Stress, anger and Mediterranean diet as predictors of metabolic syndrome

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CA: circunferencia abdominal; DietMed: dieta mediterránea; c-HDL: colesterol ligado a high density lipoproteins («lipoproteínas de alta densidad»); c-LDL: colesterol ligado a low density lipoproteins («lipoproteínas de baja densidad»); IMC: Índice de masa corporal; PAD: presión arterial diastólica; PAS: presión arterial sistólica; PSS: Perceived Stress Scale («Escala de Estrés Percibido»); QoL CF: Quality of Life («Calidad de Vida»), componente físico; QoL CM: Quality of Life («Calidad de Vida»), componente mental; SM: síndrome metabólico; TCol: colesterol total; TG: triglicéridos. Fuente: Textor et al.<a class="elsevierStyleCrossRef" href="#bib0255">20</a>. 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Caballo" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Jaqueline" "apellidos" => "Garcia-Silva" "email" => array:1 [ 0 => "garcia.jake@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nuria" "apellidos" => "Navarrete Navarrete" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana" "apellidos" => "Ruano Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "María Isabel" "apellidos" => "Peralta-Ramírez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Juan Diego" "apellidos" => "Mediavilla García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Vicente E." 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Source: Created with DAGitty (<a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="http://www.dagitty.net/">http://www.dagitty.net</a>, Textor et al., 2011). Note: MetS, metabolic syndrome; BMI, body mass index; TCol, total cholesterol; TG, triglycerides; HDLc, high density lipoprotein cholesterol; LDLc, low density lipoprotein cholesterol; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; MedDiet, Mediterranean diet; PSS, Perceived Stress Scale; QoL MC, quality of life—mental component; QoL CF, quality of life—physical component." ] ] ] "textoCompleto" => "IntroductionThe metabolic syndrome (MetS) is a set of metabolic disorders consisting of central distribution obesity, dyslipidemia, increased blood pressure (BP) and hyperglycemia, insulin resistance being the link between such disorders.<a class="elsevierStyleCrossRef" href="#bib0160">1</a>Regarding lifestyle, there is evidence showing that factors such smoking and alcohol consumption, sedentary lifestyle and diet high in fat are closely related to cardiovascular diseases (CVDs).<a class="elsevierStyleCrossRef" href="#bib0165">2</a> Diet is the lifestyle related factor with the greatest impact, considering that healthy living habits and strict adherence to the Mediterranean diet (MedDiet) have been associated with a lower risk of CVD.<a class="elsevierStyleCrossRef" href="#bib0170">3</a>Although the etiopathogenesis of MetS is not exactly known, in addition to the genetic and lifestyle factors it is known that there are different psychological and emotional factors related to the lifestyle that, on a genetically predisposed individual, can favor the appearance of MetS,<a class="elsevierStyleCrossRef" href="#bib0165">2</a> but so far, these conclusions are unclear.As for the role of emotions, it has been found that the expression of anger and hostility were positively associated with an increase in fasting glucose, glycosylated hemoglobin, inversely with HDLc, and with an increased risk of myocardial infarction in patients with MetS.<a class="elsevierStyleCrossRef" href="#bib0175">4</a> The results published by other authors point to differences between genders. Elovainio et al.<a class="elsevierStyleCrossRef" href="#bib0180">5</a> found associations of hostility with low educational level, higher alcohol consumption, more smoking and an increase in BP in both sexes, as well as lower physical activity and an increased risk of developing MetS in women. And, in another study, among women, life satisfaction was inversely associated with triglyceride levels, LDL-C, and risk of hypertriglyceridemia, reduced HDLc and MetS.<a class="elsevierStyleCrossRef" href="#bib0185">6</a> An association was also identified between hostility and TG levels. Among men, hostility was associated with fasting plasma insulin.<a class="elsevierStyleCrossRef" href="#bib0185">6</a> We find it relevant to highlight the role of anger and hostility in MetS, as opposed to factors classically known as lifestyle habits, diet and psychological stress.As for psychological stress, its relationship with MetS has been studied more widely, and there is evidence that daily stress is associated with the development of MetS and CVDs.<a class="elsevierStyleCrossRef" href="#bib0190">7</a> Specifically, weight gain with conjugal dissatisfaction, perceived stress and distress; dyslipidemia with psychosocial stress; diabetes Mellitus type II (DM-II) with perceived stress and distress in men; and hypertension with marital stress and perceived stress.<a class="elsevierStyleCrossRef" href="#bib0190">7</a> It has also been shown that chronic stress is associated with metabolic diseases and insulin resistance; and with obesity and triglycerides in patients with MetS.<a class="elsevierStyleCrossRefs" href="#bib0195">8,9</a> However, despite the known implications of psychological variables such as anger or stress in cardiovascular and metabolic diseases, it is necessary to investigate how these variables affect each of the MetS components.<a class="elsevierStyleCrossRef" href="#bib0205">10</a> Therefore, the objective of this study has been to identify what psychological, emotional and life habits variables predict the different MetS components in our study population, and check if there are differences attributable to gender.Patients and methodsParticipantsThe study inclusion criteria were men and women aged 25–65 years with waist circumference (WC) >88cm for women and >102cm for men and two or more of the following characteristics: blood pressure: systolic ≥130mmHg and diastolic ≥85mmHg; fasting glucose level ≥110mg/dL; triglycerides: ≥150mg/dL; HDL cholesterol ≤40mg/dL in men and ≤50mg/dL in women.<a class="elsevierStyleCrossRef" href="#bib0160">1</a> Exclusion criteria were severe osteoarthritis, active inflammatory diseases, severe psychiatric disorders and/or presence of significant cognitive impairment assessed through the Mini-Mental State Examination.A total of 103 subjects had MetS criteria's, 56 were women (54%) with a mean age of 55.95 years (SD=7.78) and 47 men (45.6%) with a mean age of 54.11 years (SD=8.11).The subjects were recruited at the University Hospital Virgen de las Nieves (HUVN) in Granada (Spain), from 2013 to 2014. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the demographic characteristics of the study population. All subjects included, after reading the study information sheet, signed the informed consent elaborated according to the recommendations of the Declaration of Helsinki. The research protocol was approved by the Ethical Committee of the HUVN.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Measures and instrumentsAnthropometric, physiological and analytical measures<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-Weight, height and body mass index (BMI).</li><li class="elsevierStyleListItem" id="lsti0010">-WC: measured using a tape measure placed in a horizontal plane, located at the midpoint between the last rib and the iliac crest.</li><li class="elsevierStyleListItem" id="lsti0015">-Blood pressure: taken according to the recommendations of the American Heart Association, considering the mean of three determinations separated by two minutes.<a class="elsevierStyleCrossRef" href="#bib0160">1</a></li><li class="elsevierStyleListItem" id="lsti0020">-The lipid profile (HDLc, total cholesterol, triglycerides) and glycemic (fasting glucose) were also evaluated in fasting blood.</li></ul>Life habits instruments<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025">-Demographic data sheet to establish a profile of the sample evaluated, include alcohol consumption (frequency and quantity) and physical activity was assessed in the initial interview. The questions were related to whether they did any physical activity, which time, for how long and how many times a week.</li><li class="elsevierStyleListItem" id="lsti0030">-Mediterranean Diet Adherence Screener (MEDAS-14): to evaluate the level of adherence to the MedDiet. Consisting of 14 items that evaluate whether foods are included that can prevent cardiovascular risk such as olive oil, fish, vegetables, fruits, cereals and also foods that can increase the chances of risk such as cold meats, trans fats and excess salt. The degree of adherence to the MedDiet is given by the sum of the items. A score below 11 is considered low adherence and higher than 11 as high.<a class="elsevierStyleCrossRef" href="#bib0210">11</a></li><li class="elsevierStyleListItem" id="lsti0035">-The Fagerström Test for Nicotine Dependence (FTND): to assess the level of physical dependence to nicotine. The test consists of six items with two or four response alternatives. The score ranges from 0 to 10. High scores in the FTND (6 or more) indicate a high degree of dependence. This scale is the most commonly used instrument to assess nicotine dependence although it is only moderately reliable: 0.60 in studies carried out in Spain.<a class="elsevierStyleCrossRef" href="#bib0215">12</a></li></ul>Psychological InstrumentsThe following instruments are validated in Spanish and have adequate reliability.<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040">-Mini Mental State Examination (MMSE): to make an initial mental health assessment and identify possible cognitive deficits.<a class="elsevierStyleCrossRefs" href="#bib0220">13,14</a></li><li class="elsevierStyleListItem" id="lsti0045">-Perceived Stress Scale (PSS): to evaluate the perceived stress in the last month. The Spanish version of the PSS was shown to be sufficiently reliable (internal consistency, α=0.81 and test–retest, r=0.73), valid (concurrent) and sensitive.<a class="elsevierStyleCrossRef" href="#bib0230">15</a></li><li class="elsevierStyleListItem" id="lsti0050">-Medical Outcomes Study 12-Item Short Form (SF-12): to assess health-related quality of life. It is a shortened version of the SF-36 which showed high correlations (0.94–0.96 and 0.94–0.97) which the original questionnaire, which assessed quality of life linked to physical and mental health. In both the Spanish and American populations, the 12 items explained over 90% of the variance in the physical and mental components of the SF-36. With regard to reliability, the internal consistency ranged between 0.72–0.89 and the test–retest reliability was between 0.73–0.86.<a class="elsevierStyleCrossRefs" href="#bib0235">16,17</a></li><li class="elsevierStyleListItem" id="lsti0055">-State-Trait Anger Expression Inventory (STAXI-2): assesses the different components of anger, like Experience, Expression and Control, as well as State and Trait. It consists of 49 items organized into 6 scales and 5 subscales. A score from each scale and subscale can be obtained as well as general inventory score. The internal consistency of the scales and subscales measured using Cronbach's alpha ranges between 0.67 and 0.89.<a class="elsevierStyleCrossRefs" href="#bib0245">18,19</a></li></ul>ProcedureFirst, after signing the consent form, the participants were given a structured interview performed by a psychologist, where the main demographic variables and the anthropometric measures were obtained. Finally, the evaluation instruments described above were administered. The complete procedure lasted approximately two hours, divided into two parts, one for the interview and one for the administration of the questionnaires.Statistical analysisA descriptive analysis was performed to show the profile of the sample, considering age, level of studies, economic and labor situation, possible comorbidities, eating habits and physical exercise.Later, in order to check if there were differences between the main demographic, anthropometric, habits and psychological variables between men and women, different Student t-tests were carried out for independent samples.DAGs graphic (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) was performed by Dagitty, version 2.3 (Updated 2015-08-19).<a class="elsevierStyleCrossRef" href="#bib0255">20</a><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Finally, different multiple linear regression analyses using the ‘Enter’ method were performed to establish which variables were predictors of MetS components. The dependent variables were MetS components (BMI, WC, HDLc) and quality of life, and independent variables were the perceived stress scores, trait anger, the anger expression score and MedDiet adherence. The data was calculated using Software SPSS 21.0.ResultsG*Power version 3.1.9.2 was used to confirm that for all analyses the number of participants was sufficiently enough for securing 95% of power and α=.05 or less. Considering the necessity of comparing data from three distinct predictors, G*Power yielded the required amount of 44 participants.Description of the main demographic variables, life habits, clinical and pharmacological characteristics of the sampleA descriptive analysis was performed to show the sample profile. The continuous variables were presented as mean and standard deviation, and categorical variables with frequencies and percentages. To verify if there were significant differences between the main demographic, anthropometric, habits and psychological variables, we performed Student's t-tests for independent samples and Fisher for categorical variables. Violations of normality were not found, as data Skewness and Kurtosis values were in acceptable ranges (SK<2.10 and Ku<6.07). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the demographic characteristics of the study subjects and <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the baseline anthropometric and clinical characteristics of the study patients.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Compared with men, women had higher values of perceived stress, total cholesterol and HDLc, less alcohol consumption and lower weight, WC and SBP.Predictive variables of the main indicators of MetSRegression analysis showed that perceived stress was a predictor of quality of life (mental component) in patients with MetS. Thus, people with MetS who presented greater psychological stress had a worse quality of life. On the other hand, the anger trait was also a predictor of body mass index and WC in women. Anger was a predictor of higher BMI and greater WC in women. Low adherence to the MedDiet was associated with lower levels of HDLc and quality of life (mental component). These results are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The results showed that psychological stress was a predictor of quality of life (β=−.55, SE=.07, p=<.000, R2=31). Hence, an increase in one SD in PSS resulted in decrease in quality of life.Similarly, anger was a predictor of BMI (β=.23, SE=.02, p=.047, R2=.11) and abdominal circumference (β=27, SE=05, p=.021, R2=.11). Here, there was an increase in BMI and waist circumference with the increase of one SD in anger.As expected, adherence to a Mediterranean diet was a predictor of HDLc (β=.20, SE=.55, p=.045, R2=22) and of quality of life (β=−.18, SE=.27, p=.031, R2=34). Precisely, an increase of one SD in the adherence to Mediterranean diet resulted in higher HDLc and less quality of life.DiscussionThe objective of this study was to identify if the lifestyle and certain psychological variables influenced or were related to the MetS components. We found that the stress perceived by MetS subjects is a predictor of the mental component of quality of life. Perceived stress and quality of life have been studied as independent factors in MetS patients. On the one hand, it has been shown that subjects with high stress were more than twice as likely to develop MetS than those with low stress.<a class="elsevierStyleCrossRef" href="#bib0260">21</a> On the other hand, it has been observed that having experienced a greater number of stressful events throughout life is associated with greater resistance to insulin, obesity and triglyceride.<a class="elsevierStyleCrossRef" href="#bib0195">8</a> However, as far as we know there are no studies on the relationship between these variables in MetS.As for the quality of life, we have observed that the mental component is related to psychological stress. The scores of this component in our study being smaller than those of the physical component, which contrasts with other results, that they had lower levels of physical activity, lower scores on physical and social dimensions of quality of life, but did not observe differences for mental health or perceived stress between individuals with and without MetS.<a class="elsevierStyleCrossRef" href="#bib0165">2</a> However, the presence of MetS was strongly associated with the mental component in the Tziallas et al. study<a class="elsevierStyleCrossRef" href="#bib0265">22</a>; and in people with intermediate cardiovascular risk, better dietary habits and greater adherence to the MedDiet have been associated with higher scores on the mental component of quality of life.<a class="elsevierStyleCrossRef" href="#bib0270">23</a> In this study, the decrease of quality of life was probably due to having to adjust their daily habits. Future work could explore if this result changes longitudinally, once the new eating habits are fully established.In addition, we found differences between genders, specifically that women have lower quality of life in the physical component than men. In this line, there are studies that show that the MetS components have a significant negative impact on the quality of life, physical and mental in women, but not in men.<a class="elsevierStyleCrossRef" href="#bib0275">24</a>As for anger, we found significant relationship with BMI and WC, but not with hypertension. There are few studies on the relationship between anger and MetS or their individual components. Among them, the authors found that adults over 35 years, experience and express anger to a lesser extent than younger adults, suggesting that they have acquired, with age, more effective strategies to regulate their emotions.<a class="elsevierStyleCrossRef" href="#bib0205">10</a> However, older adults who were unable to show the typical decline of anger with age were at increased risk for MetS compared to those of the same age who did not experience expressions of anger. Considering that aging hinders the adaptation of biological systems, therefore physical health can be negatively affected by the increase in excitement caused by anger. In relation to the specific components of MetS, a study showed that different forms of anger expression are related to increased blood pressure, both systolic and diastolic, as well as certain ECVs.<a class="elsevierStyleCrossRef" href="#bib0280">25</a> We find it relevant to highlight the role of anger and hostility in MetS, as opposed to factors classically known as lifestyle habits, diet and psychological stress.Finally, the type of diet is related to the prevalence of obesity, ECVs, DM II and MetS, being the fats the nutrients with greater impact.<a class="elsevierStyleCrossRefs" href="#bib0285">26,27</a> A strict adherence to the MedDiet has been associated with a low risk of CVD and a lower risk of MetS, emphasizing the protective role of the MedDiet in the components of MetS, such as WC, HDLc, triglycerides, blood pressure and glucose.<a class="elsevierStyleCrossRef" href="#bib0295">28</a> In addition, there is evidence that the MedDiet can counteract the increased adiposity in the risk of CVD.<a class="elsevierStyleCrossRef" href="#bib0300">29</a> In the PREDIMED trial, participants with greater adherence to the MedDiet were 47% less likely to have low criteria of HDLc.<a class="elsevierStyleCrossRef" href="#bib0305">30</a> These data support our findings on adherence to the MedDiet and its relationship with HDLc.Regarding eating behaviors, associations were observed between diet high in glycaemic content with depression, with total mood disturbance, and fatigue especially in overweight or obese adults.<a class="elsevierStyleCrossRef" href="#bib0310">31</a> Hence, mood can directly influence dietary intake.Among the limitations of the study, we commented that the subjects in our sample were under pharmacological prescription for the control of BP, dyslipidemia and hyperglycemia, which may have underestimated the relation of the study variables. Another factor that deserves attention refers to the geographic region from which this study took its sample, characterized by high adherence to the Mediterranean diet; therefore, further work could explore how participants with different eating habits differ in the variables here explored.The results obtained reflect the importance of the multidisciplinary approach when deepening the factors involved in the disease. The investigation of the implications that certain psychological and emotional aspects may have on health should be continued. Nonetheless, the role of gender is also very important, mainly because males and females deal with emotions differently, which could reflect specific lifestyle behaviors that should be taken into account in future studies/interventions.ConclusionsIn conclusion, perceived stress, anger and low adherence to the MedDiet are closely related to MetS. Thus, managing stress and anger, as well as promoting adherence to a proper diet can help reduce the risk of MetS and its components, which implies an improvement in health and quality of life. We believe that it is important that health professionals who directly assist these patients know the importance of these variables and how they relate to cardiovascular risk.FundingThis work was supported by the [Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)] for the PhD. student grant [number 5566-10-0].Conflict of interestNo potential conflict of interest was reported by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1063462" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1011665" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1063461" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1011664" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Measures and instruments" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Anthropometric, physiological and analytical measures" ] ] ] 2 => array:3 [ "identificador" => "sec0030" "titulo" => "Life habits instruments" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Psychological Instruments" ] ] ] 3 => array:2 [ "identificador" => "sec0040" "titulo" => "Procedure" ] 4 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Description of the main demographic variables, life habits, clinical and pharmacological characteristics of the sample" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Predictive variables of the main indicators of MetS" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-31" "fechaAceptado" => "2017-08-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1011665" "palabras" => array:5 [ 0 => "Metabolic syndrome" 1 => "Psychological stress" 2 => "Anger" 3 => "Mediterranean diet" 4 => "Quality of life" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1011664" "palabras" => array:5 [ 0 => "Síndrome metabólico" 1 => "Estrés psicológico" 2 => "Ira" 3 => "Dieta mediterránea" 4 => "Calidad de vida" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveMetabolic syndrome (MetS) is a cluster of metabolic conditions that include abdominal obesity, reduction in cholesterol concentrations linked to high density lipoproteins (HLDc), elevated triglycerides, increased blood pressure and hyperglycaemia. Given that this is a multicausal disease, the aim of this study is to identify the psychological, emotional and lifestyle variables that can have an influence on the different MetS components. Patients and methodsA cross-sectional study with 103 patients with diagnostic criteria for MetS (47 male and 56 female). Anthropometric, clinical and analytical measurements were collected to assess the variables associated with MetS. The main psychological and emotional variables were also assessed. ResultsDifferent multiple linear regression tests were performed to identify which variables were predictive of MetS. The dependent variables were body mass index (BMI), abdominal circumference, HDLc, and quality of life, and the predictive variables were psychological stress, anger and adherence to a Mediterranean diet. The results showed that psychological stress was a predictor of quality of life (β=−0.55, p≤0). Similarly, anger was a predictor of BMI (β=0.23, p=.047) and abdominal circumference (β=0.27, p=.021). As expected, adherence to a Mediterranean diet was a predictor of HDLc (β=0.2, p=.045) and of quality of life (β=−0.18, p=.031). ConclusionsThe results confirm a link between adherence to certain dietary habits and lifestyle, however they go one step further and show the importance of psychological and emotional factors like psychological stress and anger in some MetS components." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoEl síndrome metabólico (SM) es un conjunto de condiciones metabólicas que incluyen obesidad abdominal, reducción de las concentraciones de colesterol unido a las high density lipoproteins (c-HDL, «lipoproteínas de alta densidad»), triglicéridos elevados, aumento de la presión arterial e hiperglucemia. Dado que se trata de una enfermedad multicausal, el objetivo de este estudio es identificar las variables psicológicas, emocionales y de estilo de vida que pueden ejercer una influencia sobre los diferentes componentes del SM. Pacientes y métodosEstudio transversal con 103 pacientes diagnosticados de SM (47 varones y 56 mujeres). Se recogieron medidas antropométricas, clínicas y analíticas para valorar las variables asociadas al SM. También se evaluaron las principales variables psicológicas y emocionales. ResultadosSe realizaron diferentes pruebas de regresión lineal múltiple para identificar qué variables eran predictoras del SM. Las variables dependientes fueron el índice de masa corporal (IMC), la circunferencia abdominal, el c-HDL y la calidad de vida, y las variables predictoras fueron el estrés psicológico, la ira y la adherencia a la dieta mediterránea. Los resultados mostraron que el estrés psicológico era un predictor de la calidad de vida (β=−0,55, p≤0). De igual modo, la ira fue un predictor del IMC (β=0,23, p=0,047) y de la circunferencia abdominal (β=0,27, p=0,021). Según lo previsto, la adherencia a la dieta mediterránea fue un predictor del c-HDL (β=0,2, p=0,045) y de la calidad de vida (β=−0,18, p=0,031). ConclusionesLos resultados confirman un vínculo entre la adherencia a ciertos hábitos alimentarios y el estilo de vida; sin embargo, se sitúan un paso por delante y resaltan la importancia de los factores psicológicos y emocionales como el estrés y la ira en algunos componentes del SM." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Garcia-Silva J, Navarrete Navarrete N, Ruano Rodríguez A, Peralta-Ramírez MI, Mediavilla García JD, Caballo VE. Estrés, ira y dieta mediterránea como factores predictores del síndrome metabólico. Med Clin (Barc). 2018;151:59–64." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2101 "Ancho" => 2333 "Tamanyo" => 607749 ] ] "descripcion" => array:1 [ "en" => "Directed acyclic graph (DAG) on the hypothesized stress, anger, mediterranean diet, sex, age, alcohol and smoking as predictors of the metabolic syndrome components. Source: Created with DAGitty (<a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="http://www.dagitty.net/">http://www.dagitty.net</a>, Textor et al., 2011). Note: MetS, metabolic syndrome; BMI, body mass index; TCol, total cholesterol; TG, triglycerides; HDLc, high density lipoprotein cholesterol; LDLc, low density lipoprotein cholesterol; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; MedDiet, Mediterranean diet; PSS, Perceived Stress Scale; QoL MC, quality of life—mental component; QoL CF, quality of life—physical component." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% (n=103) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Education</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.3 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secondary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7 (10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">General Certificate of Education (A-Level) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vocational Training \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.3 (23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diploma of Higher Education/University Degree \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.4 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Economic status</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.6 (13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Middle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.5 (52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.9 (38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Physical activity</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Active \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.1 (66) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inactive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.9 (37) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Diet</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Satisfactory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.1 (31) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Requires change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.9 (72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Comorbidities</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Osteoarthritis/polyosteoarthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gout \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.9 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.8 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1813191.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Descriptive statistics that describe the profile of the sample, taking into account age, level of education, economic and employment status, possible comorbidities, dietary habits and physical exercise." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note: SD, standard deviation; BMI, body mass index; TCol, total cholesterol; TG, triglycerides; HDLc, high density lipoprotein cholesterol; LDLc, low density lipoprotein cholesterol; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure; MedDiet, Mediterranean diet; PSS, Perceived Stress Scale; SF12 MC, mental component; SF12 CF, physical component; STAXIt, trait; STAXIaei, Anger Expression Index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men (n=47) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women (n=56) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">t/Fisher \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">p \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean/SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean/SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean/SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.11 (7.95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54.11 (8.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.95 (7.78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.172 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.244 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.83 (15.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.06 (14.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.92 (13.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−5.583 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (4.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.75 (4.37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.21 (5.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.476 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.635 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TCol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">202.15 (44.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">188.20 (48.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">214.23 (36.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">191.21 (92.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">201.55 (100.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182.26 (84.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.027 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.307 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDLc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.64 (13.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.72 (11.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.65 (13.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.287 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDLc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">124.49 (41.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.39 (43.96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131.92 (38.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.739 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.085 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glycaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120.22 (40.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126.02 (45.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115.19 (36.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.311 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.193 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">112.64 (12.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116.18 (12.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109.73 (12.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.629 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.010 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132.65 (19.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">134.06 (18.21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131.43 (21.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.347 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.730 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.86 (16.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.77 (10.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.58 (19.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.285 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.202 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MedDiet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.99 (2.39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.59 (2.36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.32 (2.39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.542 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.126 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.75 (9.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.74 (9.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.32 (9.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.993 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SF12 MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.55 (5.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.11 (6.08) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.09 (5.93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−1.965 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.052 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SF12 PC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.30 (8.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.01 (7.38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.87 (8.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.850 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.397 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STAXIt \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.53 (29.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.80 (29.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.98 (28.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.551 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.583 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STAXIaie \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.00 (27.57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.21 (27.62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.35 (27.56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.942 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.348 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcohol % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.2 (63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.9 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.6 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoker % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.3 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.4 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.540 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.306 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1813192.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of the means and percentages of anthropometric, psychological and lifestyle data for men and women." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Note: DV, dependent variables; PV, predictive variables; BMI, body mass index; WC, waist circumference; HDLc, high density lipoprotein cholesterol; QoLmc, quality of life mental component; PSS, Perceived Stress Scale; STAXItC, trait in centiles; MedDiet, Mediterranean diet." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">R2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">R2corrected \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">β \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">t \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">STAXItC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.075 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.234 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.047 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">WC</td><td class="td" title="table-entry " align="left" valign="top">STAXItC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.118 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.071 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.275 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.349 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.221 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">HDLc</td><td class="td" title="table-entry " align="left" valign="top">MedDiet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.223 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.201 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.031 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.045 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−.348 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.447 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">QoLmc</td><td class="td" title="table-entry " align="left" valign="top">PSS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.342 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.314 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−.557 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−6.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MedDiet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−.188 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.188 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1813190.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Linear regression models (dependent variables: BMI, WC, HDLc, QoLmc) with stress, anger and adherence to a Mediterranean diet." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2002" "volumen" => "106" "paginaInicial" => "3143" "paginaFinal" => "3421" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12485966" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychosocial status and health related quality of life in relation to the metabolic syndrome in a Swedish middle-aged population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.H. 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Stress, anger and Mediterranean diet as predictors of metabolic syndrome

Estrés, ira y dieta mediterránea como factores predictores del síndrome metabólico

Jaqueline Garcia-Silvaa,

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garcia.jake@hotmail.com

Corresponding author.

, Nuria Navarrete Navarreteb, Ana Ruano Rodríguezc, María Isabel Peralta-Ramíreza,d, Juan Diego Mediavilla Garcíae, Vicente E. Caballoa,d

a Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Granada, Granada, Spain

b Unidad de Gestión Clínica, Departamento de Medicina Interna, Complejo Hospitalario Universitario de Granada, Granada, Spain

c Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain

d Centro de Investigación, Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain

e Unidad de Hipertensión y Riesgo Vascular, Departamento de Medicina Interna, Complejo Hospitalario Universitario de Granada, Granada, Spain

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considering that healthy living habits and strict adherence to the Mediterranean diet &#40;MedDiet&#41; have been associated with a lower risk of CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although the etiopathogenesis of MetS is not exactly known&#44; in addition to the genetic and lifestyle factors it is known that there are different psychological and emotional factors related to the lifestyle that&#44; on a genetically predisposed individual&#44; can favor the appearance of MetS&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a> but so far&#44; these conclusions are unclear&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As for the role of emotions&#44; it has been found that the expression of anger and hostility were positively associated with an increase in fasting glucose&#44; glycosylated hemoglobin&#44; inversely with HDLc&#44; and with an increased risk of myocardial infarction in patients with MetS&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> The results published by other authors point to differences between genders&#46; Elovainio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a> found associations of hostility with low educational level&#44; higher alcohol consumption&#44; more smoking and an increase in BP in both sexes&#44; as well as lower physical activity and an increased risk of developing MetS in women&#46; And&#44; in another study&#44; among women&#44; life satisfaction was inversely associated with triglyceride levels&#44; LDL-C&#44; and risk of hypertriglyceridemia&#44; reduced HDLc and MetS&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> An association was also identified between hostility and TG levels&#46; Among men&#44; hostility was associated with fasting plasma insulin&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> We find it relevant to highlight the role of anger and hostility in MetS&#44; as opposed to factors classically known as lifestyle habits&#44; diet and psychological stress&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">As for psychological stress&#44; its relationship with MetS has been studied more widely&#44; and there is evidence that daily stress is associated with the development of MetS and CVDs&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> Specifically&#44; weight gain with conjugal dissatisfaction&#44; perceived stress and distress&#59; dyslipidemia with psychosocial stress&#59; diabetes Mellitus type II &#40;DM-II&#41; with perceived stress and distress in men&#59; and hypertension with marital stress and perceived stress&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> It has also been shown that chronic stress is associated with metabolic diseases and insulin resistance&#59; and with obesity and triglycerides in patients with MetS&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;9</span></a> However&#44; despite the known implications of psychological variables such as anger or stress in cardiovascular and metabolic diseases&#44; it is necessary to investigate how these variables affect each of the MetS components&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a> Therefore&#44; the objective of this study has been to identify what psychological&#44; emotional and life habits variables predict the different MetS components in our study population&#44; and check if there are differences attributable to gender&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study inclusion criteria were men and women aged 25&#8211;65 years with waist circumference &#40;WC&#41; &#62;88<span class="elsevierStyleHsp" style=""></span>cm for women and &#62;102<span class="elsevierStyleHsp" style=""></span>cm for men and two or more of the following characteristics&#58; blood pressure&#58; systolic &#8805;130<span class="elsevierStyleHsp" style=""></span>mmHg and diastolic &#8805;85<span class="elsevierStyleHsp" style=""></span>mmHg&#59; fasting glucose level &#8805;110<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; triglycerides&#58; &#8805;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; HDL cholesterol &#8804;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in men and &#8804;50<span class="elsevierStyleHsp" style=""></span>mg&#47;dL in women&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> Exclusion criteria were severe osteoarthritis&#44; active inflammatory diseases&#44; severe psychiatric disorders and&#47;or presence of significant cognitive impairment assessed through the Mini-Mental State Examination&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 103 subjects had MetS criteria&#39;s&#44; 56 were women &#40;54&#37;&#41; with a mean age of 55&#46;95 years &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#46;78&#41; and 47 men &#40;45&#46;6&#37;&#41; with a mean age of 54&#46;11 years &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#46;11&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The subjects were recruited at the University Hospital Virgen de las Nieves &#40;HUVN&#41; in Granada &#40;Spain&#41;&#44; from 2013 to 2014&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the demographic characteristics of the study population&#46; All subjects included&#44; after reading the study information sheet&#44; signed the informed consent elaborated according to the recommendations of the Declaration of Helsinki&#46; The research protocol was approved by the Ethical Committee of the HUVN&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Measures and instruments</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Anthropometric&#44; physiological and analytical measures</span><p id="par0045" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Weight&#44; height and body mass index &#40;BMI&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">WC&#58; measured using a tape measure placed in a horizontal plane&#44; located at the midpoint between the last rib and the iliac crest&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Blood pressure&#58; taken according to the recommendations of the American Heart Association&#44; considering the mean of three determinations separated by two minutes&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">The lipid profile &#40;HDLc&#44; total cholesterol&#44; triglycerides&#41; and glycemic &#40;fasting glucose&#41; were also evaluated in fasting blood&#46;</p></li></ul></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Life habits instruments</span><p id="par0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Demographic data sheet to establish a profile of the sample evaluated&#44; include alcohol consumption &#40;frequency and quantity&#41; and physical activity was assessed in the initial interview&#46; The questions were related to whether they did any physical activity&#44; which time&#44; for how long and how many times a week&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Mediterranean Diet Adherence Screener &#40;MEDAS-14&#41;&#58; to evaluate the level of adherence to the MedDiet&#46; Consisting of 14 items that evaluate whether foods are included that can prevent cardiovascular risk such as olive oil&#44; fish&#44; vegetables&#44; fruits&#44; cereals and also foods that can increase the chances of risk such as cold meats&#44; trans fats and excess salt&#46; The degree of adherence to the MedDiet is given by the sum of the items&#46; A score below 11 is considered low adherence and higher than 11 as high&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">The Fagerstr&#246;m Test for Nicotine Dependence &#40;FTND&#41;&#58; to assess the level of physical dependence to nicotine&#46; The test consists of six items with two or four response alternatives&#46; The score ranges from 0 to 10&#46; High scores in the FTND &#40;6 or more&#41; indicate a high degree of dependence&#46; This scale is the most commonly used instrument to assess nicotine dependence although it is only moderately reliable&#58; 0&#46;60 in studies carried out in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a></p></li></ul></p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Psychological Instruments</span><p id="par0090" class="elsevierStylePara elsevierViewall">The following instruments are validated in Spanish and have adequate reliability&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Mini Mental State Examination &#40;MMSE&#41;&#58; to make an initial mental health assessment and identify possible cognitive deficits&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Perceived Stress Scale &#40;PSS&#41;&#58; to evaluate the perceived stress in the last month&#46; The Spanish version of the PSS was shown to be sufficiently reliable &#40;internal consistency&#44; <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;81 and test&#8211;retest&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;73&#41;&#44; valid &#40;concurrent&#41; and sensitive&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Medical Outcomes Study 12-Item Short Form &#40;SF-12&#41;&#58; to assess health-related quality of life&#46; It is a shortened version of the SF-36 which showed high correlations &#40;0&#46;94&#8211;0&#46;96 and 0&#46;94&#8211;0&#46;97&#41; which the original questionnaire&#44; which assessed quality of life linked to physical and mental health&#46; In both the Spanish and American populations&#44; the 12 items explained over 90&#37; of the variance in the physical and mental components of the SF-36&#46; With regard to reliability&#44; the internal consistency ranged between 0&#46;72&#8211;0&#46;89 and the test&#8211;retest reliability was between 0&#46;73&#8211;0&#46;86&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#44;17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">-</span><p id="par0110" class="elsevierStylePara elsevierViewall">State-Trait Anger Expression Inventory &#40;STAXI-2&#41;&#58; assesses the different components of anger&#44; like Experience&#44; Expression and Control&#44; as well as State and Trait&#46; It consists of 49 items organized into 6 scales and 5 subscales&#46; A score from each scale and subscale can be obtained as well as general inventory score&#46; The internal consistency of the scales and subscales measured using Cronbach&#39;s alpha ranges between 0&#46;67 and 0&#46;89&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">18&#44;19</span></a></p></li></ul></p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Procedure</span><p id="par0115" class="elsevierStylePara elsevierViewall">First&#44; after signing the consent form&#44; the participants were given a structured interview performed by a psychologist&#44; where the main demographic variables and the anthropometric measures were obtained&#46; Finally&#44; the evaluation instruments described above were administered&#46; The complete procedure lasted approximately two hours&#44; divided into two parts&#44; one for the interview and one for the administration of the questionnaires&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0120" class="elsevierStylePara elsevierViewall">A descriptive analysis was performed to show the profile of the sample&#44; considering age&#44; level of studies&#44; economic and labor situation&#44; possible comorbidities&#44; eating habits and physical exercise&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Later&#44; in order to check if there were differences between the main demographic&#44; anthropometric&#44; habits and psychological variables between men and women&#44; different Student t-tests were carried out for independent samples&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">DAGs graphic &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; was performed by Dagitty&#44; version 2&#46;3 &#40;Updated 2015-08-19&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Finally&#44; different multiple linear regression analyses using the &#8216;Enter&#8217; method were performed to establish which variables were predictors of MetS components&#46; The dependent variables were MetS components &#40;BMI&#44; WC&#44; HDLc&#41; and quality of life&#44; and independent variables were the perceived stress scores&#44; trait anger&#44; the anger expression score and MedDiet adherence&#46; The data was calculated using Software SPSS 21&#46;0&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0140" class="elsevierStylePara elsevierViewall">G&#42;Power version 3&#46;1&#46;9&#46;2 was used to confirm that for all analyses the number of participants was sufficiently enough for securing 95&#37; of power and <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;05 or less&#46; Considering the necessity of comparing data from three distinct predictors&#44; G&#42;Power yielded the required amount of 44 participants&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Description of the main demographic variables&#44; life habits&#44; clinical and pharmacological characteristics of the sample</span><p id="par0145" class="elsevierStylePara elsevierViewall">A descriptive analysis was performed to show the sample profile&#46; The continuous variables were presented as mean and standard deviation&#44; and categorical variables with frequencies and percentages&#46; To verify if there were significant differences between the main demographic&#44; anthropometric&#44; habits and psychological variables&#44; we performed Student&#39;s <span class="elsevierStyleItalic">t</span>-tests for independent samples and Fisher for categorical variables&#46; Violations of normality were not found&#44; as data Skewness and Kurtosis values were in acceptable ranges &#40;SK<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#46;10 and Ku<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6&#46;07&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> describes the demographic characteristics of the study subjects and <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the baseline anthropometric and clinical characteristics of the study patients&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Compared with men&#44; women had higher values of perceived stress&#44; total cholesterol and HDLc&#44; less alcohol consumption and lower weight&#44; WC and SBP&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Predictive variables of the main indicators of MetS</span><p id="par0155" class="elsevierStylePara elsevierViewall">Regression analysis showed that perceived stress was a predictor of quality of life &#40;mental component&#41; in patients with MetS&#46; Thus&#44; people with MetS who presented greater psychological stress had a worse quality of life&#46; On the other hand&#44; the anger trait was also a predictor of body mass index and WC in women&#46; Anger was a predictor of higher BMI and greater WC in women&#46; Low adherence to the MedDiet was associated with lower levels of HDLc and quality of life &#40;mental component&#41;&#46; These results are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">The results showed that psychological stress was a predictor of quality of life &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;55&#44; SE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;07&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;&#60;<span class="elsevierStyleHsp" style=""></span>&#46;000&#44; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#41;&#46; Hence&#44; an increase in one SD in PSS resulted in decrease in quality of life&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Similarly&#44; anger was a predictor of BMI &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;23&#44; SE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;047&#44; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;11&#41; and abdominal circumference &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#44; SE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>05&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;021&#44; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;11&#41;<span class="elsevierStyleItalic">&#46;</span> Here&#44; there was an increase in BMI and waist circumference with the increase of one SD in anger&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">As expected&#44; adherence to a Mediterranean diet was a predictor of HDLc &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;20&#44; SE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;55&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;045&#44; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41; and of quality of life &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;18&#44; SE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;27&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;031&#44; <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;&#46; Precisely&#44; an increase of one SD in the adherence to Mediterranean diet resulted in higher HDLc and less quality of life&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">The objective of this study was to identify if the lifestyle and certain psychological variables influenced or were related to the MetS components&#46; We found that the stress perceived by MetS subjects is a predictor of the mental component of quality of life&#46; Perceived stress and quality of life have been studied as independent factors in MetS patients&#46; On the one hand&#44; it has been shown that subjects with high stress were more than twice as likely to develop MetS than those with low stress&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> On the other hand&#44; it has been observed that having experienced a greater number of stressful events throughout life is associated with greater resistance to insulin&#44; obesity and triglyceride&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> However&#44; as far as we know there are no studies on the relationship between these variables in MetS&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">As for the quality of life&#44; we have observed that the mental component is related to psychological stress&#46; The scores of this component in our study being smaller than those of the physical component&#44; which contrasts with other results&#44; that they had lower levels of physical activity&#44; lower scores on physical and social dimensions of quality of life&#44; but did not observe differences for mental health or perceived stress between individuals with and without MetS&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a> However&#44; the presence of MetS was strongly associated with the mental component in the Tziallas et al&#46; study<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a>&#59; and in people with intermediate cardiovascular risk&#44; better dietary habits and greater adherence to the MedDiet have been associated with higher scores on the mental component of quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a> In this study&#44; the decrease of quality of life was probably due to having to adjust their daily habits&#46; Future work could explore if this result changes longitudinally&#44; once the new eating habits are fully established&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In addition&#44; we found differences between genders&#44; specifically that women have lower quality of life in the physical component than men&#46; In this line&#44; there are studies that show that the MetS components have a significant negative impact on the quality of life&#44; physical and mental in women&#44; but not in men&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">As for anger&#44; we found significant relationship with BMI and WC&#44; but not with hypertension&#46; There are few studies on the relationship between anger and MetS or their individual components&#46; Among them&#44; the authors found that adults over 35 years&#44; experience and express anger to a lesser extent than younger adults&#44; suggesting that they have acquired&#44; with age&#44; more effective strategies to regulate their emotions&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">10</span></a> However&#44; older adults who were unable to show the typical decline of anger with age were at increased risk for MetS compared to those of the same age who did not experience expressions of anger&#46; Considering that aging hinders the adaptation of biological systems&#44; therefore physical health can be negatively affected by the increase in excitement caused by anger&#46; In relation to the specific components of MetS&#44; a study showed that different forms of anger expression are related to increased blood pressure&#44; both systolic and diastolic&#44; as well as certain ECVs&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> We find it relevant to highlight the role of anger and hostility in MetS&#44; as opposed to factors classically known as lifestyle habits&#44; diet and psychological stress&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Finally&#44; the type of diet is related to the prevalence of obesity&#44; ECVs&#44; DM II and MetS&#44; being the fats the nutrients with greater impact&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">26&#44;27</span></a> A strict adherence to the MedDiet has been associated with a low risk of CVD and a lower risk of MetS&#44; emphasizing the protective role of the MedDiet in the components of MetS&#44; such as WC&#44; HDLc&#44; triglycerides&#44; blood pressure and glucose&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> In addition&#44; there is evidence that the MedDiet can counteract the increased adiposity in the risk of CVD&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> In the PREDIMED trial&#44; participants with greater adherence to the MedDiet were 47&#37; less likely to have low criteria of HDLc&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a> These data support our findings on adherence to the MedDiet and its relationship with HDLc&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Regarding eating behaviors&#44; associations were observed between diet high in glycaemic content with depression&#44; with total mood disturbance&#44; and fatigue especially in overweight or obese adults&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> Hence&#44; mood can directly influence dietary intake&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Among the limitations of the study&#44; we commented that the subjects in our sample were under pharmacological prescription for the control of BP&#44; dyslipidemia and hyperglycemia&#44; which may have underestimated the relation of the study variables&#46; Another factor that deserves attention refers to the geographic region from which this study took its sample&#44; characterized by high adherence to the Mediterranean diet&#59; therefore&#44; further work could explore how participants with different eating habits differ in the variables here explored&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The results obtained reflect the importance of the multidisciplinary approach when deepening the factors involved in the disease&#46; The investigation of the implications that certain psychological and emotional aspects may have on health should be continued&#46; Nonetheless&#44; the role of gender is also very important&#44; mainly because males and females deal with emotions differently&#44; which could reflect specific lifestyle behaviors that should be taken into account in future studies&#47;interventions&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">In conclusion&#44; perceived stress&#44; anger and low adherence to the MedDiet are closely related to MetS&#46; Thus&#44; managing stress and anger&#44; as well as promoting adherence to a proper diet can help reduce the risk of MetS and its components&#44; which implies an improvement in health and quality of life&#46; We believe that it is important that health professionals who directly assist these patients know the importance of these variables and how they relate to cardiovascular risk&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">This work was supported by the &#91;<span class="elsevierStyleGrantSponsor" id="gs1">Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoal de N&#237;vel Superior</span> &#40;CAPES&#41;&#93; for the PhD&#46; student grant &#91;number <span class="elsevierStyleGrantNumber" refid="gs1">5566-10-0</span>&#93;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflict of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">No potential conflict of interest was reported by the authors&#46;</p></span></span>"
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    "fechaAceptado" => "2017-08-06"
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      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1011665"
          "palabras" => array:5 [
            0 => "Metabolic syndrome"
            1 => "Psychological stress"
            2 => "Anger"
            3 => "Mediterranean diet"
            4 => "Quality of life"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1011664"
          "palabras" => array:5 [
            0 => "S&#237;ndrome metab&#243;lico"
            1 => "Estr&#233;s psicol&#243;gico"
            2 => "Ira"
            3 => "Dieta mediterr&#225;nea"
            4 => "Calidad de vida"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Metabolic syndrome &#40;MetS&#41; is a cluster of metabolic conditions that include abdominal obesity&#44; reduction in cholesterol concentrations linked to high density lipoproteins &#40;HLDc&#41;&#44; elevated triglycerides&#44; increased blood pressure and hyperglycaemia&#46; Given that this is a multicausal disease&#44; the aim of this study is to identify the psychological&#44; emotional and lifestyle variables that can have an influence on the different MetS components&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study with 103 patients with diagnostic criteria for MetS &#40;47 male and 56 female&#41;&#46; Anthropometric&#44; clinical and analytical measurements were collected to assess the variables associated with MetS&#46; The main psychological and emotional variables were also assessed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Different multiple linear regression tests were performed to identify which variables were predictive of MetS&#46; The dependent variables were body mass index &#40;BMI&#41;&#44; abdominal circumference&#44; HDLc&#44; and quality of life&#44; and the predictive variables were psychological stress&#44; anger and adherence to a Mediterranean diet&#46; The results showed that psychological stress was a predictor of quality of life &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;55&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#41;&#46; Similarly&#44; anger was a predictor of BMI &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;23&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;047&#41; and abdominal circumference &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;27&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;021&#41;&#46; As expected&#44; adherence to a Mediterranean diet was a predictor of HDLc &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;2&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;045&#41; and of quality of life &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;18&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;031&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The results confirm a link between adherence to certain dietary habits and lifestyle&#44; however they go one step further and show the importance of psychological and emotional factors like psychological stress and anger in some MetS components&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome metab&#243;lico &#40;SM&#41; es un conjunto de condiciones metab&#243;licas que incluyen obesidad abdominal&#44; reducci&#243;n de las concentraciones de colesterol unido a las <span class="elsevierStyleItalic">high density lipoproteins</span> &#40;c-HDL&#44; &#171;lipoprote&#237;nas de alta densidad&#187;&#41;&#44; triglic&#233;ridos elevados&#44; aumento de la presi&#243;n arterial e hiperglucemia&#46; Dado que se trata de una enfermedad multicausal&#44; el objetivo de este estudio es identificar las variables psicol&#243;gicas&#44; emocionales y de estilo de vida que pueden ejercer una influencia sobre los diferentes componentes del SM&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal con 103 pacientes diagnosticados de SM &#40;47 varones y 56 mujeres&#41;&#46; Se recogieron medidas antropom&#233;tricas&#44; cl&#237;nicas y anal&#237;ticas para valorar las variables asociadas al SM&#46; Tambi&#233;n se evaluaron las principales variables psicol&#243;gicas y emocionales&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realizaron diferentes pruebas de regresi&#243;n lineal m&#250;ltiple para identificar qu&#233; variables eran predictoras del SM&#46; Las variables dependientes fueron el &#237;ndice de masa corporal &#40;IMC&#41;&#44; la circunferencia abdominal&#44; el c-HDL y la calidad de vida&#44; y las variables predictoras fueron el estr&#233;s psicol&#243;gico&#44; la ira y la adherencia a la dieta mediterr&#225;nea&#46; Los resultados mostraron que el estr&#233;s psicol&#243;gico era un predictor de la calidad de vida &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;55&#44; p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#41;&#46; De igual modo&#44; la ira fue un predictor del IMC &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;23&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;047&#41; y de la circunferencia abdominal &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;27&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;021&#41;&#46; Seg&#250;n lo previsto&#44; la adherencia a la dieta mediterr&#225;nea fue un predictor del c-HDL &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;2&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41; y de la calidad de vida &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;18&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los resultados confirman un v&#237;nculo entre la adherencia a ciertos h&#225;bitos alimentarios y el estilo de vida&#59; sin embargo&#44; se sit&#250;an un paso por delante y resaltan la importancia de los factores psicol&#243;gicos y emocionales como el estr&#233;s y la ira en algunos componentes del SM&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garcia-Silva J&#44; Navarrete Navarrete N&#44; Ruano Rodr&#237;guez A&#44; Peralta-Ram&#237;rez MI&#44; Mediavilla Garc&#237;a JD&#44; Caballo VE&#46; Estr&#233;s&#44; ira y dieta mediterr&#225;nea como factores predictores del s&#237;ndrome metab&#243;lico&#46; Med Clin &#40;Barc&#41;&#46; 2018&#59;151&#58;59&#8211;64&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Directed acyclic graph &#40;DAG&#41; on the hypothesized stress&#44; anger&#44; mediterranean diet&#44; sex&#44; age&#44; alcohol and smoking as predictors of the metabolic syndrome components&#46; <span class="elsevierStyleItalic">Source</span>&#58; Created with DAGitty &#40;<a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="http://www.dagitty.net/">http&#58;&#47;&#47;www&#46;dagitty&#46;net</a>&#44; Textor et al&#46;&#44; 2011&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#58; MetS&#44; metabolic syndrome&#59; BMI&#44; body mass index&#59; TCol&#44; total cholesterol&#59; TG&#44; triglycerides&#59; HDLc&#44; high density lipoprotein cholesterol&#59; LDLc&#44; low density lipoprotein cholesterol&#59; WC&#44; waist circumference&#59; SBP&#44; systolic blood pressure&#59; DBP&#44; diastolic blood pressure&#59; MedDiet&#44; Mediterranean diet&#59; PSS&#44; Perceived Stress Scale&#59; QoL MC&#44; quality of life&#8212;mental component&#59; QoL CF&#44; quality of life&#8212;physical component&#46;</p>"
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>103&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Education</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>General Certificate of Education &#40;A-Level&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;6 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vocational Training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;3 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diploma of Higher Education&#47;University Degree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;4 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Economic status</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;6 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Middle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;5 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;9 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Physical activity</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;1 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inactive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;9 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Diet</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Satisfactory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;1 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Requires change&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;9 &#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Osteoarthritis&#47;polyosteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;6 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gout&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;9 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Descriptive statistics that describe the profile of the sample&#44; taking into account age&#44; level of education&#44; economic and employment status&#44; possible comorbidities&#44; dietary habits and physical exercise&#46;</p>"
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      ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#58; SD&#44; standard deviation&#59; BMI&#44; body mass index&#59; TCol&#44; total cholesterol&#59; TG&#44; triglycerides&#59; HDLc&#44; high density lipoprotein cholesterol&#59; LDLc&#44; low density lipoprotein cholesterol&#59; WC&#44; waist circumference&#59; SBP&#44; systolic blood pressure&#59; DBP&#44; diastolic blood pressure&#59; MedDiet&#44; Mediterranean diet&#59; PSS&#44; Perceived Stress Scale&#59; SF12 MC&#44; mental component&#59; SF12 CF&#44; physical component&#59; STAXIt&#44; trait&#59; STAXIaei&#44; Anger Expression Index&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">t</span>&#47;Fisher&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean&#47;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean&#47;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean&#47;SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;11 &#40;7&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#46;11 &#40;8&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;95 &#40;7&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;244&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;83 &#40;15&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;06 &#40;14&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#46;92 &#40;13&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;5&#46;583&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;4&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;75 &#40;4&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;21 &#40;5&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;476&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;635&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TCol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">202&#46;15 &#40;44&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">188&#46;20 &#40;48&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">214&#46;23 &#40;36&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">191&#46;21 &#40;92&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">201&#46;55 &#40;100&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">182&#46;26 &#40;84&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;307&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDLc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;64 &#40;13&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;72 &#40;11&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;65 &#40;13&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;287&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDLc&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&#46;49 &#40;41&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&#46;39 &#40;43&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131&#46;92 &#40;38&#46;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;739&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;085&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glycaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&#46;22 &#40;40&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126&#46;02 &#40;45&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115&#46;19 &#40;36&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;311&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">112&#46;64 &#40;12&#46;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&#46;18 &#40;12&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;73 &#40;12&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;629&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">132&#46;65 &#40;19&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134&#46;06 &#40;18&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131&#46;43 &#40;21&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;347&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;730&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87&#46;86 &#40;16&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#46;77 &#40;10&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#46;58 &#40;19&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;285&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;202&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MedDiet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;99 &#40;2&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;59 &#40;2&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;32 &#40;2&#46;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;542&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;75 &#40;9&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;74 &#40;9&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;32 &#40;9&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SF12 MC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;55 &#40;5&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;11 &#40;6&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;09 &#40;5&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;1&#46;965&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SF12 PC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;30 &#40;8&#46;09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#46;01 &#40;7&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;87 &#40;8&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;850&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;397&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STAXIt&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;53 &#40;29&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;80 &#40;29&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;98 &#40;28&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;583&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STAXIaie&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#46;00 &#40;27&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;21 &#40;27&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#46;35 &#40;27&#46;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;942&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcohol &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;2 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;9 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;6 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoker &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;3 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;7 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;4 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;540&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Linear regression models &#40;dependent variables&#58; BMI&#44; WC&#44; HDLc&#44; QoLmc&#41; with stress&#44; anger and adherence to a Mediterranean diet&#46;</p>"
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Article information

ISSN: 23870206
Original language: English

DOI:10.1016/j.medcle.2018.05.028

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