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Jobet Bustos E, Loyola Alegría MI, Ortiz Castro C, Rigotti A, Echeverría G, Mallea C, Barja S. [Improvement in adherence to Mediterranean diet in children attending preschool centers]. NUTR HOSP 2024; 41:58-68. [PMID: 38095069 DOI: 10.20960/nh.04727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Introduction Background: the Mediterranean diet has been associated with a lower prevalence of obesity and metabolic syndrome, and with healthier lifestyles in adults and children, but data is scarce in younger ages. The Mediterranean-type ecosystem of the central region of Chile as well as its traditional gastronomy would facilitate the adoption of this dietary pattern. Objectives: to assess the adherence to Mediterranean diet in preschoolers and their parents, and to evaluate the impact of a nutrition education intervention and diet implementation. Methods: prospective cohort study. The KidMed index was applied to children older than 18 months, and the Mediterranean Dietary Index in Chile (Chilean-MDI) to their parents, before and after a remote educational intervention. Results: one hundred and thirty-nine families participated, with 95 preschoolers; 56 % were girls, aged 26.2 ± 8.7 months. The basal mean KidMed score was 7.4 ± 1.9 and increased to 7.9 ± 1.9 after the intervention (p = 0.1). The Chilean-MDI score was 6.9 ± 1.8 and 7.1 ± 1.7, respectively (p = 0.09). When separated by categories, there was improvement from low and moderate adherence to optimal adherence in both children and their parents (Chi2, p = 0.009 y p = 0.04). In 58 dyads, there was a positive correlation between the KidMed and the Chilean-MDI index, pre- and post-intervention (Pearson R = 0.3 y 0.34; p = 0.004 y 0.003, respectively). Conclusions: most of these sample of preschoolers and their parents had a moderate adherence to Mediterranean diet, with an improvement after an educational intervention.
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Affiliation(s)
- Emilia Jobet Bustos
- Programa de Pediatría. Escuela de Medicina. Pontificia Universidad Católica de Chile
| | | | | | - Attilio Rigotti
- Departamento de Nutrición, Diabetes y Metabolismo. Centro de Nutrición Molecular y Enfermedades Crónicas. Facultad de Medicina. Pontificia Universidad Católica
| | - Guadalupe Echeverría
- Centro de Nutrición Molecular y Enfermedades Crónicas, y Departamento de Nutrición, Diabetes y Metabolismo. Escuela de Medicina. Universidad Católica de Chile
| | - Claudia Mallea
- .Centro de Nutrición Molecular y Enfermedades Crónicas. Facultad de Medicina. Pontificia Universidad Católica de Chile
| | - Salesa Barja
- Departamento de Gastroenterología Pediátrica y Nutrición. Facultad de Medicina. Pontificia Universidad Católica de Chile.Hospital Josefina Martínez
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2
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López-Gil JF, García-Hermoso A, Sotos-Prieto M, Cavero-Redondo I, Martínez-Vizcaíno V, Kales SN. Mediterranean Diet-Based Interventions to Improve Anthropometric and Obesity Indicators in Children and Adolescents: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2023; 14:858-869. [PMID: 37127186 PMCID: PMC10334150 DOI: 10.1016/j.advnut.2023.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023] Open
Abstract
To our knowledge, no systematic review with meta-analysis has separately synthesized the effects of Mediterranean diet-based interventions in children and adolescents in relation to the effects on anthropometric measures. A better understanding of the effects of Mediterranean diet-based interventions on anthropometric variables could facilitate their implementation in efforts to prevent obesity in the young population. The aim of the present meta-analysis was to evaluate the effects of Mediterranean diet-based interventions on anthropometric and obesity indicators among children and adolescents. Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews), including all studies up until 15 March, 2023. Eligible articles were randomized controlled trials measuring the effect of an intervention based on the promotion of the Mediterranean diet and obesity-associated parameters. The effect size of each study was estimated by Cohen's d for continuous variables or risk difference for categorical variables. Compared to the control group, the Mediterranean diet-based interventions showed small and significant reductions in body mass index (d = -0.14; 95% CI: -0.26, -0.01; I2 = 77.52%). Participants in the Mediterranean diet-based interventions had a significant reduction in the percentage of obesity (risk difference = 0.12; 95% CI: 0.01, 0.23; I2 = 84.56%) in comparison with the control group. Interventions had greater effects when aiming at participants with excess weight (that is, overweight or obesity), both for body mass index, waist circumference, waist-to-height ratio, percentage of obesity, and percentage of abdominal obesity. Mediterranean diet-based interventions have a significant effect on reducing the body mass index as well as reducing obesity in children and adolescents (aged 3-18 y). This trial was registered at PROSPERO as CRD42023386789.
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Affiliation(s)
- José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States; One Health Research Group, Universidad de Las Américas, Quito, Ecuador.
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra, Spain
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; IMDEA-Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
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Maffeis C, Olivieri F, Valerio G, Verduci E, Licenziati MR, Calcaterra V, Pelizzo G, Salerno M, Staiano A, Bernasconi S, Buganza R, Crinò A, Corciulo N, Corica D, Destro F, Di Bonito P, Di Pietro M, Di Sessa A, deSanctis L, Faienza MF, Filannino G, Fintini D, Fornari E, Franceschi R, Franco F, Franzese A, Giusti LF, Grugni G, Iafusco D, Iughetti L, Lera R, Limauro R, Maguolo A, Mancioppi V, Manco M, Del Giudice EM, Morandi A, Moro B, Mozzillo E, Rabbone I, Peverelli P, Predieri B, Purromuto S, Stagi S, Street ME, Tanas R, Tornese G, Umano GR, Wasniewska M. The treatment of obesity in children and adolescents: consensus position statement of the Italian society of pediatric endocrinology and diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery. Ital J Pediatr 2023; 49:69. [PMID: 37291604 DOI: 10.1186/s13052-023-01458-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/18/2023] [Indexed: 06/10/2023] Open
Abstract
This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.
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Affiliation(s)
- Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Francesca Olivieri
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy.
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, Naples, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, Department of Health Science, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Maria Rosaria Licenziati
- Department of Neurosciences, Neuro-Endocrine Diseases and Obesity Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, Milan, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Gloria Pelizzo
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Mariacarolina Salerno
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Annamaria Staiano
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Raffaele Buganza
- Pediatric Endocrinology Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
| | - Francesca Destro
- Department of Pediatric Surgery, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, S. Maria Delle Grazie Hospital, Naples, Pozzuoli, Italy
| | - Mario Di Pietro
- Pediatric and Neonatal Unit, Hospital of Teramo and Atri, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Luisa deSanctis
- Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionan Area, University of Bari, Bari, Italy
| | | | - Danilo Fintini
- Refernce Center for Prader Willi Syndrome, Endocrinology and Diabetology Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Elena Fornari
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | | | - Francesca Franco
- Pediatric Department, Azienda Sanitaria Universitaria del Friuli Centrale, Hospital of Udine, Udine, Italy
| | - Adriana Franzese
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Lia Franca Giusti
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Lucca, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Lera
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Alessandria, Italy
| | | | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Valentina Mancioppi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | | | - Anita Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Verona, Italy
| | - Beatrice Moro
- UOSD Diabetology, Complesso Ai Colli, AULSS 6 Euganea, Padua, Italy
| | - Enza Mozzillo
- Department of Traslational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Paola Peverelli
- Department of Pediatrics and Gynecology, Hospital of Belluno, Belluno, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefano Stagi
- Department of Health Sciences, University of Florence, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Maria Elisabeth Street
- Department of Medicine and Surgery, Unit of Paediatrics, University of Parma, University Hospital of Parma, Parma, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
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4
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Herrera-Ramos E, Tomaino L, Sánchez-Villegas A, Ribas-Barba L, Gómez SF, Wärnberg J, Osés M, González-Gross M, Gusi N, Aznar S, Marín-Cascales E, González-Valeiro MÁ, Terrados N, Tur JA, Segú M, Fitó M, Homs C, Benavente-Marín JC, Labayen I, Zapico AG, Sánchez-Gómez J, Jiménez-Zazo F, Alcaraz-Ramón PE, Sevilla-Sanchez M, Pulgar-Muñoz S, Bouzas C, Sistac-Sorigué C, Schröder H, Serra-Majem L. Trends in Adherence to the Mediterranean Diet in Spanish Children and Adolescents across Two Decades. Nutrients 2023; 15:nu15102348. [PMID: 37242233 DOI: 10.3390/nu15102348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/28/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Unhealthy dietary habits determined during childhood may represent a risk factor to many of the chronic non-communicable diseases (NCDs) in adulthood. Mediterranean Diet (MD) adherence in children and adolescents (8-16 years) living in Spain was investigated using the KIDMED questionnaire in a comparative analysis of two cross-sectional nationwide representative studies: enKid (1998-2000, n = 1001) and PASOS (2019-2020, n = 3540). Taking into account the educational level of pupils, as well as the characteristics of the place of living, a significant association was found between a KIDMED score ≥ 8 (optimal MD adherence) and primary education as well as residency in an area of <50,000 inhabitants, while living in the southern regions was associated with non-optimal MD adherence (p < 0.001). Participants of the 2019-2020 study showed an increase in the consumption of dairy products (31.1% increase), pasta/rice (15.4% increase), olive oil (16.9% increase), and nuts (9.7% increase), as well as a decreased sweets and candies intake (12.6% reduction). In contrast, a significantly lower MD adherence was found when comparing the 2019-2020 (mean ± SE: 6.9 ± 0.04) and the 1998-2000 study (7.37 ± 0.08); p < 0.001), due to less consumption of fish (20.3% reduction), pulse (19.4% reduction), and fruits (14.9% reduction), and an increased intake of commercial goods/pastries or fast-food intake (both 19.4% increase). The lowest adherence was recorded for adolescents also in the most recent study, where 10.9% of them presented a KIDMED score ≤ 3. This study shows that eating habits are deteriorating among Spanish children and adolescents. Such findings point out the urgency of undertaking strong measures to promote the consumption of healthy, sustainable, and non-ultra-processed food, such as those available in an MD, not only at a scientific and academic level, but also at a governmental one.
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Affiliation(s)
- Estefanía Herrera-Ramos
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Laura Tomaino
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Almudena Sánchez-Villegas
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- IS-FOOD-Institute for Sustainability & Food Chain Innovation, Universidad Pública de Navarra (UPNA), IDISNA, 31006 Pamplona, Spain
| | - Lourdes Ribas-Barba
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Fundación para la Investigación Nutricional (FIN), Barcelona Science Park, 08028 Barcelona, Spain
| | - Santiago F Gómez
- Gasol Foundation, Sant Boi de Llobregat, 08830 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- GREpS, Health Education Research Group, Nursing and Physiotherapy Department, University of Lleida, 25008 Lleida, Spain
| | - Julia Wärnberg
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, 29590 Málaga, Spain
| | - Maddi Osés
- IS-FOOD-Institute for Sustainability & Food Chain Innovation, Universidad Pública de Navarra (UPNA), IDISNA, 31006 Pamplona, Spain
| | - Marcela González-Gross
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politecnica de Madrid, 28003 Madrid, Spain
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Susana Aznar
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha-Toledo Campus, 45071 Toledo, Spain
- Biomedical Research Networking Center on Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
| | - Elena Marín-Cascales
- Research Center for High Performance Sport, Catholic University of Murcia, 30107 Murcia, Spain
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
| | | | - Nicolás Terrados
- Regional Unit of Sports Medicine-Municipal Sports Foundation of Avilés, 33402 Avilés, Spain
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Josep A Tur
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, IUNICS, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IDISBA), 07122 Palma de Mallorca, Spain
| | - Marta Segú
- Probitas Foundation, 08022 Barcelona, Spain
| | - Montserrat Fitó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Clara Homs
- Gasol Foundation, Sant Boi de Llobregat, 08830 Barcelona, Spain
- Global Research on Wellbeing (GroW), Faculty of Health Sciences, Blanquerna Ramon Llull University, 08025 Barcelona, Spain
| | - Juan Carlos Benavente-Marín
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- EpiPHAAN Research Group, School of Health Sciences, Instituto de Investigación Biomédica en Málaga (IBIMA), University of Málaga, 29590 Málaga, Spain
| | - Idoia Labayen
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- IS-FOOD-Institute for Sustainability & Food Chain Innovation, Universidad Pública de Navarra (UPNA), IDISNA, 31006 Pamplona, Spain
| | - Augusto G Zapico
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politecnica de Madrid, 28003 Madrid, Spain
- Department of Language, Arts and Physical Education, Universidad Computense de Madrid, 28040 Madrid, Spain
| | - Jesús Sánchez-Gómez
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Fabio Jiménez-Zazo
- PAFS Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha-Toledo Campus, 45071 Toledo, Spain
| | - Pedro Emilio Alcaraz-Ramón
- Research Center for High Performance Sport, Catholic University of Murcia, 30107 Murcia, Spain
- Facultad de Deporte, UCAM Universidad Católica de Murcia, 30107 Murcia, Spain
| | - Marta Sevilla-Sanchez
- Faculty of Sports Sciences and Physical Education, Universida de da Coruña, 15001 A Coruña, Spain
| | - Susana Pulgar-Muñoz
- Regional Unit of Sports Medicine-Municipal Sports Foundation of Avilés, 33402 Avilés, Spain
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Cristina Bouzas
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Research Group of Community Nutrition & Oxidative Stress, IUNICS, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IDISBA), 07122 Palma de Mallorca, Spain
| | | | - Helmut Schröder
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, 28029 Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Lluis Serra-Majem
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Preventive Medicine Service, Canarian Health Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), 35016 Las Palmas de Gran Canaria, Spain
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5
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Rico-Sapena N, Galiana-Sánchez ME, Moncho J. Validation of a Questionnaire of Food Education Content on School Catering Websites in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3685. [PMID: 35329372 PMCID: PMC8954418 DOI: 10.3390/ijerph19063685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
The aim of this study was to design and validate a questionnaire on quality and food education on catering company websites. For the validation of the questionnaire, its reliability, feasibility and content validity characteristics were determined. For content validity, a panel of experts was used and the overall and item-wise Content Validity Index (CVI) of the experts' responses was calculated. Reliability was determined by the inter-judge agreement method with the analysis of 30 websites using the intraclass correlation coefficient (ICC) and the Bland and Altman plot. Adequate content validity was verified by obtaining a very high CVI (above 0.80) in the analysis of the expert panel's responses and excellent inter-observer agreement with a very high global ICC (above 0.90) value in the determination of test-retest reliability. The questionnaire is a valid instrument for the evaluation of the quality of school catering websites and their content in food education, as it has good feasibility, high content validity and excellent reliability.
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Affiliation(s)
- Nuria Rico-Sapena
- Unidad Técnica Agroalimentaria, Departamento Servicio Territorial de Agricultura de Alicante, Dirección Territorial de Alicante—Consejería de Agricultura, Desarrollo Rural, Emergencia Climática y Transición Ecológica, 03690 Alicante, Spain;
| | - María Eugenia Galiana-Sánchez
- Balmis Research Group in History of Science, Health Care and Food, NISALdes, University of Alicante, 03009 Alicante, Spain
| | - Joaquín Moncho
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain;
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6
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Lassale C, Fitó M, Morales-Suárez-Varela M, Moya A, Gómez SF, Schröder H. Mediterranean diet and adiposity in children and adolescents: A systematic review. Obes Rev 2022; 23 Suppl 1:e13381. [PMID: 34816577 DOI: 10.1111/obr.13381] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023]
Abstract
Our aim was to summarize, through a systematic review, the current evidence from dietary intervention and observational studies on the impact of adherence to the Mediterranean diet on adiposity markers and obesity in children and adolescents. We searched Medline up to June 1, 2021 for the identification of intervention and observational studies meeting the inclusion criteria, following the PRISMA statement. We included 55 articles: 8 intervention studies and 47 observational studies. Three trials report a beneficial effect of the dietary intervention, whereas two did not, and three did not compare with a control. All observational studies were cross-sectional, and only five studies also included a longitudinal analysis. More than half of the cross-sectional studies found no significant association between adherence to Mediterranean diet and adiposity. Three out of the five longitudinal studies found a negative association. The majority of both observational and intervention studies was of low quality. Despite a large number of published studies, overall, there is only limited evidence of a beneficial effect of following a traditional Mediterranean diet to maintain a healthy body weight in childhood. More high-quality intervention and longitudinal data are needed to form the base of large-scale health programs to prevent childhood obesity.
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Affiliation(s)
- Camille Lassale
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Montserrat Fitó
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - María Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Andrés Moya
- CIBER of Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,Institute of Integrative Systems Biology, Universitat de València and Spanish Research Council (CSIC), Valencia, Spain.,Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Santiago F Gómez
- Gasol Foundation, Sant Boi de Llobregat, Spain.,GREpS, Health Education Research Group, Nursing and Physiotherapy Department, University of Lleida, Lleida, Spain
| | - Helmut Schröder
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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7
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Mediterranean diet adherence amongst adolescents in North Lebanon: the role of skipping meals, meals with the family, physical activity and physical well-being. Br J Nutr 2021; 128:1349-1356. [PMID: 34266518 DOI: 10.1017/s0007114521002269] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Mediterranean diet (MD) is a model of a healthy diet and healthy lifestyle. Adherence to the MD has been correlated with a reduction in many metabolic disorders including cancers. The factors associated with adolescents' adherence to the MD in North Lebanon using the KIDMED index have never been explored. Therefore, we thought to examine these factors amongst a sample of them. A cross-sectional survey was conducted in the city of Tripoli, North Lebanon. A total of 798 adolescents aged 11-18 years were randomly selected to participate in this study. All participants completed a questionnaire assessing adherence to the MD (KIDMED index), physical activity (physical activity questionnaires for older children and adolescents), health-related quality of life (KIDSCREEN-27 index) and sociodemographic characteristics (age, sex, grade level and parents' educational status). Anthropometric measurements, including weight, height and waist circumference, were also collected. Adherence to the MD was good amongst only 13·3 % of the adolescents. The prevalence rate of overweight and obesity was elevated, affecting 36·9 % of the students. Lower adherence to the MD was significantly correlated with skipping meals (P = 0·001). Meanwhile, adolescents who were engaged in a high level of physical activity, those who consumed more meals with their families and those who benefited from better physical well-being had a better diet quality (P < 0·001). Nutrition intervention programmes, as well as public health policies, would be of interest in order to improve diet quality amongst Lebanese adolescents.
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8
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Maiz E, Urkia-Susin I, Urdaneta E, Allirot X. Child Involvement in Choosing a Recipe, Purchasing Ingredients, and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:279-289. [PMID: 33573994 DOI: 10.1016/j.jneb.2020.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment. DESIGN Quasi-experimental. SETTING Two schools in Bilbao, Spain. PARTICIPANTS A total of 202 children (aged 8-9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group. INTERVENTION Three 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities. MAIN OUTCOME MEASURES Food neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches. ANALYSIS Chi-square test of independence, ANCOVA, and t tests were performed. RESULTS Students from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups. CONCLUSIONS AND IMPLICATIONS Both interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.
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Affiliation(s)
- Edurne Maiz
- Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Guipúzcoa, Spain; BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain.
| | - Iratxe Urkia-Susin
- BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain; Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Álava, Spain
| | - Elena Urdaneta
- BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain; Euskampus, Cooperative Innovation, Leioa, Vizcaya, Spain
| | - Xavier Allirot
- BCCInnovation, Technological Center of Gastronomy, Paseo Juan Avelino Barriola, Donostia-San Sebastián, Guipúzcoa, Spain
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9
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Vilca-Cáceres VA, Gómez-Pacco NL, Vargas Callo WDR. Calidad nutricional y niveles de aceptabilidad de productos innovados con base a pescado: empanizados y kamaboko. JOURNAL OF THE SELVA ANDINA RESEARCH SOCIETY 2020. [DOI: 10.36610/j.jsars.2020.110200153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents: Randomised clinical trial. ENFERMERIA CLINICA 2020; 31:51-56. [PMID: 32299659 DOI: 10.1016/j.enfcli.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 02/09/2020] [Accepted: 03/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyse the impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents. METHOD Randomised clinical trial (RCT), controlled with a multimodal educational intervention (control group [n=36] and experimental group [n=46]). Data collection at the beginning and end of the study, in teenagers from Cáceres, Spain. In both groups anthropometric measurements and sociodemographic data were determined. The quality of the Mediterranean diet was assessed through the KIDMED test, the degree of physical activity through the PAQ-A questionnaire and weight status with the growth charts of the Faustino Orbegozo Eizaguirre Foundation. RESULTS We obtained a significant increase in the experimental group in the PAQ-A questionnaire that assesses physical activity (P=.029). No significant differences were observed between groups in the weight status (P=.916). When comparing the quality of the Mediterranean diet (high vs moderate or low quality) with physical activity (Pcontrol=.730; experimental P=.495) and with weight status (Pcontrol=.838; experimental P=.372), No significant differences are observed. CONCLUSIONS The educational intervention did not improve the quality of the Mediterranean diet or physical activity, although most of our sample had normal weight and acceptable physical activity. We must continue to improve the healthy eating pattern of our adolescents, to ensure an adequate state of health in the future.
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11
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Rico-Sapena N, Galiana-Sanchez ME, Bernabeu-Mestre J, Trescastro-López EM, Vasallo JM. [Effects of an alternative program to promote healthy eating in school canteen]. CIENCIA & SAUDE COLETIVA 2019; 24:4071-4082. [PMID: 31664380 DOI: 10.1590/1413-812320182411.02482018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/04/2018] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to determine the effects on school feeding habits in an educational intervention alternative to the conventional model of feeding promotion to a center with school canteens and ecological garden project. Cross-sectional and comparative descriptive observational study of 111 boys and girls between 9 and 12 years old, in the 2013-15 period. A school with alternative intervention was compared with another one that only included contents of the Infant and Primary Education curriculum, by means of evaluation of adherence to the mediterranean diet of the students with a validated Kidmed questionnaire. The intervention center presented greater adherence to the mediterranean diet than the control center. In the intervention center, the percentage of students with optimal diet (64.52%) was higher than those who needed to improve their diet (33.87%), contrary to what occurs in control center (42.86% and 51.02% respectively). The students of the intervention center presented a higher percentage of affirmative answers in Kidmed test. The program of promotion of healthy alternative food of the intervention center could be effective for the acquisition of a diet of greater adherence to the mediterranean diet.
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Affiliation(s)
- Nuria Rico-Sapena
- Universitat d'Alacant. Carretera Sant Vicent del Raspeig s/n, Sant Vicent del Raspeig. 03690. Alicante, Espanha.
| | | | - Josep Bernabeu-Mestre
- Universitat d'Alacant. Carretera Sant Vicent del Raspeig s/n, Sant Vicent del Raspeig. 03690. Alicante, Espanha.
| | - Eva Maria Trescastro-López
- Universitat d'Alacant. Carretera Sant Vicent del Raspeig s/n, Sant Vicent del Raspeig. 03690. Alicante, Espanha.
| | - Joaquín Moncho Vasallo
- Universitat d'Alacant. Carretera Sant Vicent del Raspeig s/n, Sant Vicent del Raspeig. 03690. Alicante, Espanha.
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12
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Grammatikopoulou MG, Gkiouras K, Daskalou E, Apostolidou E, Theodoridis X, Stylianou C, Galli-Tsinopoulou A, Tsigga M, Dardavessis T, Chourdakis M. Growth, the Mediterranean diet and the buying power of adolescents in Greece. J Pediatr Endocrinol Metab 2018; 31:773-780. [PMID: 29856727 DOI: 10.1515/jpem-2018-0039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022]
Abstract
Background The aim of the present cross-sectional study was to evaluate associations between pocket money, Mediterranean diet (MD) adherence and growth among Greek adolescents. Methods A total of 319 (157 boys and 162 girls) Greek adolescents, aged 10-18 years participated in the study. Pocket money was recorded, MD adherence was assessed with the KIDMED score and growth was evaluated using the World Health Organization (WHO) growth charts. Results Participants receiving pocket money exceeding 6.0€ daily demonstrated increased fast-food consumption and breakfast skipping. Overall, a negative relationship was revealed between pocket money and obesity. However, lower allowance receivers were less likely to be obese, consume fruit per day and more likely to consume breakfast and sweets, compared to average pocket money receivers. Increased MD adherence was associated with a lower risk of overweight and as expected, unhealthy eating habits were observed among obese adolescents. Conclusions Interrelationships tend to exist between MD adherence, pocket money and growth among adolescents.
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Affiliation(s)
- Maria G Grammatikopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Laboratory of Nutrition, Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Laboratory of Nutrition, Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece.,Laboratory of Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratia Daskalou
- Laboratory of Nutrition, Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Eirini Apostolidou
- Laboratory of Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Theodoridis
- Department of Medicine, School of Health Sciences, University of Thessaly, Larisa, Greece
| | - Charilaos Stylianou
- Pediatric Endocrinology Unit, Paphos General Hospital, Paphos, Cyprus.,Fourth Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- Fourth Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Maria Tsigga
- Laboratory of Nutrition, Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Theodore Dardavessis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece, Phone: +30 2310999035, Fax: +30 2312205270
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13
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Chiavaroli L, Kendall CWC, Braunstein CR, Blanco Mejia S, Leiter LA, Jenkins DJA, Sievenpiper JL. Effect of pasta in the context of low-glycaemic index dietary patterns on body weight and markers of adiposity: a systematic review and meta-analysis of randomised controlled trials in adults. BMJ Open 2018; 8:e019438. [PMID: 29615407 PMCID: PMC5884373 DOI: 10.1136/bmjopen-2017-019438] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Carbohydrate staples such as pasta have been implicated in the obesity epidemic. It is unclear whether pasta contributes to weight gain or like other low-glycaemic index (GI) foods contributes to weight loss. We synthesised the evidence of the effect of pasta on measures of adiposity. DESIGN Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. DATA SOURCES MEDLINE, Embase, CINAHL and the Cochrane Library were searched through 7 February 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trials ≥3 weeks assessing the effect of pasta alone or in the context of low-GI dietary patterns on measures of global (body weight, body mass index (BMI), body fat) and regional (waist circumference (WC), waist-to-hip ratio (WHR), sagittal abdominal diameter (SAD)) adiposity in adults. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% CIs. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). GRADE assessed the certainty of the evidence. RESULTS We identified no trial comparisons of the effect of pasta alone and 32 trial comparisons (n=2448 participants) of the effect of pasta in the context of low-GI dietary patterns. Pasta in the context of low-GI dietary patterns significantly reduced body weight (MD=-0.63 kg; 95% CI -0.84 to -0.42 kg) and BMI (MD=-0.26 kg/m2; 95% CI -0.36 to -0.16 kg/m2) compared with higher-GI dietary patterns. There was no effect on other measures of adiposity. The certainty of the evidence was graded as moderate for body weight, BMI, WHR and SAD and low for WC and body fat. CONCLUSIONS Pasta in the context of low-GI dietary patterns does not adversely affect adiposity and even reduces body weight and BMI compared with higher-GI dietary patterns. Future trials should assess the effect of pasta in the context of other 'healthy' dietary patterns. TRIAL REGISTRATION NUMBER NCT02961088; Results.
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Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine R Braunstein
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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