a Mediterranean diet supplemented with olive oil or nuts is associated with improved cognitive function. TRIAL REGISTRATION: Isrctn.org Identifier: ISRCTN35739639.

Tresserra-Rimbau A, Medina-Remón A, Lamuela-Raventós RM, Bulló M, Salas-Salvadó J, Corella D, Fitó M, Gea A, Gómez-Gracia E, Lapetra J, Arós F, Fiol M, Ros E, Serra-Majem L, Pintó X, Muñoz MA, Estruch R; PREDIMED Study Investigators.
Moderate red wine consumption is associated with a lower prevalence of the metabolic syndrome in the PREDIMED population.
Br J Nutr. 2015;113 Suppl 2:S121-30.
PMID:26148915

Abstract:
Previous studies on the association between alcohol intake and the development of the metabolic syndrome (MetS) have yielded inconsistent results. Besides, few studies have analysed the effects of red wine (RW) consumption on the prevalence of the MetS and its components. As moderate RW drinkers have a better lipid profile and lower incidence rates of diabetes, hypertension and abdominal obesity, all components of the MetS, it was hypothesised that moderate RW consumption could be associated with a lower prevalence of the MetS. In the present cross-sectional study of 5801 elderly participants at a high cardiovascular risk included in the PREDIMED (Prevención con Dieta Mediterránea) study, 3897 fulfilled the criteria of the MetS at baseline. RW intake was recorded using a validated 137-item FFQ. Multiple logistic regression analysis was carried out to estimate the association between RW intake and the prevalence of the MetS. Compared with non-drinkers, moderate RW drinkers (≥ 1 drink/d) were found to have a reduced risk of prevalent MetS (OR 0.56, 95 % CI 0.45, 0.68; P < 0.001), a lower risk of having an abnormal waist circumference (OR 0.59, 95 % CI 0.46, 0.77; P < 0.001), low HDL-cholesterol concentrations (OR 0.42, 95 % CI 0.32, 0.53; P < 0.001), high blood pressure (OR 0.28, 95 % CI 0.17, 0.45; P < 0.001) and high fasting plasma glucose concentrations (OR 0.67, 95 % CI 0.54, 0.82; P < 0.001) after adjusting for several confounders. This association was found to be stronger in female participants, in participants aged < 70 years and in participants who were former or current smokers. No significant association was found between RW intake (≥ 1 drink/d) and TAG concentrations. In conclusion, moderate RW consumption is associated with a lower prevalence of the MetS in an elderly Mediterranean population at a high cardiovascular risk.

INSTITUCIONS QUE RECONEIXEN AL GRUP DE RECERCA

Instituto de Salud Carlos III

CIBER Fisiopatologia de la Obesidad y Nutrición (CB207/03/2004)

Institut De Investigacions Biomèdiques De August Pi I Sunyer (IDIBAPS).

Nutrició FMCS, Universitat Rovira i Virgili, Reus

Departament de Epidemiologia i Salut Pública, Facultat de Medicina, Universitat de Navarra

Departament de Epidemiologia i Salut Pública, Facultat de Medicina, Universitat de Las Palmas

Departament de Medicina Preventiva i Salut Pública de la Universitat de València

Fundació Pública Andalusa per a la Investigació de Màlaga en Biomedicina i Salut (FIMABIS)

Fundació Basca d’ Innovació i Investigació Sanitaria, Hospital Universitari Araba. Seu Txagorritxu

Facultat de Farmàcia, Universitat de Barcelona.

Districte sanitari atenció primària de Sevilla, Fund. Pública Andalusa per a la Gestió de la Investigació en Salud de Sevilla

Unitat de Lipids i Aterosclerosi, IMIBIC, Hospital universitari Reina Sofia, Universitat de Códoba

Facultat de Ciències de la Salut de la Universitat Jaume I

Hospital Universitari de Bellvitge, Fundació IDIBELL

Consorci Mar Parc de Salut de Barcelona

Facultat de Ciències de Mallorca, Universitat de les Illes Balears

Institut Català de Ciències Cardiovasculars de Barcelona

Centre Nacional de Investigacions Cardiovasculars Carlos III (CNIC) de Madrid

Mount Sinai Medical Center de Nueva York

Laboratori de Nutrició i Genètica de la Universitat de Tufts

Institut Madrileny d’ Estudis Avançats (IMDEA)

Harvard School of Public Health, Boston, Massachusetts

Department of Pathology, Jefferson University, Philadelphia

Mario Negri Sud, Santa Maria d’Imbaro, Itàlia

Departament d’ Epidemiologia i Prevenció, IRCCS Institut Neurològic Mediterrani NEUROMED, Pozzilli, Italia.