Impact of mediterranean diet promotion on environmental sustainability: a longitudinal analysis

OBJECTIVE

This article aims to estimate the differences in environmental impact (greenhouse gas [GHG] emissions, land use, energy used, acidification and potential eutrophication) after one year of promoting a Mediterranean diet (MD).

METHODS

Baseline and 1-year follow-up data from 5800 participants in the PREDIMED-Plus study were used. Each participant's food intake was estimated using validated semi-quantitative food frequency questionnaires, and the adherence to MD using the Dietary Score. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The association between MD adherence and its environmental impact was calculated using adjusted multivariate linear regression models.

RESULTS

After one year of intervention, the kcal/day consumed was significantly reduced (-125,1 kcal/day), adherence to a MD pattern was improved (+0,9) and the environmental impact due to the diet was significantly reduced (GHG: -361 g/CO2-eq; Acidification:-11,5 g SO2-eq; Eutrophication:-4,7 g PO4-eq; Energy use:-842,7 kJ; and Land use:-2,2 m2). Higher adherence to MD (high vs. low) was significantly associated with lower environmental impact both at baseline and one year follow-up. Meat products had the greatest environmental impact in all the factors analysed, both at baseline and at one-year follow-up, in spite of the reduction observed in their consumption.

CONCLUSIONS

A program promoting a MD, after one year of intervention, significantly reduced the environmental impact in all the factors analysed. Meat products had the greatest environmental impact in all the dimensions analysed.

Health-related quality of life and mortality in the 'Seguimiento Universidad de Navarra' prospective cohort study

OBJECTIVE

To study the association between health-related quality of life (HRQoL) and all-cause mortality in a healthy middle-aged Mediterranean cohort.

METHODS

We included 15,390 participants -mean age 42.8 years at first HRQoL ascertainment, all university graduates-. HRQoL was assessed with the self-administered Medical Outcomes Study Short Form-36 (SF-36) twice, with a 4-year gap. We used multivariable-adjusted Cox regression models to address the relation between self-reported health and Physical or Mental Component Summary (PCS-36 or MCS-36) and mortality, and their interaction with prior comorbidities or adherence to the Mediterranean diet (MedDiet).

RESULTS

Over 8.7 years of median follow-up time, 266 deaths were identified. Hazard ratio (HR) for the excellent vs. poor/fair category in self-reported health was 0.30 (95 % confidence interval (CI), 0.16-0.57) in the model with repeated measurements of HRQoL. Both the PCS-36 (HRquartile4(Q4)vs.Q1 0.57 [95%CI, 0.36-0.90], ptrend < 0.001; HRper+10points: 0.64 [95%CI, 0.54-0.75]) and the MCS-36 (HRQ4vs.Q1 0.67 [95%CI, 0.46-0.97], ptrend = 0.025; HRper+10points: 0.86 [95%CI, 0.74-0.99]) were inversely associated with mortality in the model with repeated measurements of HRQoL. Previous comorbidities or adherence to the MedDiet did not modify these associations.

CONCLUSIONS

Self-reported HRQoL -assessed as self-reported health, PCS-36 and MCS-36- obtained with the Spanish version of the SF-36 were inversely associated with mortality risk, regardless of the presence of previous comorbidities or adherence to the MedDiet.

The risk of incident depression when assessed with the Lifestyle and Well-Being Index

OBJECTIVES

Novel findings indicate links between unhealthy lifestyles and depression based on active inflammatory processes. Thus, identifying participants with poor habits could reveal differences in trends of incident depression. This study aimed to examine the association between an objective lifestyle assessment, as measured by the Lifestyle and Well-Being Index (LWB-I), and incident depression in healthy participants of a Spanish cohort.

STUDY DESIGN

This was a longitudinal analysis of a subsample of 10,063 participants from the Seguimiento Universidad de Navarra cohort study.

METHODS

Group comparisons and Cox proportional hazard models were conducted using the LWB-I, which categorizes the sample into groups with healthy and unhealthy lifestyles and well-being. The main outcome was incident depression as well as secondary outcomes.

RESULTS

Those classified to the transition category of LWB-I were associated with a hazard ratio of 0.67 (95% confidence interval: 0.52-0.87), and those in the excellent category showed a hazard ratio of 0.44 (95% confidence interval: 0.33-0.58), which in both groups reflects a significantly lower risk of incident depression compared with the group including those classified in the poor LWB-I level. Moreover, the available sensitivity analyses concerning time of depression diagnosis or antidepressant treatment further supported the role of nutrition and physical activity on incident depression. Interestingly, throughout the follow-up, incident depression was inversely related to healthier daily habits as measured by the LWB-I.

CONCLUSIONS

A global assessment of lifestyles such as the LWB-I provides valuable insight into the complex relationship between lifestyle factors and their link to depression risk.

Depression and metabolic syndrome in participants of the "Seguimiento Universidad de Navarra" (SUN) cohort study

BACKGROUND

Depression is a major public health concern worldwide and its association with metabolic syndrome (MetS) remains unclear. Thus, we prospectively examined the association between depression and the risk of MetS, according to different diagnosis criteria.

METHODS

This study included 9,237 participants of a Spanish dynamic prospective cohort of adult university graduates [mean (SD) age: 36.7 year (10.7)], initially free of any specific criterion of MetS, who were followed-up for a median of 8.3 years. The exposure variables were medical diagnosis of depression at baseline or in the first 2-year follow-up questionnaire. The outcome variable was the incidence of MetS, assessed according to each of three different criteria proposed by: International Diabetes Federation (IDF); National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III); IDF/NCEP-ATP III (updated harmonizing definition). Multivariable-adjusted Relative Risks (RR) of new-onset MetS and their 95% Confidence Intervals (95% CI) were estimated, using Poisson regression models.

RESULTS

The cumulative incidences of MetS were 475 cases (IDF definition), 288 cases (NCEP-ATP III definition) and 492 cases (update harmonized definition). No association was observed between baseline depression and incidence of MetS, but the presence of depression after 2-years of follow-up was significantly associated with a higher risk of new-onset MetS, according to NCEP-ATP III definition (multivariable-adjusted RR, 2.46; 95% CI, 1.06-5.67).

LIMITATIONS

Diagnosis of depression and MetS were self-reported.

CONCLUSIONS

In this large prospective cohort of Spanish middle-aged adult university graduates, a direct association between depression and the risk of MetS according to NCEP-ATP III definition was found.

Estimation of the age of majority through radiographic evaluation of the third molar maturation degree

Background

Although the third molar is the tooth with the greatest anatomical and developmental variability, some authors consider it important to estimate whether a subject is of legal age or not. The Demirjian’s technique is the most widely used tool to estimate dental age and was therefore used in our study to assess possible correlation between the age of majority and the maturational degree of the lower third molars, evaluated through radiographic images.

Material and Methods

This observational transversal study was conducted on 180 panoramic radiographs from consecutive patients. The degree of maturation of the lower third molar was independently classified by two observers, according to the Demirjian´s maturational stage method.

Results

A total of 180 patients – 65 men (36.12%) and 115 women (63.88%) – were included (mean age 21.6 years; standard deviation 5.2). The age range of our subjects corresponded to maturational stages D to H in the Demirjian’s classification. A logistic regression analysis showed that subjects classified into the highest maturational stage H had a significantly higher probability of being considered of legal age by both observers, as compared with subjects in the lowest stage D. Inter-observer agreement was very high. Gender predictive capacity was not observed.

Conclusions

Our results showed that subjects with the lower third molars in the highest maturational stage could be estimated to be older than 18 years and therefore considered of legal age, a finding also reported by other authorsThe Demirjian´s tooth maturational stage method, applied to the lower third molars, can be reliably used to estimate whether an individual is of legal age (18 years or older). High concordance between different observers using this method can be expected.

Key words:Age estimation, third molar development, panoramic radiographs, Demirjian’s method, dental age estimation, forensic odontology.

Preventing the recurrence of depression with a Mediterranean diet supplemented with extra-virgin olive oil. The PREDI-DEP trial: study protocol

BACKGROUND

The role of dietary patterns in the prevention of unipolar depression has been analyzed in several epidemiological studies. The primary aims of this study are to determine the effectiveness of an extra-olive oil-enriched Mediterranean diet in reducing the recurrence of depression and improving the symptoms of this condition.

METHODS

Multicenter, two-arm, parallel-group clinical trial. Arm 1, extra-virgin olive oil Mediterranean diet; Arm 2, control group without nutritional intervention. Dieticians are in charge of the nutritional intervention and regular contact with the participants. Contacts are made through our web platform ( https://predidep.es/participantes/ ) or by phone. Recurrence of depression is assessed by psychiatrists and clinical psychologists through clinical evaluations (semi-structured clinical interviews: Spanish SCID-I). Depressive symptoms are assessed with the Beck Depression Inventory. Information on quality of life, level of physical activity, dietary habits, and blood, urine and stool samples are collected after the subject has agreed to participate in the study and once a year.

DISCUSSION

To the best of our knowledge, the PREDI-DEP trial is the first ongoing randomized clinical trial designed to assess the role of the Mediterranean diet in the prevention of recurrent depression. It could be a cost-effective approach to avoid recurrence and improve the quality of life of these patients.

TRIAL REGISTRATION

The study has been prospectively registered in the U.S. National Library of Medicine ( https://clinicaltrials.gov ) with NCT number: NCT03081065.

The influence of obesity and weight gain on quality of life according to the SF-36 for individuals of the dynamic follow-up cohort of the University of Navarra

BACKGROUND

The health-related quality of life is an important element for the comprehensive assessment of overweight and obesity.

OBJECTIVE

To assess the impact of obesity and weight gain on the health-related quality of life of the dynamic cohort of the Follow-up Program of the University of Navarra.

MATERIAL AND METHODS

The analysis included 10,033 participants of the prospective dynamic cohort of the Follow-up Project of the University of Navarra, with a response rate of approximately 90%. The quality of life was measured with the Short Form 36 Health Survey (SF-36) (0, worst quality of life; 100, best quality of life). The statistical analysis was performed with generalized lineal models (mean of each SF-36 domain and 95% CI). A difference of 3 points was considered clinically relevant.

RESULTS

The SF-36 analysis showed that physical function, general health and the physical component summary were inferior in individuals with excess weight and obesity at the start of the study, compared with individuals with normal weight. The study population with unchanged excess weight or obesity after 2 years of follow-up presented lower scores on the SF-36 domains corresponding to physical function, body pain, physical component summary and general health than individuals who maintained the normal weight category according to BMI (kg/m²).

CONCLUSIONS

Obesity appears to be associated with a negative impact on health-related quality of life, affecting the physical area more significantly than the psychosocial.

Self-perceived level of competitiveness, tension, and dependency and lifestyles in the 'Seguimiento Universidad de Navarra' cohort study

OBJECTIVE

The objective of this study is to assess the differences in lifestyles according to levels of self-perceived competitiveness, psychological tension, and dependency in a Mediterranean cohort of university graduates.

STUDY DESIGN

Levels of personality traits, food consumption, nutrient intake, eating attitudes, physical activity, sedentary lifestyle, and alcohol and tobacco consumption were assessed through a questionnaire administered at baseline. This was a cross-sectional study in the context of the Seguimiento Universidad de Navarra cohort. Participants are 15,346 Spanish adults.

RESULTS

Participants with a high level of self-perceived competitiveness consumed more vegetables and fish but less refined grains; they had higher protein intake and healthier eating attitudes. They were more physically active and less likely to be smokers. Participants with a high level of tension or dependency were less physically active, and participants more dependent also had poorer adherence to the Mediterranean diet.

CONCLUSIONS

Self-perceived personality traits, especially the trait of competitiveness, are likely to be associated with healthier dietary patterns, better nutrient profile, better eating attitudes, physical activity, and less exposure to smoking. The use of short questions about self-perceived levels of competitiveness, psychological tension, and dependency can contribute to add additional information when assessing lifestyles and diet in adults.

Effect of Zinc Intake on Growth in Infants: A Meta-analysis

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on growth in infants. Out of 5500 studies identified through electronic searches and reference lists, 19 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on growth was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status, and risk of bias. From each select growth study, final measures of weight, length, mid upper arm circumference (MUAC), head circumference, weight for age z-score (WAZ), length for age z-score (LAZ), and weight for length z-score (WLZ) were assessed. Pooled β and 95% confidence interval (CI) were calculated. Additionally, we carried out a sensitivity analysis. Zn intake was not associated with weight, length, MUAC, head circumference, and LAZ in the pooled analyses. However, Zn intake had a positive and statistically effect on WAZ (β = 0.06; 95%CI 0.02 to 0.10) and WLZ (β = 0.05; 95%CI 0.01 to 0.08). The dose-response relationship between Zn intake and these parameters indicated that a doubling of Zn intake increased WAZ and WLZ by approximately 4%. Substantial heterogeneity was present only in length analyses (I(2) = 45%; p = 0.03). Zn intake was positively associated with length values at short time (four to 20 weeks) (β = 0.01; CI 95% 0 to 0.02) and at medium doses of Zn (4.1 to 8 mg/day) (β = 0.003; CI 95% 0 to 0.01). Nevertheless, the effect magnitude was small. Our results indicate that Zn intake increases growth parameters of infants. Nonetheless, interpretation of these results should be carefully considered.

Weight status of European preschool children and associations with family demographics and energy balance-related behaviours: a pooled analysis of six European studies

This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4-7 years); (ii) identify energy balance-related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in prevalence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long-term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers.

Adherence to the Mediterranean diet and quality of life in the SUN Project

BACKGROUND/OBJECTIVES

Mediterranean diet has been related with reduced morbidity and better well-being. The aim of this study was to assess whether the adherence to the Mediterranean diet were associated with mental and physical health related to quality of life.

SUBJECTS/METHODS

This analysis included 11 015 participants with 4 years of follow-up in the SUN Project (a multipurpose cohort study based on university graduates from Spain). A validated 136-item food frequency questionnaire was used to assess the adherence to the Mediterranean diet at baseline, according to a nine-point score, presented in four categories (low, low-moderate, moderate-high and high). Health-related quality of life (HRQL) was measured after 4 years of follow-up with the Spanish version of the SF-36 Health Survey. Generalized Linear Models were fitted to assess adjusted mean scores, the regression coefficients (β) and their 95% confidence intervals (95% CIs) for the SF-36 domains according to categories of adherence to Mediterranean diet.

RESULTS

Multivariate-adjusted models revealed a significant direct association between adherence to Mediterranean diet and all the physical and most mental health domains (vitality, social functioning and role emotional). Vitality (β=0.50, 95% CI=0.32-0.68) and general health (β=0.45, 95% CI=0.26-0.62) showed the highest coefficients. Mean values for physical functioning, role physical, bodily pain, general health and vitality domains were significantly better with increasing adherence to the Mediterranean diet. Those having improved their initial high diet scores have better scores in physical functioning, general health and vitality.

CONCLUSIONS

Adherence to the Mediterranean diet seems to be a factor importantly associated with a better HRQL.

Association between folate, vitamin B(6) and vitamin B(12) intake and depression in the SUN cohort study

BACKGROUND

An association between low blood levels of folate, vitamins B(6) and B(12) and a higher prevalence of depressive symptoms has been reported in several epidemiological studies. The present study aimed to assess the association between folate, vitamins B(6) and B(12) intake and depresion prevalence in the SUN cohort study.

METHODS

The study comprised a cross-sectional analysis of 9670 participants. A validated semi-quantitative food frequency questionnaire was used to ascertain vitamin intake. The association between the baseline intake of folate, vitamins B(6) and B(12) categorised in quintiles and the prevalence of depression was assessed. The analyses were repeated after stratifying by smoking habits, alcohol intake, physical activity and personality traits.

RESULTS

Among women, odds ratios (OR) [95% confidence interval (CI)] for the third to fifth quintile for vitamin B(12) intake were 0.58 (0.41-0.84), 0.56 (0.38-0.82) and 0.68 (0.45-1.04), respectively. Among those men with a low level of anxiety and current smokers, a significant positive association between low folate intake and the prevalence of depression was found. The OR (95% CI) for the first quintile of intake was 2.85 (1.49-5.45) and 2.18 (1.08-4.38), respectively, compared to the upper quintiles of intake (Q2-Q5) considered as a group.

CONCLUSION

Low folate intake was associated with depression among currently smoking men and men with low anxiety levels. Low intake of vitamin B(12) was associated with depression among women. No significant associations were found for vitamin B(6) intake.

Mediterranean diet and depression

OBJECTIVE

The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of B vitamins and w-3 fatty acids. A protective role on depression has been suggested for both nutrients.

DESIGN

Cross-sectional analysis from the SUN (Seguimiento Universidad de Navarra) prospective cohort study. Data from 9670 participants (4211 men and 5459 women) were analised. Logistic regression analyses were fitted to assess the association between B-vitamins and w-3 fatty acids intake (quintiles) and the prevalence of depression.

RESULTS

Folate intake was inversely associated with depression prevalence among men, especially smokers. Among women, B12 vitamin intake was inversely associated with depression, especially among smokers and physically active women. No significant associations were observed for w-3 fatty acids intake.

CONCLUSIONS

The adherence to a Mediterranean Dietary Pattern ensures an adequate intake of fruits, nuts, vegetables, cereals, legumes or fish, important sources of nutrients linked to depression prevention.

Validity of self reported diagnoses of cancer in a major Spanish prospective cohort study

INTRODUCTION

This study aims to assess the validity of self reported diagnoses of cancer by persons recruited for the Spanish EPIC (European prospective investigation into cancer and nutrition) cohort study and to identify variables associated with correctly reporting a diagnosis of cancer.

METHODS

41 440 members of EPIC were asked at the time of recruitment whether they had been diagnosed with cancer and the year of diagnosis and site. The process of validating self reported diagnoses of cancer included comparison of the cohort database with the data from the population based cancer registries. Cancer diagnostic validity tests were calculated. The association between a correct report and certain sociodemographic, tumour related, or health related variables were analysed by logistic regression.

RESULTS

The overall sensitivity of self reported diagnoses of cancer is low (57.5%; 95% CI: 51.9 to 63.0), the highest values being shown by persons with a higher level of education or with a family history of cancer and the lowest values by smokers. Breast and thyroid cancers are those with the highest diagnostic validity and uterus, bladder, and colon-rectum those with the lowest. In both sexes the variables showing a significant association with a correct report of cancer are: higher education level, number of previous pathologies, invasive tumour, and, in women, a history of gynaecological surgery.

CONCLUSIONS

The overall sensitivity of self reported diagnoses of cancer is comparatively low and it is not recommended in epidemiological studies for identifying tumours. However, self reported diagnoses might be highly valid for certain tumour sites, malignant behaviour, and average to high levels of education.

Olive oil consumption and weight change: The SUN prospective cohort study

The aim of this dynamic prospective follow-up study was to assess the association between olive oil consumption and the likelihood of weight gain or the incidence of overweight or obesity in a large Mediterranean cohort of 7,368 male and female Spanish university graduates (the SUN Project) who were followed for a median period of 28.5 mon. A validated Food Frequency Questionnaire was administered at baseline, and respondents also completed a follow-up questionnaire after 28.5 mon. Changes in participants' consumption of olive oil and their weight were assessed during follow-up. A higher baseline consumption of olive oil was associated with a lower likelihood of weight gain, although the differences were not statistically significant. The adjusted difference in weight gain (kg) was -0.16 [95% confidence interval (CI): -0.42 to +0.11] for participants in the upper quintile of olive oil consumption (median: 46 g/d) compared with those in the lowest quintile (median: 6 g/d). For participants with a high baseline consumption of olive oil whose olive oil consumption also increased during follow-up, we found a slightly increased but nonsignificant risk of incidence of overweight or obesity (adjusted odds ratio = 1.19, 95% CI: 0.73 to 1.95). Our study, carried out in a sample of free-living people, shows that a high amount of olive oil consumption is not associated with higher weight gain or a significantly higher risk of developing overweight or obesity in the context of the Mediterranean food pattern.

Adherence to a Mediterranean dietary pattern and weight gain in a follow-up study: the SUN cohort

INTRODUCTION

The promotion of Mediterranean Diets has generated some doubts, because of the concern that its high fat content might lead to the development of obesity.

METHODS

Longitudinal analysis of 6319 participants in the SUN cohort study. We used a validated semiquantitative food frequency questionnaire (136 items). Baseline adherence to a Mediterranean dietary pattern (MDP) was assessed using a score (score_1) including vegetables, fruits, cereals, nuts, pulses, fish, olive oil and moderate consumption of red wine (positively weighted), whereas meat and dairy products were negatively weighted. We assessed the association between the overall baseline adherence to the MDP (score_1) and subsequent weight change after 28 months of follow-up. We also built another score (score_2) to assess changes in diet during follow-up and appraised the association between the joint exposure to both scores and weight change during follow-up.

RESULTS

Participants in the first quartile of score_1 (lowest baseline adherence to MDP) showed a higher weight gain (+0.73 kg) than those in the top quartile (+0.45 kg). The results indicated an inverse dose-response relationship (P for trend = 0.016). A similar inverse association was apparent when we used change in adherence to the MDP (score_2). However, both inverse associations did not remain statistically significant after adjusting for relevant confounders. Consumption of dairy products was inversely associated with weight gain.

CONCLUSIONS

Although participants increased their average weight during the follow-up period, weight increments were smaller among those with a higher adherence to an 'a priori' defined MDP. Results did not remain statistically significant after multivariate adjustment.

Disparities in food habits in Europe: systematic review of educational and occupational differences in the intake of fat

BACKGROUND

A higher socio-economic level is associated with healthier dietary habits. Nevertheless, socio-economic differences in the intake of fat have not consistently been reported in Europe. The objective of our study was to systematically assess differences in total fat (TF) intake and saturated fat (SF) intake across social groups.

METHODS

Representative samples from nine European countries were used to perform a meta-analysis of surveys between 1985-1999, including both published and nonpublished results.

RESULTS

Because important heterogeneity was found and the estimates for TF from Spain and Estonia were different from all others, we calculated the differences in intake excluding these two countries. We found a lower TF intake in the highest (versus the lowest) occupational level both for men (difference: -1.1% of total energy intake; 95% CI: -1.3 to -0.8%) and women (difference: -0.9%; 95% CI: -1.2 to -0.6%) when Estonia and Spain were excluded.

CONCLUSION

European surveys indicate that people in the lowest category of occupation consume more fat and SF than people in the highest category.

[Attitudes and practices regarding physical activity: situation in Spain with respect to the rest of Europe]

AIM

To identify attitudes and practices in the Spanish population regarding physical activity, and to compare the situation in Spain with that of other member stages of the European Union (EU).

DESIGN

Descriptive, cross-sectional study.

SETTING

European Union (representative samples of all 15 member stages). Participants. From each member stage we obtained a representative sample of approximately 1000 subjects older than 15 years. A total of 15 239 individuals were asked to complete a questionnaire on attitudes regarding physical activity, body weight and health. Main measures. We classified participants into 6 possible stades of change toward physical activity, and subsequently regrouped them into static (precontemplation and relapse) and dynamic stages (contemplation, decision, action and maintenance). Multivariate analysis with unconditional logistic regression was used to determine which sociodemographic variables were related with static stages.

RESULTS

Static stages of change were more prevalent in Spain than in the rest of the EU. Spanish participants of both sexes who had received primary education, were married, were smokers or were obese were more likely to be in a static stage with regard to physical activity.

CONCLUSIONS

The proportion of Spaniards with a poor attitude toward changing their level of physical activity was higher than in the rest of the EU, and Spanish citizens were less perseverant in achieving positive changes.

Gender, age, socio-demographic and lifestyle factors associated with major dietary patterns in the Spanish Project SUN (Seguimiento Universidad de Navarra)

OBJECTIVE

To ascertain the major dietary patterns in the cohort 'SUN' and to assess the association of several sociodemographic (including age and gender) and lifestyle variables with the adherence to these dietary patterns.

DESIGN

This study is a cross-sectional analysis of 3847 subjects (1587 men and 2260 women) belonging to a prospective cohort study based on self-reported questionnaires. A factor analysis based on 30 predefined food groups was conducted to ascertain the major dietary patterns in the cohort. Multiple regression models were fitted to assess the relationship between several sociodemographic and lifestyle variables and the adherence to these dietary patterns (measured using two scores with observed values ranging from -3.2 to +4.6 for the Western pattern and -3.1 to +5.5 for the Mediterranean pattern).

RESULTS

Two major dietary patterns were found. The first pattern was labelled as a 'Western' dietary pattern and the other as a 'Spanish-Mediterranean' dietary pattern. Younger subjects were more likely to follow a 'Western' dietary pattern; the coefficient representing the change for every 10 y increase in age was b=-0.24 (P<0.001) for men and b=-0.12 (P<0.001) for women. More physically active subjects were less likely to follow a 'Western' dietary pattern and more likely to follow a 'Spanish-Mediterranean' dietary pattern.

CONCLUSIONS

An association between a higher level of physical activity during leisure time and adherence to a 'Spanish-Mediterranean' diet was apparent. However, the profile of being a young, sedentary and single male was identified as the most likely to exhibit a departure from the traditional 'Spanish-Mediterranean' diet and follow a 'Western' dietary pattern.

Determinants of the adherence to an "a priori" defined Mediterranean dietary pattern

BACKGROUND

A prospective cohort study with university level participants was initiated to study the effect of Mediterranean diet on health.

AIMS

The objective of this study was to identify possible lifestyle and socioeconomic variables associated with the consumption of a Mediterranean dietary pattern (MDP).

METHOD

This analysis includes 1587 males and 2260 females. MDP was defined "a priori" by summing the standardized residuals of nutrients and foods after adjusting a regression model using total energy intake as the independent variable. Multiple regression and non-parametric locally weighted regression models were adjusted with the relative adherence to the MDP as the dependent variable in males and females.

RESULTS

Women were more compliant than men with the MDP (Coefficient regression (b) = 4.1; Confidence Interval (CI) 95 % = 3.2 to 4.9). The compliance with the MDP was significantly poorer among younger participants both in men and women (p < 0.001 in men and in women). Participants who were more physically active were more likely to fulfill the traditional MDP (p = 0.01 in men and p < 0.001 in women).

CONCLUSIONS

Our findings provide evidence supporting the progressive departure from the traditional MDP in younger and highly educated subjects of the Mediterranean area. A more active life-style is associated with a better compliance with the MDP.

[The Mediterranean diet and cardiovascular disease: results of a pilot study from the SUN project (University of Navarre Follow-Up Study)]

BACKGROUND

The Mediterranean diet has been postulated as a model for the prevention of coronary heart disease. The SUN project ("Seguimiento Universidad de Navarra") is an epidemiological prospective cohort study of University of Navarre alumni started in 2000 with the main objective of identifying dietary and non-dietary determinants of these disorders. The feasibility of the project was verified in a two-phase pilot study.

METHOD

Volunteers participated in the first phase of the pilot study. Dietary and non-dietary exposures were measured using self-administered questionnaires and interview. A random sample of 600 graduates was selected for the second phase of the pilot study. The selected alumni received a questionnaire by mail. The 10th, 25th, 50th, 75th and 90th percentiles were calculated for the consumption of each food item or nutrient to estimate the inter-subject variability.

RESULTS

The participants understood and answered the questionnaires properly. The mean time spent in completing the questionnaire was 55 minutes (95% CI: 50.7-59.3). A wide inter-subject variability was found in the consumption of food items considered as more representative of the Mediterranean diet (olive oil, fruits, vegetables and wine) with major differences between the 10th and 90th percentile. A Mediterranean diet pattern was found with a wide inter-subject variability.

CONCLUSIONS

The response rate was acceptable. This finding is likely to ensure the identification of associations between the consumption of given food items and the occurrence of the main outcomes we are targeting.

Perception of body image as indicator of weight status in the European union

OBJECTIVE

To identify the factors associated with an adequate perception of body image in relation to body weight.

MATERIAL AND METHODS

An observational, cross-sectional study was conducted in a representative sample of the European Union (7,155 men and 8,077 women). Body Mass Index (BMI) was grouped into four categories, perceived body image was assessed using the nine silhouettes drawing scheme. A multivariable logistic regression model for each sex was used to adjust for potentially confounding variables.

RESULTS

Underweight men and women classified themselves better than other groups (92.9% of correct answers among men and 79.3% among women). Overall, women classified themselves better than men (57.6% vs. 32.7%).

DISCUSSION

Perceived body image as a method of assessment for body weight has different validity depending on sociodemographic or attitudinal categories. Perceived body image as an estimate of the nutritional status has a limited individualized application. Thus, perhaps it could be applied as a proxy measure of adiposity among slim males and among slim and overweight females, but not among the other groups.

Underestimation of body mass index through perceived body image as compared to self-reported body mass index in the European Union

An observational, cross-sectional study was conducted in a representative sample of the European Union (7155 men and 8077 women) to calculate the underestimation of body weight as assessed by body image among the overweight and obese population and identify the associated factors to this behavior. Participants were older than 15 years and they were living in the 15 European Union countries. Body mass index (BMI) was grouped into 4 categories using the cutpoints established by the WHO, while perceived body image (PBI) was assessed using a nine-silhouettes drawing. The degree of underestimation between PBI as compared to BMI was identified in overweight and obesity categories of BMI. A multivariable logistic regression model for each gender was used to adjust for potentially confounding variables. Men classified themselves worse than women, being more likely to underestimate their body weight (65.2% of men underestimated their weight vs 32.2% women), regardless of other socioeconomic and attitudinal variables. The greatest degree of underestimation was observed in Mediterranean individuals (68.7% of men and 37.9% of women underestimated their weight). The subjects in the 'maintenance' stage of physical activity tended more often to wrongly select their actual image (71.8% for men and 38.7% for women).