A brief assessment of eating habits and weight gain in a Mediterranean cohort

Individual and family predictors of ultra-processed food consumption in Spanish children: The SENDO project

BACKGROUND

Ultra-processed food (UPF) consumption is increasing exponentially, becoming a matter of concern for Public Health, given its adverse health effects.

OBJECTIVE

To identify individual and faGmily factors predicting UPF consumption in childhood.

DESIGN

The SENDO project is an ongoing prospective dynamic cohort of Spanish children. In this study, we used baseline information of participants recruited between January 2015 and June 2021. Dietary information was collected with a validated semi-quantitative FFQ, and food items were classified using the NOVA classification. Individual and family factors associated with UPF consumption (P < 0·20) in univariate analyses were introduced in a model of generalised estimating equations which accounted for intra-cluster correlations between siblings.

SETTING

The SENDO project (Spain), 2015-2021.

PARTICIPANTS

Spanish children are recruited at the age of 4-5 years and followed yearly through online questionnaires completed by parents.

RESULTS

In this sample of 806 participants (49 % girls; mean age 5 years (sd: 0·90)), the mean UPF consumption was 37·64 % of total energy intake (sd: 9·59). Large family size and longer exposure to screens predicted higher consumption of UPF. On the other hand, better knowledge of children's dietary recommendations, healthy dietary attitudes towards child's eating habits and longer breastfeeding were associated with lower consumption of UPF. All these factors accounted for approximately 16 % of the variability on the consumption of UPF in childhood.

CONCLUSION

Since most of the factors identified in this study are modifiable, they should be considered in public health strategies aimed at promoting healthy dietary habits in early life.

Parental perception of child's weight, their attitudes towards child's dietary habits and the risk of obesity

BACKGROUND

The association between parental perception of child's weight and their attitudes towards his/her dietary habits has not been reported yet. This study aimed to assess the association between parental underestimation of child's weight and parental attitudes towards child's dietary habits.

METHODS

We conducted a cross-sectional analysis of SENDO cohort participants recruited between January 2015 and June 2020. All information was collected through online questionnaires completed by parents. We calculated crude and multivariable-adjusted odds ratio (OR) and 95% confidence intervals (CI) for unhealthy attitudes towards child's dietary habits associated with parental underestimation of child's weight.

RESULTS

Sixteen percent of children in the SENDO project had parents who underestimated their weight. Parents who underestimated their child's weight status were more likely to have unhealthy attitudes toward his/her dietary habits [OR 3.35; 95% CI (1.71-6.53)].

CONCLUSIONS

Parental underestimation of child's weight was associated with unhealthy attitudes towards child's dietary habits. Pediatricians and public health practitioners should pay attention to the parental perception of child's weight to identify parents who underestimate it as an at-risk group in which to inquire about lifestyle and dietary habits.

Initial impact of the COVID-19 pandemic on college student mental health: A longitudinal examination of risk and protective factors

The spread of the novel coronavirus has led to unprecedented changes in daily living. College students (N = 205) completed a battery of questionnaires in April of 2020, after having completed similar measures 8, 5, and 2 months prior as part of a larger study. A repeated measures ANOVA suggested significantly greater depression and anxiety symptom severity during the pandemic than any other time during the 2019-2020 academic year. Two-thirds reported a level of distress above clinical cutoffs on the PHQ-9 and GAD-7. Pre-existing depression and anxiety symptom severity was associated with greater psychological distress during the pandemic. One quarter of students reported using substances to cope with the pandemic. Static and modifiable factors associated with psychological distress and controlling for pre-existing psychological distress were examined. Cognitive and behavioral avoidance, online social engagement, and problematic Internet use were associated with greater risk. Women and Latinx participants were more likely to experience elevated distress during the pandemic, even when controlling for distress prior to the pandemic.

Healthy-eating attitudes and the incidence of cardiovascular disease: the SUN cohort

There is an emerging use of brief dietary questionnaires to investigate diet-health relation. We prospectively assess the association between eating attitudes (yes/no) and incident cardiovascular disease (CVD) in 19,138 participants of the Seguimiento Universidad de Navarra (SUN) Cohort. We calculated a baseline healthy-eating attitudes score (in quartiles), positively weighting answers on more fruit, vegetables, fish and fiber and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. We observed 139 incident cases of CVD. A higher score was associated with a lower risk of CVD [3-5 points Hazard Ratio (HR): 0.38 (95% confidence interval: 0.18-0.81); 6-8 points: 0.57 (0.29-1.12); 9-10 points: 0.31 (0.15-0.67), compared to 0-2 points]. Key contributors were the attitude to increase fruit [HR: 0.59 (0.40-0.87)], vegetables [HR: 0.57 (0.29-1.12)] and fiber intake [HR: 0.69 (0.48-0.98)]. Brief questionnaire on attitudes towards healthy-eating may be a useful tool for the primary prevention of CVD.

Ultraprocessed food consumption and risk of overweight and obesity: the University of Navarra Follow-Up (SUN) cohort study

BACKGROUND

Ultraprocessed food consumption has increased in the past decade. Evidence suggests a positive association between ultraprocessed food consumption and the incidence of overweight and obesity. However, few prospective studies to our knowledge have investigated this potential relation in adults.

OBJECTIVE

We evaluated the association between ultraprocessed food consumption and the risk of overweight and obesity in a prospective Spanish cohort, the SUN (University of Navarra Follow-Up) study.

DESIGN

We included 8451 middle-aged Spanish university graduates who were initially not overweight or obese and followed up for a median of 8.9 y. The consumption of ultraprocessed foods (defined as food and drink products ready to eat, drink, or heat and made predominantly or entirely from processed items extracted or refined from whole foods or synthesized in the laboratory) was assessed with the use of a validated semiquantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted HRs and 95% CIs for incident overweight and obesity.

RESULTS

A total of 1939 incident cases of overweight and obesity were identified during follow-up. After adjustment for potential confounders, participants in the highest quartile of ultraprocessed food consumption were at a higher risk of developing overweight or obesity (adjusted HR: 1.26; 95% CI: 1.10, 1.45; P-trend = 0.001) than those in the lowest quartile of consumption.

CONCLUSIONS

Ultraprocessed food consumption was associated with a higher risk of overweight and obesity in a prospective cohort of Spanish middle-aged adult university graduates. Further longitudinal studies are needed to confirm our results. This trial was registered at clinicaltrials.gov as NCT02669602.

A pharmacokinetic analysis and dietary information are necessary to confirm or reject the hypothesis on persistent organic pollutants causing type 2 diabetes

A number of studies have found an association between the concentrations of persistent organic pollutants (POP) and type 2 diabetes. Causality has remained uncertain. This study describes the pharmacokinetic behavior of PCDD/Fs (polychlorinated dibenzo-p-dioxins and dibenzofurans) both in a theoretical model based on elimination rate constants, and in a group of 409 adult surgical patients with known PCDD/F concentrations and dietary information. A model assuming 10% annual decrease in past PCDD/F intake, predicted the measured profile of TEQ (toxic equivalents) in the patient population fairly well. The dominant determinant of PCDD/F level was age, and the level in patients was also associated with consumption of animal source products. Predicted daily intakes correlated with diet, but also with body mass index (BMI), indicating that high BMI was preceded by high consumption of foods containing PCDD/Fs. The results suggest that a third factor, e.g. high intake of animal source foods, could explain both higher levels of POPs in the body and higher incidence of type 2 diabetes, and BMI is not sufficient in describing the confounding caused by diet. Thus, to fully address the causality between POPs and type 2 diabetes, careful studies considering the pharmacokinetics of the studied compounds, and including the analysis of food consumption, are needed.

Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality

BACKGROUND

Dietary guidelines recommend avoiding foods high in saturated fat. Yet, emerging evidence suggests cardiometabolic benefits of dairy products and dairy fat. Evidence on the role of butter, with high saturated dairy fat content, for total mortality, cardiovascular disease, and type 2 diabetes remains unclear. We aimed to systematically review and meta-analyze the association of butter consumption with all-cause mortality, cardiovascular disease, and diabetes in general populations.

METHODS AND FINDINGS

We searched 9 databases from inception to May 2015 without restriction on setting, or language, using keywords related to butter consumption and cardiometabolic outcomes. Prospective cohorts or randomized clinical trials providing estimates of effects of butter intake on mortality, cardiovascular disease including coronary heart disease and stroke, or diabetes in adult populations were included. One investigator screened titles and abstracts; and two reviewed full-text articles independently in duplicate, and extracted study and participant characteristics, exposure and outcome definitions and assessment methods, analysis methods, and adjusted effects and associated uncertainty, all independently in duplicate. Study quality was evaluated by a modified Newcastle-Ottawa score. Random and fixed effects meta-analysis pooled findings, with heterogeneity assessed using the I2 statistic and publication bias by Egger's test and visual inspection of funnel plots. We identified 9 publications including 15 country-specific cohorts, together reporting on 636,151 unique participants with 6.5 million person-years of follow-up and including 28,271 total deaths, 9,783 cases of incident cardiovascular disease, and 23,954 cases of incident diabetes. No RCTs were identified. Butter consumption was weakly associated with all-cause mortality (N = 9 country-specific cohorts; per 14g(1 tablespoon)/day: RR = 1.01, 95%CI = 1.00, 1.03, P = 0.045); was not significantly associated with any cardiovascular disease (N = 4; RR = 1.00, 95%CI = 0.98, 1.02; P = 0.704), coronary heart disease (N = 3; RR = 0.99, 95%CI = 0.96, 1.03; P = 0.537), or stroke (N = 3; RR = 1.01, 95%CI = 0.98, 1.03; P = 0.737), and was inversely associated with incidence of diabetes (N = 11; RR = 0.96, 95%CI = 0.93, 0.99; P = 0.021). We did not identify evidence for heterogeneity nor publication bias.

CONCLUSIONS

This systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality, CVD, and diabetes. These findings do not support a need for major emphasis in dietary guidelines on either increasing or decreasing butter consumption, in comparison to other better established dietary priorities; while also highlighting the need for additional investigation of health and metabolic effects of butter and dairy fat.

Ageing, arterial blood pressure, body mass index, and diet

For three decades we followed up for longevity indicators, including diet, arterial blood pressure, and body mass index 379 mobile, long-living persons from Croatia, now aged 70 to 92 years, of whom 167 men aged (78.6 ± 4.0) years and 212 women aged (77.9 ± 4.1) years. One hundred and ninety-five were from the continental and 184 from the coastal Croatia. The participants were examined in 1972, 1982, and again in 2006/7. Changes in body mass index (BMI), arterial blood pressure (ABP), and in answers to our Food Frequency Questionnaire about dietary habits were analysed using log-linear models. Over the last 24 years of aging (age 55 to 78 years) the subjects showed a statistically significant decrease in body mass and height and a significant increase in the systolic blood pressure. Diastolic blood pressure and BMI showed no significant changes over this period. Consumption of preserved and fresh meat, bread, and starch (potato, pastry and rice) dropped significantly with age, while the consumption of fish, fresh and cooked vegetables, fruit, and dairy products significantly increased. These dietary changes were not associated with changes in the systolic and diastolic ABP. About 80 % were overweight (BMI >25 kg m(-2)) throughout the follow-up, even though their body mass dropped significantly after the age of 55. However, their survival suggests that BMI may not be the best indicator of longevity or healthy aging.

Obesity-related eating behaviours in the adult population of Spain, 2008-2010

Knowledge of the socio-demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross-sectional study assessed the frequency of self-reported eating behaviours among 11,603 individuals representative of the non-institutionalized Spanish population aged ≥ 18 years in the period 2008-2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three-fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age- and sex-adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08-1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30-1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47-0.63). In conclusion, the prevalence of several obesity-related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.