[Properties of milk in sleep induction]. / Propiedades de la leche en la inducción del sueño.

Introduction: Sleep induction and its quality are issues of growing concern because its deterioration affects a large number of people and poses a risk to their well-being and quality of life and long-term health. There are several factors involved in the problem, but nutrition is one of them and in particular milk consumption has often been linked to sleep habits, sometimes as a promoter and sometimes as an inhibitor. The purpose of this review is to examine the matter further. On reaching the brain, tryptophan is the basis for the synthesis of serotonin and melatonin, which improve the induction and quality of sleep. But there is competition between tryptophan and other long-chain neutral amino acids (LNAA) (valine, leucine, isoleucine, tyrosine and phenylalanine) to cross the blood-brain barrier and reach the brain. In this sense, milk proteins with a high tryptophan content and the highest ratio between tryptophan and LNAA are very useful in promoting sleep. Moreover, milk also provides various micronutrients that help in the transformation of tryptophan into serotonin and melatonin, as well as antioxidant components, anti-inflammatory and bioactive peptides, and recent studies indicate that it favorably modulates the composition of the intestinal microbiota. Studies show that increasing milk consumption, up to the recommended intake and within a correct diet, favors the achievement and maintenance of quality sleep.

Introducción: La inducción del sueño y su calidad son temas de preocupación creciente porque su deterioro afecta a un número elevado de personas y supone un riesgo en su bienestar y calidad de vida y en la salud a largo plazo. Hay diversos factores implicados en el problema, pero la nutrición es uno de ellos y, en concreto, el consumo de leche se ha relacionado frecuentemente con los hábitos de sueño, a veces como factor promotor y otras como inhibidor. Profundizar en el tema es el objeto de la presente revisión. El triptófano, al llegar al cerebro, es la base para la síntesis de serotonina y melatonina, que mejoran la inducción y la calidad del sueño. Pero hay una competencia entre el triptófano y otros aminoácidos neutros de cadena larga (ANCL) (valina, leucina, isoleucina, tirosina y fenilalanina) para cruzar la barrera hematoencefálica y llegar al cerebro. En este sentido, las proteínas de la leche, con elevado contenido en triptófano y la relación más elevada entre triptófano y ANCL, son muy útiles en la promoción del sueño. Por otra parte, la leche también aporta diversos micronutrientes que ayudan en la transformación del triptófano en serotonina y melatonina, así como componentes antioxidantes, antiinflamatorios y péptidos bioactivos, y estudios recientes indican que modula favorablemente la composición de la microbiota intestinal. Los estudios realizados ponen de relieve que aumentar el consumo de leche, hasta el aporte aconsejado y dentro de una alimentación correcta, favorece el conseguir y mantener un sueño de calidad.

Adherence to 24-h movement guidelines in Spanish schoolchildren and its association with insulin resistance: a cross-sectional study.

Introduction: Being more active, being less sedentary, and sleeping enough are associated with adequate body weight and adiposity in children. However, few researchers have analyzed these different lifestyle behaviors and the adherence to 24 h movement guidelines with respect to insulin resistance (IR) at school age. Therefore, we aimed to analyse the association between the adherence to 24 h movement guidelines (physical activity, sedentary time, sleep) and IR in Spanish schoolchildren. Methods: A cross-sectional study of 839 children (8-13 years, 51.1% girls) were studied. Anthropometric, biochemical, and lifestyle behavioral data were collected. IR was defined as HOMA-IR>3.16. Compliance with the 24 h movement guidelines were defined as ≥60 min/day of moderate and/or vigorous physical activity, < 120 min/day of screen time, and 9-11 h/day of sleep time. Associations between adherence to the 24 h movement guidelines and IR were performed by multivariate logistic regression analyses. Results: The IR in our sample was 5.0%, being higher in girls. Compliance with physical activity or screen time, but not with sleep recommendations, was associated with lower fasting glucose, fasting insulin, and HOMA-IR values. A low adherence to 24 h movement guidelines was associated with a higher risk of IR (odds ratio (95% CI): 2.150 [1.089-4.247]), especially in girls (odds ratio (95% CI): 2.800 [1.180-6.645]). Conclusion: Higher physical activity levels and lower screen times were associated with a lower risk of IR in schoolchildren, underlining the importance of adhering to as many healthy lifestyle recommendations as possible.

Breakfast Quality and Insulin Resistance in Spanish Schoolchildren: A Cross-Sectional Study.

Background: Breakfast has traditionally been considered one of the most important meals of the day; however, there is little evidence for the influence of breakfast quality and insulin resistance (IR). This study aimed to assess the quality of breakfast in a group of schoolchildren, and its association with IR. Methods: A cross-sectional study with 852 children (8−13 years) was carried out. Fasting plasma glucose, insulin and anthropometric parameters were measured. A three-day dietary record was used to assess their diet and to calculate the Breakfast Quality Index (BQI). The sample was divided into tertiles according to the BQI (tertile 3: better breakfast quality). The homeostatic model was used to assess insulin resistance (HOMA-IR), and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.2%. The mean BQI score was 4.50 ± 1.25, and boys had lower scores than girls. Children in the BQI tertile 3 had a better global diet quality. In boys, being in the BQI tertile 3 was associated with a lower risk of IR (OR [95% CI]: 0.10 [0.01−0.77], p < 0.05). Conclusions: A higher-quality breakfast was associated with better overall diet quality and a lower risk of IR, especially in boys.

Association of Healthy Eating Index-2015 and Dietary Approaches to Stop Hypertension Patterns with Insulin Resistance in Schoolchildren.

Background: Diet quality patterns are associated with a lower incidence of insulin resistance (IR) in adults. The aim of this study was to investigate the association between two diet quality indices and IR in schoolchildren and to identify the best diet quality index associated with a lower risk of IR. Methods: A total of 854 schoolchildren (8−13 years) were included in a cross-sectional study, who completed a three-day dietary record to assess their diet. Fasting plasma glucose and insulin were also measured, and anthropometric data were collected. Healthy Eating Index-2015 (HEI-2015), Dietary Approaches to Stop Hypertension (DASH), and adjusted DASH (aDASH) were calculated as diet quality indices. The homeostasis model assessment of insulin resistance (HOMA-IR) was used, and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.5%, and it was higher in girls. The mean HEI-2015 and DASH scores were 59.3 and 23.4, respectively, and boys scored lower in both indices. In girls, having a HEI-2015 score above the 33rd percentile was associated with a lower risk of IR (odds ratio [95% CI]: 0.43 [0.19−0.96], p = 0.020). Conclusion: Greater adherence to a healthy dietary pattern, as assessed by a higher HEI-2015 score, was associated with a lower risk of IR in schoolchildren, especially in girls.

[Childhood obesity as a health priority. Guidelines for improving weight control]. / La obesidad infantil como prioridad sanitaria. Pautas en la mejora del control de peso.

Introduction: Childhood obesity is a growing concern, because the problem affects a high percentage of children and is the source of many diseases in the present and in the future, which can lead to a decrease in life expectancy and quality of life. In order to combat the problem, it is necessary to analyze the factors associated with excess weight in childhood in order to act on them and try to curb the trend observed in recent years. Various socio-demographic aspects, as well as inactivity and sedentary lifestyle in children are factors that are associated with an increased risk of obesity and central adiposity. With great prominence in this issue, we have to highlight that the consumption of food is improvable: decrease the consumption of sugar, fat and sodium, and above all increase the consumption of fruits, vegetables, whole grains, fish, dairy is associated with lower obesity and central obesity in children. There is no single responsible for the problem and the interaction between healthy behaviors increases the chances of success in the fight against childhood obesity, which should be considered when planning nutritional education campaigns. Many aspects of the diet and lifestyle of the child population must be improved, perhaps now more emphasis is being placed on restrictive guidelines. Of course, it is desirable to reduce the consumption of sweets and snacks, but messages aimed at increasing the consumption of vegetables, fruits, whole grains and approximating the diet to the theoretical ideal can be prioritized. Constructive guidelines should stand out from restrictive ones.

Introducción: La obesidad infantil es objeto de preocupación creciente, porque el problema afecta a un elevado porcentaje de niños y es el origen de numerosas enfermedades en el presente y en el futuro, pudiendo condicionar un descenso en la esperanza y calidad de vida. Para combatir el problema es necesario analizar los factores que se asocian con el exceso de peso en la infancia para actuar sobre ellos e intentar frenar la tendencia observada en los últimos años. Diversos aspectos sociodemográficos, así como la inactividad y el sedentarismo de los niños son factores que se asocian con mayor riesgo de padecimiento de obesidad y adiposidad central. Con gran protagonismo en este tema debe destacarse que el consumo de alimentos es mejorable: disminuir el consumo de azúcar, grasa y sodio, y sobre todo aumentar el consumo de frutas, verduras, cereales integrales, pescado, lácteos se asocia con menor padecimiento de obesidad y obesidad central en los niños. Pero no hay un único responsable del problema y la interacción entre conductas saludables aumenta las posibilidades de éxito en la lucha contra la obesidad infantil, lo que debe ser considerado al planificar campañas de educación nutricional. Se deben mejorar numerosos aspectos de la alimentación y estilo de vida de la población infantil, quizá en este momento se hace más hincapié en pautas restrictivas, aunque es muy conveniente reducir el consumo de dulces y snacks, resulta muy deseable y quizá prioritario el aumentar el consumo de verduras, hortalizas, frutas, cereales integrales y aproximar la dieta al ideal teórico. Las pautas constructivas deberían destacar respecto a las restrictivas.

[Nutritional problems in celiac patients. Difficulties in achieving an adequate nutritional status]. / Problemática nutricional en pacientes celíacos. Dificultades para conseguir una situación nutricional adecuada.

Introduction: Celiac disease is the most common chronic intestinal disease. It affects approximately 1 % of the world population, affects all age groups and has symptoms both digestive and extra-digestive. The treatment of celiac disease is based on the strict withdrawal of gluten from the diet. This treatment supposes the improvement of symptoms and histology and the reduction of long-term comorbidities. People with celiac disease often follow diets that are far from the theoretical ideal, so they must be supervised and guided to achieve gluten-free diets that are also varied and balanced. In these patients it is important to avoid gluten consumption, but also to achieve an adequate supply of nutrients. However, their health problems, together with the limitations they must introduce in the diet make it more difficult to achieve a correct diet, so the group deserves special nutritional monitoring and surveillance.

Introducción: La enfermedad celíaca es la enfermedad crónica intestinal más frecuente que existe. Afecta aproximadamente al 1 % de la población mundial, a todos los grupos de edad y tiene síntomas de presentación tanto digestivos como extradigestivos. El tratamiento de la enfermedad celíaca se basa en la retirada estricta del gluten de la dieta. Este tratamiento supone la mejora de los síntomas y de la histología y la disminución de comorbilidades a largo plazo. Las personas con enfermedad celíaca realizan con frecuencia dietas alejadas del ideal teórico, por lo que deben ser supervisadas y orientadas para lograr dietas sin gluten y también variadas y equilibradas. En estos pacientes es importante evitar el consumo de gluten, pero también lograr un aporte adecuado de nutrientes y su problemática sanitaria, junto con las limitaciones que deben introducir en la dieta, hacen más difícil lograr una alimentación correcta, por lo que el colectivo merece una vigilancia y un control nutricional especiales.

Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years­Results from the EsNuPI Study

Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One "Spanish Reference Sample" (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler's or growing up milk and fortified and enriched milks, here called "Adapted Milk Consumers Sample" (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.

Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study.

Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to <10 years old (n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler's milk, and enriched and fortified milks) (n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to <10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.

Patterns of Change in Dietary Habits and Physical Activity during Lockdown in Spain Due to the COVID-19 Pandemic.

BACKGROUND: Lockdown due to COVID-19 influenced food habits and lifestyles with potential negative health impact. This study aims to identify patterns of change in eating habits and physical activity during COVID-19 lockdown in Spain and to identify associations with sociodemographic factors and usual habits. METHODS: This cross-sectional study included 1155 adults recruited online to answer a 10-section questionnaire. The protocol assessed usual diet by means of a semi-quantitative food frequency questionnaire, usual physical activity (PA) and supplement use, dietary changes, sedentary time, PA, exposure to sunlight, sleep quality, and smoking during confinement. Patterns of dietary change were identified by factor analysis. Factor scores were included in cluster analysis together with change in PA. RESULTS: Six patterns of dietary change were identified that together with PA changes during lockdown defined three clusters of lifestyle change: a cluster less active, a more active cluster, and a third cluster as active as usual. People who were usually less active were more likely to be classified in the cluster that increased physical activity in confinement. Scores of the Healthy Mediterranean-Style dietary pattern were higher in this group. Conclusions: Different patterns of change in lifestyles in confinement suggest the need to tailor support and advice to different population groups.

Leukocytes and Neutrophil-Lymphocyte Ratio as Indicators of Insulin Resistance in Overweight/Obese School-Children.

Background and Aims: Inflammation in overweight/obesity may condition the development of insulin resistance (IR). New markers of inflammation and systemic inflammation, such as leukocyte and platelet counts, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), could be used as indicators of IR. The aim of the present study was to investigate the relationship between these markers and IR in overweight/obese children. Materials and Methods: A total of 1,035 schoolchildren were studied (398 overweight/obese). Anthropometric, hematological and biochemical measurements were collected. Inflammation was considered to be present when the values of leukocytes, platelets, NLR, PLR and MLR were ≥p75 for each sex. IR was defined as HOMA-IR >3.16. Results: In overweight/obese schoolchildren, leukocytes were higher in both boys and girls, and platelets and NLR were higher in boys with IR than in boys with insulin sensitivity. An association between leucocytes and NLR values (≥p75) and IR was found in the entire population [2.911 (1.328-6.381); p = 0.008 and 2.660 (1.185-5.968); p = 0.018, respectively] and in boys [9.255 (1.896-45.168); p = 0.006 and 6.996 (1.377-35.544); p = 0.019, respectively]. Conclusion: Elevated white blood cell values and elevated NLR in overweight/obese children, and particularly in boys, could be indicators of the presence of IR in these subjects and should be considered when predicting possible complications, such as type II diabetes mellitus.

[Nutrition in the prevention and control of osteoporosis]. / Nutrición en la prevención y el control de la osteoporosis.

INTRODUCTION: Objective: although osteoporosis develops in advanced stages of life, it must be prevented and stopped from the pediatric age, acting on modifiable factors, especially diet and lifestyle. The objective of this work is to review the latest evidence on nutritional improvements that can help in the prevention and control of the disease. Methods: bibliographic search related to the topic. Results: it is advisable to avoid energy restrictions, especially in postmenopausal women and particularly if they have osteopenia/osteoporosis since, in relation to these pathologies, excess weight may be preferable, rather than underweight. Protein intake higher than the recommended one is beneficial for the bone, provided that the calcium intake is adequate. Excessive intake of sugar and saturated fat should be avoided, but attempts should be made to achieve the nutritional goals set for ω-3 polyunsaturated fatty acids and fiber. It is important to monitor vitamin D status and calcium intake, which is inadequate in high percentages of individuals, as well as improving the contribution of vitamins K, C and group B, and also magnesium, potassium, iron, zinc, copper, fluorine, manganese, silicon and boron, and avoiding the excessive contribution of phosphorus and sodium. Conclusions: osteoporosis is an underdiagnosed pathology and of increasing prevalence. Due to its high morbidity and mortality, prevention is important and, from a nutritional point of view, it is convenient to bring the diet closer to the theoretical ideal. In general, increasing the consumption of dairy products, fish, vegetables and fruits, as well as reducing the consumption of salt, during childhood and throughout life, seems convenient for the bone improvement of most of the population.

INTRODUCCIÓN: Introducción y objetivos: la osteoporosis, aunque se manifiesta en etapas avanzadas de la vida, se debe prevenir y frenar desde la edad pediátrica, actuando sobre los factores modificables, especialmente la alimentación y el estilo de vida. El objetivo del presente trabajo es revisar las últimas evidencias sobre las mejoras nutricionales que pueden ayudar en la prevención y el control de la enfermedad. Métodos: búsqueda bibliográfica en relación con el tema. Resultados: conviene evitar las restricciones energéticas, especialmente en mujeres posmenopáusicas, sobre todo si tienen osteopenia/osteoporosis dado que, en relación con estas patologías, puede ser preferible un exceso de peso frente a un peso insuficiente. Una ingesta proteica superior a la recomendada es beneficiosa para el hueso siempre que la ingesta de calcio sea adecuada. Se debe evitar una ingesta excesiva de azúcar y de grasa saturada, pero se deben intentar alcanzar los objetivos nutricionales marcados para los ácidos grasos poliinsaturados ω-3 y la fibra. Es importante vigilar la situación en vitamina D y la ingesta de calcio, que es inadecuada en elevados porcentajes de individuos. También conviene mejorar el aporte de vitaminas K, C y del grupo B, así como de magnesio, potasio, hierro, zinc, cobre, flúor, manganeso, silicio y boro, y evitar el aporte excesivo de fósforo y sodio. Conclusiones: la osteoporosis es una patología infradiagnosticada y de prevalencia creciente. Por su elevada morbilidad y mortalidad es importante la prevención y desde el punto de vista nutricional conviene aproximar la dieta al ideal teórico. En general, el incremento en el consumo de lácteos, pescado, verduras, hortalizas y frutas, así como la reducción del consumo de sal, durante la infancia y a lo largo de la vida parecen convenientes para la mejora ósea de la mayor parte de la población.

[Dairy matrix: nutritional and sanitary benefits of the interrelation between its nutrients]. / Matriz láctea: beneficios nutricionales y sanitarios de la interrelación entre sus nutrientes.

INTRODUCTION: The effect of nutrients on health has been studied traditionally. From this point of view, milk and dairy products contribute to maintaining and improving nutritional status. Due to its high content of some nutrients such as saturated fat, among others, dairy consumption has been linked to the appearance of several diseases such as obesity or cardiovascular disease. However, food cannot be classified as good or bad based on its nutrient content. On the contrary, those interactions between nutrients and other bioactive compounds that occur in the food matrix must also be taken into account, as they can lead to different results than those expected derived from their consumption. In the case of dairy products, the scientific evidence indicates that dairy matrix could play an important role in the prevention of several non-communicable diseases.

INTRODUCCIÓN: Tradicionalmente se ha estudiado el efecto de los nutrientes en la salud. Desde este punto de vista, la leche y los derivados lácteos son alimentos que contribuyen a mantener y mejorar el estado nutricional. Por su elevado contenido en algunos nutrientes como la grasa saturada, entre otros, el consumo de lácteos se ha relacionado con la aparición de diversas enfermedades como la obesidad o la enfermedad cardiovascular. Sin embargo, los alimentos no se pueden clasificar como buenos o malos por su contenido en nutrientes, sino que también hay que tener en cuenta que en la matriz alimentaria se producen interacciones entre los nutrientes y otros compuestos bioactivos que pueden hacer que el consumo de dichos alimentos tenga resultados distintos a los esperados. En el caso de los lácteos, la evidencia científica señala que la matriz láctea podría jugar un papel importante frente a la prevención de diversas enfermedades crónicas no transmisibles.

[Importance of choline in cognitive function]. / Importancia de la colina en la función cognitiva.

INTRODUCTION: Choline is a critical nutrient for cognitive development, metabolism and liver function, and regulation of homocysteine metabolism. It is necessary for the synthesis of the neurotransmitter acetylcholine, the synthesis of betaine and that of phosphatidylcholine. In the perinatal stage, the contribution of choline is essential to guarantee optimal cognitive development and prevent neural tube defects. In adults and the elderly, choline intake has been associated with better performance in some cognitive functions and a lower incidence of dementia. Despite their important role in health, most groups of the population do not reach their adequate intake of choline, and even some groups, such as pregnant women or childbearing women, have a higher risk of having suboptimal intakes. The main dietary sources of choline are eggs, dairy and meats, so reducing or limiting the consumption of these foods negatively impacts on the intake of this nutrient. Given the need to improve the intake of this vitamin, it is necessary to increase the knowledge that the population has about this nutrient, raising awareness about the importance of choline for health, and its main food sources.

INTRODUCCIÓN: La colina es un nutriente crítico para el desarrollo cognitivo, el metabolismo y la función hepática y la regulación del metabolismo de la homocisteína. Es necesaria para la síntesis del neurotransmisor acetilcolina, la síntesis de betaína y la de fosfatidilcolina. En la etapa perinatal el aporte de colina es fundamental para garantizar el desarrollo cognitivo y prevenir defectos del tubo neural. En adultos mayores y ancianos la ingesta de colina se ha asociado a mejor rendimiento en algunas funciones cognitivas y menor incidencia de demencia. A pesar de su importante papel en la salud, la mayoría de los colectivos no alcanza sus ingestas adecuadas (IA) de colina, aunque algunos colectivos, como gestantes o mujeres en edad fértil, tienen un mayor riesgo de tener ingestas subóptimas. Las principales fuentes dietéticas de esta vitamina son los huevos, lácteos y carnes, y disminuir o limitar el consumo de estos alimentos impacta negativamente en la ingesta de este nutriente. Dada la necesidad de mejorar la ingesta de esta vitamina, es necesario mejorar el conocimiento que tiene la población sobre este nutriente, concienciándola sobre la importancia de la colina para la salud y sus principales fuentes alimentarias.

[Weight status, body composition, and diet quality of Spanish schoolchildren according to their level of adherence to the 24-hour movement guidelines]. / Situación ponderal, composición corporal y calidad de la dieta de los escolares españoles en función del nivel de adherencia a las guías de movimiento de 24 horas.

INTRODUCTION: Introduction: moderate to vigorous physical activity, limiting sedentary behaviors, and getting adequate rest are lifestyle factors that help prevent overweight and obesity. However, there are few studies that relate all of these factors to weight status, body composition, and diet quality in school children. Objective: to assess the differences in anthropometric status and diet quality in a group of Spanish schoolchildren, according to their level of adherence to the 24-hour movement guidelines. Methods: a total of 367 schoolchildren aged 7-11 years were studied. Anthropometric, dietary, and movement patterns were collected. Subsequently, they were divided into three groups based on their adherence to the extant guidelines: low adherence (BA), medium adherence (AM) and high adherence (AA). Results: only 15 % of the schoolchildren met the guidelines. The percentage of overweight was higher in the BA group than in the AM and AA groups. The BA group also had a lower fibre intake; a lower contribution to the recommendations for vitamins B6, B12 and C, selenium and magnesium; and a higher intake of saturated fatty acids. The schoolchildren who did not meet screen time recommendations had a higher odds ratio for overweight/obesity (OR = 1.92 (1.10-3.36); p = 0.022). Conclusion: schoolchildren who adhere to 2 or more movement guideline recommendations had less overweight and a diet of better nutritional quality. Non-compliance with the screen time recommendation leads to a higher risk of overweight or obesity.

INTRODUCCIÓN: Introducción: la actividad física moderada o vigorosa, la limitación de los comportamientos sedentarios y el descanso adecuado son factores del estilo de vida que ayudan a prevenir el sobrepeso y la obesidad. Sin embargo, existen pocos trabajos que relacionen el conjunto de estos factores con la situación ponderal, la composición corporal y la calidad de la dieta en escolares. Objetivo: conocer las diferencias en cuanto a situación antropométrica y calidad de la dieta de un grupo de escolares españoles en función del nivel de adherencia a las guías de movimiento de 24 horas. Métodos: se han estudiado 367 escolares de 7-11 años de edad. Se recogieron datos antropométricos, dietéticos y de comportamientos de movimiento. Posteriormente se dividieron en tres grupos sobre la base de su adherencia a las guías: baja adherencia (BA), adherencia media (AM) y alta adherencia (AA). Resultados: solo un 15 % de los escolares cumplía con las guías. El porcentaje de sobrepeso era mayor en el grupo BA que en el AM y el AA. El grupo BA también presentaba una menor ingesta de fibra; una menor contribución a las recomendaciones de vitaminas B6, B12 y C, selenio y magnesio; y una mayor ingesta de ácidos grasos saturados. Los escolares que incumplían la recomendación referente al tiempo de pantalla tenían mayor riesgo de desarrollar sobrepeso u obesidad (OR = 1,92 (1,10-3,36); p = 0,022). Conclusión: los escolares que se adhieren a 2 o más recomendaciones de las guías de movimiento presentan menos sobrepeso y una mejor calidad nutricional de la dieta. El incumplimiento de la recomendación de tiempo de pantalla supone un mayor riesgo de sobrepeso u obesidad.

Breakfast Habits of a Representative Sample of the Spanish Child and Adolescent Population (The ENALIA Study): Association with Diet Quality.

The association between breakfast quality and total diet quality of children and adolescents ((1-17.9 years (n = 1570)) from the National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) was analyzed. Dietary information was collected using two non-consecutive one-day food diaries (1-10 years old) or two 24 h dietary recalls (>10 years). Breakfast quality index (BQI) and a variant of Nutrient Rich Foods index (NRF9.3) were calculated to assess the total diet quality. Children and adolescents who had breakfast on at least one day (n = 1561) were divided into two groups according to BQI: Worse Quality Breakfast (WQB) (BQI < 4 points (P66), n = 781) and Good Quality Breakfast (GQB) (BQI ≥ 4, n = 780). Younger children and those whose parents have university education presented higher BQI. GQB group had significantly higher intakes of micronutrients (vitamins A, D, C, B1, B2, B6, niacin, folate, calcium, potassium, magnesium). Fewer GQB children exceeded the Acceptable Macronutrient Distribution Range for fat and had folate and calcium intakes below their estimated average requirement. Daily NRF9.3 was 496.2 ± 54.0, being higher in GQB (503.8 ± 50.6 vs. 488.6 ± 56.2, p < 0.001). Increasing the quality of breakfast increased the possibility of having a NRF9.3 higher than P50 (OR: 1.893, CI: 1.549-2.315, p < 0.0001). Breakfasts have room for quality improvement in a high percentage of children. A higher quality breakfast is associated with a benefit in the quality of the total diet.

Carbohydrates, Starch, Total Sugar, Fiber Intakes and Food Sources in Spanish Children Aged One to <10 Years-Results from the EsNuPI Study.

Diet quality is a modifiable factor that may contribute to the onset of diet-related chronic diseases. Currently, in Spain there are no studies that examine the intakes and sources for total carbohydrates, starch, total sugar, and fiber by both children consuming all kind of milks and children regularly consuming adapted milk formulas. Our goal was to evaluate the contribution of different food groups to total carbohydrates, starch, total sugar, and fiber consumption within the EsNuPI study participants by assessing their usual intakes by applying two 24 h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707) and another cohort which included children consuming adapted milks including follow-on milk, toddler's or growing up milk, fortified and enriched milks, here called Adapted Milk Consumers Cohort" (AMS) (n = 741). Estimation of the usual intake showed that nutrient intake increased with age for all nutrients except for fiber. The percentage of children by age and gender who met the reference intake (RI) range for total carbohydrates, was in all groups more than 50% of individuals, except for girls aged 6 to <10 years from the reference cohort in which only 46.9% complied the RI. Median fiber intake, both in the SRS and the AMS, was well below the adequate intake (AI) for children between 3 and 10 years. Main total carbohydrates sources were cereals, followed by milk and dairy products, fruits, bakery and pastry, vegetables and sugars and sweets. The highest contributors to starch intakes were cereals, bakery and pastry, vegetables, and fruits. Major sources of total sugar intakes were milk and dairy products, fruits, bakery and pastry, sugars and sweets, vegetables, and cereals. Nonetheless, milk and dairy products, and fruits, mainly provided lactose and fructose, respectively, which are not considered free sugars. Higher contribution to fiber intakes was provided by fruits, cereals, vegetables and bakery and pastry. There were no significant differences in relation with the total sugar intake according to the body mass index (BMI) between SRS and AMS. The present study suggests a high proportion of children had total carbohydrates intakes in line with recommendations by public health authorities, but still a significant number presented insufficient total carbohydrate and fiber intakes, while total sugar consumption was high, with no major differences between SRS and AMS cohorts.

Dietary Intake, Nutritional Adequacy and Food Sources of Total Fat and Fatty Acids, and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Results of the EsNuPI Study.

We aimed to determine the usual intake of total fat, fatty acids (FAs), and their main food sources in a representative cohort of the Spanish pediatric population aged 1 to <10 years (n = 707) who consumed all types of milk and an age-matched cohort who consumed adapted milk over the last year (including follow-on formula, toddler's milk, growing-up milk, and fortified and enriched milks) (n = 741) who were participants in the EsNuPI study (in English, Nutritional Study in the Spanish Pediatric Population). Dietary intake, measured through two 24 h dietary recalls, was compared to the European Food Safety Authority (EFSA) and the Food and Agriculture Organization of the United Nations (UN-FAO) recommendations. Both cohorts showed a high intake of saturated fatty acids (SFAs), according to FAO recommendations, as there are no numerical recommendations for SFAs at EFSA. Also, low intake of essential fatty acids (EFAs; linoleic acid (LA) and α-linolenic acid (ALA)) and long-chain polyunsaturated fatty acids (LC-PUFA) of the n-3 series, mainly docosahexaenoic acid (DHA) were observed according to EFSA and FAO recommendations. The three main sources of total fat and different FAs were milk and dairy products, oils and fats, and meat and meat products. The consumption of adapted milk was one of the main factors associated with better adherence to the nutritional recommendations of total fat, SFAs, EFAs, PUFAs; and resulted as the main factor associated with better adherence to n-3 fatty acids intake recommendations. Knowledge of the dietary intake and food sources of total fat and FAs in children could help in designing and promoting effective and practical age-targeted guidelines to promote the consumption of EFA- and n-3 PUFA-rich foods in this stage of life.

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †.

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler's milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.