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Lopez-de-Andres A.,Rey Juan Carlos University | Jimenez-Garcia R.,Rey Juan Carlos University | Hernandez-Barrera V.,Rey Juan Carlos University | Perez-Farinos N.,Agencia Espanola de Seguridad Alimentaria y Nutricion | And 6 more authors.
Cardiovascular Diabetology | Year: 2014

Background: Diabetes is associated with a high risk of death due to coronary artery disease (CAD). People with diabetes suffering from CAD are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of coronary revascularization procedures in diabetic and non-diabetic patients in Spain between 2001 and 2011.Methods: We identified all patients who had undergone coronary revascularization procedures, percutaneous coronary interventions (PCI) and coronary artery bypass graft (CABG) surgeries, using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. The incidence of discharges attributed to coronary revascularization procedures were calculated stratified by diabetes status. We calculated length of stay and in-hospital mortality (IHM). We apply joinpoint log-linear regression to identify the years in which changes in tendency occurred in the use of PCI and CABG in diabetic and non-diabetic patients. Multivariate analysis was adjusted by age, sex, year and comorbidity (Charlson comorbidity index).Results: From 2001 to 2011, 434,108 PCIs and 79,986 CABGs were performed. According to the results of the joinpoint analysis, we found that sex and age-adjusted use of PCI increased by 31.4% per year from 2001 to 2003, by 15.9% per year from 2003 to 2006 and by 3.8% per year from 2006 to 2011 in patients with diabetes. IHM among patients with diabetes who underwent a PCI did not change significantly over the entire study period (OR 0.99; 95% CI 0.97-1.00).Among patients with diabetes who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 10.4% per year from 2001 to 2003, and then decreased by 1.1% through 2011. Diabetic patients who underwent a CABG had a 0.67 (95% CI 0.63-0.71) times lower probability of dying during hospitalization than those without diabetes.Conclusions: The annual percent change in PCI procedures increased in diabetic and non-diabetic patients. Higher comorbidity and the female gender are associated with a higher IHM in PCI procedures. In diabetic and non-diabetic patients, we found a decrease in the use of CABG procedures. IHM was higher in patients without diabetes than in those with diabetes. © 2014 Lopez-de-Andres et al.; licensee BioMed Central Ltd.


Grant
Agency: Cordis | Branch: FP7 | Program: CP-IP | Phase: KBBE.2011.2.4-02 | Award Amount: 7.58M | Year: 2012

Total Diet Studies (TDS) allow getting information on real dietary exposure to food contaminants consumption (heavy metals, mycotoxins, POPs...) and estimating chronic exposure to pesticide residues in food and food additives intake. TDS consider total exposure from whole diets and are based on food contamination as consumed rather than contamination from raw commodities, thus ensuring a realistic exposure measure. TDS facilitate risk assessment (RA) and health monitoring (HM). Some EU Member States (MS) and Candidate Countries (CC) have no TDS programme or use various methods to collect data, which were not examined yet to tell whether they are comparable or not. This is of interest for EFSA or WHO-FAO. Similarly it is important to harmonise methods to assess dietary exposure risks in MS, CC and at the European level compared with other world regions. The methods proposed will aim for food sampling, standard analytical procedures, exposure assessment modelling, priority foods and selected chemical contaminants consistency across MS and CC. Various approaches and methods to identify sampling and analyses will be assessed and best practice defined. Contaminants and foods which contribute most to total exposure in European populations will be defined. Priority will be given to training and support in EU MS and CC currently without TDS. It will demonstrate best practice in creating a TDS programme using harmonised methods in regions previously lacking TDS, and ensure consistency of data collected. A database will be set up describing existing EU studies and collating harmonised exposure measures and designed to allow risk assessors and managers handling dietary exposure more accurately and more specifically. TDSEXPOSURE will spread excellence in TDS throughout stakeholders and establish a legacy of harmonised methods for sampling and analysis, and science-based recommendations for future global studies.


Vin K.,French Agency for Food | Papadopoulos A.,French Agency for Food | Cubadda F.,Istituto Superiore Of Sanita National Health Institute | Aureli F.,Istituto Superiore Of Sanita National Health Institute | And 13 more authors.
Food and Chemical Toxicology | Year: 2014

A method to validate the relevance of the Total Diet Study (TDS) approach for different types of substances is described. As a first step, a list of >2800 chemicals classified into eight main groups of relevance for food safety (natural components, environmental contaminants, substances intentionally added to foods, residues, naturally occurring contaminants, process contaminants, contaminants from packaging and food contact materials, other substances) has been established. The appropriateness of the TDS approach for the different substance groups has then been considered with regard to the three essential principles of a TDS: representativeness of the whole diet, pooling of foods and food analyzed as consumed. Four criteria were considered for that purpose (i) the substance has to be present in a significant part of the diet or predominantly present in specific food groups, (ii) a robust analytical method has to be available to determine it in potential contributors to the dietary exposure of the population, and (iii) the dilution impact of pooling and (iv) the impact of everyday food preparation methods on the concentration of the substance are assessed. For most of the substances the TDS approach appeared to be relevant and any precautions to be taken are outlined. © 2014 Elsevier Ltd.


Papadopoulos A.,French Agency for Food | Sioen I.,Ghent University | Cubadda F.,Istituto Superiore Of Sanita National Health Institute | Ozer H.,TUBITAK - Marmara Research Center | And 10 more authors.
Food and Chemical Toxicology | Year: 2015

The objective of this article is to develop a general method based on the analytic hierarchy process (AHP) methodology to rank the substances to be studied in a Total Diet Studies (TDS). This method was tested for different substances and groups of substances (N = 113), for which the TDS approach has been considered relevant. This work was performed by a group of 7 experts from different European countries representing their institutes, which are involved in the TDS EXPOSURE project. The AHP methodology is based on a score system taking into account experts' judgments quantified assigning comparative scores to the different identified issues. Hence, the 10 substances of highest interest in the framework of a TDS are trace elements (methylmercury, cadmium, inorganic arsenic, lead, aluminum, inorganic mercury), dioxins, furans and polychlorinated biphenyls (PCBs), and some additives (sulfites and nitrites). The priority list depends on both the national situation (geographical variations, consumer concern, etc.) and the availability of data. Thus, the list depends on the objectives of the TDS and on reachable analytical performances. Moreover, such a list is highly variable with time and new data (e.g. social context, vulnerable population groups, emerging substances, new toxicological data or health-based guidance values). © 2014 Elsevier Ltd.

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