Med Diet 4.0: the Mediterranean diet with four sustainable benefits.

OBJECTIVE: To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns. DESIGN: A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined. RESULTS: The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet. CONCLUSIONS: By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

[School meals: state of the art and recommendations]. / El comedor escolar: situación actual y guía de recomendaciones.

School meals contribute substantially to overall energy and nutrient intake adequacy of children, but also play an important role in the development of child food habits and the socialisation process. Evidence shows that school based environmental actions, which include changes in school meals and school food policies related to increased availability and access to healthy foods and drinks while in the school are effective to foster healthy eating practices among children. A growing number of children engage in school meals. Available information to date shows that the quality of the food on offer is not always consistent with dietary guidelines. Vegetables and fish are served less often than desirable and excess added fats are used in food preparations. Norms and regulations are very detailed regarding food safety issues and administrative management of the service, including subcontracting of catering providers and care staff. Nutrition and health promotion issues should also be included in regulations by means of nutrition recommendations for school meals along with information on food based dietary guidelines and portion sizes. School meals should be part of the educational project using a whole school approach.

Epidemiology of obesity in Spain. Dietary guidelines and strategies for prevention.

Obesity is considered a major Public Health issue in most developed countries nowadays for its wide spread across population groups, as well as its contribution to the development of chronic diseases, particularly cardiovascular diseases and diabetes. Available population data in Spain from the SEEDO'2000 study show a prevalence of obesity (BMI > or = 30 kg/m(2)) of 14,5% in adults aged 25-60 years, estimates based on individual measurement of body weight and height. Obesity rates are higher among women aged 45 years and older, low social class, living in semi-urban places. Geographical distribution of the problem shows a trend for higher rates towards the South- SouthEast of the country, i.e. Andalucía, Murcia and the Canary Islands. Population data for Spanish children and young people based on the enKid study--cross-sectional study on a random national sample of the population aged 2-24 years--estimate a prevalence of obesity of 13.9% for the whole group. Geographical distribution draws a similar pattern to that described for adults. Higher peaks of the problem are identified between 9-13 years among boys from a low socioeconomical background. The analysis of determinants of obesity in Spanish children and young people show that overweight and obesity is related to absence of breastfeeding, low consumption of fruit and vegetables; high consumption of cakes and buns, soft drinks and butchery products, low physical activity levels and a positive association with time spent watching TV. The joint consensus document produced by the Spanish Association of Pediatrics (AEP), Spanish Society of Community Nutrition (SENC) and Spanish Society for the Study of Obesity (SEEDO) considers a global strategy for the prevention of obesity from early stages in life. The important role of the family and the school setting as well as the responsibility of the Health Administration and Pediatric care in the prevention of obesity is highlighted in the document.

[Community nutrition]. / Nutrición comunitaria.

A growing body of scientific and epidemiological evidence indicates that diet and health are related: diet may be a risk factor or have potential protective effects. As a consequence, the focus of nutrition research has experienced a shift towards qualitative aspects of diet which could influence chronic disease, longevity, quality of life and physical and cognitive performance, leading to the development of Community Nutrition. The main undertakings in a Community Nutrition Unit are related to the identification, assessment and monitoring of nutrition problems at the community level and to planning, design, implementation and evaluation of nutrition intervention programs. Such programs combine a number of suitable strategies in a whole population approach, a high risk approach or an approach targeted at specific population groups, and are implemented in different settings, such as the work place, schools or community organizations. Community nutrition interventions aim to gradually achieve change in eating patterns towards a healthier profile. Community Nutrition programs require the use of a combination of strategies and a working group of people from different backgrounds. Many factors influence the nutritional status of an individual or a population. In order to gain effective work output, sound understanding of these patterns and a practical surveillance system are required.

[Prevalence of obesity in developed countries: current status and perspectives]. / Prevalencia de obesidad en los países desarrollados: situación actual y perspectivas.

Obesity is one of the main public health problems in developed countries. It is considered to be a risk factor associated with the genesis or development of the major chronic diseases. The classification of a population by weight and the awareness of its determining factors are essential elements in order to undertake health planning programmes and health promotion projects. In Europe, the prevalence of obesity (BMI 30) is greater in northern countries (7% in men and 9% in women in the Netherlands; 5.3% and 9.1% respectively in Sweden) than in southern countries (Spain: 11.5% in men and 15.2% for women) or further east (Germany: 10.6% in men and 11.6% among women). In the United States, obesity is taking on alarming proportions, with an increase of 8 percentage points between 1976 and 1994, placing the problem at a level of 22.5% of the population classified as obese. The prevalence of obesity in Spain is 13.4%, higher after the age of 45 years, among women and in individuals with a lower educational level. The pattern of geographical distribution evidences a greater prevalence towards the south and south-east, with statistical significance among males. It is necessary to analyze in further depth the factors involved in the genesis of obesity and to institutionalize community health programmes for its prevention, monitoring and treatment.

[Calcium intake and bone mineral density in a group of Spanish school-children]. / Ingesta de calcio y densidad mineral ósea en una población de escolares españoles (estudio CADO).

INTRODUCTION: There are limited data available on bone mass status in Spanish children and or whether the differences are associated with diet/hygiene habits or geographical variability. SUBJECTS AND METHODS: To determine this association a cross-sectional study was carried out in three different areas (northern, central and southern Spain) and included 1176 schoolchildren between 5 and 12 years old, randomly selected from schools in those areas. Bone density of the distal phalanges was measured by bone ultrasound. We examine the correlations between these data and calcium and vitamin D intake, physical activity and bone mass index. RESULTS: Of the 1176 children initially included, 1035 nutritional questionnaires were completed and bone ultrasound data were obtained on 991 of them. Eighteen percent of girls and 13% of boys had a calcium intake below 800 mg per day. More than 70% of children have a daily vitamin D intake under 2.5 mcg. Age and exercise showed a direct linear relationship with bone mineral density, and an inverse one for overweight. CONCLUSIONS: Both high physical activity and high calcium intake were associated with a higher bone mineral density, while overweight showed the opposite effect. Diet habits and exercise must be considered the main strategies to prevent adult osteoporosis during childhood.

[Food habits of students using school dining rooms in Spain. "Tell Me How You Eat" Study]. / Hábitos alimentarios de los alumnos usuarios de comedores escolares en España. Estudio "Dime Cómo Comes"

OBJECTIVE: To describe food habits of school-aged population having school meals and to evaluate perceived quality of the service. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Community School lunchrooms in different Spanish regions. PARTICIPANTS: Random population sample of children and young people (3-16 year) having school meals in Spain. MEASUREMENTS: The study protocol included socio-economical data, food consumption and dietary habits at the school and out of the school. Information was collected by means of two questionnaires: one completed by children at school and a second one completed by the family at home. RESULTS: Valid response was collected from 322 children and 212 families, a response rate of 96.1% children and 63.3% of the families. 88% of the children reported daily consumption of breakfast, 45% used to have a midmorning snack, which consisted of a sandwich (29%); sweet bakery products (27%) or biscuits (15%). 45% of the 12-16-year-old old group reported eating only half of the portion served at lunch in the school, mainly due to disgusting taste or preparation (50%). In the school menus vegetables and fish were offered less frequently than other food groups. 81% of the children referred having an after-school snack in the afternoon, consisting of a sandwich (65%); bakery products (20%); bread and chocolate (20%); yoghurt or fruit (20%). CONCLUSIONS: School meals provide a wonderful opportunity to widen the variety of foods in the daily diet of children. Recommendations about school meals should address the quality and variety of the foods served for a healthy diet and stress the educational dimension.

[Prevalence of iron-deficiency anemia in the Basque Country]. / Prevalencia de anemia ferropénica en el País Vasco.

OBJECTIVE: To describe the prevalence of iron deficiency anaemia in the Basque Country by age group and sex and to identify the main groups at risk. DESIGN: Cross-sectional study. SETTING: Basque Country. PARTICIPANTS: School-aged population of Bilbao (n = 762); further education students of San Sebastian (n = 372); adult population of the Basque Country (n = 2348) and elderly population of Bilbao, institutionalized (n = 154) and free living people (n = 410). Every sample was drafted by random sampling methods. METHODS: Blood samples were collected by venopunction after 10-12 h. fasting, according to the same protocol. Haematological and biochemical analytes were assessed in the reference laboratory for the Basque Country, which followed internal and external quality control programs during that period. Iron deficiency anaemia was defined according to the criteria from the Spanish Society for Parenteral and Enteral Nutrition (SENPE). MEASUREMENTS AND MAIN RESULTS: Prevalence of iron deficiency anaemia in school-aged children was 0.6% for boys and 0.7% for girls, with the highest rate for girls aged 12-14 years (2.3%). Men aged 25-60 years showed a prevalence rate of 0.1% and women in the same age group 2.1%. Younger women, 25-34 years, showed the highest prevalence in this age group (2.9%). Among elderly people, overall prevalence was 0.4%, although people aged 80 years and over was affected more frequently. CONCLUSIONS: The prevalence of iron deficiency anaemia in the Basque Country is low though it is relatively frequent among young women and very old people. Both population subgroups should be monitored.