Sugar and low/no-calorie-sweetened beverage consumption and associations with body weight and waist circumference changes in five European cohort studies: the SWEET project

PURPOSE

Results of prospective studies investigating associations between low/no-calorie sweeteners (LNCS) and body weight-related outcomes are inconclusive. We conducted dose-response and theoretical replacement individual patient data meta-analyses using harmonised prospective data to evaluate associations between sugar-sweetened beverage (SSB) consumption, low/no-calorie sweetened beverage (LNCB) consumption, and changes in body weight and waist circumference.

METHODS

Individual participant data were obtained from five European studies, i.e., Lifelines Cohort Study, NQplus study, Alpha Omega Cohort, Predimed-Plus study, and Feel4diabetes study, including 82,719 adults aged 18-89 with follow-up between 1 and 9 years. Consumption of SSB and LNCB was assessed using food-frequency questionnaires. Multiple regression analyses adjusting for major confounders and including substitution models were conducted to quantify associations in individual cohorts; random-effects meta-analyses were performed to pool individual estimates.

RESULTS

Overall, pooled results showed weak adverse associations between SSB consumption and changes in body weight (+ 0.02 kg/y, 95%CI 0.00; 0.04) and waist circumference (+ 0.03 cm/y, 95%CI 0.01; 0.05). LNCB consumption was associated with higher weight gain (+ 0.06 kg/y, 95%CI 0.04; 0.08) but not with waist circumference. No clear associations were observed for any theoretical replacements, i.e., LNCB or water for SSB or water for LNCB.

CONCLUSION

In conclusion, this analysis of five European studies found a weak positive association between SSB consumption and weight and waist change, whilst LNCB consumption was associated with weight change only. Theoretical substitutions did not show any clear association. Thus, the benefit of LNCBs as an alternative to SSBs remains unclear.

Sugar-sweetened beverages, low/no-calorie beverages, fruit juice and non-alcoholic fatty liver disease defined by fatty liver index: the SWEET project

BACKGROUND

Sweetened beverage intake may play a role in non-alcoholic fatty liver disease (NAFLD) development, but scientific evidence on their role is limited. This study examined associations between sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB) and fruit juice (FJ) intakes and NAFLD in four European studies.

METHODS

Data for 42,024 participants of Lifelines Cohort, NQPlus, PREDIMED-Plus and Alpha Omega Cohort were cross-sectionally analysed. NAFLD was assessed using Fatty Liver Index (FLI) (≥60). Restricted cubic spline analyses were used to visualize dose-response associations in Lifelines Cohort. Cox proportional hazard regression analyses with robust variance were performed for associations in individual cohorts; data were pooled using random effects meta-analysis. Models were adjusted for demographic, lifestyle, and other dietary factors.

RESULTS

Each additional serving of SSB per day was associated with a 7% higher FLI-defined NAFLD prevalence (95%CI 1.03-1.11). For LNCB, restricted cubic spline analysis showed a nonlinear association with FLI-defined NAFLD, with the association getting stronger when consuming ≤1 serving/day and levelling off at higher intake levels. Pooled Cox analysis showed that intake of >2 LNCB servings/week was positively associated with FLI-defined NAFLD (PR 1.38, 95% CI 1.15-1.61; reference: non-consumers). An inverse association was observed for FJ intake of ≤2 servings/week (PR 0.92, 95% CI: 0.88-0.97; reference: non-consumers), but not at higher intake levels. Theoretical replacement of SSB with FJ showed no significant association with FLI-defined NAFLD prevalence (PR 0.97, 95% CI 0.95-1.00), whereas an adverse association was observed when SSB was replaced with LNCB (PR 1.12, 95% CI 1.03-1.21).

CONCLUSIONS

Pooling results of this study showed that SSB and LNCB were positively associated with FLI-defined NAFLD prevalence. Theoretical replacement of SSB with LNCB was associated with higher FLI-defined NAFLD prevalence. An inverse association was observed between moderate intake of FJ and FLI-defined NAFLD. Our results should be interpreted with caution as reverse causality cannot be ruled out.

Association of Sugar-Sweetened Beverages, Low/No-Calorie Beverages and Fruit Juice Intakes with Non-alcoholic Fatty Liver Disease: The SWEET Project

Objectives

Examine associations between the intake of sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB), and fruit juice (FJ) and non-alcoholic fatty liver (NAFLD) in 4 population-based studies included in the SWEET project.

Methods

Data of 42,024 participants from the Lifelines Cohort Study (LCS), NQPlus, PREDIMED-Plus and the Alpha Omega Cohort (AOC) were cross-sectionally analyzed. Dietary intake was assessed using food frequency questionnaires. NAFLD was assessed using the Fatty Liver Index (≥60). Restricted cubic spline analyses were used to visualize dose-response associations in LCS. Multivariate Cox proportional hazard regression analyses with robust variance were performed for the associations with NAFLD (prevalence ratio [PR]) in all cohorts and linear regression analyses were conducted for the associations with its markers (triglycerides, gamma-glutamyl transferase, aspartate aminotransferase and alanine aminotransferase). Models were adjusted for demographic, lifestyle, and dietary factors. Results of different cohorts were pooled using random-effects meta-analysis.

Results

NAFLD prevalence was 22% in LCS and NQplus, 60% in AOC and 78% in PREDIMED-Plus. Each additional serving/day of SSB was associated with a 7% higher NAFLD prevalence (PR 1.07, 95%CI 1.03–1.10). For LNCB, dose-response analyses showed evidence for a nonlinear association with NAFLD i.e., a sharp increase at intake ≤ 1 serving/day and more gradual at higher intake levels. The intake of >2 LNCB servings/week was positively associated with NAFLD (PR 1.38, 95%CI 1.15–1.60, ref: non-consumers), which disappeared after adjustment for BMI (PR 1.04, 95%CI 0.94–1.14). A J-shaped association was observed between FJ and NAFLD with an inverse association for intakes of >0–2 servings/week (PR 0.92, 95%CI: 0.88–0.96), but not for higher intakes, compared to no intake. Modest positive associations were observed between all beverages and most NAFLD clinical markers.

Conclusions

Pooling results across 4 studies showed that SSB and LNCB were associated with higher NAFLD prevalence and the majority of its markers. A J-shaped association was observed between FJ and NAFLD, suggesting lower prevalence at medium intakes.

Funding Sources

The SWEET project has received funding from the European Union's Horizon 2020 research and innovation program.

Research Note: Orange corn altered the cecal microbiome in laying hens

Carotenoids, which are pigments known to have many health benefits, such as their antioxidant properties, are being researched for their potential as a feed additive for production animals. These pigments are found in varying quantities in different breeds of corn, and their impact on the chicken microbiome requires further investigation. This 35 d laying hen (Novagen White) feeding trial involved varying the levels and composition of carotenoids by changing the corn source: white (0.9 µg total carotinoids/g total diet), yellow (5.7 µg/g), and orange (24.9 µg/g). For each of the three corn diet treatments, 6 replicate cages were randomly assigned. The cecal microbial community composition of the hens was then studied by 16S rRNA gene amplicon sequencing. The composition of the cecal bacterial community, as determined by Bray-Curtis dissimilarity, was different (P < 0.05) in chickens fed the orange corn diet, compared to chickens on the white corn diet, but there was no statistical difference between animals fed yellow corn compared to the white or orange corn groups. There was no change in the alpha diversity between any of the groups. Within Lactobacillus, which is one of the most abundant genera, 2 amplicon sequence variants (ASVs) were decreased and one ASV was increased in the orange corn group compared to both the white and yellow corn groups. While previous studies showed that orange corn did not alter the community composition in broilers, it appears that orange corn based feed may alter the community composition of laying hens.

Dietary planning, self-efficacy, and outcome expectancies play a role in an online intervention on fruit and vegetable consumption

OBJECTIVE

An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment.

METHOD

A two-arm digital intervention with 269 men and 395 women (M_age = 41.2, SD_age = 11.45; range: 19-66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform.

RESULTS

Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes.

CONCLUSION

FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount of planning. Initial motivation, as indicated by outcome expectancies, seemed to be beneficial for men. Self-efficacious individuals benefitted from their engagement in planning, but self-efficacy did not compensate for failing to plan.

Is the pelvis stable during supine total hip arthroplasty?

Intra- operative changes in pelvic position during total hip arthroplasty (THA) can affect acetabular orientation. We evaluated these changes during supine THA using a proprietary mobile application called PelvicTracker. Twenty- two patients undergoing THA using direct anterior approach were included in the study. In the sagittal plane, the pelvis was extended (anterior tilt) as compared to the start of surgery in 19/ 22 hips at the time of cup implantation (mean extension: 3.1°; range: 1°-6°). In the transverse plane, the pelvis was rolled to the opposite side of surgery in 12 hips (mean roll: 2.8°; range: 1°-5°), to the same side in 8 hips (mean roll: 3.9°, range: 1°-9°) and unchanged in 2 hips at the time of cup implantation. Predicted change in cup version of ≥5° due to changes in pelvic position was seen in 7/22 (32%) patients. Although minor, changes in pelvic position do occur during supine THA which may affect acetabular orientation.

Bax deficiency extends the survival of Ku70 knockout mice that develop lung and heart diseases

Ku70 (Lupus Ku autoantigen p70) is essential in nonhomologous end joining DNA double-strand break repair, and ku70^−/− mice age prematurely because of increased genomic instability and DNA damage responses. Previously, we found that Ku70 also inhibits Bax, a key mediator of apoptosis. We hypothesized that Bax-mediated apoptosis would be enhanced in the absence of Ku70 and contribute to premature death observed in ku70^−/− mice. Here, we show that ku70^−/−bax^+/− and ku70^−/−bax^−/− mice have better survival, especially in females, than ku70^−/− mice, even though Bax deficiency did not decrease the incidence of lymphoma observed in a Ku70-null background. Moreover, we found that ku70^−/− mice develop lung diseases, like emphysema and pulmonary arterial (PA) occlusion, by 3 months of age. These lung abnormalities can trigger secondary health problems such as heart failure that may account for the poor survival of ku70^−/− mice. Importantly, Bax deficiency appeared to delay the development of emphysema. This study suggests that enhanced Bax activity exacerbates the negative impact of Ku70 deletion. Furthermore, the underlying mechanisms of emphysema and pulmonary hypertension due to PA occlusion are not well understood, and therefore ku70^−/− and Bax-deficient ku70^−/− mice may be useful models to study these diseases.

Socio-economic determinants of micronutrient intake and status in Europe: a systematic review

OBJECTIVE

To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake.

DESIGN

MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability.

SETTING

Europe.

SUBJECTS

Children, adults and elderly.

RESULTS

Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5-47 %) and for vitamin D in total of four studies (4-31 %).

CONCLUSIONS

The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases.

EURRECA-Evidence-based methodology for deriving micronutrient recommendations

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence explored the process of setting micronutrient recommendations to address the variance in recommendations across Europe. Work centered upon the transparent assessment of nutritional requirements via a series of systematic literature reviews and meta-analyses. In addition, the necessity of assessing nutritional requirements and the policy context of setting micronutrient recommendations was investigated. Findings have been presented in a framework that covers nine activities clustered into four stages: stage one "Defining the problem" describes Activities 1 and 2: "Identifying the nutrition-related health problem" and "Defining the process"; stage two "Monitoring and evaluating" describes Activities 3 and 7: "Establishing appropriate methods," and "Nutrient intake and status of population groups"; stage three "Deriving dietary reference values" describes Activities 4, 5, and 6: "Collating sources of evidence," "Appraisal of the evidence," and "Integrating the evidence"; stage four "Using dietary reference values in policy making" describes Activities 8 and 9: "Identifying policy options," and "Evaluating policy implementation." These activities provide guidance on how to resolve various issues when deriving micronutrient requirements and address the methodological and policy decisions, which may explain the current variation in recommendations across Europe. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.].

Differing association of macrophage subsets with atherosclerotic plaque stability

AIM

While initial research suggests that M2 macrophages are athero-protective, more recently, proatherogenic functions, such as a greater uptake of lipid than M1 macrophages, have been demonstrated, raising the question of their actual association with plaque stability. The present study, therefore, assessed the association between macrophage subset and plaque stability. Furthermore, it examined whether the fibrocyte, that we have previously identified in the plaque, represents a subset of M2 macrophages.

METHODS

Twenty human carotid atherosclerotic plaque specimens were examined for the presence of macrophages using immunohistochemistry for pan macrophages (CD68), M1 (CD64, CD86) and M2 (CD163, CD206) subsets. The slides were assessed by digital whole slide scanning/image analysis to quantify the expression of these markers in the plaque. Comparisons in marker distribution and quantity relative to plaque stability were made. Adoption of a fibrocyte phenotype was assessed by double immunofluorescence staining of the markers with procollagen I.

RESULTS

M1 and M2 macrophages were present throughout the plaque including the core and cap. While the levels of CD68 (pan macrophage maker) and CD86 negatively correlated with cap thickness, the levels of the M2 marker, CD163, did not and moreover, did not differ between plaques when they were separated into stable and unstable groups. Notably, collagen production was evident in most but not all M2 macrophages.

CONCLUSION

Our findings demonstrate that while macrophage levels in general negatively correlate with plaque cap thickness, levels of M2 macrophages do not. This may be in part due to their ability to produce collagen (ie adopt a fibrocyte phenotype) in the plaque.

New technologies applied to food frequency questionnaires: a current perspective

The food frequency questionnaires are widely used in epidemiological researches like dietary assessment method. Traditionally, they have been self-administered in paper but the use of information and communication technologies has led to develop Internet and computerized food frequency questionnaires. It is the objective of this article to offer a global perspective of the new technologies applied to FFQ. It will be presented the purpose of the food frequency questionnaire, the number of strengths of the web-based surveys versus print-surveys and finally, a description of the manuscripts that have used web-based and computerized FFQ.

Projected prevalence of inadequate nutrient intakes in Europe

BACKGROUND

The purpose of this study was to analyze the prevalence of nutrient intake inadequacy in Europe, applying the Nordic Nutritional Recommendations in the context of the EURRECA Network of Excellence.

METHODS

Nutrient data was obtained from the European Nutrition and Health Report II. Those nutritional surveys using a validated food frequency questionnaire or diet history and a food diary/ register with at least 7 days of registers or with an adjustment for intraindividual variability were included. The nutrients analyzed were: vitamin C, vitamin D, vitamin B(12), folic acid, calcium, iron, zinc, selenium, copper, and iodine. The estimated average requirement cut point was applied to estimate inadequacy. The Nordic and Institute of Medicine nutrient recommendations were used as references.

RESULTS

The mean prevalence of inadequacy was below 11% for zinc, iron, and vitamin B(12) (only in the elderly), and it was 11-20% for copper in adults and the elderly and for vitamin B(12) in adults and vitamin C in the elderly. The prevalence was above 20% for vitamin D, folic acid, calcium, selenium, and iodine in adults and the elderly and for vitamin C in adults.

CONCLUSIONS

Vitamin C, vitamin D, folic acid, calcium, selenium, and iodine were the nutrients showing a higher prevalence of inadequate intakes in Europe.

Plant food supplement (PFS) market structure in EC Member States, methods and techniques for the assessment of individual PFS intake

The popularity of herbal products, especially plant food supplements (PFS) and herbal medicine is on the rise in Europe and other parts of the world, with increased use in the general population as well as among specific subgroups encompassing children, women or those suffering from diseases such as cancer. The aim of this paper is to examine the PFS market structures in European Community (EC) Member States as well as to examine issues addressing methodologies and consumption data relating to PFS use in Europe. A revision of recent reports on market data, trends and main distribution channels, in addition an example of the consumption of PFS in Spain, is presented. An overview of the methods and administration techniques used to assess individual food consumption as a starting point, including their uses and limitations, as well as some examples of studies that collect Food Supplement (FS) information, including herbal/botanical/plant-derived products are also discussed. Additionally, the intake estimation process of food nutrients is described and used to propose the PFS ingredients intake estimation process. Nationally representative PFS consumption data is scarce in Europe. The majority of studies have been conducted in Scandinavia and the UK. However the heterogeneity of definitions, study design and objectives make it difficult to compare results and extrapolate conclusions.

New technologies for promoting a healthy diet and active living

Information and communication technologies (ICT) offer innovative formats for promoting healthy lifestyles and reinforcing public health initiatives. They can be applied to large population segments without losing the functionality of being tailored to individual fluctuating needs. Advantages of ICT include real-time provision and adaptation of nutrition and health recommendations based on an individual's particular situation, the potential to combine assessment procedures with healthy lifestyle support and the ability to unify psychosocial and cultural dimensions to enhance adherence. Two pilot programs are presented that show the potential for applying ICT to the promotion of healthy eating and physical activity habits.

Methodological limitations in measuring childhood and adolescent obesity and overweight in epidemiological studies: does overweight fare better than obesity?

Objectives

International definitions of childhood obesity based on body mass index (BMI) are intended to be used for international comparisons of obesity prevalence. In general, they are not appropriate to be used in clinical practice. The objective of this study is to compare international-ecological vs. national-clinical reference data of obesity in Spain, as well as to describe trends.

Design

Cross-sectional study from a representative national random sample of Spanish children and youth conducted between 1998 and 2000. Prevalence estimates of obesity in a national random sample of Spanish children and youth are presented in this paper, defined by age- and sex-specific BMI national reference standards for the 85th percentile (overweight) and 95th percentile (obesity), as well as by Cole et al. criteria. The study protocol included personal data, data on education and socio-economic status for the family and anthropometric measurements.

Setting

Population-based study set in Spain.

Subjects

A random sample of 3534 individuals, aged 2–24 years.

Results

Prevalence of obesity using national reference data was higher (15.3%) than using international data (5.8%), but overweight rates were similar. Agreement observed for both definitions was low for obesity but higher for overweight. Obesity trends among children and adolescents in Spain show increasing patterns in boys but not in girls.

Conclusions

Results indicate the need to standardise the definitions of obesity and overweight in childhood and recommend the use of overweight due to the greater degree of agreement observed among the different methods used. The IOTF reference method underestimates obesity rates in Spanish schoolchildren.

Food and nutrient intakes and K-ras mutations in exocrine pancreatic cancer

BACKGROUND

No studies have investigated the relation between K-ras mutations and dietary factors in exocrine pancreatic cancer (EPC), and fewer than 10 studies have done so in other neoplasms.

PATIENTS AND METHODS

Incident cases of EPC were prospectively identified, and interviewed face-to-face during hospital admission. Food and nutrient intakes were measured with a food frequency questionnaire. Logistic regression was used to compare EPC cases (n = 107) with and without K-ras mutations (case-case study).

RESULTS

K-ras mutations were more common among daily consumers of milk and other dairy products than among non-daily consumers: the odds ratio adjusted by total energy, age, sex, smoking, alcohol and coffee consumption (ORa) was 5.1 (95% CI 1.1 to 24.5, p = 0.040). For all dairy products, including butter, the ORa for the medium and upper tertiles of intake were 5.4 and 11.6, respectively (p for trend = 0.023). The ORa for regular coffee drinkers further adjusted by dairy consumption was 4.7 (95% CI 1.1 to 20.7, p = 0.043). K-ras mutated cases reported a lower intake of vitamin E (ORa = 0.2, p for trend = 0.036), polyunsaturated fats and omega 3 fatty acids (ORa = 0.2; p for trend <0.03).

CONCLUSIONS

Results support the hypothesis that in EPC exposure to specific dietary components or contaminants may influence the occurrence or persistence of K-ras mutations.

The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review

The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components.

Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations.

A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

The Contribution of Ready-to-Eat Cereals to Daily Nutrient Intake and Breakfast Quality in a Mediterranean Setting

OBJECTIVES

To examine if and how ready-to-eat cereals (RTEC) contribute to the quality of the diet of children, adolescents and young adults in a Mediterranean setting.

METHODS

A random sample of 3534 subjects aged 2 to 24 years in Spain was studied. Food and nutrient intakes were determined by a 24 hour recall. RTEC consumption was assessed by a quantitative food frequency questionnaire. Additional questions on socioeconomic level and nutritional knowledge were administered. Cereal consumption was classified into non-consumers and daily intakes between 1 and 20g, 21 and 40g, and more than 40g. After excluding the underreporters the final sample consisted of 2852 individuals.

RESULTS

About half of the population (49.8%) reported eating RTEC. Macronutrient profile improved with increasing cereal consumption. Intakes of thiamine, riboflavin and vitamin B6 increased significantly with increasing consumption of RTEC in all age-sex groups, whereas niacin and folate intake improved in almost all groups and calcium, iron and vitamin D in at least half of the groups. Except for magnesium, vitamin B12 and vitamin E in males, consumption of RTEC was significantly associated with increased coverage of the daily nutrient requirements for all micronutrients studied. Higher levels of RTEC consumption was associated with a greater consumption of dairy products, and related to better breakfast quality.

CONCLUSIONS

Level of RTEC consumption is associated with a better nutritional profile in the diets of Spanish children, adolescents and young adults and a lower risk for inadequate micronutrient intakes. RTEC consumers have better quality breakfasts, in terms of both food choices as well as energy and nutrient content.

Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents

OBJECTIVE

To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns.

DESIGN

Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered).

SETTING

Spain.

SUBJECTS

In total, 3850 children and youths aged 2-24 years residing in Spain.

RESULTS

Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age.

CONCLUSIONS

The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.

Assessment of dietary adequacy for an elderly population based on a Mediterranean model

This study analysed whether at different energy levels, a varied diet based on Mediterranean Diet patterns would meet the RDIs for specific nutrients in a population > 65 y. Based on RDIs for elderly persons > 65 y for PRO, FAT CHO, phosphorus, calcium, magnesium, iron, zinc, vitamin C, B6, folate and fibre, menu models based on Mediterranean diet food patterns were calculated for the following calorie levels: 1400, 1500, 1600, 1700 and 1800 kcals. 15 menu variations for each calorie level were then created based on the previously calculated models. Utilising the Program for Alimentation and Nutrition (PAN) database, nutritional analysis was carried out for all menus and the mean nutrient values for a 2 week period were calculated for each calorie level. Intakes at all calorie levels provided adequate amounts of folate, phosphorus, iron and Vitamin B6. Intakes were low in all groups for Calcium, Zinc, Magnesium and Vitamin E, with the exception of the 1800 kcal level for Vitamin E. Results show that at low energy levels, meeting nutrient needs was difficult and that even at higher calorie intakes, contrary to what was expected, certain nutrients were found to be inadequate.

Dietary guidelines for the breast-feeding woman

Sociodemographic and economic changes in Spain have played a role in the choice of infant feeding as more and more women enter the workforce. Nevertheless, the prevalence of breast-fed-only infants at 6 weeks remains fairly high, at 65.5% in 1999, although there is a sharp decline by 3 and 6 months postpartum. Achieving adequate nutritional status for lactation principally begins during pregnancy, as this constitutes the biological stage for accumulating nutrient stores. The benefits of breast-feeding for the mother and infant are presented, along with nutrition and dietary guidelines for the nursing woman. Apart from dietary considerations, special attention should be paid to encouraging a positive attitude and environment for breast-feeding success.

Risk of inadequate intakes of vitamins A, B1, B6, C, E, folate, iron and calcium in the Spanish population aged 4 to 18

A meta-analysis of the most representative Spanish nutrition studies was carried out to identify inadequate intakes of vitamins, A, B1, B6, C, E, folate, iron, and calcium in children aged 4 to 18. Information on vegetable, fruit and fruit juice/beverage intake was also solicited. Data drawn from the selected studies yielded a total of 6540 children and adolescents in eight geographical areas. The sample was stratified by age (children: 4 to 14 years old and adolescents: 13-18 years old) and sex. Inadequate intakes (below two-thirds of the recommended values) were notable in children for vitamin E, vitamin C, and vitamin A and in girls, iron. In adolescents, low intakes were especially marked for vitamin E and vitamin A, and in girls, calcium, folate, and iron. Adolescents consumed more vegetables, fruit juice, and fruit drinks whereas children had higher fruit intakes. Regional differences in consumption were also detected. Strategies for improving nutrient intake in these vulnerable populations are discussed.

Differential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans

BACKGROUND & AIMS

Chronic tissue injury in the esophagus associated with gastroesophageal reflux disease may result in sensitization of afferent pathways mediating mechanosensitivity and chemosensitivity. The aim of this study was to evaluate the sensitivity to intraluminal acid and to distention of the esophagus in patients with mild-to-moderate gastroesophageal reflux disease.

METHODS

Perceptual responses to intraluminal acid perfusion and to esophageal distention and pressure volume relationships were evaluated in 10 healthy volunteers and in 11 patients. Mechanosensitivity was evaluated with a barostat using unbiased distention protocols and verbal descriptor ratings of sensations. Chemosensitivity to acid was determined at baseline and after a 1-month treatment of acid suppression.

RESULTS

Patients showed enhanced perception of acid perfusion but not of esophageal distension. Chemosensitivity but not mechanosensitivity was correlated with reflux symptoms and with the degree of endoscopically shown tissue injury at baseline. Tissue injury was not associated with altered compliance.

CONCLUSIONS

Mild-to-moderate chronic tissue injury in gastroesophageal reflux disease differentially affects mechanosensitive and chemosensitive afferent pathways. Chronic acid reflux by itself is not likely to play a role in reported esophageal hypersensitivity to distention in patients with noncardiac chest pain.

How could changes in diet explain changes in coronary heart disease mortality in Spain? The Spanish paradox

We review and compare trends in coronary heart disease (CHD) and stroke mortality in Spain from 1966 to 1990 and changes in food consumption at national and regional levels. Since 1976, a decrease in cardiovascular disease (CVD) mortality in males and females has been observed, and standardized CHD mortality rates have fallen. Stroke mortality decreased during the same period. Trends in food consumption show increases in intakes of meat, dairy products, fish, and fruit, but decreases in consumption of olive oil, sugar, and all foods rich in carbohydrates. Although fat and saturated fat intakes increased, these changes were not accompanied by an increase in CHD mortality rates. This paradoxical situation can be explained by expanded access to clinical care, increased consumption of fruit and fish, improved control of hypertension, and a reduction in cigarette smoking. Diet appears to have an important role in this paradox, but it may not be as critical as other factors. Nevertheless, we suggest dietary guidelines for prevention of CHD in Spain.