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Grant support

The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research Grant 2013e2018, 340918) to M.A.M.-G., and the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de Investigacion para la Salud (FIS), which is co-funded by the European Regional Development Fund (five coordinated FIS projects led by J.S.-S. and J.Vid., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926; PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332), the Especial Action Project entitled: Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus grant to J.S.-S., the Recercaixa grant to J.S.-S. (2013ACUP00194), grants from the Consejeria de Salud de la Junta de Andalucia (PI0458/2013, PS0358/2016, and PI0137/2018), a grant from the Generalitat Valenciana (PROMETEO/2017/017), a Fernando Tarongi Bauza PhD grant to Cristina Bouzas, a SEMERGEN grant, and funds from the European Regional Development Fund (CB06/03 and CB12/03). Nerea Becerra-Tomas was supported by a Juan de la Cierva Formacion postdoctoral fellowship (FJC2018e036016-I). Indira Paz Graniel receives a Grant from the Spanish Ministry of Education, Culture and Sports (FPU 17/01925). Anna Tresserra Rimbau was supported by a Juan de la Cierva Formacion postdoctoral fellowship (FJCI-2016-28694) from the Ministry of Economy, Industry and Competitivity. Laura Barrubes receives a Grant from the Spanish Ministry of Education, Culture and Sports (FPU 16/00165). Centro de Investigacion Biomedica en Red-Fisiopatologia de la Obesidad y Nutricion is an initiative of the Instituto de Salud Carlos III of Spain, which is financed by the European Regional Development Fund, "A way to make Europe"/"Investing in your future" (CB06/03 and CB12/03). It is supported by the official funding agency for biomedical research of the Spanish government, ISCIII, Spain.

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Becerra-Tomas, NAuthorPaz-Graniel, IAuthorBarrubes, LAuthorBabio, NAuthorSalas-Salvado, JCorresponding Author

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Article

Fruit consumption and cardiometabolic risk in the PREDIMED-plus study: A cross-sectional analysis

Publicated to:Nutrition Metabolism And Cardiovascular Diseases. 31 (6): 1702-1713 - 2021-06-07 31(6), DOI: 10.1016/j.numecd.2021.02.007

Authors: Becerra-Tomas, Nerea; Paz-Graniel, Indira; Tresserra-Rimbau, Anna; Martinez-Gonzalez, Miguel A; Barrubes, Laura; Corella, Dolores; Munoz-Martinez, Julia; Romaguera, Dora; Vioque, Jesus; Alonso-Gomez, Angel M; Warnberg, Julia; Martinez, Jose A; Serra-Majem, Luis; Estruch, Ramon; Bernal-Lopez, Maria R; Lapetra, Jose; Pinto, Xavier; Tur, Josep A; Garcia-Rios, Antonio; Gallego, Blanca Riquelme; Delgado-Rodriguez, Miguel; Matia-Martin, Pilar; Daimiel, Lidia; Velilla-Zancada, Sonsoles; Vidal, Josep; Vazquez, Clotilde; Ros, Emilio; Buil-Cosiales, Pilar; Babio, Nancy; Fernandez-Carrion, Rebeca; Perez-Vega, Karla A; Morey, Marga; Torres-Collado, Laura; Tojal-Sierra, Lucas; Perez-Lopez, Jessica; Abete, Itziar; Cabrera, Judith P; Casas, Rosa; Fernandez-Garcia, Jose C; Santos-Lozano, Jose M; Esteve-Luque, Virginia; Bouzas, Cristina; Fernandez-Lazaro, Cesar, I; Sorli, Jose, V; Freixer, Gala; Martin, Marian; Munoz, Montserrat G; Salaverria-Lete, Itziar; Toledo, Estefania; Castaner, Olga; Salas-Salvado, Jordi

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Abstract

Background and aims: Total fruit consumption is important for cardiovascular disease prevention, but also the variety and form in which is consumed. The aim of the study was to assess the associations between total fruit, subgroups of fruits based on their color and fruit juices consumption with different cardiometabolic parameters.Methods and results: A total of 6633 elderly participants (aged 55-75 years) with metabolic syndrome from the PREDIMED-Plus study were included in this analysis. Fruit and fruit juice consumption was assessed using a food frequency questionnaire. Linear regression models were fitted to evaluate the association between exposure variables (total fruit, subgroups based on the color, and fruit juices) and different cardiometabolic risk factors. Individuals in the highest category of total fruit consumption (>3 servings/d) had lower waist circumference (WC) (13 = -1.04 cm; 95%CI:-1.81,-0.26), fasting glucose levels (13 =-2.41 mg/dL; 95%CI(-4.19,-0.63) and LDL-cholesterol (13 =-4.11 mg/dL; 95%CI:-6.93,-1.36), but, unexpectedly, higher systolic blood pressure (BP) (13 = 1.84 mmHg; 95%CI: 0.37, 3.30) and diastolic BP (13 = 1.69 mmHg; 95%CI:0.83, 2.56) when compared to those in the lowest category of consumption (<1 servings/d). Participants consuming >1 serving/day of total fruit juice had lower WC (13 = -0.92 cm; 95%CI:-1.56,-0.27) and glucose levels (13 =-1.59 mg/dL; 95%CI:-2.95,-0.23) than those consuming <1 serving/month. The associations with cardiometabolic risk factors differed according to the color of fruits.Conclusion: Fruit consumption is associated with several cardiometabolic risk factors in Mediterranean elders with metabolic syndrome. The associations regarding BP levels could be attributed, at least partially, to reverse causality bias inherent to the cross-sectional design of the study.(C)& nbsp;2021 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Keywords

10-year incidenceAdultAgeAge factorsAgedArticleAssociationBiochemical analysisBiological markerBiomarkersBloodBlood glucoseBlood pressureBlood pressure monitoringBlood-pressureBody massBody mass indexCaloric intakeCardiometabolic risk factorCardiometabolic risk factorsCardiovascular diseaseCardiovascular diseasesCardiovascular riskCardiovascular-diseaseCausalityClinical trialColorComparative studyCross-sectional studiesCross-sectional studyDiastolic blood pressureDiet, healthyDietary complianceExposure variableFemaleFood compositionFood frequency questionnaireFruitFruit and vegetable juiceFruit and vegetable juicesFruit consumptionFruit juiceFruit juicesFruitsGlucose blood levelHumanHumansHypercholesterolemiaHyperglycemiaHypertensionHypertriglyceridemiaJuice consumptionLinear regression analysisLow density lipoprotein cholesterolMajor clinical studyMaleMetabolic syndromeMetabolic syndrome xMetabolismMiddle agedMulticenter studyNutritional factorsNutritional valueNutritive valueObesityOrange juicePathophysiologyPhysical activityPhysical-activity questionnairePilot studyPrevalenceProtectionProtective factorsRisk assessmentRisk reductionRisk reduction behaviorSmokingSpainSystolic blood pressureValidationVegetable consumptionWaist circumference

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Nutrition Metabolism And Cardiovascular Diseases due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine (Miscellaneous).

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.16. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.29 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 3.98 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-08, the following number of citations:

  • WoS: 15
  • Scopus: 17
  • OpenCitations: 14

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-08:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 95.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 92 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 16.03.
  • The number of mentions on the social network Facebook: 1 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 14 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Argentina; United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Becerra Tomás, Nerea) .

the author responsible for correspondence tasks has been Salas Salvadó, Jorge.