Updating the Food-Based Dietary Guidelines for the Spanish Population: The Spanish Society of Community Nutrition (SENC) Proposal

A Higher Adherence to the ALINFA Nutritional Intervention Is Effective for Improving Dietary Patterns in Children

Food patterns are deteriorating and, consequently, not meeting nutritional recommendations. Learning about the adherence to a diet is crucial for understanding children's dietary habits. The objective of the present analysis was to assess the degree of compliance with the ALINFA nutritional intervention and the effectiveness of adherence groups, and to evaluate potential baseline factors predicting a higher adherence to the intervention. A total of 44 children aged 6 to 12 years-old participated in the eight-week intervention. A two-week dietary plan was specifically designed, providing participants with food products, ready-to-eat dishes, and recipes. An intake of 75% of calories of the prescribed diet was defined to divide the participants into high- and low-adherence groups (HA/LA, respectively). From the 44 participants, 24 showed a LA to the intervention, whereas 20 of them were in the HA group. Diet quality improved in both groups (p < 0.001), mainly by increasing cereals and nuts, and reducing pastries. A decrease in BMI z-score was observed (LA: p < 0.001; HA: p = 0.021). Fat mass (p = 0.002), LDL-c (p = 0.036), and CRP (p = 0.023) reductions were only achieved in the HA group, whereas leptin decreased only in the LA group (p = 0.046). All participants ameliorated their dietary habits, but those with better diet quality at baseline experienced greater enhancements in their nutritional status.

Meeting the 24-h movement recommendations and its relationship with Mediterranean dietary patterns in early childhood: the SENDO project

The aim of this study was twofold: (1) to assess the association between meeting all three 24-h movement recommendations and adherence to the Mediterranean diet (MedDiet) in early childhood and (2) to examine whether participants who meet all three 24-h movement recommendations have greater adherence to the individual MedDiet foods/components than those who do not meet these recommendations. A cross-sectional study was conducted using a sample of 822 participants from the Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project (Pamplona, Spain). Physical activity was assessed through a questionnaire that covered 17 different types of activities. Screen time was assessed by averaging the daily hours spent on activities such as watching TV, using a computer, or playing video games. Sleep duration was determined by taking the average of sleep durations during both weekdays and weekends. Adherence to the MedDiet was evaluated using the Mediterranean Diet Quality Index in children and adolescents (KIDMED). Greater odds of having an optimal adherence to the MedDiet were found for participants meeting all three 24-h movement recommendations (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.33-2.87, p = 0.001) in comparison with their counterparts not meeting these recommendations. Specifically, significant differences were found for "fruit or fruit juice every day" (p = 0.012), "second fruit every day" (p = 0.001), and "fresh or cooked vegetables regularly once a day" (p = 0.018) in relation to meeting all three 24-h movement recommendation status.    Conclusions: This study provides further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern. What is Known: • Only a limited number of studies have investigated the joint connection between the 24-h movement recommendations and dietary habits. • Integrating the 24-h movement recommendations with dietary recommendations could potentially yield greater effectiveness compared to promoting these recommendations independently within public health strategies. What is New: • This is the first study in assessing the relationship between 24-h movement recommendations and adherence to the Mediterranean diet in early childhood. • These findings provide further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern.

Social Media for Nutrition Education-A Randomized Controlled Trial to Promote Fruit and Vegetable Intake in a University Setting: "The University of Valladolid Community Eats Healthy" Study

Social media- and internet-based interventions are nowadays widely used tools in health interventions. Although evidence of their effectiveness is still low, their applications could be very promising due to their affordability and wide reach. The current paper aims to evaluate the effectiveness of an intervention program, "The University of Valladolid Community Eats Healthy" (UVEH), to increase fruit and vegetable (FV) intake in adults from the University of Valladolid (U. Valladolid) employing three online methodologies. A sample of 211 volunteers was randomly assigned into four groups: virtual campus (VC), Facebook (FB), Instagram (IG), and control. An intervention based on the Theory of Planned Behavior was implemented for seven weeks. Data were collected at the beginning (T0) and the end of the program (T1). The Predimed questionnaire was employed to assess FV intake. Vegetable intake was statistically significantly higher in the VC group (17.4% pre vs. 72.7% post). In the rest of the groups, there was also an increase in intake. Fruit consumption increased slightly only in the VC group (23.9% pre vs. 45.5% post). Participation decreased through the weeks: FB (week 2), IG (week 3), and VC (week 4). Retention was higher in the VC (48%) and control (60%) groups. Internet-based interventions employing interactive platforms such as virtual campus can be effective in enhancing participants' dietary habits in a clinically relevant manner.

Greek adaptation of the Teruel Orthorexia Scale (TOS) in adults from the Republic of Cyprus: A bidimensional model may not be universal

The Teruel Orthorexia Scale (TOS) is a 17-item instrument designed to assess distinct facets of Orthorexia Nervosa (ON) and Healthy Orthorexia (HO). While a bidimensional model of TOS scores has been supported in diverse national and linguistic groups, the psychometric properties of the TOS have not been previously assessed in Greek-speaking populations. To rectify this, we assessed the psychometric properties of a novel Greek translation of the TOS in a sample of adults from Cyprus. A total of 1248 respondents (710 women, 538 men) completed the Greek TOS, as well as previously validated measures of perfectionism, obsessive-compulsive symptomatology, eating restriction, negative affect, and appearance evaluation. Our results showed that a bidimensional model of the TOS had less-than-adequate fit when modelled using both confirmatory factor analysis and exploratory structural equation modeling (ESEM). Conversely, both exploratory factor analysis and ESEM supported extraction of a 3-factor model consisting of a HO facet and separate components of emotional orthorexia and cognitive-social orthorexia. This 3-factor model showed a lack of measurement bias (measurement invariance across gender identity and lack of differential item functioning as function of age and body mass index), but there were differences in latent factor means as function of respondent age and body mass index. The 3-factor model showed adequate evidence of construct validity, with the latent emotional orthorexia and cognitive-social orthorexia facets showing significant and moderate associations with the additional constructs measured in the survey. Broadly speaking, these findings support the psychometric properties of a 3-factor model of the Greek TOS, but also suggest that the bidimensional model of the TOS may not have universal applicability. We encourage further assessments of factorial validity in other national and linguistic contexts.

Imbalanced dietary patterns, anthropometric, and body composition profiles amongst adults with Down syndrome

Introduction: We aimed to analyze the anthropometric and body composition profiles of Down syndrome (DS) adults; to describe their dietary habits, nutrient intake, and physical activity patterns; and to identify the related risk factors which may influence their health status and quality of life.Methods: A cross-sectional study was conducted on a cohort of 23 DS adults (45% women) aged 21-44 years. Anthropometry and body composition were assessed by bioelectrical impedance. Dietary nutrient intake was assessed quantitatively using a 72-h recall. A food frequency questionnaire and the prevention with Mediterranean diet-PREDIMED questionnaire were used for qualitative rating.Results: Higher fat mass (FM) and lower lean mass (LM), bone mass (BM), and waist to hip ratio (WHR) were observed in women compared to men. LM and BM decreased, and body mass index (BMI), FM, and WHR increased with aging (all P < 0.05). Vitamin D and iodine intakes were not met by 70% and 60% of the studied participants, respectively. A total of 82% of the participants consumed less than 5 portions of fruits and vegetables per day and overconsumed food groups such as sweets and snacks and red meat (> 2 times per week). Protein intake showed a significant positive correlation with height (r = 0.489, P < 0.05), whereas fat intake was positively correlated with sweets and snacks (r = 0.521, P < 0.05).Conclusion: The present findings support the existence of poor anthropometric and body composition profiles, and diet quality, underscoring the need for an interdisciplinary team assessment to enhance health and quality of life in DS adults.

Nutrient intake, alcohol consumption, emotional eating and anxiety in women nursing students

Objective

The aim of the study was to analyze dietary habits, alcohol habits, emotional eating and anxiety in a sample of Spanish nursing students. These students appear to be essential to the field of public health and to teaching their future patients about their own good practices.

Methods

A cross-sectional investigation was conducted. Participants completed the Emotional Eater Questionnaire, the Alcohol Use Disorder Identification Test (AUDIT) test to evaluate alcohol intake, the State-Trait anxiety Inventory (STAI) test to measure levels of anxiety as a state and anxiety as a trait, and self-reported sociodemographic data. Following classroom instruction, three-day food records were used to gauge food intake.

Results

The calorie intake for the macronutrients Ca, Mg, K, and Fe were below the Recommended Dietary Intakes (DRI) and imbalanced. The percentage E of proteins was 132.7 % more than recommended, while the percentage of carbohydrates is below the recommended level. Dietary energy consumption barely equaled 78 % of the total energy consumed by this sex and age group. With respect to emotional eating, nursing women students were low emotional eater (44 %) > emotional eater (30 %) > non-emotional eater (22.7 %). The students' emotional eating is substantially connected with fast food and sweets, or less healthy food intake behaviors. According to the Alcohol Use Disorder Identification Test (AUDIT), 82.7 % of female students used alcohol on a regular basis in a low-risk manner.

Conclusion

The findings demonstrated a link between anxiety and dietary fat intake. Trait anxiety was negatively connected with emotional eating (EE), whereas state anxiety was positively correlated with meat consumption. It is crucial to consider these findings when creating prevention/intervention plans and profiles of harmful eating behaviors.

Determinants of Consumption of Vegetables among the Spanish Population: A Cross-Sectional Study

The consumption of vegetables is one of the fundamentals of a healthy diet. The purposes of the present study were to describe the frequency of consumption of vegetables in the general Spanish population and to explore the relations between the consumption of vegetables and sex, age, cohabitation circumstances, educational level, and body mass index (BMI).

METHODS

An analytical cross-sectional study was accomplished based on data from the European Health Survey in Spain (2020).

RESULTS

A total of 20,745 (52.1% women) subjects with a median age of 54 years old were included. Only 2.8% of them ate vegetables at least three times a day. The adjusted generalized linear model showed that being a woman increased the odds of consuming vegetables at least three times a day by 1.666 times (p < 0.001). Not cohabiting as a couple decreased the odds by 0.783 (p < 0.001). Having studied at a university increased the odds by 1.812 times (p < 0.001) and possessing a certificate of higher education by 1.408 (p = 0.030). Being overweight decreased the odds by 0.924 (p = 0.006). For every additional year of age, the odds of consuming vegetables at least three times a day increased by 1.3% (p < 0.001).

CONCLUSIONS

The vast majority of the general Spanish population did not consume an optimal amount of vegetables. Women, people with higher levels of education, and older individuals reported having a more frequent intake of vegetables. Not cohabiting as a couple and being overweight were related to a less frequent intake of vegetables.

Post-Pandemic Feeding Patterns and Mediterranean Diet Adherence in Spanish Toddlers

During the last decade, feeding patterns, more specifically those of children, have worsened-affecting dietary habits and Mediterranean diet adherence. Here, we examine the post-pandemic feeding habits of Spanish toddlers. A total of 2465 parents of children aged between 12 and 36 months completed an online 25-item multiple-choice survey asking about dietary habits and Mediterranean diet adherence. Only 34 children (1.38%) had an adequate intake of all of the food groups included in the questionnaire. Adherence worsened as toddlers grew (p < 0.0001). Further, lower compliance was found in children with a higher intake of fast food (p < 0.001), those with siblings (p = 0.0045), and children who were the second or third child (p = 0.0005). The food group with the most commonly reported adequate intake was fish (88% of children), followed by pulses (80%), water (79%), and meat (78%). Cow's milk was the most commonly consumed dairy product among all age groups analyzed. Half of the children exhibited a low consumption of milk and dairy products. These results showed that a lack of adherence to a balanced diet is common among Spanish toddlers in the post-pandemic period and that greater parent education could improve the nutrition of toddlers.

A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol

Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.

Analysis of metals and metalloid in commercial fish species from the Galapagos Marine Reserve: Toxicological and nutritional assessment

Aquatic pollution derived from metal presence in the Galapagos Islands could affect biodiversity and human health. This research provide a baseline on food safety in commercial fish species of the Galapagos Islands. We sampled muscle tissue of pelagic (Acanthocybium solandri) and demersal (Caulolatilus affinis, Pontinus clemensi, Hyporthodus mystacinus, and Paralabrax albomaculatus) species. Metal and metalloid concentrations per species were analyzed by Inductively Coupled Plasma Optical Spectrometry (ICP-OES). According to the Food and Agriculture Organization (FAO) regulation none of the studied species should be ingested; and according to the European Food Safety Authority (EFSA) regulation, all the studied species were above the Maximum Allowable Concentration (MAC) for Cd. According to EFSA, C. affinis should not be commercialized. Finally, A. solandri, P. clemensi and H. mystacinus do not represent a human health risk since its Margen of Safety (MoS) < 1 for people of up to 100 kg of body weight.

Effect of Combining Impact-Aerobic and Strength Exercise, and Dietary Habits on Body Composition in Breast Cancer Survivors Treated with Aromatase Inhibitors

This study examines both the effect of a twice-weekly combined exercise-1 h session of strength and 1 h session of impact-aerobic-on body composition and dietary habits after one year of treatment with aromatase inhibitors (AI) in breast cancer survivors. Overall, forty-three postmenopausal women with a BMI ≤ 35 kg/m², breast cancer survivors treated with AI, were randomized into two groups: a control group (CG) (n = 22) and a training group (IG) (n = 21). Body composition, i.e., abdominal, visceral, and subcutaneous adipose tissue) was measured by magnetic resonance. In addition, some questionnaires were used to gather dietary data and to measure adherence to the Mediterranean diet. After one year, women in the IG showed a significant improvement in body composition, indicated by decreases in subcutaneous and visceral adipose tissue, and total fat tissue. Furthermore, the dietary habits were compatible with moderate adherence to the Mediterranean diet pattern and a low dietary intake of Ca, Zn, Folic Ac, and vitamins D, A, and E. A twice-weekly training program combining impact aerobic exercise and resistance exercise may be effective in improving the body composition for postmenopausal women who have breast cancer treated with AI, and the results suggest the need for nutritional counselling for this population.

Nut consumption and academic performance among adolescents: the EHDLA study

PURPOSE

The aim of this study was to examine the relationship between nut consumption and academic performance in Spanish adolescents and to explore the role of sociodemographic, anthropometric, and lifestyle covariates on this association.

METHODS

A cross-sectional study was carried out using a food frequency questionnaire for estimating nut consumption in the number of 20-30 g servings per week, and academic performance data were obtained from school records. Analyses of covariance were adjusted for sociodemographic, anthropometric and lifestyle covariates, including total energy intake.

RESULTS

Among the 846 adolescents included in the analyses (55.3% girls, age range from 12 to 17 years), the mean ± standard deviation consumption of nuts was 2.7 ± 2.8 servings per week, while the mean of all school grades recorded was 6.5 ± 2.0. Furthermore, compared to no consumption, the consumption of ≥ 3 nut servings per week was consistently associated with higher grades in language (p for trend = 0.005), combination of language and math (p for trend = 0.026), grade point average (p for trend = 0.039), and combination of all school records (p for trend = 0.046). These associations were observed regardless of all covariates considered, although sex and socioeconomic level played a significant role in the completely adjusted models.

CONCLUSION

Nut consumption is associated with higher academic performance in a representative sample of Spanish adolescents. These cross-sectional results should be confirmed in longitudinal and intervention studies.

Lactose and Galactose Content in Spanish Cheeses: Usefulness in the Dietary Treatment of Patients with Galactosaemia

In galactosaemia, a strict galactose-free diet is necessary to prevent or resolve acute symptoms in infants. However, because the body produces up to 10 times more galactose than is found in a galactose-restricted diet, excessively restrictive diets should be avoided in children and adults to prevent nutritional deficiencies. Since cheese is a nutritional source of the calcium necessary for bone health, the latest international guidelines on the management of classical galactosaemia (2017) allow the consumption of cured cheeses with less than 25 mg of galactose/100 g and recommend that each country verifies the adequacy of the cheeses, since most mature cheeses do not always have a lower galactose content. In total, 32 cheese samples were purchased (19 Spanish and 13 international cheeses), and their lactose and galactose contents were analysed using ion chromatography with pulsed amperometric detection (IC-PAD). Five Spanish cheeses contained less than 25 mg of galactose/100 g: García Baquero semi-cured cheese; Hacendado, Gran Reserva and Mahón cured cheeses; and García Baquero Reserva 12-month cured cheese. In addition, eight international cheeses were confirmed as suitable: Comté, Gouda, Gruyere, Maasdam, Parmigiano, Edam, Emmental, and some samples of Cheddar. In addition to the well-known low-galactose Swiss and Dutch cheeses, according to the current results, five Spanish cheeses can be safely consumed. The greater availability of types of cheese favours better bone health in patients with galactosaemia.

Nutritional Analysis of the Spanish Population: A New Approach Using Public Data on Consumption

Official population consumption data are frequently used to characterize the diet of countries; however, this information may not always be representative of reality. This study analyses the food consumption of the Spanish population by reconstructing the whole food chain. The results have been compared with the data provided by the National Consumption Panel to which the food losses/waste reported in the literature along the distribution chain have been added. The difference between them allowed a new calculation of the estimated food consumption that was subjected to a dietary-nutritional analysis. Most of the foods were consumed more than those officially reported (range of 5-50%). The unhealthy ratios of consumed foods and recommended servings were: meat products (Rcr = 3.6), fruits and legumes (Rcr = 0.5), and nuts (Rcr = 0.14). Caloric intake surpasses needs. The results were consistent with the data on the prevalence of overweight and obesity in Spain, as well as with the prevalence of associated diseases. To make a judgment about the quality of a country's diet, it is necessary to have reliable data on food consumption, as well as energy and nutrient intake. This study encourages other authors to implement this method to verify and quantify the possible difference between official and real consumption data.

Psychometric properties of a Greek translation of the Intuitive Eating Scale-2 (IES-2) in adults from Cyprus

The construct of intuitive eating is commonly assessed using the 23-item, 4-factor Intuitive Eating Scale-2 (IES-2; Tylka & Kroon Van Diest, 2013). In this study, we assessed the psychometric properties of a novel Greek translation of the IES-2 in adults from Cyprus. In Study 1 (N = 626), an exploratory factor analysis indicated that the IES-2 should be conceptualized as consisting of six factors that showed complete invariance across women and men. Study 2 (N = 793), using exploratory structural equation modelling (ESEM) and beifactor analysis (B-ESEM), indicated that the 6-factor B-ESEM model had adequate fit and evidenced complete invariance across sex once the correlated uniqueness of negatively worded IES-2 items was accounted for. This final model evidenced adequate composite reliability, and a global G-factor evidenced adequate convergent, concurrent, and discriminant validity. In contrast, the IES-2 S-factors showed more equivocal patterns of validity, with some S-factors showing less-than-adequate associations with body image variables, self-esteem, symptoms of disordered eating, and fruit and vegetable intake. In general, these results provide satisfactory evidence of the psychometric properties of the Greek IES-2 in adults from Cyprus, but also suggest that models of IES-2 scores may vary across national or cultural contexts.

Energy and Macronutrients Intake in Indoor Sport Team Athletes: Systematic Review

Indoor team sports are characterized by matches that are shorter in duration and with frequent substitution (high-intensity intermittent). The main goal of teams is to best cover athletes' physiological demands, while meeting their dietary intake needs is critical. The aim of this study is to conduct a systematic review of the dietary intake of indoor team sports athletes and to analyze whether they comply with nutritional recommendations. A search of PubMed-MEDLINE, Web of Science, and Scopus databases from 2008 to July 2022 was conducted and 2727 documents were identified. The studies focused on adult professional or semi-professional volleyball, basketball, handball, or futsal athletes. Two independent researchers screened and extracted the data, with 20 documents included after they met the inclusion criteria. Most of the athletes, both men and women, did not meet the official recommendations based on under-consumption (energy and carbohydrates) or over-consumption (fats). In relation to protein, 28.6% of studies met the recommendations, with 50% of those who did not meet it being due to under-consumption. Although there are references on athletes' dietary intakes, there are no references considering sexes or types of sport. More adapted recommendations are needed in order to more precisely evaluate athletes' intake to know if they meet their real nutritional requirements.

Comparison of Adherence to Mediterranean Diet between Spanish and German School-Children and Influence of Gender, Overweight, and Physical Activity

BACKGROUND

Poor dietary habits and low levels of physical activity (PA) have a strong tendency to track from childhood into adulthood. The Mediterranean Diet (MD) is known to be extremely healthy, associated with lower BMI and a lower risk of obesity in children and adolescents. Therefore, adherence to the MD was compared between Spanish (n = 182) and German (n = 152) children aged 10 to 13 years to examine a possible more "westernized" diet in Spain with a non-Mediterranean country, that traditionally prefers a "Western diet" and to determine the association between adherence to the MD and gender, body composition, and PA levels.

METHODS

In the German observational longitudinal cohort study and the Spanish cohort study, body composition and questionnaires (KIDMED, Diet Quality (IAES)) were obtained, and accelerometers (Actigraph) were applied to detect PA.

RESULTS

Girls had higher BMI-standard deviation score (SDS) than boys and Spanish girls were less active than boys. Differences were detected in MD habits, such as favorable fruit-, vegetables-, fish-intakes, and dairy products in Spanish children and unfavorable consumptions of fast food, processed bakery goods, candies, and sweet beverages in German children. Independently of country, girls, children with lower BMI-SDS and children with higher PA level were related with better diet quality.

CONCLUSION

Spanish children showed higher adherence to MD and diet quality (IAES) compared to German children, but there was a trend toward a more "westernized" diet. Gender, body composition, and PA influenced nutrition regardless of country.

Fish, Seafood, and Fish Products Purchasing Habits in the Spanish Population during COVID-19 Lockdown

The Mediterranean diet is a healthy dietary pattern in which fish consumption is an important key element. In Spain, fish intake is the second highest in Europe. Dietary guidelines recommend an intake of 1-3 portions a week of fish. However, Spanish fish sales have been decreasing since 2008. The unexpected pandemic spread of the SARS-CoV-2 in 2020 led the Spanish Government to take restrictive measures that had an impact on people's behavior, including food purchases and consumption. The aim of the study was to analyze purchase data of fish, seafood, and fish products during the lockdown in Spain, using data from loyalty card holders (>5,000,000 participants) from a hypermarket chain in Spain. The results show a 45% increase in the purchase of all types of fish, seafood, and fish products, with the highest increment observed in the retiree (+65 years) as compared to the younger populations. Moreover, the retiree, in spite of the digital divide, were also the ones that most increased online shopping. These data should be considered since events like COVID-19 confinement can have a permanent impact on people's dietary habits, a possibility that should be monitored in the future.

Breakfast and psychosocial behavioural problems in young population: The role of status, place, and habits

The aim of this study was to examine whether breakfast status, place and habits are associated with psychosocial behavioural problems in a nationally representative sample of young people aged 4–14 years residing in Spain. This study analysed secondary data from the Spanish National Health Survey (2017), including 3,772 Spanish children and adolescents. Breakfast status, place, and habits were assessed by ad hoc questions answered by parents/guardians. The Strengths and Difficulties Questionnaire (SDQ) parents’ version form was applied to evaluate the psychosocial health of their children. Skipping breakfast and eating breakfast out of home were linked to greater odds of psychosocial behavioural problems (skipping breakfast: OR = 3.29; CI 95%, 1.47–7.35; breakfast out of home: OR = 2.06; CI 95%, 1.27–3.33) than eating breakfast at home. Similarly, not consuming coffee, milk, tea, chocolate, cocoa, yogurt, etc., for breakfast was related to greater odds of psychosocial behavioural problems (OR = 1.76; CI 95%, 1.21–2.55). This association was also found for those who did not eat bread, toast, cereals, pastries, etc., for breakfast (OR = 1.31; CI 95%, 1.01–1.73). Conversely, not consuming eggs, cheese, ham, etc., was associated with lower odds of psychosocial behavioural problems (OR = 0.56; CI 95%, 0.38–0.83). Our results show that eating breakfast (specifically at home) and breakfast habits related to the intake of certain food/beverages groups were associated with higher or lower odds of psychosocial behavioural problems.

Cooking Methods and Their Relationship with Anthropometrics and Cardiovascular Risk Factors among Older Spanish Adults

Food consumption has a prominent role in the occurrence of cardiometabolic diseases, however, little is known about the specific influence of cooking methods. This study examined the association between cooking methods and anthropometrics, cardiovascular risk factors, and cardiac damage biomarkers in older adults. Data were taken from 2476 individuals aged ≥65 from the Seniors-ENRICA 2 cohort in Spain and recruited between 2015 and 2017. Eight cooking methods (raw, boiling, roasting, pan-frying, frying, toasting, sautéing, and stewing) were assessed using a face-to-face validated dietary history. Study associations were summarized as adjusted percentage differences (PDs) in anthropometrics, cardiovascular risk factors, and cardiac damage biomarkers between extreme sex-specific quintiles ((5th − 1st/1st) × 100) of food consumed with each cooking method, estimated using marginal effects from generalized linear models. After adjusting for potential confounders, including diet quality, PDs corresponding to raw food consumption were −13.4% (p-trend: <0.001) for weight, −12.9% (p-trend: <0.001) for body mass index (BMI), −14.8% (p-trend: <0.001) for triglycerides, and −13.6% (p-trend: <0.115) for insulin. PDs for boiled food consumption were −13.3% (p-trend: <0.001) for weight, −10.0% (p-trend: <0.001) for BMI, and −20.5% (p-trend: <0.001) for insulin. PDs for roasted food consumption were −11.1 (p-trend: <0.001) for weight and −23.3% (p-trend: <0.001) for insulin. PDs for pan-fried food consumption were −18.7% (p-trend: <0.019) for insulin, −15.3% (p-trend: <0.094) for pro-B-type natriuretic peptide amino-terminal, and −10.9% (p-trend: <0.295) for troponin T. No relevant differences were observed for blood pressure nor for other cooking methods. Raw food consumption along with boiling, roasting, and pan-frying were associated with healthier cardiovascular profiles, mainly due to lower weight and insulin levels. Future experimental research should test the effectiveness of these cooking methods for cardiovascular prevention in older adults.

Mapping of Outdoor Food and Beverage Advertising around Spanish Schools

Overweight and obesity rates have increased worldwide in the last decades. The marketing strategies of food considered to be unhealthy significantly exacerbate the childhood obesity dilemma. Studies typically analyze the content of advertisement in television, movies, or social media, but there is a gap in the assessment of the real-life promotion of food and beverages around the schools. The primary aim of the study was to assess the products advertised around public and concerted schools in three cities in the north of Spain, and to categorize them as healthy (core) or unhealthy (discretionary). The secondary aim was to describe the types of food and beverages in advertisements, as well as to determine the density of core and discretionary product advertisements. A cross-sectional descriptive study was carried out between September and December 2021. The units of analysis were outdoor food and beverage advertisements that were located around public and concerted schools of three cities in the north of Spain. We found 104 schools that met the criteria. We identified 6469 products advertised, 35.1% core and 61.2% discretionary, observing significant differences (p < 0.001) among the cities. Fruit (core) and alcohol (discretionary) were the most heavily advertised products. In conclusion, children attending schools located in the assessed cities are currently exposed to a significant amount of discretionary product advertisement, a situation that should be regulated.

Mundo vegetal y enfermedad renal crónica: ¿riesgo o beneficio?

La alimentación a lo largo de la enfermedad renal se encuentra unida a un gran número de restricciones. Actualmente las recomendaciones nutricionales en los pacientes con enfermedad renal están cambiando, presentando elementos comunes con la población general. Se recomienda disminuir el consumo de alimentos ultraprocesados, al considerarse fuente de sal, grasas y aditivos, de los que muchos de ellos son aditivos fosfóricos y potásicos; estos aditivos presentan una biodisponiblidad del 100%, en comparación con el fósforo y el potasio dietético que se encuentra en los alimentos de origen natural, y cuya absorción se encuentra entre el 50-80%, dependiendo del tipo de alimento.El manejo del potasio dietético es uno de los grandes problemas en la población renal. En la actualidad, se está demostrando que el aumento de sus niveles en sangre, presenta más agentes causales y no sólo la ingesta dietética de potasio, como: la presencia de ayunos prolongados, estreñimiento, mal control metabólico de la glucosa y el consumo de ciertos fármacos, entre otros factores.Estos datos ponen de manifiesto que antes de recurrir a la restricción alimentaria de fuentes de potasio dietético es conveniente considerar nuevos métodos de actuación.

Sociodemographic and Lifestyle Determinants of Adherence to Current Dietary Recommendations and Diet Quality in Middle-Aged Spanish Premenopausal Women

Background

A healthy diet when approaching menopause could prevent some of the symptoms associated with the climacteric. Few studies examine adherence to current healthy dietary recommendations in middle-aged premenopausal women. Our objective was to analyze the diet quality and the adherence to the Spanish Society of Community Nutrition (SENC) dietary recommendations in middle-aged Spanish premenopausal women, and to identify the associated sociodemographic and lifestyle factors.

Methods

This is a cross-sectional study based on 1251 premenopausal women, aged 39–50, who attended to Madrid City Council Medical Diagnostic Center. Women completed an epidemiological and a food frequency questionnaire. Degree of adherence to the SENC recommendations was estimated with a score that evaluated null (0 points) and full (1 point) adherence of each specific recommendation. Associations were explored using an ordinal logistic multivariable regression model.

Results

Regarding food groups, the worst adherence was found for sweets, red/processed meat, olive oil and eggs. Most of the participants exceeded the recommended caloric intake from proteins and fats, and practically all of them showed vitamin D intake deficiency. The overall score ranged from 2 to 12 (out of 15), with a median of 6.0 (interquartile range: 5.0–7.0). Former smokers (OR: 1.38; 95%CI: 1.08–1.78), as well as those with higher educational level (OR_SSecondary:1.68; 95%CI: 0.97–2.93, OR_University:1.82; 95%IC: 1.05–3.14), with two or more children (OR: 1.31; 95%IC: 1.00-1.72), with higher caloric intake (OR_{>2188.2kcal/day}: 8.22; 95%CI: 6.19–10.92) and with greater physical activity (OR_{≥21METS−h/week}: 1.29; 95%CI: 0.95-1.76) showed greater adherence.

Conclusions

Almost two-thirds of middle-aged premenopausal participants showed low or moderate compliance with SENC recommendations. Education, smoking, parity, and physical activity were associated with the degree of adherence to these recommendations.

Association of household food insecurity with dietary intakes and nutrition-related knowledge, attitudes, and practices among parents, aged ≥ 18 years in Gaza Strip, Palestine: A descriptive study

The purpose of this study was to examine the association between household food insecurity and dietary intake and nutrition-related knowledge, attitudes, and practices (KAP) among parents aged ≥18 years in the Gaza Strip, Palestine. The current cross-sectional study was carried out in 2021 among adults (mothers and fathers) aged ≥18 years. A total of 614 participants were selected from all Gaza Strip governorates using a cluster random sampling method. To assess the nutrition-related KAP, we employed the Food and Agriculture Organization (FAO) of the United Nations questionnaire (Modules 5, 6, 7, and 9). Data regarding household food security status, demographic and socioeconomic characteristics of the study participants, anthropometric measurements, and dietary intakes were obtained using standard questionnaires and methods. Statistical analysis was performed using SPSS version 25. About 71.5% and 28.5% of the study participants were household food-insecured and household food-secured, respectively. Significant associations were found between participants from household food-secured and household food-insecured concerning several socio-demographic variables, anthropometric measures, intakes of energy, protein, carbohydrate, and calcium; nutrition-related knowledge and attitudes toward undernutrition and vitamin A deficiency; nutrition-related KAP of iron deficiency anemia; and nutrition-related attitudes and practices of food safety (P-values < 0.05 for all). In conclusion, the demographic and socioeconomic status, anthropometric measurements, and poor dietary intakes may be associated with high levels of household food insecurity, while having nutrition-related adequate KAP may be associated with low levels of household food insecurity among parents aged ≥18 years.

Food Education, Cookery Books and School Canteens in the Fight against Malnutrition: The Case of the Spanish Edalnu Programme (1961-1986)

The Spanish population completed its nutritional transition in the 1960s and 1970s, when it overcame the problems of malnutrition. Among the initiatives that made this possible, the Food and Nutrition Education Programme (Edalnu) (1961-1986) stands out. In addition to correcting the negative influence exerted by ignorance to nourish oneself correctly, it was intended to prevent the problems of overfeeding that most developed countries showed. The objective of this research addresses, in this context and from the parameters of applied history, the condition of the complementary pedagogical instrument that the Edalnu awarded to the school canteen in the fight against malnutrition, as well as the nutritional, dietetic, culinary and gastronomic criteria used for its operation. The results show that the school canteens sought to reinforce the food knowledge acquired in the classroom. Based on the dialogue between chefs and experts in nutrition and dietetics, balanced meals adapted to regional gastronomic diversity were prepared, which helped to promote, in line with current criteria, healthy and sustainable eating habits through traditional plant-based recipes, with a predominance of seasonal and local products, and with a complementary contribution of ingredients of animal origin.

SAlBi educa (Tailored Nutrition App for Improving Dietary Habits): Initial Evaluation of Usability

In recent years, the use of applications to improve dietary habits has increased. Although numerous nutrition apps are available on the market, only few have been developed by health and nutrition professionals based on scientific evidence and subsequently tested to prove their usability. The main objective of this study was to design, develop, and evaluate the usability of a tailored nutrition application to be used to promote healthy eating habits. In order to decide app design and content, three focus groups took place with fifteen professionals from primary healthcare, nutrition, and food science and computer science, as well as expert users. For the general and feedback message design, a reference model based on the scientific literature was developed. To address the multi-perspective approach of users' and external healthcare professionals' feedback, a one-day pilot testing with potential users and healthcare professionals was conducted with four focus groups. To evaluate the relevance and potential usability of the app a 1-month pilot test was conducted in a real-life environment. A total of 42 volunteers participated in the one-day pilot testing, and 39 potential users participated in the 1-month pilot test. The SAlBi educa app developed includes an online dietary record, a self-monitoring tool to evaluate dietary patterns, general and feedback messages, and examples of traditional Mediterranean recipes. The usability study showed that volunteers think that SAlBi educa is pleasant (59%) and easy to learn to use (94%). Over 84% of the volunteers declared that the nutritional messages were clear and useful. Volunteers stated that general and tailored recommendations, as well as self-monitoring, were SAlBi educa's most motivating and useful features. SAlBi educa is an innovative, user-friendly nutritional education tool with the potential to engage and help individuals to follow dietary habits based on the Mediterranean model.

Docosahexaenoic and Eicosapentaenoic Intervention Modifies Plasma and Erythrocyte Omega-3 Fatty Acid Profiles But Not the Clinical Course of Children With Autism Spectrum Disorder: A Randomized Control Trial

Background

The pathogenesis of autism spectrum disorder (ASD) is under investigation and one of the main alterations relates to the metabolic and inflammatory system dysfunctions. Indeed, based on a possible deficit of omega-3 fatty acids (FAs) of patients with ASD and looking for an anti-inflammatory effect, dietary supplements with omega-3 fatty acids have been proposed. We aimed to evaluate differences in plasma and erythrocyte FA profiles and plasma cytokines in patients with infantile ASD after supplementation with docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids or placebo and both compared at baseline with a reference healthy group.

Methods

A double-blind, randomized placebo-controlled intervention with DHA/EPA for 6 months was carried out in 54 children between 2 and 6 years diagnosed with ASD. They were selected and randomly assigned into two groups: 19 children received 800 mg/day of DHA and 25 mg/day of EPA, or placebo. In addition, another reference group of 59 healthy children of the same age was included. Plasma lipids and cytokines, and FA profiles in plasma and erythrocytes were measured at baseline and after 6 months of treatment in ASD children, and at baseline in the reference group.

Results

There were no differences in demographic, anthropometric characteristics, and omega-3 intake between the healthy reference group and the ASD children at baseline. Children with ASD showed the higher plasma percentages of palmitic acid and total saturated FA and lower total omega-6 polyunsaturated FA (PUFA) compared with healthy children. An increased level of DHA and reduced EPA level in erythrocytes were detected in the ASD group vs. the reference group. After 6 months of treatment, the ASD group that received DHA enriched product significantly increased the plasma and erythrocyte percentages of DHA, but no differences were observed in the clinical test scores and other parameters as plasma cytokines between the two groups of ASD related to the intervention.

Conclusion

Spanish children with ASD exhibit an appropriate omega-3 FA status in plasma and erythrocytes. Neither a clinical improvement of ASD children nor a better anti-inflammatory or fatty acid state has been found after an intervention with DHA/EPA for 6 months. So, the prescription of n-3 LC-PUFA and other dietary supplements in ASD should be only indicated after a confirmed alteration of FA metabolism or omega-3 LC-PUFA deficiency evaluated by specific erythrocyte FA.

Clinical Trial Registration

[www.ClinicalTrials.gov], identifier [NCT03620097].

The Eating Healthy and Daily Life Activities (EHDLA) Study

BACKGROUND

Childhood obesity is one of the greatest public health concerns facing advanced societies, Spain being one of the countries with the highest incidence. In this sense, the Region of Murcia has been pointed out as the Spanish autonomous community with the highest prevalence of excess weight among young people. More specifically, the Valle de Ricote has shown an even greater proportion of excess weight among young people. Several sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors are related to excess weight. Based on the lack of information, this research project will try to provide relevant information to design intervention programs, as well as to implement effective public policies to try and reverse this alarming situation. Therefore, this research project aims (1) to obtain cross-sectional and longitudinal data on the excess weight and their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated among adolescents from the Valle de Ricote (Region of Murcia, Spain) (aged 12-17 years), and (2) to examine the association between excess weight and their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated among this population.

METHODS

A cross-sectional study and follow-up study will be performed. This research project will involve adolescents using a simple random sampling technique. A total of three secondary schools from the Valle de Ricote (Region of Murcia, Spain) will be included in this project. The minimum sample size will be 1138, establishing a 95% confidence interval, a 40% prevalence of excess weight, a 3% margin of error, and a non-response rate of 10%. Primary outcome measures will be: (1) anthropometric measurements, (2) sociodemographic factors, (3) environmental factors, (4) lifestyle factors, (5) health-related factors, (6) cognitive factors, and (7) psychological factors.

CONCLUSION

This research project will aim to determine the prevalence of excess weight and interrelate their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated. The obtained results will help to manage and propose possible multidisciplinary interventions and strategies in order to prevent and reduce the excess weight in adolescents from the Valle de Ricote. Furthermore, orientations will be given to transfer the obtained results to the public sector to evaluate or change the adopted policies.

Alcohol Consumption by Italian and Spanish University Students in Relation to Adherence to the Mediterranean Diet and to the Food Neophobia: A Pilot Study

This work aimed to relate alcohol consumption with adherence to the Mediterranean diet (MD) and with food neophobia (FN) among Italian and Spanish university students. Volunteers (n = 194, 108 Italian and 86 Spanish), recruited at the La Sapienza University of Rome and the Catholic University of Murcia, filled in standardized questionnaires to evaluate alcohol consumption (AUDIT), FN (FN Scale: FNS), and adherence to the MD (MDS-14, MED-55, QueMD). In addition to the previously reported QueMD sub-score (aMED), a sub-score for non-typical MD foods (ntMED, carbonated and/or sugar-sweetened beverages (soft drinks), butter, margarine, or cooking cream, and manufactured sweets, pastries, and cakes) was evaluated. Italian females had higher MED-55 and FNS scores, and a lower AUDIT score than Spaniards (p < 0.01). Students who stayed with their family (resident) were more adherent to MD than those who moved away from home. Resident Italians consumed less beer, hard liquors, and cocktails than Spaniards on Saturday nights (p < 0.01). There were negative correlations between AUDIT and QueMD (R squared: 0.137, p < 0.05), and AUDIT and ntMED (R squared: 0.201, p < 0.01) in Spaniards, however, there was no relationship between AUDIT and other MD scores. In conclusion, this pilot study suggests that non-typical MD foods and Saturday night consumptions, related to being far from home, have a great impact on alcohol consumption.

Sustainable Diet Optimization Targeting Dietary Water Footprint Reduction—A Country-Specific Study

Food production creates 70% of the total anthropogenic water footprint, and it is the main cause of water pollution. Thus, more sustainable diets could contribute to the achievement of the Sustainable Development Goals. A linear programming-based stepwise optimization was designed to create dietary water footprint-reduced, culturally acceptable, and healthier diets in the case of Hungary based on a representative dietary survey. Optimization resulted in a considerable total dietary water footprint reduction (women: 18%; men: 28%) with a moderate dietary shift (~32%). Milk and dairies (observed: ~31.5%, optimized: ~20.5%) and meats and meat products (observed: ~28.0%, optimized: 28.9%) contributed the most to the dietary water footprint. In the water footprint–healthiness synergy, the vegetables, eggs, poultries, and fermented dairies were the most beneficial, increasing in amount, while fatty dairies, foods high in added sugar, and meat products were the most non-beneficial food sub-groups, decreasing in amount in the optimized diets. The problematic nutrients to fulfill in the optimized diets were energy, dietary fibers, sodium, vitamin D, zinc, vitamin B12, calcium, iron, and potassium at the maximum water footprint reduction. The study provides supporting evidence about the dietary water footprint–healthiness synergy for the further improvement of the national food-based dietary guideline.

Associations between Taste Perception Profiles and Empirically Derived Dietary Patterns: An Exploratory Analysis among Older Adults with Metabolic Syndrome

Taste perception is a primary driver of food choices; however, little is known about how perception of all five tastes (sweet, salt, sour, bitter, umami) collectively inform dietary patterns. Our aim was to examine the associations between a multivariable measure of taste perception—taste perception profiles—and empirically derived dietary patterns. The cohort included 367 community-dwelling adults (55–75 years; 55% female; BMI = 32.2 ± 3.6 kg/m²) with metabolic syndrome from PREDIMED-Plus, Valencia. Six taste perception profiles were previously derived via data-driven clustering (Low All, High Bitter, High Umami, Low Bitter and Umami, High All But Bitter, High All But Umami); three dietary patterns were derived via principal component analysis (% variance explained = 20.2). Cross-sectional associations between profiles and tertials of dietary pattern adherence were examined by multinomial logistic regression. Overall, there were several significant differences in dietary pattern adherence between profiles: the vegetables, fruits, and whole grains pattern was significantly more common for the High All But Umami profile (OR range for high vs. low adherence relative to other profiles (1.45–1.99; 95% CI minimum lower, maximum upper bounds: 1.05, 2.74), the non-extra virgin olive oils, sweets, and refined grains pattern tended to be less common for Low All or High Bitter profiles (OR range: 0.54–0.82), while the alcohol, salty foods, and animal fats pattern tended to be less common for Low Bitter and Umami and more common for High All But Bitter profiles (OR range: 0.55–0.75 and 1.11–1.81, respectively). In conclusion, among older adults with metabolic syndrome, taste perception profiles were differentially associated with dietary patterns, suggesting the benefit of integrating taste perception into personalized nutrition guidance.

Evolution of Nutritional Habits Behaviour of Spanish Population Confined Through Social Media

Introduction: In Spain, on 14 March 2020, a state of alarm is declared to face the health emergency situation caused by the COVID-19 coronavirus, limiting the freedom of movement of people. The Spanish population is confined. Objective: With this situation, "NUTRITIONAL HEALTH IS NOT CONFINED" arises a research project that seeks to promote nutritional education based on the pattern of the Mediterranean diet (MD) using new computer technologies. It is about providing the population with the information of general interest about the promotion of a healthy diet through social networks and analysing the impact of its dissemination, in the form of a longitudinal intervention study of the Spanish nutritional evolution during confinement, with a daily survey format, and it is intended to assess food consumption during the period of confinement. Materials and methods: In total, 936 participants were asked every day. Short publications were published every day based on the scientific evidence (FAO, WHO, AECOSAN) through social media such as Instagram, accompanied by a questionnaire of 11 questions (yes/no) where it was intended to assess the evolution of daily consumption. Results and Discussion: The diffusion through social media has allowed to have a greater reach of the population. We observed that mood throughout confinement generally improves. There are certain eating habits from the MD that are well established in the daily diet of our population, such as the consumption of fruits, vegetables, legumes, dairy products, and eggs. It seems that enjoying good health is a growing concern in pandemic situations, which is why inappropriate behaviours such as "snacking" between meals or the consumption of processed foods such as snacks, industrial pastries, soft drinks, and sweets are avoided, increasing the amount of healthy food such as meat and fish. This study opens up future avenues of research promoting MD and implements new cohort nutritional databases, especially about young adult people, who are adept at navigating digital spaces and therefore using social media.

Assessment of Spanish Food Consumption Patterns during COVID-19 Home Confinement

People's eating habits and lifestyle can have a negative impact on health. In situations of difficulty or socioeconomic crisis, these habits tend to be modified, leading to unhealthy dietary patterns that result in an increase of chronic non-communicable diseases (NCDs). Previous studies have indicated that, due to the state of alarm imposed in Spain to combat the spread of COVID-19, an increase in the purchase of non-core products occurred, along with a decrease in the daily physical activity of the population. This could be a risk factor for COVID-19 infection. The objective of this observational study was to analyze the dietary pattern of the Spanish population during home confinement and to compare it with the pattern of habitual consumption collected in the last National Health Survey, analyzing the possible changes. More than half of the respondents in the sample increased their consumption of sweets and snacks during confinement, while the consumption of fresh products decreased. Most claimed to be emotionally hungry, leading to an increase in their daily energy intake. The stress and anxiety generated by confinement could be the cause of the increased consumption of products rich in sugars and saturated fats, which are associated with greater stress and anxiety.

Dietary Patterns, Adherence to the Food-Based Dietary Guidelines, and Ultra-Processed Consumption During the COVID-19 Lockdown in a Sample of Spanish Young Population

Purpose: The aim of this study was to explore the dietary patterns, adherence to Food-Based Dietary Guidelines, and the ultra-processed consumption during the COVID-19 lockdown among a Spanish young population aged 3-17 years. Methods: Parents/legal guardians of preschoolers, children, and adolescents aged 3-17 years were enrolled through social networks. The eating habits were assessed by a Food Propensity Questionnaire applied in the ENALIA (Encuesta Nacional de Alimentación en la población Infantil y Adolescente) Spanish survey, which aims to collect food intake information and other data about eating habits on children and adolescents (0-18 years old). Participants were dichotomized following the Food-Based Dietary Guidelines for the Spanish young population offered by the Spanish Society of Community Nutrition. The ultra-processed food score was determined following the principles established in the NOVA classification. Results: Data from 604 children and adolescents were included. An association between age group and the recommendations of snacks (p = 0.002), fruits (p = 0.010), and diaries (p < 0.001) was found. Adolescents showed a lower mean compliance with these guidelines than children (p = 0.004) and preschoolers (p < 0.001). Similarly, children reported lower Food-Based Dietary Guidelines than preschoolers (p = 0.015). Regarding ultra-processed consumption, it was also observed a higher intake in adolescents than in children (p = 0.037), as well as in preschoolers (p < 0.001). Conclusions: The associations that were found highlight the low proportion of the young population (especially adolescents) meeting the Food-Based Dietary Guidelines and the high consumption of ultra-processed foods during COVID-19 lockdown.

Dietary Patterns, Eating Behavior, and Nutrient Intakes of Spanish Preschool Children with Autism Spectrum Disorders

Eating behavior problems are characteristic of children with autism spectrum disorders (ASD) with a highly restricted range of food choices, which may pose an associated risk of nutritional problems. Hence, detailed knowledge of the dietary patterns (DPs) and nutrient intakes of ASD patients is necessary to carry out intervention strategies if required. The present study aimed to determine the DPs and macro-and micronutrient intakes in a sample of Spanish preschool children with ASD compared to typically developing control children. Fifty-four children with ASD (two to six years of age) diagnosed with ASD according to the Diagnostic Manual-5 criteria), and a control group of 57 typically developing children of similar ages were recruited. A validated food frequency questionnaire was used, and the intake of energy and nutrients was estimated through three non-consecutive 24-h dietary registrations. DPs were assessed using principal component analysis and hierarchical clustering analysis. Children with ASD exhibited a DP characterized by high energy and fat intakes and a low intake of vegetables and fruits. Likewise, meat intake of any type, both lean and fatty, was associated with higher consumption of fish and dietary fat. Furthermore, the increased consumption of dairy products was associated with increased consumption of cereals and pasta. In addition, they had frequent consumption of manufactured products with poor nutritional quality, e.g., beverages, sweets, snacks and bakery products. The percentages of children with ASD complying with the adequacy of nutrient intakes were higher for energy, saturated fat, calcium, and vitamin C, and lower for iron, iodine, and vitamins of group B when compared with control children. In conclusion, this study emphasizes the need to assess the DPs and nutrient intakes of children with ASD to correct their alterations and discard some potential nutritional diseases.

Wine, Polyphenols, and Mediterranean Diets. What Else Is There to Say?

A considerable amount of literature has been published claiming the cardiovascular benefits of moderate (red) wine drinking, which has been considered a distinguishing trait of the Mediterranean diet. Indeed, red wine contains relevant amounts of polyphenols, for which evidence of their biological activity and positive health effects are abundant; however, it is also well-known that alcohol, even at a low level of intake, may have severe consequences for health. Among others, it is directly related to a number of non-communicable diseases, like liver cirrhosis or diverse types of cancer. The IARC classifies alcohol as a Group 1 carcinogen, causally associated with the development of cancers of the upper digestive tract and liver, and, with sufficient evidence, can be positively associated with colorectum and female breast cancer. In these circumstances, it is tricky, if not irresponsible, to spread any message on the benefits of moderate wine drinking, about which no actual consensus exists. It should be further considered that other hallmarks of the Mediterranean diet are the richness in virgin olive oil, fruits, grains, and vegetables, which are also good sources of polyphenols and other phytochemicals, and lack the risks of wine. All of these aspects are reviewed in this article.

Dietary Intake Adequacy and Food Sources of Nutrients Involved in the Methionine-Methylation Cycle in Women of Childbearing Age from the ANIBES Spanish Population

Growing evidence confirms choline as a critical perinatal nutrient. However, intake levels of choline and betaine among the Spanish fertile population remain unknown. Given their role in one-carbon metabolism with potential epigenetic effects, the aim of the present study was to evaluate the dietary intakes, their adequacy to existing guidelines and the main food sources together with other micronutrients involved in the methylation-methionine cycle (vitamin B₆, folates and vitamin B₁₂) in women of childbearing age. The ANIBES study, a cross-sectional study of a representative sample of women of childbearing age (18–45 years, n = 641) resident in Spain, was used. The sample was divided into younger women (18–30 years, n = 251) and older women (31–45 years, n = 390). Dietary intake was assessed by a three-day dietary record by using a tablet device. Total median intakes for the total sample were 303.9 mg/d for choline; 122.6 mg/d for betaine; 1.3 mg/d for vitamin B₆; 140.8 μg/d for folates, and 3.8 μg/d for vitamin B₁₂. The older subgroup showed significantly higher choline (p < 0.05), betaine (p < 0.001) and folates (p < 0.05) intakes than younger women. Main food sources for the whole sample were meat and meat products for choline (28.3%), vitamin B₆ (25.7%) and vitamin B₁₂ (22.8%); cereals and derivatives (79.9%) for betaine; vegetables (20.0%) for folates. Overall intake adequacy was only observed for vitamin B₁₂, with a very limited number of participants showing adequate intakes for all the other micronutrients. These results illustrate there is a relevant need to raise awareness about optimizing the status of the methionine cycle-related vitamins and cofactors in this potentially vulnerable population.

Association of Diet, Physical Activity Guidelines and Cardiometabolic Risk Markers in Children

The aim was to identify different dietary and physical activity (PA) patterns in 5- to 14-year-old children with a high prevalence of overweight and obesity using cluster analysis based on their adherence to the Spanish Society of Community Nutrition dietary guidelines and levels of PA, and to determine their associations with age, sex, body composition, and cardiometabolic risk markers. In 549 children, hierarchical cluster analysis was used to identify subgroups with similar adherence to dietary recommendations and level of PA. Three clusters were identified: Cluster 1, with the lowest level of vigorous PA and adherence to dietary recommendations; Cluster 2, with the lowest levels of moderate and vigorous PA and the highest adherence to dietary recommendations; and Cluster 3, with the highest level of PA, especially vigorous PA and a medium level adherence to dietary recommendations. Cluster 3 had lower total body fat and higher lean body mass percentages than Cluster 2. Cluster 2 had lower high-density lipoprotein cholesterol and higher low-density lipoprotein cholesterol levels than Cluster 1. The results from our study suggest that it is important to consider adherence to PA recommendations together with adherence to dietary guidelines to understand patterns of obesogenic habits in pediatric populations with high prevalence of overweight and obesity.

[Shapes or icons from the dietary guidelines. A reality going beyond healthy food]

BACKGROUND

icons or shapes represent the development and approval of dietary guidelines including recommendations of food consumption and nutrient intakes according to the behavioral models of countries worldwide. The Food and Agriculture Organization (FAO) collected and recognized them.

METHODS

websites of food-based dietary guidelines of the FAO. Websites of the different Spanish scientific societies that have elaborated and developed them, including the Mediterranean Diet Foundation.

RESULTS

in all, 94 countries are collected in the FAO food guidelines website, with predominant models of 33 diet plates and 51 food pyramids, emerging 11 as new graphics systems, that reflect, in addition to food: 52, physical activity; 63, water or hydration; 20, social and emotional values; and 13, reduction or elimination of alcoholic beverages.

CONCLUSIONS

the models with icons or shapes so far are consistent with the modes of distribution of food at meals and adapting to new criteria that include behavioral guidelines. New designs are incorporated that include food safety guidelines in generic graphic structures that do not represent any of the classic models: food plates or food pyramids.

Review: Trends for meat, milk and egg consumption for the next decades and the role played by livestock systems in the global production of proteins

Meeting the food demands of a growing global population within planetary boundaries is a challenge. Sustainably producing animal-sourced foods while supplying sufficient protein to meet the requirements of a healthy diet is a particular challenge. This paper informs the development of pathways to sustainable animal production by examining trends in animal-sourced foods since 2000, including the significance of animal- relative to plant-protein sources. Drawing on three distinct scenarios defined by the Food and Agriculture Organization (FAO), (i.e. Business As Usual (BAU), a continuation of historical trends of food preferences including initiatives to address Sustainable Development Goal targets; Stratified Societies (SSs), leaving challenges unattended; and Towards Sustainability (TS); a more equitable global society and more sustainable food system due to effective polices), future demand for animal-sourced foods is projected. Analysis is based on FAO Food Balance Sheet data (2000-2017) and projected national protein demand per capita (2012-2050). Analysis is disaggregated to five global regions defined by the World Health Organization. It finds that patterns of past demand for animal-sourced foods vary by food (e.g. red vs white meat) and region. However, the European region consistently has the highest levels of consumption of animal-sourced foods, while the South-East Asian and African regions have the lowest. The ratio of animal to plant-sourced protein varies across regions, ranging from 0.29 in Africa to 1.08 in Europe in 2017. Over time, the ratio is relatively stable or moderately increasing, driven by rising incomes in low- or middle-income countries. Under the future scenarios, all World Health Organization regions show a marked increase in demand for animal-sourced protein across BAU and SS. The TS scenario, however, projects notable declines in consumption across Europe and the Americas when compared to the 2012 BAU baseline, with a decline in milk also in the Western Pacific. In contrast, meat and milk consumption in Africa and South-East Asia is projected to increase, reflecting their far lower starting consumption levels. The analysis and subsequent discussion highlight the importance of having regional-specific strategies to deal with the challenge of sustainable livestock production and consumption, with a requirement to consider the impact of actions in one region on others. Clearly, the challenge is not merely one for science and technology but one based on wider aspects of the food system and its diverse stakeholders.

Body Composition, Dietary Intake and the Risk of Low Energy Availability in Elite-Level Competitive Rhythmic Gymnasts

The aim of this study was to analyze dietary intake and body composition in a group of elite-level competitive rhythmic gymnasts from Spain. We undertook body composition and nutritional analysis of 30 elite gymnasts, divided into two groups by age: pre-teen (9-12 years) (n = 17) and teen (13-18 years) (n = 13). Measures of height, weight, and bioimpedance were used to calculate body mass index and percent body fat. Energy and nutrient intakes were assessed based on 7-day food records. The two groups had similar percentages of total body fat (pre-teen: 13.99 ± 3.83% vs. teen: 14.33 ± 5.57%; p > 0.05). The energy availability values for pre-teens were above the recommended values (>40 kcal/FFM/day) 69.38 ± 14.47 kcal/FFM/day, while those for the teens were much lower (34.7 ± 7.5 kcal/FFM/day). The distribution of the daily energy intake across the macronutrients indicates that both groups ingested less than the recommended level of carbohydrates and more than the recommended level of fat. Very low intakes of calcium and vitamin D among other micronutrients were also noted. The main finding is that teenage gymnasts do not consume as much energy as they need each day, which explains their weight and development. Moreover, they are at a high risk of developing low energy availability that could negatively impact their performance and future health.

Impact of Portion Control Tools on Portion Size Awareness, Choice and Intake: Systematic Review and Meta-Analysis

Portion control utensils and reduced size tableware amongst other tools, have the potential to guide portion size intake but their effectiveness remains controversial. This review evaluated the breadth and effectiveness of existing portion control tools on learning/awareness of appropriate portion sizes (PS), PS choice, and PS consumption. Additional outcomes were energy intake and weight loss. Published records between 2006–2020 (n = 1241) were identified from PubMed and WoS, and 36 publications comparing the impact of portion control tools on awareness (n = 7 studies), selection/choice (n = 14), intake plus related measures (n = 21) and weight status (n = 9) were analyzed. Non-tableware tools included cooking utensils, educational aids and computerized applications. Tableware included mostly reduced-size and portion control/calibrated crockery/cutlery. Overall, 55% of studies reported a significant impact of using a tool (typically smaller bowl, fork or glass; or calibrated plate). A meta-analysis of 28 articles confirmed an overall effect of tool on food intake (d = –0.22; 95%CI: –0.38, –0.06; 21 comparisons), mostly driven by combinations of reduced-size bowls and spoons decreasing serving sizes (d = –0.48; 95%CI: –0.72, –0.24; 8 comparisons) and consumed amounts/energy (d = –0.22; 95%CI: –0.39, –0.05, 9 comparisons), but not by reduced-size plates (d = –0.03; 95%CI: –0.12, 0.06, 7 comparisons). Portion control tools marginally induced weight loss (d = –0.20; 95%CI: –0.37, –0.03; 9 comparisons), especially driven by calibrated tableware. No impact was detected on PS awareness; however, few studies quantified this outcome. Specific portion control tools may be helpful as potentially effective instruments for inclusion as part of weight loss interventions. Reduced size plates per se may not be as effective as previously suggested.

Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts

Adolescent high-performance gymnasts are considered to be at risk for low energy intake. The aim of the present study was to determine the effects of implementing a nutritional education program during the sports season on the nutritional status and nutrition knowledge of the female artistic gymnasts from the Technification Center of the Balearic Islands (n = 24; age, 14.1 ± 2.3 years). A quasi-experimental intervention design was applied, which consisted of implementing a nutritional education program of seven sessions given during eight months. Measurements of nutritional intake, nutrition knowledge, and anthropometric parameters, as well as hematological and biochemical blood parameters, were performed. Gymnasts reported low energy and carbohydrate intakes, with significant increases during the study (energy, 28.3 ± 1.4 vs. 32.8 ± 1.4 kcal kg⁻¹, p = 0.015, carbohydrate 3.2 ± 0.2 vs. 3.9 ± 0.2 g kg⁻¹, p = 0.004). The average values for parameters such as hemoglobin, ferritin, lipoprotein, and vitamin C and E levels in the plasma were within normal ranges. Low intakes of most of the food groups were observed during the study, with similar initial and final values. Nutrition knowledge did not change as a result of the study (28.0 ± 1.7 vs. 31.1 ± 1.3, p = 0.185). In conclusion, gymnasts reported low energy intakes. However, blood markers and most of the anthropometrical parameters measured were within normal ranges. The nutrition education program implemented did not produce significant improvements in the dietary habits or nutritional knowledge of gymnasts.

A New Food Composition Database of Lactose-Free Products Commercialized in Spain: Differences in Nutritional Composition as Compared to Traditional Products

We developed a new database to evaluate the nutritional composition of lactose-free products from Spain. The database includes dairy products and other products, all of which show the "lactose-free" declaration on their label, accounting for 327 products in total. Of these, 123 are dairy products, 16 are non-dairy products which include a dairy ingredient (5%) and 188 items (57% of the sample) are non-dairy products that do not contain any dairy ingredient. The main subgroups are yogurt (25%), milk (24%), and cheese (17%). Nineteen percent of the compiled products included nutritional claims on their labels. Most lactose-free products did not contain either added sugars or low- or no-calorie sweeteners (58%), while 34% included added sugars and only 6%, sweeteners or a combination of both (2%). We found that 19.5%, mainly within the milk subgroup, were fortified with vitamins A, D, E, K, B₉, and B₁₂, P, and Ca. There were no significant differences in the nutritional composition between lactose-free products and traditional products. According to the NOVA classification, 55% of compiled lactose-free products were ultra-processed, and 20% processed. The array of lactose-free products marketed in Spain proves that there are enough, both in quantity and quality, to satisfy the dairy needs of lactose intolerants.

Moderate Consumption of Beer and Its Effects on Cardiovascular and Metabolic Health: An Updated Review of Recent Scientific Evidence

There is growing interest in the potential health-related effects of moderate alcohol consumption and, specifically, of beer. This review provides an assessment of beer-associated effects on cardiovascular and metabolic risk factors to identify a consumption level that can be considered “moderate”. We identified all prospective clinical studies and systematic reviews that evaluated the health effects of beer published between January 2007 and April 2020. Five of six selected studies found a protective effect of moderate alcohol drinking on cardiovascular disease (beer up to 385 g/week) vs. abstainers or occasional drinkers. Four out of five papers showed an association between moderate alcohol consumption (beer intake of 84 g alcohol/week) and decreased mortality risk. We concluded that moderate beer consumption of up to 16 g alcohol/day (1 drink/day) for women and 28 g/day (1–2 drinks/day) for men is associated with decreased incidence of cardiovascular disease and overall mortality, among other metabolic health benefits.

Family Meals, Conviviality, and the Mediterranean Diet among Families with Adolescents

Two aspects that characterize the Mediterranean diet (MD) are "what" and "how" we eat. Conviviality relates to "how" we eat and to the pleasure of sharing meals with significant people. The most studied concept is "family meals", which includes conviviality, which involves "enjoying" family meals. Given the lack of research on convivial family meals in Mediterranean countries, the purpose of this qualitative study was to analyze the family meal representations and practices of families with 12- to 16-year-old adolescents to assess whether they responded to a pattern of conviviality, and to examine their association with MD adherence. Twelve semi-structured interviews were conducted and food frequency and family meal questionnaires were administered. A food pattern analysis was carried out and digital photos of meals were analyzed to examine eating habits and meal composition, respectively. The findings showed that parents believed family meals are a space for socialization and communication. Items relating to the conviviality of family meals identified in the study were meal frequency, meals at the table, lack of digital distractions, pleasant conversations, and time spent on family meals. Attention should be paid to conviviality in Mediterranean families when designing multi-approach strategies to promote healthy eating among adolescents.

Trends in Diet Quality and Related Sociodemographic, Health, and Occupational Characteristics among Workers in Spain: Results from Three Consecutive National Health Surveys (2006-2017)

Poor dietary practices are commonly reported in working populations from different economic sectors, resulting in increased absenteeism and a decrease in productivity. The aims of this study were to describe the frequency of food consumption and diet quality in workers aged ≥16 years from 2006 to 2017 in Spain and to evaluate the factors associated with diet quality. A nationwide cross-sectional study was carried out among workers using data from the Spanish National Health Surveys in 2006 (n = 11,068), 2011 (n = 7497) and 2017 (n = 8890). Sociodemographic, occupational, and health-related variables were used as well as diet quality data. A multiple linear regression was performed to determine the characteristics related to overall diet quality. The percentage of workers who consumed vegetables, at most, once or twice per week decreased from 2006 to 2017 (p < 0.001). A lower diet quality score was related to the consumption of tobacco and alcohol and being aged ≥25 years old, while a higher diet quality score was linked to being a woman, having Spanish nationality, receiving optimal perceived social support, being physically active in one's main occupation, doing leisure-time physical activity, and the type of contract.

Mediterranean Diet for the Prevention of Gestational Diabetes in the Covid-19 Era: Implications of Il-6 In Diabesity

The aim of this review is to highlight the influence of the Mediterranean Diet (MedDiet) on Gestational Diabetes Mellitus (GDM) and Gestational Weight Gain (GWG) during the COVID-19 pandemic era and the specific role of interleukin (IL)-6 in diabesity. It is known that diabetes, high body mass index, high glycated hemoglobin and raised serum IL-6 levels are predictive of poor outcomes in coronavirus disease 2019 (COVID-19). The immunopathological mechanisms of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection include rising levels of several cytokines and in particular IL-6. The latter is associated with hyperglycemia and insulin resistance and could be useful for predicting the development of GDM. Rich in omega-3 polyunsaturated fatty acids, vitamins, and minerals, MedDiet improves the immune system and could modulate IL-6, C reactive protein and Nuclear Factor (NF)-κB. Moreover, polyphenols could modulate microbiota composition, inhibit the NF-κB pathway, lower IL-6, and upregulate antioxidant enzymes. Finally, adhering to the MedDiet prior to and during pregnancy could have a protective effect, reducing GWG and the risk of GDM, as well as improving the immune response to viral infections such as COVID-19.