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Article

Association among Adherence to the Mediterranean Diet, Cardiorespiratory Fitness, Cardiovascular, Obesity, and Anthropometric Variables of Overweight and Obese Middle-Aged and Older Adults

1
Research Group on Health, Physical Activity, Fitness and Motor Behaviour (GISAFFCOM), Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain
2
Active Aging, Exercise and Health/HEALTHY-AGE Network, Consejo Superior de Deportes (CSD), Ministry of Culture and Sport of Spain, 28040 Madrid, Spain
3
Sports Injury Prevention Research Group, Catholic University San Antonio of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain
*
Author to whom correspondence should be addressed.
Submission received: 17 August 2020 / Revised: 7 September 2020 / Accepted: 7 September 2020 / Published: 10 September 2020
(This article belongs to the Special Issue The Role of Physical Activity and Diet in Human Health during Aging)

Abstract

:
The aim of this study was to evaluate the independent and combined associations between adherence to the Mediterranean diet (AMedDiet), cardiorespiratory fitness (CRF), and different parameters of overweight and obese middle-aged and older adults. Sixty-two participants were enrolled in this cross-sectional study. Fat mass was measured with Dual energy X-ray absorptiometry. AMedDiet and physical activity (PA) were assessed with the PREDIMED and Global PA Questionnaire (GPAQ). Maximal aerobic power was assessed using the 6-min walk test. Systolic (SBP) and diastolic (DBP) blood pressure (BP) were measured with Omron M6, and double product (DP) and mean BP (MBP) were calculated. Kinanthropometry proportionality variables related to obesity were also calculated. Participants with a low CRF as an independent factor or together with a low AMedDiet obtained significantly higher BP, total and trunk fat mass, and proportionality variables (all p ˂ 0.0001). According to the multiple nonlinear regression analysis, Vo2max, AMedDiet, and sex explained 53.4% of SBP, with this formula: 238.611 − (3.63*Vo2max) + (0.044*Vo2max2) − (13.051*AMedDiet) + (0.68*AMedDiet2) + (12.887*sex). SBP and p rediction SBP with the new formula showed a correlation of 0.731 (p ˂ 0.0001); showing a difference between the values of −0.278 (p = 0.883). In conclusion, CRF as an independent factor and combined with AMedDiet can be associated with BP, body composition, and proportionality in overweight and obese middle-aged and older adults.

1. Introduction

Aging is associated with the emergence of chronic diseases, such as cardiovascular disease, overweightness, and obesity [1,2,3]. The adult and older stages are associated with an increase in fat mass [4,5,6], which is linked with a higher incidence of chronic diseases [1,3]. The prevalence of overweightness and obesity in older adults is a worldwide public health problem [7], and the high increase in the number of overweight and obese older adults have resulted in strong concerns about the cost of providing adequate care [8].
Recently, the American Heart Association announced that being older and obese were two of the most dangerous risk factors for uncontrolled hypertension, and defined hypertension as a major risk factor for death and stroke, especially in older years [9]. Also, blood pressure (BP) has been reported to be a risk factor for cardiovascular disease for middle-aged and older adults [10].
Being overweight and obese, coupled with a poor physical condition, are related to aging and are also associated with the risk of death from chronic diseases. Therefore, intervention strategies are needed to encourage changes in body composition and physical condition [11,12]. Public health organizations seek to promote and develop healthy interventions strategies (i.e., daily physical activity, exercise, Mediterranean diet (MedDiet), etc.) among middle-aged and older adults, as they are key aspects for the prevention of obesity [13,14]. Among the healthy strategies for managing high BP in overweight and obese adult we find regular physical activity and healthy eating plan [15,16].
The MedDiet is the traditional diet/lifestyle experienced by people residing near the Mediterranean Sea, including countries from Southern Europe, Northern Africa, and the Middle East [17]. The MedDiet has shown to be a good diet for decreasing hypertension in middle-aged and older adults [18]. In addition, a correlation between the MedDiet and blood pressure has been reported in overweight and obese people [19].
The perception of overweightness has been associated with spontaneous weight management, mainly by dieting and/or exercising [20], but less concern about weight and less perception of overweightness seems to be associated with aging. Ignoring and not addressing excess fat can have a negative impact on the lifestyle and health of older people. It is important for middle-aged and older people to understand the need for a healthy lifestyle, to take care of their diet, and to be physically active. For that, physical activity and healthy dietary habits are essential for greater health-related cardiorespiratory fitness (CRF), and together with body composition have been shown to be directly associated with improved health [21]. Physical activity program interventions are simple, cost-effective strategies for delaying the prevention of chronic disease, hypertension, disability, and improving physical function of middle-aged and older adults. [8]. There is strong evidence that regular exercise or chronically increased physical activity, which increases cardiorespiratory fitness (CRF), attenuates the progressive age-related rise in blood pressure (BP) and prevents hypertension [22]. In addition, the role of the MedDiet in the prevention of chronic diseases has been evidenced by numerous studies [23,24,25,26].
Previous studies [27,28,29,30,31] have shown that increased adherence to the MedDiet (AMedDiet) reduces the risk of chronic diseases such as cardiovascular disease, BP, type II diabetes mellitus, cancer, mortality risk, etc., and increases life expectancy and quality of life. Due to the importance of a balanced and healthy diet, along with an adequate level of physical activity, which increases CRF and energy expenditure to prevent overweightness and obesity and to improve health-related quality of life in aging, studies that address this issue and propose solutions or intervention strategies are necessary.
Therefore, the aims of this study were (a) to analyze the connections between age, AMedDiet, cardiovascular variables, and CRF; and (b) to evaluate the independent and combined association of the MedDiet and CRF on BP parameters, body composition, and proportionality of overweight and obese middle-aged and older adults.

2. Materials and Methods

2.1. Study Design

This cross-sectional study is part of a randomized controlled trial study of subjects recruited for research on the association between MedDiet, physical activity, physical fitness, and body composition on physical and psychological health in older adults. It is registered at the International Standard Randomized Controlled Trial (ISRCTN); (ISRCTN28506133). The cross-sectional study design followed the Strobe Statement.

2.2. Participants

The participants were recruited through advertisements on senior centers and presentations in the community of the Region de Murcia (Spain).
A total of 62 participants were recruited (average age: 67.72 ± 8.02). The inclusion criteria were: (a) Having a body mass index between 25 and 29.9 (overweight) or between 30 and 34.9 (obese), (b) women and men over 50 years of age, and (c) who were physically independent. Exclusion criteria were: (a) Physical limitations or musculoskeletal injuries that could affect testing of performance, and (b) taking hormonal or steroid or non-steroidal anti-inflammatory medications.
Sample size and power were established in connection with a standard deviation for Vo2max from previous data [32]. The sample size for this study consisted of 62 participants, providing a power of 95% and a significance level of α = 0.05; an estimated error of 1.54 mL/kg/min is reported. The Rstudio 3.15.0 software was used to establish the sample size.

2.3. Ethics Approval and Consent to Participate

The study obtained approval on CE111908 by the Catholic University of Murcia ethics committee on research and in accordance with the Declaration of Helsinki. All patients signed written informed consent forms prior to participation in the study. This study was conducted at a Sport Science laboratory.

2.4. Variables and Instruments

The same researchers performed all the measurements in a single session between 10:00 and 14:00 h. The participants were examined barefoot with the temperature of laboratory standardized at 24 °C. Before the test measurement, the participants did not perform warm-up or stretching exercises. There was a 5-min rest between measurements. In order to establish the reliability of the examiner, prior to the examination, a double-blind study was performed with 30 subjects, obtaining an intraclass correlation coefficient higher than 95%.
Adherence to the Mediterranean Diet (AMedDiet): the PREDIMED test was used, an instrument for dietary evaluation that provides information on the AMedDiet of older adults [33], which was previously validated in the Spanish population [34]. The PREDIMED study is a multicenter, randomized, primary cardiovascular prevention trial conducted in Spain (www.predimed.es). The reliability of this test was verified in a validation test with older Spanish people up to 65 years of age [35].
The Global Physical Activity Questionnaire (GPAQ) is a modified version of the International Physical Activity Questionnaire (IPAQ) [36], and was developed by the World Health Organization (WHO) in response to a greater interest in the role of physical activity (PA) on health [37,38]. This questionnaire classifies participants according to activity level as the main objective of physical activity measurement, and allows for the study of trends and associations with other types of behavior or health outcomes.
The maximal aerobic power (Vo2max) was assessed using the 6-min walk test (6MWT). The 6MWT has been shown to be a valid, reliable, objective, inexpensive, and easy test used to evaluate cardiorespiratory fitness (CRF) [39,40,41,42,43]. It is a simple test to perform and is better related to the person’s daily life activities than other tests [41,42]. It is used to measure an individual’s sub-maximum aerobic capacity while walking for 6 min. It is suggested that this test should be performed on a flat surface that allows walking for 20 to 30 m. The subject should be relaxed and wear comfortable clothing and shoes, and the heart rate (HR) of each subject was recorded with a POLAR 400 heart rate monitor just before the start of the test and just after the end. The route was marked every 5 m and cones were placed at the turning area. The subject walked at a pace appropriate to his/her condition, being able to stop or slow down if he/she was fatigued, resuming as soon as possible. The trainer could motivate the subjects with phrases such as “You are doing well”, and the total meters walked was recorded [44]. Vo2 max was calculated with the following formula for men and women: Vo2 max for men = 110.546 + 0.063 × (6 min walk test) – 0.250 × (age) − 0.486 × (BMI) − 0.420 × (height) − 0.109 x (HR); and Vo2max for women = Vo2max = 22.506 − 0.271 × (weight) + 0.051 × (6 min walk test) − 0.065 × (age) [45]. This test has good reliability (ranging from 0.95 to 0.97) [46].
Blood pressure (BP) was measured in the sitting position on the right arm, and the mean of two recordings at least 3 min apart was recorded. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) were measured using a Omron M6, Vernon Hills, monitor [47]. The double product (DP), consisting of the SBP multiplied by the PR, is an index of myocardial oxygen consumption. DP = Heart rate × systolic blood pressure [48]. Mean blood pressure (MBP) was calculated with the following formula: 1/3 (SBP − DBP) + DBP. MBP is used in clinical practice and allows blood pressure to be used as a single variable. MBP has been shown to be a precursor to cardiovascular risk in adults [10].
Body composition measurements with Dual energy X-ray absorptiometry (DXA) is a method used for body composition measurements for the evaluation of soft tissue composition [49,50]. DXA (QDR 4500A, fan-beam densitometer, Hologic, Waltham, MA, USA) was used for the measurement of trunk and total fat masses and percentages.
Kinanthropometric parameters were measured based on the standards of the International Society for the Advancement on Kinanthropometry (ISAK) [51]. Weight (kg) was evaluated in light clothing without footwear to the nearest 0.1 kg by using an electronic scale, and height (cm) was measured using a stadiometer to the nearest millimeter (Seca 763 digital scale, Birmingham, UK). Biiliocristal and biacromial breaths were measured with a large sliding caliper to the nearest millimeter (Realmet, Barcelona, Spain). Waist girth was measured with an anthropometric measuring tape (W606PM, Lufkin, EE.UU.).
Body mass index (BMI), Ponderal Index (PI), biiliocristal/biacromial ratio, and waist/height ratio (WHR) are parameters related to overweightness and obesity [52,53]. BMI was calculated as weight (kg) divided by height (m) squared [54]. PI was calculated as: weight (g) × 100/(height, cm3) [55,56]. Biiliocristal/biacromial ratio was calculated as biiliocristal breath divided by biacromial breath, both in cm [57]. WHR was calculated as waist girth divided by height, both in cm [53].

2.5. Statistical Analyses

An analysis of normality of the variables was conducted with the Kolmogorov–Smirnov test and the analysis of sphericity with Mauchly’s test. Data that did not exhibit a normal distribution were subjected to natural log transformation. Data are expressed as means (X) and standard deviations (SD). Pearson’s bivariate correlation coefficients were used to determine the association between age, cardiovascular variables, AMedDiet, physical activity, and cardiorespiratory fitness. For this, the following ranges were established: r < 0.5 for low correlation, 0.5–0.7 for moderate correlation, and >0.7 for high correlation.
Between-group differences (low vs. high AMedDiet; and low vs. high level of CRF) were examined by independent t-tests. Participants were classified based on the AMedDiet (low/high) and CRF (low/high). In order to ensure a balanced distribution between groups (low vs. high AMedDiet and low vs. high CRF), the cut-off points were established based on the mean of each variable (AMedDiet and CRF). The combined effect of CRF and AMedDiet was assessed by the comparison of means (4 groups) based on one-factor analysis of variance (ANOVA), with Bonferroni correction for multiple comparisons.
A X2 analysis (categorical variables) was used to analyze the differences between groups. A Cramer’s V post hoc comparison was applied for 2 × 2 tables, and for 2 × n tables a contingency coefficient was applied, showing the value of the statistic and the p value. The maximum expected value was 0.707; with an r ˂ 0.3 showing a low association; a moderate association was defined as an r value between 0.3 and 0.5 and a high association was defined as r > 0.5.
Stepwise multiple linear regression models were used to explore the associations between age, sex, CRF, and AMedDiet with cardiovascular variables (DBP, MBP, and DP). The analysis reported three models: Model 1 for CRF, Model 2 for CRF and AMedDiet, and Model 3 for CRF, AMedDiet, and sex. To analyze whether a nonlinear multiple regression models provided the best explanation of the variance, a curvilinear estimation analysis was used to explore the best model association between the dependent and independents variables. A multiple nonlinear regression analysis was performed to analyze the association between the dependent variable with the independent variables.
Statistical significance was set at p < 0.05. The statistical analyses were carried out using SPSS (Version 22, SPSS Inc., Chicago, IL, USA).

3. Results

Table 1 show the characteristics of the participant.
Table 2 shows the bivariate correlations between age, AMedDiet, physical activity, cardiorespiratory fitness, and correlations between them and BP variables, proportionality, and body composition. Age shows a positive and significant correlation with SBP, biiliocristal/biacromial ratio, and WHR, and a negative correlation with DBP, distance in 6 min test, Vo2max, and PI. AMedDiet was correlated with SBP and MVPA. Vo2max was correlated with age, SBP, MBP, DP, VPA, proportionality, and fat mass.
Table 3 report the result of cardiovascular, proportionality, and body composition according to AMedDiet. Low AMedDiet shows high values SBP, MBP, PR, DP, BMI, and fat mass, although this difference is no significate.
Participants who reported a high CRF showed lower values of SBP, DBP, MBP, DP, BMI, PI, biiliocristal/biacromial ratio, and all the variables related with fat mass, significantly (Table 4).
The analysis between groups of level of CRF + AMedDiet shows that the group with low CRF and low AMedDiet had the highest SBP, MBP, DP, BMI, PI, WHR, and all the variables related to fat mass, significantly. Table 5 shown this and other differences between the variables and groups.
According to the multiple linear regression analysis, Vo2max, AMedDiet, and sex together explained 35.8% of the variation in SBP (Model 3—Table 6). The formula reported for the analysis was: SBP = 2.243 − (0.004*Vo2max) − (0.008* AMedDiet) + (0.047*Sex). The variable prediction SBP was calculated with this formula. The relationship between SBP and prediction SBP was analyzed by means of Student’s t test, showing a correlation of 0.598 (p ˂ 0.0001) and a difference between the values of −0.00008 (Table 6).
In order to analyze if a nonlinear multiple regression models provided the best explanation of the variance, a curvilinear estimation shows that the best association between SBP and Vo2max, AMedDiet, and sex was via a quadratic, quadratic, and linear approach, respectively. The predicted formula was: SBP = a − (b*Vo2max) + (c*Vo2max2) − (d*AMedDiet) + (e*AMedDiet2) + (f*sex). A multiple nonlinear regression analysis was performed as well. Vo2max, AMedDiet, and sex together explained 53.4% of the variation in SBP. The formula found for the analysis was the following: 238.611 − (3.63*Vo2max) + (0.044*Vo2max2) − (13.051*AMedDiet) + (0.68*AMedDiet2) + (12.887*sex). The relationship between SBP and prediction SBP was analyzed by means of Student’s t test, showing a correlation of 0.731 (p ˂ 0.0001) and a difference between the values of −0.278 (p = 0.883).

4. Discussion

The focus of the present study was to analyze the association of AMedDiet and CRF of various BP components, which can be used to predict cardiovascular diseases in overweight and obese middle-aged and older adults. A strong relationship between DBP, SBP, MBP, and PR, individually or jointly, and cardiovascular disease has been reported in the literature for middle-aged and older adults [10]. Performing regular physical activity and following a healthy eating plan has been recommended for managing high BP and its effects, especially in the overweight and obese [15,16]. The current study found a correlation between CRF and BP components. In fact, middle-aged and older adults with low CRF showed higher SBP, DBP, MBP, and DP than middle-aged and older adults with high CRF. Previous studies have shown that the increase in Vo2max as a result of aerobic exercise training or combined aerobic and resistance training, produces an independent effect on the decrease of resting and exercise BP [58,59]. In fact, the American College of Sports Medicine has recommended primarily aerobic training to reduce BP [60].
Surprisingly, no correlation was found between physical activity and BP components. Stewart et al. [61] also reported in middle-aged and older adults that BP, and especially DBP, had a higher correlation with CRF than with physical activity. This can be attributed to the importance of long-term practice of exercise, with a sufficient training load [62]. However, there was a correlation between CRF and VPA, although not between CRF and MPA, in the current study. In the same way, a correlation between trunk fat and VPA was found, while no correlations with MPA were observed. This is very important due to the importance of trunk fat in BP parameters and cardiovascular disease [58,63]. Previous studies have suggested the superior effect of vigorous exercise for the improvement of CRF, vascular function and body composition in middle-aged and older adults [58,62,64,65]. Other studies have demonstrated that moderate or vigorous physical activity have different associations on key health parameters. It is possible, therefore, that vigorous physical activity has higher positive associations with the health of overweight and obese middle-aged and older adults. Despite these promising results, questions remain, and further research is needed.
Eating habits are a changeable variable with a high association with BP, and specifically the MetDiet has shown considerable benefits against hypertension in middle-aged and older adults [18]. One important finding of the current research was that AMetDiet had a negative correlation with a high SBP and the group with a low AMetDiet showed high BP variables, although no significant differences were found with respect to the high AMetDiet group. A possible explanation for this may be that the importance of the association on BP was the degree of AMedDiet, but not to achieve a categorical classification. In fact, previous studies have also found a correlation between AMedDiet and DBP and SBP [66,67,68] or only SBP in overweight and obese people after adjusting for several potential confounders [19]. This differs from the findings presented here, where the relation between AMetDiet and DBP could be a consequence of the ages of the participants. In accordance with the present results, previous study has demonstrated that SBP increases with age, while DBP decreases [69]. In this line, SBP has been proposed as superior to DBP in the prediction and evaluation of cardiovascular disease in older adults [10,69,70]. Another possible explanation for this is that fat mass can be associated with greater extent DBP than SBP [19]. Future studies on the association of AMetDiet in DBP and SBP dependent on age and fat mass are therefore recommended.
Besides the correlation between and DBP and SBP, a positive correlation was found between age and CRF and proportionality parameters related with obesity. The same findings have been found in previous studies [61,71], which can be consequence of the aging process [4,5,6]. Furthermore, the PR showed a negative correlation with age, in the same line as previous findings [72].
Body composition plays a pivotal and independent role in BP [58,61]. Although body composition is influenced by physical practice and diet habits [58], increased total fat, particularly abdominal fat, are key features of obese and aging [73]. The results of this study determined that overweight and obese middle-aged and older adults showed healthy values in trunk and total fat and in other proportionality parameters related with obesity [74,75] such as BMI, PI, biiliocristal/biacromial ratio, and WHR when having a high CRF. Previous studies have found that aerobic exercise training or combined aerobic and resistance training can change anthropometric parameters and body composition, related to an improvement in BP parameters [58,61]. The same trend was found related with AMedDiet, especially for trunk fat, although differences were not significant. This confirms the results of previous studies whereby body composition changes were higher as related with CRF than with AMedDiet [76,77]. This finding is very interesting, as trunk fat was shown to have an independent association with BP parameters [58], especially with SBP, while BMI or PI, which related to body mass and height, were strongly correlated with DBP change [61].
It is interesting to note that when eating habits and physical condition were combined, overweight and obese middle-aged and older adults with low AMedDiet and low CRF showed higher SBP, MBP, DP, fat mass, BMI, PI, and WHR than the group with a low AMedDiet and high CRF and/or high AMedDiet and high CRF. This confirms that both aspects are associated with BP variables [2,3], body composition, and proportionality variables related to obesity [58,61,74,75], although CRF seems to have somewhat more importance than diet habits [58,61]. A possible explanation for this might be that overweight and obese people, especially during the aging process, have some hormonal and hemodynamic changes which are associated with hypertension [78] and changes in body composition and physiology of fat [79]. Systematic endurance training, which is highly related with CRF [58,59], has an influence on these parameters [80]. In fact, according to the present results, when CRF is low, the AMedDiet is not a relevant factor [76,77]. Despite these promising results, questions remain.
SBP is an important factor of cardiovascular disease in older adults [10,69,70]. In fact, SBP has been proposed as the primary target of antihypertensive therapy [81]. The most interesting finding was that CRF was an aspect with a high association with SBP, followed by the AMedDiet and sex, and together explained 53.4% of the variation in SBP. Previous studies have tried to archive this aim but not in middle-aged and older adults [61,71]. It is not surprising that physical exercise and diet are among the parameters that are most associated with SBP, since these lifestyle factors are highly related to higher BP parameters [15,16]. The other factor was sex, with men showing a higher risk of developing hypertension, which confirms the results of previous studies [82]. A previous study tried to archive a prediction model of SBP for young and adults.
The strengths of this study were its multifactorial focus and the sample characteristics. In fact, it is the first study which associated eating habits, PA, CRF, and obesity parameters with BP components of overweight and obese middle-aged and older adults, and the interaction between these variables. Another strength was that it is the first study that analyzed factors that can explain the variation in SBP of middle-aged and older adults.
Concerning the study limitations, this study did not include some variables that could also be associated with BP such as smoking, drinking alcohol, being stressed, sleep quality and quantity, ingestion of salt, or lipid parameters [71]. In addition, this study is not able to corroborate findings with hormonal data. Furthermore, the physical activity was measured with a questionnaire and not with an objective system such as an accelerometer. Another limitation was that due to its cross-sectional design, causal associations could not be established.

5. Conclusions

Middle-aged and older adults who are overweight and obese show the existence of correlations between age, AMedDiet, cardiovascular variables, PA, and CRF. Furthermore, CRF as an independent factor and combined with AMedDiet can influence BP, body composition, and proportionality in middle-aged and older adults who are overweight and obese.

Author Contributions

Conceptualization, P.J.M.-P.; methodology, P.J.M.-P., N.G.-G., A.E.-G., T.A.-L., and R.V.-C.; software, P.J.M.-P. and A.E.-G.; validation, P.J.M.-P., A.E.-G., and R.V.-C.; formal analysis, N.G.-G.; investigation, P.J.M.-P., A.E.-G., T.A.-L., and A.L.-V.; resources, P.J.M.-P., N.G.-G., and R.V.-C.; data curation, N.G.-G.; writing—original draft preparation, P.J.M.-P., N.G.-G., and R.V.-C.; writing—review and editing, P.J.M.-P., N.G.-G., and R.V.-C.; visualization: A.E.-G. and T.A.-L.; supervision: P.J.M.-P.; project administration, P.J.M.-P.; funding acquisition, P.J.M.-P., N.G.-G., A.L.-V., and R.V.-C. All authors have read and agreed to the published version of the manuscript.

Funding

Project “Intelligent bio-healthy machinery: design and manufacture of new ergonomic, efficient, healthy outdoor fitness machinery with an app for mobile devices (APP) for training assessment and control/BIOFIT-PARK study”, subsidized in the 2017 by Challenge-Collaboration call of the Ministry of Science, Innovation and Universities of Spain.

Acknowledgments

Authors thanks the local community which has participated in this study and all participants.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Volpi, E.; Nazemi, R.; Fujita, S. Muscle tissue changes with aging. Curr. Opin. Clin. Nutr. Metab. Care 2004, 7, 405–410. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  2. Melton, L.J.; Khosla, S.; Crowson, C.S.; O’Connor, M.K.; O’Fallon, W.M.; Riggs, B.L. Epidemiology of Sarcopenia. J. Am. Geriatr. Soc. 2000, 48, 625–630. [Google Scholar] [CrossRef]
  3. Kim, T.N.; Choi, K.M. Sarcopenia: Definition, Epidemiology, and Pathophysiology. J. Bone Metab. 2013, 20, 1. [Google Scholar] [CrossRef] [Green Version]
  4. Aagaard, P.; Suetta, C.; Caserotti, P.; Magnusson, S.P.; Kjær, M. Role of the nervous system in sarcopenia and muscle atrophy with aging: Strength training as a countermeasure. Scand. J. Med. Sci. Sport. 2010, 20, 49–64. [Google Scholar] [CrossRef] [PubMed]
  5. Guizelini, P.; de Aguiar, R.; Denadai, B.; Caputo, F.; Greco, C. Effect of resistance training on muscle strength and rate of force development in healthy older adults: A systematic review and meta-analysis. Exp. Gerontol. 2018, 102, 51–58. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  6. Coen, P.M.; Musci, R.V.; Hinkley, J.M.; Miller, B.F. Mitochondria as a target for mitigating sarcopenia. Front. Physiol. 2019, 10, 1883. [Google Scholar] [CrossRef] [Green Version]
  7. Peralta, M.; Ramos, M.; Lipert, A.; Martins, J.; Marques, A. Prevalence and trends of overweight and obesity in older adults from 10 European countries from 2005 to 2013. Scand. J. Public Health 2018, 46, 522–529. [Google Scholar] [CrossRef]
  8. Batsis, J.A.; Zagaria, A.B. Addressing Obesity in Aging Patients. Med. Clin. N. Am. 2018, 102, 65–85. [Google Scholar] [CrossRef]
  9. Osher, E.; Stern, N. Obesity in elderly subjects: In sheep’s clothing perhaps, but still a wolf! Diabetes Care 2009, 32 (Suppl. 2), S398. [Google Scholar] [CrossRef] [Green Version]
  10. Franklin, S.S.; Lopez, V.A.; Wong, N.D.; Mitchell, G.F.; Larson, M.G.; Vasan, R.S.; Levy, D. Single versus combined blood pressure components and risk for cardiovascular disease the framingham heart study. Circulation 2009, 119, 243–250. [Google Scholar] [CrossRef] [Green Version]
  11. Ryan, A.S. Exercise in aging: Its important role in mortality, obesity and insulin resistance. Aging Health 2010, 6, 551–563. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  12. Thinggaard, M.; Jacobsen, R.; Jeune, B.; Martinussen, T.; Christensen, K. Is the Relationship Between BMI and Mortality Increasingly U-Shaped With Advancing Age? A 10-Year Follow-up of Persons Aged 70–95 Years. J. Gerontol. A Biol. Sci. Med. Sci. 2010, 65A, 526–531. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  13. WHO. Nutrition, Physical Activity and the Prevention of Obesity Policy developments in the WHO European Region; WHO: Geneva, Switzerland, 2007. [Google Scholar]
  14. Heath, G.W.; Parra, D.C.; Sarmiento, O.L.; Andersen, L.B.; Owen, N.; Goenka, S.; Montes, F.; Brownson, R.C.; Alkandari, J.R.; Bauman, A.E.; et al. Evidence-based intervention in physical activity: Lessons from around the world. Lancet 2012, 380, 272–281. [Google Scholar] [CrossRef] [Green Version]
  15. James, P.A.; Oparil, S.; Carter, B.L.; Cushman, W.C.; Dennison-Himmelfarb, C.; Handler, J.; Lackland, D.T.; LeFevre, M.L.; MacKenzie, T.D.; Ogedegbe, O.; et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA J. Am. Med. Assoc. 2014, 311, 507–520. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  16. Eckel, R.H.; Jakicic, J.M.; Ard, J.D.; De Jesus, J.M.; Houston Miller, N.; Hubbard, V.S.; Lee, I.M.; Lichtenstein, A.H.; Loria, C.M.; Millen, B.E.; et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: A report of the American College of cardiology/American Heart Association task force on practice guidelines. Circulation 2014, 129, 2960–2984. [Google Scholar] [CrossRef] [Green Version]
  17. Aridi, Y.S.; Walker, J.L.; Roura, E.; Wright, O.R.L. Adherence to the Mediterranean Diet and Chronic Disease in Australia: National Nutrition and Physical Activity Survey Analysis. Nutrients 2020, 12, 1251. [Google Scholar] [CrossRef]
  18. Psaltopoulou, T.; Naska, A.; Orfanos, P.; Trichopoulos, D.; Mountokalakis, T.; Trichopoulou, A. Olive oil, the Mediterranean diet, and arterial blood pressure: The Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am. J. Clin. Nutr. 2004, 80, 1012–1018. [Google Scholar] [CrossRef]
  19. Tzima, N.; Pitsavos, C.; Panagiotakos, D.B.; Skoumas, J.; Zampelas, A.; Chrysohoou, C.; Stefanadis, C. Mediterranean diet and insulin sensitivity, lipid profile and blood pressure levels, in overweight and obese people; The Attica study. Lipids Health Dis. 2007, 6, 22. [Google Scholar] [CrossRef] [Green Version]
  20. Bouzas, C.; del Mar Bibiloni, M.; Tur, J.A. Relationship between body image and body weight control in overweight ≥55-year-old adults: A systematic review. Int. J. Environ. Res. Public Health 2019, 16, 1622. [Google Scholar] [CrossRef] [Green Version]
  21. Caspersen, C.; Powell, K.; Christenson, G. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep. 1985, 100, 126–131. [Google Scholar]
  22. Kokkinos, P. Cardiorespiratory fitness, exercise, and blood pressure. Hypertension 2014, 64, 1160–1164. [Google Scholar] [CrossRef] [PubMed]
  23. Guasch-Ferré, M.; Salas-Salvadó, J.; Ros, E.; Estruch, R.; Corella, D.; Fitó, M.; Martínez-González, M.A.; Arós, F.; Gómez-Gracia, E.; Fiol, M.; et al. The PREDIMED trial, Mediterranean diet and health outcomes: How strong is the evidence? Nutr. Metab. Cardiovasc. Dis. 2017, 27, 624–632. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Martínez-González, M.A.; Salas-Salvadó, J.; Estruch, R.; Corella, D.; Fitó, M.; Ros, E. Benefits of the Mediterranean Diet: Insights From the PREDIMED Study. Prog. Cardiovasc. Dis. 2015, 58, 50–60. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  25. Downer, M.K.; Gea, A.; Stampfer, M.; Sánchez-Tainta, A.; Corella, D.; Salas-Salvadó, J.; Ros, E.; Estruch, R.; Fitó, M.; Gómez-Gracia, E.; et al. Predictors of short- and long-term adherence with a Mediterranean-type diet intervention: The PREDIMED randomized trial. Int. J. Behav. Nutr. Phys. Act. 2016, 13, 67. [Google Scholar] [CrossRef] [Green Version]
  26. Gómez Sánchez, M.; Gómez Sánchez, L.; Patino-Alonso, M.C.; Alonso-Domínguez, R.; Sánchez-Aguadero, N.; Lugones-Sánchez, C.; Rodríguez Sánchez, E.; García Ortiz, L.; Gómez-Marcos, M.A. Adherence to the Mediterranean Diet in Spanish Population and Its Relationship with Early Vascular Aging according to Sex and Age: EVA Study. Nutrients 2020, 12, 1025. [Google Scholar] [CrossRef] [Green Version]
  27. Tosti, V.; Bertozzi, B.; Fontana, L. Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2018, 73, 318–326. [Google Scholar] [CrossRef] [Green Version]
  28. Barak, Y.; Fridman, D. Impact of mediterranean diet on cancer: Focused literature review. Cancer Genom. Proteom. 2017, 14, 403–408. [Google Scholar] [CrossRef] [Green Version]
  29. Georgoulis, M.; Kontogianni, M.D.; Yiannakouris, N. Mediterranean diet and diabetes: Prevention and treatment. Nutrients 2014, 6, 1406–1423. [Google Scholar] [CrossRef] [Green Version]
  30. Roman, B.; Carta, L.; Martínez-González, Á.M.; Serra-Majem, L. Effectiveness of the Mediterranean diet in the elderly. Clin. Interv. Aging 2008, 3, 97–109. [Google Scholar] [CrossRef] [Green Version]
  31. Capurso, C.; Bellanti, F.; Lo Buglio, A.; Vendemiale, G. The mediterranean diet slows down the progression of aging and helps to prevent the onset of frailty: A narrative review. Nutrients 2020, 12, 35. [Google Scholar] [CrossRef] [Green Version]
  32. Kim, D.K.; Park, W.H. The Relationship Between Cardiorespiratory Fitness and Arterial Stiffness in Middle-Aged Men with Abdominal Obesity. Metab. Syndr. Relat. Disord. 2019, 17, 97–101. [Google Scholar] [CrossRef] [PubMed]
  33. Martínez-González, M.A.; García-Arellano, A.; Toledo, E.; Bes-Rastrollo, M.; Bullo, M.; Corella, D.; Fito, M.; Ros, E.; Lamuela-Raventós, R.M.; Rekondo, J.; et al. Obesity indexes and total mortality among elderly subjects at high cardiovascular risk: The PREDIMED study. PLoS ONE 2014, 9, e103246. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  34. Schröder, H.; Fitó, M.; Estruch, R.; Martínez-González, M.A.; Corella, D.; Salas-Salvadó, J.; Lamuela-Raventós, R.; Ros, E.; Salaverría, I.; Fiol, M.; et al. A Short Screener Is Valid for Assessing Mediterranean Diet Adherence among Older Spanish Men and Women. J. Nutr. 2011, 141, 1140–1145. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  35. Marisca-Arcas, M.; Caballero-Plasencia, M.L.A.; Monteagudo, C.; Hamdan, M.; Pardo-Vasquez, M.I.; Olea-Serrano, F. Validation of questionnaires to estimate adherence to the Mediterranean Diet and life habits in older individuals in Southern Spain. J. Nutr. Health Aging 2011, 15, 739–743. [Google Scholar] [CrossRef]
  36. De Courten, M. Developing a simple global physical activity questionnaire for population studies. Aus. Epidemiol. 2002, 9, 6–9. [Google Scholar]
  37. De La Cámara, M.A.; Higueras-Fresnillo, S.; Cabanas-Sánchez, V.; Sadarangani, K.P.; Martinez-Gomez, D.; Veiga, Ó.L. Criterion validity of the sedentary behavior question from the global physical activity questionnaire in older adults. J. Phys. Act. Health 2020, 17, 2–12. [Google Scholar] [CrossRef]
  38. Keating, X.D.; Zhou, K.; Liu, X.; Hodges, M.; Liu, J.; Guan, J.; Phelps, A.; Castro-Piñero, J. Reliability and concurrent validity of global physical activity questionnaire (GPAQ): A systematic review. Int. J. Environ. Res. Public Health 2019, 16, 4128. [Google Scholar] [CrossRef] [Green Version]
  39. Salzman, S.H. The 6-min walk test: Clinical and research role, technique, coding, and reimbursement. Chest 2009, 135, 1345–1352. [Google Scholar] [CrossRef]
  40. Pinto-Plata, V.M.; Cote, C.; Cabral, H.; Taylor, J.; Celli, B.R. The 6-min walk distance: Change over time and value as a predictor of survival in severe COPD. Eur. Respir. J. 2004, 23, 28–33. [Google Scholar] [CrossRef] [Green Version]
  41. Enright, P.L. The Six-Minute Walk Test. Proc. Resp. Care 2003, 48, 783–785. [Google Scholar]
  42. Rikli, R.E.; Jones, C.J. Senior Fitness Test Manual; Human Kinetics: Long Beach, CA, USA, 2013; ISBN 1450411185. [Google Scholar]
  43. Sperandio, E.F.; Arantes, R.L.; Matheus, A.C.; Silva, R.P.; Lauria, V.T.; Romiti, M.; Gagliardi, A.R.T.; Dourado, V.Z. Intensity and physiological responses to the 6-min walk test in middle-aged and older adults: A comparison with cardiopulmonary exercise testing. Braz. J. Med. Biol. Res. 2015, 48, 349–353. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  44. Giannitsi, S.; Bougiakli, M.; Bechlioulis, A.; Kotsia, A.; Michalis, L.K.; Naka, K.K. 6-min walking test: A useful tool in the management of heart failure patients. Ther. Adv. Cardiovasc. Dis. 2019, 13, 1753944719870084. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  45. Mänttäri, A.; Suni, J.; Sievänen, H.; Husu, P.; Vähä-Ypyä, H.; Valkeinen, H.; Tokola, K.; Vasankari, T. Six-minute walk test: A tool for predicting maximal aerobic power (VO2max) in healthy adults. Clin. Physiol. Funct. Imaging 2018, 38, 1038–1045. [Google Scholar] [CrossRef] [PubMed]
  46. Steffen, T.M.; Hacker, T.A.; Mollinger, L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys. Ther. 2002, 82, 128–137. [Google Scholar] [CrossRef] [Green Version]
  47. Stergiou, G. Home Self-Monitoring of Blood Pressure Is Fully Automated Oscillometric Technique as Good as Conventional Stethoscopic Technique? Am. J. Hypertens. 1997, 10, 428–433. [Google Scholar] [CrossRef] [Green Version]
  48. Schutte, R.; Thijs, L.; Asayama, K.; Boggia, J.; Li, Y.; Hansen, T.W.; Liu, Y.-P.; Kikuya, M.; Björklund-Bodegård, K.; Ohkubo, T.; et al. Double Product Reflects the Predictive Power of Systolic Pressure in the General Population: Evidence from 9,937 Participants on behalf of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators. Am. J. Hypertens. 2013, 26, 665. [Google Scholar] [CrossRef] [Green Version]
  49. Zhao, X.; Wang, Z.M.; Zhang, J.; Hua, J.; He, W.; Zhu, S. Estimation of Total Body Skeletal Muscle Mass in Chinese Adults: Prediction Model by Dual-Energy X-Ray Absorptiometry. PLoS ONE 2013, 8, e53561. [Google Scholar] [CrossRef] [Green Version]
  50. Bi, X.; Loo, Y.; Henry, C. Body Fat Measurements in Singaporean Adults Using Four Methods. Nutrients 2018, 10, 303. [Google Scholar] [CrossRef] [Green Version]
  51. Esparza-Ros, F.; Vaquero-Cristóbal, R.; Marfell-Jones, M. International Standards for Anthropometric Assessment (2019)—Full Profile; The International Society of the Advancement on Kinanthropometry: Murcia, Spain, 2019. [Google Scholar]
  52. Peterson, C.M.; Su, H.; Thomas, D.M.; Heo, M.; Golnabi, A.H.; Pietrobelli, A.; Heymsfield, S.B. Tri-Ponderal Mass Index vs Body Mass Index in Estimating Body Fat During Adolescence. JAMA Pediatr. 2017, 171, 629–636. [Google Scholar] [CrossRef]
  53. Corrêa, M.M.; Thumé, E.; De Oliveira, E.R.A.; Tomasi, E. Performance of the waist-to-height ratio in identifying obesity and predicting non-communicable diseases in the elderly population: A systematic literature review. Arch. Gerontol. Geriatr. 2016, 65, 174–182. [Google Scholar] [CrossRef] [PubMed]
  54. Kvamme, J.M.; Holmen, J.; Wilsgaard, T.; Florholmen, J.; Midthjell, K.; Jacobsen, B.K. Body mass index and mortality in elderly men and women: The Tromsø and HUNT studies. J. Epidemiol. Commun. Health 2012, 66, 611–617. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  55. Derraik, J.G.B.; Maessen, S.E.; Gibbins, J.D.; Cutfield, W.S.; Lundgren, M.; Ahlsson, F. Large-for-gestational-age phenotypes and obesity risk in adulthood: A study of 195,936 women. Sci. Rep. 2020, 10, 1–9. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  56. Rasmussen, F.; Johansson, M. The relation of weight, length and ponderal index at birth to body mass index and overweight among 18-year-old males in Sweden. Eur. J. Epidemiol. 1998, 14, 373–380. [Google Scholar] [CrossRef] [PubMed]
  57. Watts, P.B.; Joubert, L.M.; Lish, A.K.; Mast, J.D.; Wilkins, B. Anthropometry of young competitive sport rock climbers. Br. J. Sports Med. 2003, 37, 420–424. [Google Scholar] [CrossRef] [Green Version]
  58. Barone, B.B.; Wang, N.-Y.; Bacher, A.C.; Stewart, K.J. Decreased exercise blood pressure in older adults after exercise training: Contributions of increased fitness and decreased fatness. Br. J. Sports Med. 2009, 43, 52–56. [Google Scholar] [CrossRef] [Green Version]
  59. Whelton, S.P.; Chin, A.; Xin, X.; He, J. Effect of aerobic exercise on blood pressure: A meta-analysis of randomized, controlled trials. Ann. Intern. Med. 2002, 136, 493–503. [Google Scholar] [CrossRef]
  60. Pescatello, L.S.; Franklin, B.A.; Fagard, R.; Farquhar, W.B.; Kelley, G.A.; Ray, C.A. American College of Sports Medicine position stand. Exercise and hypertension. Med. Sci. Sports Exerc. 2004, 36, 533–553. [Google Scholar] [CrossRef]
  61. Stewart, K.J.; Bacher, A.C.; Turner, K.L.; Fleg, J.L.; Hees, P.S.; Shapiro, E.P.; Tayback, M.; Ouyang, P. Effect of exercise on blood pressure in older persons: A randomized controlled trial. Arch. Intern. Med. 2005, 165, 756–762. [Google Scholar] [CrossRef]
  62. Reichert, T.; Kanitz, A.C.; Delevatti, R.S.; Bagatini, N.C.; Barroso, B.M.; Kruel, L.F.M. Continuous and interval training programs using deep water running improves functional fitness and blood pressure in the older adults. Age 2016, 38, 20. [Google Scholar] [CrossRef] [Green Version]
  63. Vieira, V.J.; Hu, L.; Valentine, R.J.; McAuley, E.; Evans, E.M.; Baynard, T.; Woods, J.A. Reduction in trunk fat predicts cardiovascular exercise training-related reductions in C-reactive protein. Brain Behav. Immun. 2009, 23, 485–491. [Google Scholar] [CrossRef]
  64. Milanović, Z.; Sporiš, G.; Weston, M. Effectiveness of High-Intensity Interval Training (HIT) and Continuous Endurance Training for VO2max Improvements: A Systematic Review and Meta-Analysis of Controlled Trials. Sports Med. 2015, 45, 1469–1481. [Google Scholar] [CrossRef] [PubMed]
  65. Ramos, J.S.; Dalleck, L.C.; Tjonna, A.E.; Beetham, K.S.; Coombes, J.S. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: A systematic review and meta-analysis. Sports Med. 2015, 45, 679–692. [Google Scholar] [CrossRef] [PubMed]
  66. Núñez-Córdoba, J.M.; Valencia-Serrano, F.; Toledo, E.; Alonso, A.; Martínez-González, M.A. The Mediterranean diet and incidence of hypertension: The Seguimiento Universidad de Navarra (SUN) Study. Am. J. Epidemiol. 2009, 169, 339–346. [Google Scholar] [CrossRef] [PubMed]
  67. Bendinelli, B.; Masala, G.; Bruno, R.M.; Caini, S.; Saieva, C.; Boninsegni, A.; Ungar, A.; Ghiadoni, L.; Palli, D. A priori dietary patterns and blood pressure in the EPIC Florence cohort: A cross-sectional study. Eur. J. Nutr. 2019, 58, 455–466. [Google Scholar] [CrossRef]
  68. Ndanuko, R.N.; Tapsell, L.C.; Charlton, K.E.; Neale, E.P.; Batterham, M.J. Dietary Patterns and Blood Pressure in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv. Nutr. 2016, 7, 76–89. [Google Scholar] [CrossRef]
  69. Sesso, H.D.; Stampfer, M.J.; Rosner, B.; Hennekens, C.H.; Gaziano, J.M.; Manson, J.E.; Glynn, R.J. Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in Men. Hypertension 2000, 36, 801–807. [Google Scholar] [CrossRef]
  70. Franklin, S.S.; Larson, M.G.; Khan, S.A.; Wong, N.D.; Leip, E.P.; Kannel, W.B.; Levy, D. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001, 103, 1245–1249. [Google Scholar] [CrossRef] [Green Version]
  71. Kwong, E.W.-Y.; Wu, H.; Pang, G.K.-H. A prediction model of blood pressure for telemedicine. Health Inf. J. 2018, 24, 227–244. [Google Scholar] [CrossRef] [Green Version]
  72. Franklin, S.S.; Gustin, W., 4th; Wong, N.D.; Larson, M.G.; Weber, M.A.; Kannel, W.B.; Levy, D. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997, 96, 308–315. [Google Scholar] [CrossRef] [Green Version]
  73. Öztürk, Z.A.; Türkbeyler, İ.H.; Abiyev, A.; Kul, S.; Edizer, B.; Yakaryılmaz, F.D.; Soylu, G. Health-related quality of life and fall risk associated with age-related body composition changes; sarcopenia, obesity and sarcopenic obesity. Intern. Med. J. 2018, 48, 973–981. [Google Scholar] [CrossRef]
  74. Swainson, M.G.; Batterham, A.M.; Tsakirides, C.; Rutherford, Z.H.; Hind, K. Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLoS ONE 2017, 12, e0177175. [Google Scholar] [CrossRef]
  75. Telles, S.; Kala, N.; Sharma, S.K.; Balkrishna, A. Anthropometric variables as predictors of aspects of quality of life in persons with central obesity. BMC Res. Notes 2018, 11, 680. [Google Scholar] [CrossRef] [PubMed]
  76. Galan-Lopez, P.; Sánchez-Oliver, A.J.; Ries, F.; González-Jurado, J.A. Mediterranean Diet, Physical Fitness and Body Composition in Sevillian Adolescents: A Healthy Lifestyle. Nutrients 2019, 11, 2009. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  77. Galan-Lopez, P.; Domínguez, R.; Pihu, M.; Gísladóttir, T.; Sánchez-Oliver, A.J.; Ries, F. Evaluation of Physical Fitness, Body Composition, and Adherence to Mediterranean Diet in Adolescents from Estonia: The AdolesHealth Study. Int. J. Environ. Res. Public Health 2019, 16, 4479. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  78. De Pergola, G.; Nardecchia, A.; Guida, P.; Silvestris, F. Arterial hypertension in obesity: Relationships with hormone and anthropometric parameters. Eur. J. Cardiovasc. Prev. Rehabil. Off. J. Eur. Soc. Cardiol. Work. Groups Epidemiol. Prev. Card. Rehabil. Exerc. Physiol. 2011, 18, 240–247. [Google Scholar] [CrossRef]
  79. JafariNasabian, P.; Inglis, J.E.; Reilly, W.; Kelly, O.J.; Ilich, J.Z. Aging human body: Changes in bone, muscle and body fat with consequent changes in nutrient intake. J. Endocrinol. 2017, 234, R37–R51. [Google Scholar] [CrossRef] [Green Version]
  80. Sirico, F.; Bianco, A.; D’Alicandro, G.; Castaldo, C.; Montagnani, S.; Spera, R.; Di Meglio, F.; Nurzynska, D. Effects of Physical Exercise on Adiponectin, Leptin, and Inflammatory Markers in Childhood Obesity: Systematic Review and Meta-Analysis. Child. Obes. 2018, 14, 207–217. [Google Scholar] [CrossRef] [Green Version]
  81. Strandberg, T.E.; Pitkala, K. What is the most important component of blood pressure: Systolic, diastolic or pulse pressure? Curr. Opin. Nephrol. Hypertens. 2003, 12, 293–297. [Google Scholar] [CrossRef]
  82. Reckelhoff, J.F. Gender differences in the regulation of blood pressure. Hypertension 2001, 37, 1199–1208. [Google Scholar] [CrossRef] [Green Version]
Table 1. Characteristics of the participants (n = 62).
Table 1. Characteristics of the participants (n = 62).
VariableX ± SD
Age (year-old)62.71 ± 8.02
AMedDiet8.84 ± 2.63
VPA (min)141.45 ± 360.34
MPA (min)658.95 ± 647.62
MVPA (min)800.40 ± 893.04
6 min walk test (m) 536.13 ± 120.36
HR max. in 6 min walk test (bpm)120.98 ± 17.65
HR mean in 6 min walk test (bpm) 107.24 ± 14.68
Vo2max (mL/kg/min)27.49 ± 8.40
SBP (mmHg)130.60 ± 19.81
DBP (mmHg)79.19 ± 9.80
MBP (mmHg)96.33 ± 10.34
PR (bpm)70.81 ± 13.02
DP (bpm*mmHg)9203.28 ± 1986.76
Height (cm)158.40 ± 9.95
Weight (kg)74.65 ± 11.63
BMI (kg/m2)29.68 ± 3.55
PI (gr/cm3)1.88 ± 0.27
Biiliocristal/biacromial ratio83.64 ± 5.73
WHR0.90 ± 0.09
Fat mass trunk (kg)16.55 ± 3.39
Fat mass total (kg)31.90 ± 6.45
Fat percentage trunk (%)45.18 ± 4.86
Fat percentage total (%)43.88 ± 5.38
AMedDiet = adherence to Mediterranean diet; VPA = vigorous physical activity; MPA = moderate physical activity; MVPA = moderate to vigorous physical activity; SBP = systolic blood pressure; DBP = diastolic blood pressure; PR = pulse rate; MBP = mean blood pressure; bpm = beats per minute; HR = heart rate; DP = doubled-product; BMI = body mass index; PI = ponderal index; WHR = waist/height ratio; % = percentage.
Table 2. Bivariate correlations between age, cardiovascular variables, adherence to the Mediterranean diet, physical activity, and cardiorespiratory fitness.
Table 2. Bivariate correlations between age, cardiovascular variables, adherence to the Mediterranean diet, physical activity, and cardiorespiratory fitness.
VariableAgeAMedDietVPAMPAMVPA6 min Walk TestVo2max
Age-−0.1300.058−0.005−0.005−0.480 **−0.390 **
AMedDiet−0.139-0.2230.2270.254 *0.2570.245
VPA−0.1170.223-0.532 **0.789 **0.2450.323 *
MPA0.0580.2270.532 **-0.940 **0.0620.082
MVPA−0.0050.254 *0.789 **0.940 **-0.1430.188
6 min walk test−0.480 **−0.2570.2450.0620.143-0.920 **
Vo2 max−0.390 **0.2450.323 *0.0820.1880.920 **-
SBP0.354 **0.323 *−0.1070.005−0.040−0.417 **−0.433 **
DBP−0.352 **−0.056−0.085−0.106−0.1110.009−0.094
MBP0.008−0.258−0.121−0.057−0.091−0.283 *−0.353 **
PR−0.259 *−0.028−0.043−0.018−0.031−0.101−0.127
DP0.009−0.256−0.120−0.026−0.068−0.359 **−0.400 **
Fat mass/height0.144−0.048−0.2110.048−0.051−0.625 **−0.801 **
BMI0.222−0.111−0.174−0.046−0.104−0.572 **−0.700 **
PI−0.341 **−0.116−0.179−0.004−0.075−0.760 **−0.813 **
Biiliocristal/biacromial ratio0.349 **−0.134−0.0700.0470.006−0.422 **−0.537 **
WHR0.477 **−0.087−0.1220.037−0.023−0.626 **−0.623 **
Fat mass trunk0.029−0.107−0.226−0.090−0.157−0.189−0.417 **
Fat mass total−0.047−0.038−0.177−0.018−0.085−0.256−0.528 **
Fat% trunk0.119−0.132−0.299 *0.008−0.116−0.509 **−0.665 **
Fat% total0.055−0.028−0.2270.080−0.035−0.554 **−0.722 **
* = p ˂ 0.05; ** = p ˂ 0.01; AMedDiet = adherence to the Mediterranean diet; VPA = vigorous physical activity; MPA = moderate physical activity; MVPA = moderate to vigorous physical activity; SBP = systolic blood pressure; DBP = diastolic blood pressure; MBP = mean blood pressure; PR = pulse rate; DP = doubled-product; BMI = body mass index; PI = ponderal index; WHR = waist/height ratio; % = percentage.
Table 3. Cardiovascular, proportionality, and body composition variables according to adherence to the Mediterranean diet (AMedDiet).
Table 3. Cardiovascular, proportionality, and body composition variables according to adherence to the Mediterranean diet (AMedDiet).
VariableLow AMedDiet
(n = 31) (X ± DS)
High AMetDiet
(n = 31) (X ± DS)
p Value
SBP (mmHg)133.61 ± 23.09127.80 ± 16.070.332
DBP (mmHg)78.75 ± 10.7179.60 ± 9.040.746
MBP (mmHg)97.04 ± 12.1595.67 ± 8.480.619
PR (bpm)72.82 ± 10.0868.93 ± 15.200.253
DP (bpm*mmHg)9666.79 ± 1839.248770.67 ± 2051.290.085
BMI (kg/m2)30.46 ± 4.0028.90 ± 2.890.084
PI (gr/cm3)1.93 ± 0.321.83 ± 0.200.137
Biiliocristal/biacromial ratio84.65 ± 5.0882.62 ± 6.240.166
WHR0.61 ± 0.080.58 ± 0.060.152
Fat mass trunk (kg)17.34 ± 3.2115.81 ± 3.440.085
Fat mass total (kg)32.83 ± 6.2631.03 ± 6.610.293
Fat percentage trunk (%)46.08 ± 4.2644.34 ± 5.290.176
Fat percentage total (%)44.20 ± 5.1243.59 ± 5.690.671
SBP = systolic blood pressure; DBP = diastolic blood pressure; MBP = mean blood pressure; PR = pulse rate; bpm = beats per minute; DP = doubled-product; BMI = body mass index; PI = ponderal index; WHR = waist/height ratio; % = percentage.
Table 4. Cardiovascular, proportionality, and body composition variables according to cardiorespiratory fitness (CRF).
Table 4. Cardiovascular, proportionality, and body composition variables according to cardiorespiratory fitness (CRF).
VariableLow CRF
(n = 31) (X ± DS)
High CRF
(n = 31) (X ± DS)
p Value
SBP (mmHg)142.22 ± 21.32123.70 ± 14.900.001
DBP (mmHg)83.04 ± 10.4677.57 ± 7.660.041
MBP (mmHg)102.77 ± 10.2592.94 ± 7.54˂0.0001
PR (bpm)71.00 ± 12.3670.20 ± 14.560.830
DP (bpm*mmHg)10050.87 ± 2072.898625.70 ± 1801.140.012
BMI (kg/m2)32.48 ± 3.4227.49 ± 1.82˂0.0001
PI (gr/cm3)2.08 ± 0.261.69 ± 0.12˂0.0001
Biiliocristal/biacromial ratio85.34 ± 7.2282.01 ± 4.440.042
WHR0.65 ± 0.060.56 ± 0.05˂0.0001
Fat mass trunk (kg)18.86 ± 3.1214.68 ± 2.66˂0.0001
Fat mass total (kg)36.26 ± 6.7028.66 ± 4.55˂0.0001
Fat percentage trunk (%)47.25 ± 4.3543.51 ± 4.970.005
Fat percentage total (%)45.85 ± 5.4642.40 ± 5.160.024
SBP = systolic blood pressure; DBP = diastolic blood pressure; MBP = mean blood pressure; PR = pulse rate; bpm = beats per minute; DP = doubled-product; BMI = body mass index; PI = ponderal index; WHR = waist/height ratio; % = percentage.
Table 5. Cardiovascular, proportionality, and body composition variables according to adherence to the Mediterranean diet (AMedDiet) and cardiorespiratory fitness (CRF).
Table 5. Cardiovascular, proportionality, and body composition variables according to adherence to the Mediterranean diet (AMedDiet) and cardiorespiratory fitness (CRF).
VariableLow CRF + Low AMedDiet (n = 13) (X ± DS)Low CRF + High AMedDiet (n = 11) (X ± DS)High CRF + Low AMedDiet (n = 11) (X ± DS)High CRF + High AMedDiet (n = 19) (X ± DS)
SBP (mmHg)150.83 ± 20.64 a,b132.82 ± 18.57121.64 ± 16.61124.89 ± 14.16
DBP (mmHg)84.08 ± 10.0781.91 ± 11.2476.36 ± 8.1478.26 ± 7.50
MBP (mmHg)106.33 ± 8.35 a,b98.88 ± 11.0791.45 ± 9.6593.81 ± 6.14
PR (bpm)71.08 ± 10.6070.91 ± 14.5874.36 ± 11.5867.79 ± 15.82
DP (bpm*mmHg)10669.83 ± 1896.11 b9375.64 ± 2130.048980.27 ± 1469.618420.42 ± 1976.22
BMI (kg/m2)33.23 ± 3.80 a,b31.60 ± 2.83 c,d27.71 ± 2.2427.37 ± 1.58
PI (gr/cm3)2.11 ± 0.37 a,b2.03 ± 0.17 d1.78 ± 0.221.72 ± 0.11
Biiliocristal/biacromial ratio86.30 ± 6.0684.19 ± 8.5582.83 ± 4.3081.53 ± 4.56
WHR0.66 ± 0.07 a,b0.63 ± 0.04 d0.56 ± 0.050.56 ± 0.06
Fat mass trunk (kg)19.62 ± 3.07 a,b18.03 ± 3.10d14.97 ± 2.0314.52 ± 6.30
Fat mass total (kg)37.02 ± 6.34 a,b35.44 ± 7.28 d28.98 ± 4.4828.48 ± 4.70
Fat percentage trunk (%)47.11 ± 5.4247.40 ± 3.0645.12 ± 3.3742.57 ± 5.56
Fat percentage total (%)45.08 ± 6.8346.70 ± 3.5643.45 ± 3.3241.79 ± 5.98
SBP = systolic blood pressure; DBP = diastolic blood pressure; MBP = mean blood pressure; PR = pulse rate; bpm = beats per minute; DP = doubled-product; BMI = body mass index; PI = ponderal index; WHR = waist/height ratio; % = percentage; a = difference between Low CRF + Low AMedDiet and High CRF + Low AMedDiet; b = difference between Low CRF + Low AMedDiet and High CRF + High AMedDiet; c = difference between Low CRF + High AMedDiet and High CRF + Low AMedDiet; d = difference between Low CRF + High AMedDiet and High CRF + High AMedDiet.
Table 6. Stepwise multiple linear regression analysis of the relationship of systolic blood pressure (SBP) with cardiorespiratory fitness (CRF), Mediterranean diet (AMedDiet), and sex.
Table 6. Stepwise multiple linear regression analysis of the relationship of systolic blood pressure (SBP) with cardiorespiratory fitness (CRF), Mediterranean diet (AMedDiet), and sex.
AnalysisR2p ValueIncluded Independent VariablesStandardized Coefficient (β)p Value
Model 10.1880.001Vo2max−0.0030.001
Model 20.298˂0.0001Vo2max−0.0030.004
AMetDiet−0.0080.008
Model 30.358˂0.0001Vo2max−0.004˂0.0001
AMetDiet−0.0080.013
Sex0.0470.034
AMetDiet: Adherence to Mediterranean diet.

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Marcos-Pardo, P.J.; González-Gálvez, N.; Espeso-García, A.; Abelleira-Lamela, T.; López-Vivancos, A.; Vaquero-Cristóbal, R. Association among Adherence to the Mediterranean Diet, Cardiorespiratory Fitness, Cardiovascular, Obesity, and Anthropometric Variables of Overweight and Obese Middle-Aged and Older Adults. Nutrients 2020, 12, 2750. https://0-doi-org.brum.beds.ac.uk/10.3390/nu12092750

AMA Style

Marcos-Pardo PJ, González-Gálvez N, Espeso-García A, Abelleira-Lamela T, López-Vivancos A, Vaquero-Cristóbal R. Association among Adherence to the Mediterranean Diet, Cardiorespiratory Fitness, Cardiovascular, Obesity, and Anthropometric Variables of Overweight and Obese Middle-Aged and Older Adults. Nutrients. 2020; 12(9):2750. https://0-doi-org.brum.beds.ac.uk/10.3390/nu12092750

Chicago/Turabian Style

Marcos-Pardo, Pablo J., Noelia González-Gálvez, Alejandro Espeso-García, Tomás Abelleira-Lamela, Abraham López-Vivancos, and Raquel Vaquero-Cristóbal. 2020. "Association among Adherence to the Mediterranean Diet, Cardiorespiratory Fitness, Cardiovascular, Obesity, and Anthropometric Variables of Overweight and Obese Middle-Aged and Older Adults" Nutrients 12, no. 9: 2750. https://0-doi-org.brum.beds.ac.uk/10.3390/nu12092750

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