Mediterranean diet, physical activity and subcutaneous advanced glycation end-products’ accumulation: a cross-sectional analysis in the ILERVAS project

  • Enric Sánchez
  • Àngels Betriu
  • Jordi Salas-Salvadó
  • Reinald Pamplona
  • Ferrán Barbé
  • Francesc Purroy
  • Cristina Farràs
  • Elvira Fernández
  • Carolina López-Cano
  • Chadia Mizab
  • Albert LecubeEmail author
  • the ILERVAS project investigators
Original Contribution



Adherence to Mediterranean diet (MedDiet) and physical activity have been associated to lower cardiovascular risk and mortality. Our purpose was to test the modification of advanced glycation end-products (AGEs) as one of the underlying mechanisms explaining this relationship.


Cross-sectional study assessing the adherence to MedDiet (14-item Mediterranean Diet Adherence Screener) and physical activity (International Physical Activity Questionnaire short form) in 2646 middle-aged subjects without known cardiovascular disease and type 2 diabetes from the ILERVAS study. Skin autofluorescence (SAF), a non-invasive assessment of subcutaneous AGEs, was measured. Multivariable logistic regression models were done to study interactions and independent associations with a likelihood ratio test.


Participants with a high adherence to MedDiet had lower SAF than those with low adherence (1.8 [IR 1.6; 2.1] vs. 2.0 [IR 1.7; 2.3] arbitrary units, p < 0.001), without differences according to categories of physical activity. There was an independent association between high adherence to MedDiet and the SAF values [OR 0.59 (0.37–0.94), p = 0.026]. When adherence to MedDiet was substituted by its individual food components, high intake of vegetables, fruits and nuts, and low intake of sugar-sweetened soft beverages were independently associated with a decreased SAF (p ≤ 0.045). No interaction between MedDiet and physical activity on SAF values was observed except for nuts consumption (p = 0.047).


Adherence to the MedDiet, but not physical activity, was negatively associated to SAF measurements. This association can be explained by some typical food components of the MedDiet. The present study offers a better understanding of the plausible biological conditions underlying the prevention of cardiovascular disease with MedDiet. identifier: NCT03228459.


Advanced glycation end-products Mediterranean diet Physical activity Questionnaire Skin autofluorescence 



This study was supported by Grants from the Diputació de Lleida, Generalitat de Catalunya (2017SGR696 and SLT0021600250) and Instituto de Salud Carlos III (Action Plan II14//00008). CIBER de Diabetes y Enfermedades Metabólicas Asociadas and CIBER de Enfermedades Respiratorias are initiatives of the Instituto de Salud Carlos III. The authors would also like to thank Fundació Renal Jaume Arnó, all Nurses of the Bus of health and the Primary Care Lleida Units for recruiting subjects and their efforts in the accurate development of the ILERVAS project.

Author contributions

ÀB, RP, FB, FP, CF, EF, and AL designed the research; ES CL-C and CM: conducted the research; ES and JS-S analysed data; ES, ÀB and AL wrote the paper; AL had primary responsibility for final content. All authors have read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The protocol was approved by the Arnau de Vilanova University Hospital ethics committee (CEIC-1410). Additionally, the study was conducted according to the ethical guidelines of the Helsinki Declaration and Spanish legislation regarding the protection of personal information was also followed.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (TIFF 45355 kb)
394_2019_1983_MOESM2_ESM.docx (13 kb)
Supplementary file2 (DOCX 12 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Enric Sánchez
    • 1
  • Àngels Betriu
    • 2
  • Jordi Salas-Salvadó
    • 3
    • 4
  • Reinald Pamplona
    • 5
  • Ferrán Barbé
    • 6
    • 7
  • Francesc Purroy
    • 8
  • Cristina Farràs
    • 9
  • Elvira Fernández
    • 2
  • Carolina López-Cano
    • 1
  • Chadia Mizab
    • 1
  • Albert Lecube
    • 1
    • 10
    Email author
  • the ILERVAS project investigators
  1. 1.Endocrinology and Nutrition DepartmentUniversity Hospital Arnau de Vilanova, Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of LleidaLleidaSpain
  2. 2.Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA V&R)University Hospital Arnau de Vilanova, Vascular and Renal Translational Research Group, IRBLleida, University of LleidaLleidaSpain
  3. 3.Department of Human Nutrition Unit, Biochemistry and Biotechnology, Faculty of Medicine and Health SciencesUniversity Hospital of Sant Joan de Reus, IISPV, Rovira i Virgili UniversityReusSpain
  4. 4.Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII)MadridSpain
  5. 5.Experimental Medicine DepartmentIRBLleida, University of LleidaLleidaSpain
  6. 6.Respiratory DepartmentUniversity Hospital Arnau de Vilanova-Santa María, Translational Research in Respiratory Medicine, IRBLleida, University of LleidaLleidaSpain
  7. 7.Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII)MadridSpain
  8. 8.Stroke UnitUniversity Hospital Arnau de Vilanova, Clinical Neurosciences Group, IRBLleida, University of LleidaLleidaSpain
  9. 9.Primary Health Care UnitLleidaSpain
  10. 10.Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII)MadridSpain

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