P1. Epidemiology and Control of Chronic Diseases

The Epidemiology and Control of Chronic Disease research programme has come about as a result of the recognition that risk and prognosis factors relating to the most prevalent diseases and other chronic health issues are more often than not shared among patients. Some of these common determinants are life habits, factors extracted from the physical, chemical and psychosocial environment, pathogenic mechanisms such as inflammation and oxidation, and also a number of genetic factors. The prognosis of these diseases can also be affected by the same factors and by quality healthcare. Finally, control of these health issues may require legal measures, screening, health recommendations, and immuno- and chemoprophylaxis, which are also shared among diseases of this type.

Strategic objectives

  • To generate scientific knowledge that is directly relevant for the control of chronic diseases, which are the primary causes of loss of health and of the use of health services in Spain.
  • To transfer this knowledge to public health and clinical practice. To that end, this area of research, like all others at CIBERESP, will be especially sensitive to research demands and will consult with the different health administrations and will submit bids in the relevant calls for proposals for commissioned research.

Lines of Research

  • Environmental and genetic determinants of cancer.
  • Natural history of cardiovascular disease.
  • Result reporting and transfer systems.
  • Eating behaviours and their effects on health.
  • Epidemiology and prevention of traffic injuries.
  • Other chronic disorders with a high social impact.

Strategic Subprogrammes

1. Multi-centre study of population-based cancer cases and controls (MCC-Spain)

In 2008, with the funds received from the Cross-sectional Action in Cancer (Ministerio de Sanidad and Instituto de Salud Carlos III), CIBERESP started up a multi-centre study of population-based cases and controls to investigate the role of environmental factors and their interaction with genetic factors in the genesis of high-incidence tumours (breast cancer, prostate cancer, colorectal cancer and gastroesophageal cancer), the MCC-Spain study. The list of tumours was later augmented to include chronic lymphocytic leukaemia (CLL).

The general objective of the study was to evaluate the environmental and genetic factors associated with colorectal cancer, breast cancer, stomach/oesophageal cancer and prostate cancer, adding chronic lymphocytic leukaemia (CLL) to these cancers in a second phase.

Specific objectives:

  1. Assess the risk of cancer of each tumour location in connection with environmental exposures, including drinking water pollutants (arsenic, nitrates, chromium, chlorination by-products), endocrine disruptors and other persistent organic pollutants.
  2. Assess the risk of cancers in relation to the intake of statins and painkillers.
  3. Assess the risk of breast and prostate cancer in connection with hormonal factors, infections and permanent phenotypes related to environmental exposures in early stages of life.
  4. Validate the evaluation of the exposure to environmental chemical agents by means of exposure models using exposure biomarkers, individual information and environmental exposure measurements.
  5. Assess, in a first phase, a limited series of genes in relation both to primary effects and to their interaction with environmental factors.
  6. Store enough biological material for use in future GWAS (Genome Wide Association Studies) studies and others.

The MCC-Spain has recruited 10193 subjects in 23 hospitals in 12 Spanish provinces, comprising 1115 cases of prostate cancer, 1750 cases of breast cancer, 2171 cases of colorectal cancer, 492 cases of gastroesophageal cancer, 564 cases of chronic lymphocytic leukaemia (CLL) and 4101 population-based controls paired by age, sex and region of residence. MCC-Spain participates in several international consortiums and in European projects.

2. Mammographic density and breast cancer

Mammographic density (MD) is one of the most important risk determinants of breast cancer, the risk being more than 30% for a tumour in which classic risk factors do not account for 50% of the cases. The suggestion to use MD as an intermediate phenotype in epidemiological, clinical and genetic studies on breast cancer was put forth in 2005. Some Regions of Spain are considering the inclusion of MD in breast cancer screening programmes.

Objectives of the subprogramme:

  1. Determine the prevalence of high MD in women who participate in breast cancer screening programmes.
  2. Determine the primary determinants modulating MD.
  3. Investigate the genetic variants linked to higher MD.
  4. Quantify the contribution of MD in the prediction of a risk of breast cancer.
  5. Investigate the influence of MD in women carrying mutations in BRCA1 and BRCA2 genes.
  6. Investigate the variation of MD over time and its determinants.

3. Nutrition and cardiovascular risk study in Spain (ENRICA)

The ENRICA study assesses the frequency and distribution of the primary components of the natural history of cardiovascular disease in Spain, including food intake and other behavioural risk factors, biological risk factors, early damage in target organs, and diagnosed morbidity. To attain these objectives, a cross-sectional study was conducted in 2008 in 11991 people representing the non-institutionalised population of 18 years and older in Spain, which became a cohort, and the study comprised a median follow-up of 6 years. This cohort has enabled accessing two ongoing European projects, i.e., FRAILOMIC (7th Framework Programme) and ATHLOS (H2020). FRAILOMIC seeks to identify the ohmic determinants of frailty syndrome in the elderly, and the purpose of ATHLOS is to learn more about healthy aging and its determinants.

4. DARIOS Study

Main objectives:

  1. Analyse the combined prevalence of cardiovascular risk factors in 11 population-based studies of 10 Spanish Regions conducted in the first decade of the 20th century.
  2. Determine the degree of geographic variability in distribution, involving participants comprised between the ages of 35 and 74 years old.

This study includes 28,887 participants, and started in 2009. Six papers have already been published in high impact factor journals. Furthermore, a web page (http://darios.imim.es) has been set up which allows the prevalence of different combinations of cardiovascular risk factors in Spain to be estimated using different cut-off points.

5. FRESCO Study

This is a collaborative study based on the grouping of 12 population-based cohorts of 7 regions of Spain including about 55000 individuals whose ages are comprised between 35 and 79 years old. It started in 2009.

Main objectives:

  • Create a system of mathematical functions for predicting cardiovascular risk which includes, in addition to conventional factors, information about other also known factors (body mass index, waist circumference, blood glucose level, treatments, etc.).
  • Analyse the validity of different cardiovascular risk functions proposed in Spain.

6. EPIC (European Prospective Research into Cancer and Nutrition)

This is a multi-centre cohort study including over 500,000 people that is being conducted in 23 centres from 10 different European countries (Denmark, France, Germany, Greece, Italy, Netherlands, Norway, Spain, Sweden and the United Kingdom). In Spain the project is being conducted in Asturias, Gipuzkoa, Granada, Murcia and Navarre. Its international relevance can be assessed by simply writing EPIC in PubMed.

7. InterAct Study

European cohort-case study (case-cohort) designed to investigate the risk of type 2 diabetes mellitus (DM2) and the interaction between genes and modifiable lifestyle and behavioural factors, especially diet and physical activity. Eight of the 10 countries from the EPIC project are participating in InterAct. The study is primarily funded by the 6th EU Framework Programme, the Medical Research Council (MRC) of the United Kingdom and the participating Spanish Regions.

8. EPIC-CVD Study

The EPIC-CVD (previously EPIC-Heart) study is the cardiovascular component of the EPIC project. The purpose of this study is to provide further understanding of the separate and combined influence of lifestyles (primarily diet), environment and metabolic and genetic factors on heart disease and cerebrovascular disease.

9. Neuro-Epic Study

The Neuro-Epic study is the neurodegenerative disease component of the EPIC Study. The main objective is to identify the environmental and genetic factors affecting the onset of neurodegenerative diseases and to quantify their effect both separately and together. Three neurodegenerative diseases have been selected: Alzheimer’s disease, Parkinson’s disease and Amyotrophic Lateral Sclerosis.

10. Population Cancer Registry Platform

This platform has reinforced the good relations between registries with the creation of the Red de Registros de Cáncer (REDECAN) (Cancer Registry Network) in Spain for the purpose of generating scientific knowledge that is directly relevant for the control of cancer.

11. POIBC Study

The POIBC Study (FIS PI11/01900) is an intervention study to evaluate the long-term effects of implementing community-based intervention in relation to the prevention of childhood obesity, conducted on 2140 children comprised between the ages of 8 and 10 years old and their families, from four different municipalities in Catalonia.


Attached Groups

See spanish website for furher information about research groups participating in this program.

Attached groups (Spanish)