Fluid and total water intake in a senior mediterranean population at high cardiovascular risk: demographic and lifestyle determinants in the PREDIMED-Plus study.

PURPOSE: We aimed to evaluate associations between compliance with recommendations for total water intake (TWI) and total water intake from fluids (TWIF), and some socio-demographic and lifestyle factors of a senior Mediterranean population at high cardiovascular risk. METHODS: Cross-sectional analysis with data of 1902 participants from the PREDIMED-Plus study. A validated 32-item Spanish fluid-intake questionnaire was used to assess beverage consumption and water intake. Multivariable logistic regression models were used to assess the odds ratio (OR) and the 95% confidence interval (CI) for complying with European Food Safety Agency recommendations for TWI and TWIF according to various socio-demographic and lifestyle factors, and for the joint associations of Mediterranean diet (MedDiet) adherence and moderate-vigorous physical activity (MVPA). RESULTS: The mean total volume of fluid intake in the population studied was 1934 ± 617 mL/day. Water was the most frequently consumed beverage. Significant differences between sex were only observed in alcoholic and hot beverage consumption. Compliance with TWIF was associated with being women (OR 3.02; 2.40, 3.80), high adherence to MedDiet (OR 1.07; 1.02, 1.12), and participants who were more engaged in physical activity (PA) (OR 1.07; 1.02, 1.13). Age was inversely associated (OR 0.96; 0.94, 0.98). Similar results for TWI recommendations compliance were observed in relation to being women (OR 5.34; 3.85, 7.42), adherence to MedDiet (OR 1.16; 1.02, 1.31) and PA (OR 1.07; 1.00, 1.15). The joint association of PA and MedDiet, showed that participants with higher adherence to MedDiet and meeting WHO recommendations for MVPA complied better with the TWI recommendations (OR 1.66; 1.19, 2.32). CONCLUSIONS: High compliance with recommendations for TWI was associated with being a woman, and a healthy lifestyle characterized by high adherence to the MedDiet and PA.

Is the food frequency questionnaire suitable to assess micronutrient intake adequacy for infants, children and adolescents?

The objective of this study was to review how accurately micronutrient intakes in infants, children, and adolescents were assessed with validated food frequency questionnaires (FFQs) to which study quality criteria had been applied. The methodology and the analysis presented were based on several research activities carried out within the European Micronutrient Recommendation Aligned Network of Excellence. The analysis was limited to vitamin D, vitamin C, vitamin B12, folate, selenium, iron, zinc, iodine, calcium, and copper. A search strategy was defined in MEDLINE and EMBASE literature for studies validating FFQs that estimated intakes of micronutrients being evaluated. Identification of at least three validation studies per micronutrient was required to be included in the analysis. A total score for each nutrient was calculated from the mean of the correlation coefficients weighted by the quality of the study, which included a quality score that was based on sample size, statistics used, data collection procedure, consideration of seasonality and supplement use, an adjustment/weighting of the correlation coefficient according to the quality score, and a rating of the adjusted/weighted correlation. When the mean weighted correlation coefficient was equal to or higher than 0.5, micronutrient intake was considered as adequately estimated. Sufficient validation studies were identified for vitamin C, vitamin D, vitamin B12, iron, zinc, and calcium for infants and pre-school children, and vitamin C, calcium, and iron for older children and adolescents. Results showed that the FFQ was a good instrument for estimating intake of vitamin C, vitamin D, calcium, zinc and iron in infants and pre-school children, and for estimating calcium and vitamin C in children and adolescents.

Dietary assessment methods for micronutrient intake in pregnant women: a systematic review.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence needs clear guidelines for assessing the validity of reported micronutrient intakes among vulnerable population groups. A systematic literature search identified studies validating the methodology used for measuring usual dietary intake during pregnancy. The quality of each validation study selected was assessed using a EURRECA-developed scoring system. The validation studies were categorised according to whether the study used a reference method that reflected short-term intake ( < 7 d) long-term intake ( > or = 7 d) or used biomarkers (BM). A correlation coefficient for each micronutrient was calculated from the mean of the correlation coefficients from each study weighted by the quality of the study. Seventeen papers were selected, which included the validation of fifteen FFQ, two dietary records (DR), one diet history and a Fe intake checklist. Estimates of twenty-six micronutrients by six FFQ were validated against 24-h recalls indicating good correlation for six micronutrients. Estimates of twenty-four micronutrients by two FFQ were validated against estimated DR and all had good or acceptable correlations. Estimates of fourteen micronutrients by three FFQ were validated against weighed DR indicating good correlations for five. Six FFQ were validated against BM, presenting good correlations only for folic acid. FFQ appear to be most reliable for measuring short-term intakes of vitamins E and B6 and long-term intakes of thiamin. Apart from folic acid, BM do not add any more certainty in terms of intake method reliability. When frequency methods are used, the inclusion of dietary supplements improves their reliability for most micronutrients.

Dietary assessment methods for micronutrient intake: a systematic review on vitamins.

The EURRECA Network of Excellence is working towards the development of aligned micronutrient recommendations across Europe. The purpose of the present study was to define how to identify dietary intake validation studies in adults pertaining to vitamins. After establishing a search strategy, we conducted a MEDLINE and EMBASE literature review. A scoring system was developed to rate the quality of each validation study according to sample size, statistical methods, data collection procedure, seasonality and vitamin supplement use. This produced a quality index with possible scores obtained ranging from 0.5 to 7. Five thousand four-hundred and seventy-six papers were identified. The numbers meeting the inclusion criteria were: for vitamin A, 76; vitamin C, 108; vitamin D, 21; vitamin E, 75; folic acid, 47; vitamin B12, 19; vitamin B6, 21; thiamine, 49; riboflavin, 49; and niacin, 32. The most frequently used method to ascertain dietary intake was the Food Frequency Questionnaire (FFQ), whereas dietary records (DR) and 24-h recalls were the most used reference methods. The correlation coefficients (CC) between vitamin intakes estimated by FFQ and the reference method were weighted according to the study's quality index and ranged from 0.41 to 0.53 when the reference method was the DR and from 0.43 to 0.67 when the reference was 24-h recalls. A minority of studies (n 33) used biomarkers for validation and in these the CC ranged from 0.26 to 0.38. The FFQ is an acceptable method of assessing vitamin intake. The present review provides new insights regarding the characteristics that assessment methods for dietary intake should fulfil.

Dietary assessment methods for micronutrient intake in elderly people: a systematic review.

The European micronutrient recommendations aligned (EURRECA) Network of Excellence seeks to establish clear guidelines for assessing the validity of reported micronutrient intakes among vulnerable population groups. A systematic literature review identified studies validating the methodology used in elderly people for measuring usual dietary micronutrient intake. The quality of each validation study selected was assessed using a EURRECA-developed scoring system. The validation studies were categorised according to whether the reference method applied reflected short-term intake ( < 7 d), long-term intake ( > or = 7 d) or used biomarkers (BM). A correlation coefficient for each micronutrient was calculated from the mean of the correlation coefficients from each study weighted by the quality of the study. Thirty-three papers were selected, which included the validation of twenty-five different FFQ, six diet histories (DH), one 24-h recall (24HR) and a videotaped dietary assessment method. A total of five publications analysed BM, which were used to validate four FFQ, and one 24HR, presenting very good correlations only for vitamin E. The analysis of weighted correlation coefficients classified by FFQ or DH showed that most of the micronutrients had higher correlations when the DH was used as the dietary method. Comparing only FFQ results showed very good correlations for measuring short-term intakes of riboflavin and thiamin and long-term intakes of P and Mg. When frequency methods are used for assessing micronutrient intake, the inclusion of dietary supplements improves their reliability for most micronutrients.

Dietary assessment methods for intakes of iron, calcium, selenium, zinc and iodine.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence is working towards developing aligned micronutrient recommendations across Europe. The purpose of the present study was to conduct a review of methods used in validation studies carried out in adults assessing dietary intake of EURRECA priority minerals. A search strategy and inclusion criteria were defined and a scoring system was developed to rate the quality of each validation study that produced a quality index with possible scores obtained ranging from 0.5 to 7. A MEDLINE and EMBASE literature review was conducted. Articles/validation studies meeting the inclusion criteria included: 79/88 for Fe; 95/104 for Ca; 13/15 for Se; 29/30 for Zn; 7/9 for iodine. The most frequently used method to ascertain dietary intake was the Food Frequency Questionnaire (FFQ), whereas dietary records (DR) and 24 h recalls were the most used reference methods. The correlation coefficients (CC) between study mineral intakes estimated by FFQ and the reference method were weighted according to the study's quality index and obtained acceptable to good ratings, ranging from 0.36 to 0.60 when the reference method was DR and from 0.41 to 0.58 when the reference was 24 h recalls. A minority of studies (n 9) used biomarkers for validation and among these, five included iodine obtaining a CC of 0.47. The FFQ was seen as a valid method for assessing mineral intake, particularly for Ca and, to a lower extent, for iodine and Zn. Se and Fe showed only acceptable correlations. The present review provides new insights regarding the characteristics that assessment methods for dietary mineral intakes should fulfil.

Dietary assessment methods for micronutrient intake in infants, children and adolescents: a systematic review.

A systematic literature search identified studies validating the methodology used for measuring the usual dietary intake in infants, children and adolescents. The quality of each validation study selected was assessed using a European micronutrient Recommendations Aligned-developed scoring system. The validation studies were categorised according to whether the study used a reference method that reflected short-term intake ( < 7 d), long-term intake ( > or = 7 d) or used biomarkers. A correlation coefficient for each nutrient was calculated from the mean of the correlation coefficients from each study weighted by the quality of the study. Thirty-two articles were included in the present review: validation studies from infants (1-23 months); child preschool (2-5 years); children (6-12 years); adolescents (13-18 years). Validation of FFQ studies in infants and preschool children using a reference method that reflected short-term intake showed good correlations for niacin, thiamin, vitamins B6, D, C, E, riboflavin, Ca, K, Mg, Fe and Zn (with correlations ranging from 0.55 for vitamin E to 0.69 for niacin).Regarding the reference method reflecting short-term intake in children and adolescents, good correlations were seen only for vitamin C (r 0.61) and Ca (r 0.51). Using serum levels of micronutrient demonstrated that the 3 d weighed dietary records was superior to the FFQ as a tool to validate micronutrient intakes. Including supplement users generally improved the correlations between micronutrient intakes estimated by any of the dietary intake methods and respective biochemical indices.

[Assessment of nutritional quality in healthy pregnant women of the Canary Islands, Spain]. / Calidad nutricional de la dieta en gestantes sanas de Canarias.

BACKGROUND AND OBJECTIVE: To describe the composition of the diet of healthy pregnant women of the Canary Islands and to estimate the nutritional quality using the Healthy Eating Index (HEI). PATIENTS AND METHOD: Cross-sectional study based on 103 women aged 18-40 years, who gave birth at the University Hospital Materno-Infantil of Gran Canaria. Food consumption and macro and micronutrient intake were estimated using a food frequency questionnaire used in the Canary Island Nutrition Survey (ENCA) and the HEI was calculated. This index includes 10 components and the maximum possible score of the index is 100 points. RESULTS: The score of the index was 54.9. This result remains below the optimum score of > or =80, which is considered a diet of good quality of pregnant women in our study population. The average score of the first 5 components of the index showed that cereal consumption was below the daily portions recommended for pregnant women, whereas vegetables, fruit, milk and meat consumption surpassed the recommendations. A significant number of pregnant women did not reach the 50% of the recommendations for iron, folate and vitamin D intake (36.9, 26.2 and 38.8% respectively). At least 30% of the population exceeded 200% of the recommendations for proteins, thiamine, niacin, riboflavin, vitamin C and vitamin A. CONCLUSIONS: Dietary advice for improving the diet quality during pregnancy and the supplementation of mainly iron and folate are necessary.

Immunomodulatory effects of the intake of fermented milk with Lactobacillus casei DN114001 in lactating mothers and their children.

The healthy action of probiotics is not only due to their nutritional properties and their influence on the gastrointestinal environment, but also to their action on the immune system. The aim of the present study was to determine if 6 weeks of probiotic intake would be able to modulate the immune system in women who had recently delivered and were breast-feeding. The design consisted of a randomised, controlled and double-blind nutritional intervention study with parallel groups with a sample size of 104 women. The main variable is the T helper type 1/T helper type 2 (Th1/Th2) profile determined by measuring interferon-gamma (Th1) and IL-4 (Th2) values in peripheral blood by flow cytometry. The modifications of cytokines were evaluated in maternal milk by cytometric bead array in a flow cytometer and ELISA at three stages of breast-feeding: colostrum, early milk (10 d) and mature milk (45 d). Additionally, the anthropometry and infectious and allergic episodes in the newborn were followed up throughout the first 6 months of life. After the consumption of milk fermented with Lactobacillus casei during the puerperium, we observed a nonsignificant increase in T and B lymphocytes and a significant increase in natural killer cells. A decrease in the pro-inflammatory cytokine TNF-alpha in maternal milk and fewer gastrointestinal disturbances were also observed in the breast-fed child of the mothers who consumed L. casei. The intake of milk fermented with L. casei during the lactation period modestly contributes to the modulation of the mother's immunological response after delivery and decreases the incidence of gastrointestinal episodes in the breast-fed child.

[The Mediterranean diet as an example of food and nutrition sustainability: a multidisciplinary approach]. / La dieta mediterránea como ejemplo de una alimentación y nutrición sostenibles: enfoque multidisciplinar.

Sustainability represents a major concern in recent years due to climate change pressure. The diet itself contribute to the emission of greenhouse gasses, water and land use, energy consumption and environment contamination. The Mediterranean diet should be understood not only as a set of foods but also as a cultural model that involves the way foods are selected, produced, processed and distributed. The Mediterranean dietary pattern is presented not only as a cultural model but also as a healthy and environmentally friendly model. The recognition by UNESCO, with the consequent increased visibility and acceptance of the Mediterranean diet around the world, along with better and more scientific evidence regarding its benefits and effectiveness on longevity, quality of life and disease prevention, have taken this dietary pattern to an unprecedented historical moment. This is a favorable situation that could possibly enable the strengthening of the Mediterranean diet around the world, thus potentiating improvements in global health indicators and in a reduction of environmental impact by production and transportation of food resources. Therefore, the Mediterranean diet should be seen for what it is: an extremely and incomparable healthy, affordable and environmentally sustainable food model, as well as an ancient cultural heritage that confers identity and belonging. From the heart to the earth through the road of culture, the Mediterranean diet is a cultural heritage that looks to the future.

La sostenibilidad representa una gran preocupación en los últimos años debido a los efectos del cambio climático. La dieta, el uso del agua y de la tierra, el consumo de energía y la contaminación del medioambiente son elementos que contribuyen a la emisión de gases de efecto invernadero. La dieta mediterránea debe entenderse no solo como un conjunto de alimentos, sino también como un modelo cultural que involucra la forma en que los alimentos se seleccionan, producen, procesan y distribuyen. El patrón dietético mediterráneo se presenta no solo como un modelo cultural, sino también como un modelo ecológico.El reconocimiento de la Unesco, con la consiguiente mayor visibilidad y aceptación de la dieta mediterránea en todo el mundo y el mayor número de evidencias científicas sobre sus beneficios y efectividad en cuanto a la longevidad, calidad de vida y prevención de enfermedades, han llevado a este patrón dietético a un nivel sin precedentes. Esta es una situación favorable que, posiblemente, podría permitir el fortalecimiento de la dieta mediterránea en todo el mundo, potenciando mejoras en los indicadores de salud mundial y en la reducción del impacto ambiental por la producción y transporte de los recursos alimentarios.Por ello, la dieta mediterránea debe ser vista como un modelo alimentario saludable, asequible y ambientalmente sostenible, así como un patrimonio cultural antiguo que confiere identidad y pertenencia. Del corazón a la tierra a través del camino de la cultura, la dieta mediterránea es un patrimonio cultural que mira hacia el futuro.

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages.

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

Beverage Consumption Habits among the European Population: Association with Total Water and Energy Intakes.

BACKGROUND: Fluid and water intake have received limited attention in epidemiological studies. The aim of this study was to compare the average daily consumption of foods and beverages in adults of selective samples of the European Union (EU) population in order to understand the contribution of these to the total water intake (TWI), evaluate if the EU adult population consumes adequate amounts of total water (TW) according to the current guidelines, and to illustrate the real water intake in Europe. METHODS: Three national European dietary surveys have been selected: Spain used the Anthropometry, Intake, and Energy Balance Study (ANIBES) population database, Italy analyzed data from the Italian National Food Consumption Survey (INRAN-SCAI 2005-06), and French data came from the NutriNet-Santé database. Mean daily consumption was used to compare between individuals. TWI was compared with European Food Safety Authority (EFSA) reference values for adult men and women. RESULTS: On average, in Spain, TWI was 1.7 L (SE 22.9) for men and 1.6 L (SE 19.4) for women; Italy recorded 1.7 L (SE 16.9) for men and 1.7 L (SE 14.1) for women; and France recorded 2.3 L (SE 4.7) for men and 2.1 L (SE 2.4) for women. With the exception of women in France, neither men nor women consumed sufficient amounts of water according to EFSA reference values. CONCLUSIONS: This study highlights the need to formulate appropriate health and nutrition policies to increase TWI in the EU population. The future of beverage intake assessment requires the use of new instruments, techniques, and the application of the new available technologies.

Facing malnutrition and poverty: evaluating the CONIN experience.

The Undernutrition Prevention Center (UPC) of the Corporation for Childhood Nutrition (CONIN) assists children from 0-3 years of age who present with primary or secondary undernutrition. The aim of the retrospective study reported here was to complete a nutritional, cognitive, and social evaluation of UPC children in Mendoza, Argentina, from 1996 to 2005. During the study period, a total of 478 schoolchildren aged 5-17 years (186 in the CONIN group and 292 in the non-CONIN group) were evaluated. Although no differences in weight and height were found between the groups, the percentage of children below the cutoff level for the maturity test was significantly lower in the CONIN group (10.8% versus 17.6%; P = 0.043). CONIN provides important social support to families through work qualification programs and health education.