title: Living at a Geographically Higher Elevation Is Associated with Lower Risk of Metabolic Syndrome: Prospective Analysis of the SUN Cohort.
abstract: Living in a geographically higher altitude affects oxygen availability. The possible connection between environmental factors and the development of metabolic syndrome (MetS) feature is not fully understood, being the available epidemiological evidence still very limited. The aim of the present study was to evaluate the longitudinal association between altitude and incidence of MetS and each of its components in a prospective Spanish cohort, The Seguimiento Universidad de Navarra (SUN) project. Our study included 6860 highly educated subjects (university graduates) free from any MetS criteria at baseline. The altitude of residence was imputed with the postal code of each individual subject residence according to the data of the Spanish National Cartographic Institute and participants were categorized into tertiles. MetS was defined according to the harmonized definition. Cox proportional hazards models were used to assess the association between the altitude of residence and the risk of MetS during follow-up. After a median follow-up period of 10 years, 462 incident cases of MetS were identified. When adjusting for potential confounders, subjects in the highest category of altitude (>456 m) exhibited a significantly lower risk of developing MetS compared to those in the lowest tertile (<122 m) of altitude of residence [Model 2: Hazard ratio = 0.75 (95% Confidence interval: 0.58-0.97);pfor trend = 0.029]. Living at geographically higher altitude was associated with a lower risk of developing MetS in the SUN project. Our findings suggest that geographical elevation may be an important factor linked to metabolic diseases.
authors.affiliation: Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of NavarraPamplona, Spain; Centre for Nutrition Research, School of Pharmacy and Nutrition, University of NavarraPamplona, Spain.
authors.forename: Amaya
authors.initials: A
authors.lastname: Lopez-Pascual
authors.affiliation: IDISNA Navarra's Health Research InstitutePamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Centre of Biomedical Research Network, ISCIIIMadrid, Spain; Department Preventive Medicine and Public Health, University of NavarraPamplona, Spain.
authors.forename: Maira
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.affiliation: Department Preventive Medicine and Public Health, University of Navarra Pamplona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sayón-Orea
authors.affiliation: Department Preventive Medicine and Public Health, University of NavarraPamplona, Spain; Cancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordOxford, UK.
authors.forename: Aurora
authors.initials: A
authors.lastname: Perez-Cornago
authors.affiliation: Department Preventive Medicine and Public Health, University of Navarra Pamplona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Díaz-Gutiérrez
authors.affiliation: IDISNA Navarra's Health Research InstitutePamplona, Spain; Department History, Art History, and Geography, University of NavarraPamplona, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Pons
authors.affiliation: IDISNA Navarra's Health Research InstitutePamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Centre of Biomedical Research Network, ISCIIIMadrid, Spain; Department Preventive Medicine and Public Health, University of NavarraPamplona, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martínez-González
authors.affiliation: Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of NavarraPamplona, Spain; Centre for Nutrition Research, School of Pharmacy and Nutrition, University of NavarraPamplona, Spain; IDISNA Navarra's Health Research InstitutePamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Centre of Biomedical Research Network, ISCIIIMadrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: González-Muniesa
authors.affiliation: Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of NavarraPamplona, Spain; Centre for Nutrition Research, School of Pharmacy and Nutrition, University of NavarraPamplona, Spain; IDISNA Navarra's Health Research InstitutePamplona, Spain; CIBERobn Physiopathology of Obesity and Nutrition, Centre of Biomedical Research Network, ISCIIIMadrid, Spain.
authors.forename: J Alfredo
authors.initials: JA
authors.lastname: Martínez
keywords: cohort studies; environmental health; metabolic syndrome; morbidity; preventive medicine