Eating out of home in Portugal: characterisation and effects on dietary intake.

This cross-sectional study aims to describe and compare energy, nutrient intake and food consumption according to eating location and by age groups using data from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015/2016). Dietary intake was estimated by two non-consecutive days of food diaries (children)/24-h recalls (other age groups), and four eating location categories were defined according to the proportion of meals consumed at out-of-home locations: Home (at least 80 % of meals at home), Other Homes, School or Work and Restaurants and Other Places. The majority of meals (69·1 %) were consumed at home. Meals were also often taken at school by children and adolescents and in restaurants and similar outlets by adults and elderly. Children and adolescents in the School or Work category ate more fruit, vegetables and pulses and cereals and starchy tubers, whereas adults in this category ate more red and processed meats, sugar-sweetened beverages and sweets. Compared with Home category, Restaurants and Other Places was associated with worse diet adequacies among children (ß = -1·0; 95 % CI = -2·0, -0·04), adolescents: (ß = -2·4; 95 % CI = -3·2, -1·5) and adults (ß = -1·3; 95 % CI = -1·6, -1·0) reflecting higher intakes of energy, fat, trans-fatty acids and SFA, and Na. The elderly consumed more free sugars and fat when eating out of home in general. Overall, findings reflect important variation in nutrient profiles by eating location, with meals taken at school or work contributing to higher consumption of nutrient-dense foods and those taken in restaurants and other similar settings implying higher consumption of energy-dense foods.

Bisphenol A and cardiometabolic risk in adolescents: Data from the Generation XXI cohort.

BACKGROUND AND AIMS: Bisphenol A (BPA), an endocrine disruptor widely used in food contact materials, has been linked to a worse health profile. This study intends to estimate the association between BPA exposure and cardiometabolic patterns at adolescence. METHODS AND RESULTS: Data from the Portuguese population-based birth cohort Generation XXI at the age of 13 were used (n = 2386 providing 3-day food diaries and fasting blood samples). BPA exposure was measured in 24-h urine from a subsample (n = 206) and then predicted in all participants using a random forest method and considering dietary intake from diaries. Three cardiometabolic patterns were identified (normal, modified lipid profile and higher cardiometabolic risk) using a probabilistic Gaussian mixture model. Multinomial regression models were applied to associate BPA exposure (lower, medium, higher) and cardiometabolic patterns, adjusting for confounders. The median BPA exposure was 1532 ng/d, corresponding to 29.4 ng/kg/d. Adolescents higher exposed to BPA (compared to medium and lower levels) had higher BMI z-score (kg/m2) (0.68 vs. 0.39 and 0.52, respectively; p = 0.008), higher levels of body fat (kg) (16.3 vs. 13.8 and 14.6, respectively; p = 0.002), waist circumference (76.2 vs. 73.7 and 74.9, respectively; p = 0.026), insulinemia (ug/mL) (14.1 vs. 12.7 and 13.1, respectively; p = 0.039) and triglyceridemia (mg/dL) (72.7 vs. 66.1 and 66.5, respectively; p = 0.030). After adjustment, a significant association between higher BPA and a higher cardiometabolic risk pattern was observed (OR: 2.55; 95%CI: 1.41, 4.63). CONCLUSION: Higher BPA exposure was associated with a higher cardiometabolic risk pattern in adolescents, evidencing the role of food contaminants in health.

Meat or meatless meals at lunch and dinner - exploring the associated factors and transition between meals.

This study aimed to explore the factors associated with the consumption of meat vs. meatless meals and to assess the applicability of a multi-state model to describe transitions between lunch and dinner. Fifteen thousand four hundred and eight main meals (lunch and dinner) from a sample of adults (18-84 years, n = 3852) from the Portuguese Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) were categorised as meat, fish, ovolactovegetarian or snack. Adjusted generalised-mixed-effects models were used to explore the associations and a time-homogeneous Markov-multi-state model was applied to study the transitions. Women, older and higher educated individuals presented higher odds of consuming meatless meals and lower hazard of transitioning to meat in the following main meal. Strategies for replacing meat with more sustainable foods should be specific towards different population groups. Studying transitions across main meals, using multi-state models, can support the development of feasible, realistic and group-specific strategies to replace meat and promote dietary variety.

Interaction effects of socio-economic position in the association between eating location and diet quality in Portuguese children and adolescents: results from the National Food, Nutrition and Physical Activity Survey 2015-2016.

This study aims to evaluate the interaction effect of socio-economic environment (SEE) in the relationship between the eating location (EL) and diet quality, in children and adolescents. Data included Portuguese children and adolescents (3-17 years) from a National Dietary Survey Sample (IAN-AF 2015/2016, n 987). Dietary intake was obtained by 2-d food diaries (children) or 2-24-h-recall (adolescents). Participants were classified into four groups of EL: 'Home', 'Other homes', 'School' and 'Restaurants'. Diet quality was measured as a higher adherence to a healthy eating pattern. A previous developed socio-economic classification was used, and participants were grouped as belonging to a low socio-economic environment (LSE) or middle-high socio-economic environment (MHSE). Linear regression models were used to evaluate the association between EL and diet quality, stratified by the SEE. A statistically significant interaction effect was found (P < 0·01) for the SEE in the association between EL and diet quality. After adjustment for potential confounders, in LSE, participants belonging to 'Other homes' (ß = -2·07; 95 % CI:-3·70, -0·44) and 'Restaurants' (ß = -3·31; 95 % CI: -5·08, -1·54) had lower scores in the diet quality score, comparing to 'Home'. In MHSE, comparing with 'Home', 'Restaurants' showed lower diet quality (ß = -1·56; 95 % CI:-2·65, -0·48), while the 'School' had better diet quality (ß = 0·90; 95 % CI: 0·16, 1·64). The SEE influences the association between EL and diet quality and, belonging to more disadvantaged SEE, might represent a higher risk of unhealthy eating habits when eating out-of-home.

Quantitative risk-benefit assessment of Portuguese fish and other seafood species consumption scenarios.

Portugal has high fish/seafood consumption, which may have both risks and benefits. This study aims to quantify the net health impact of hypothetical scenarios of fish/seafood consumption in the Portuguese population using a risk-benefit assessment methodology. Consumption data from the National Food, Nutrition and Physical Activity Survey 2015-2016 (n 5811) were used to estimate the mean exposure to methylmercury and EPA + DHA in the current and the alternative scenarios considered. Alternative scenarios (alt) were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (alt1: excluding predatory fishes; alt2: including only methylmercury low-level fishes) or in the frequency of weekly fish/seafood consumption (alt3 to alt6: 1, 3, 5 or 7 times a week, replacing fish/seafood meals with meat or others). The overall health impact of these scenarios was quantified using disability-adjusted life years (DALY). In the Portuguese population, about 11 450 DALY could be prevented each year if the fish/seafood consumption increased to a daily basis. However, such a scenario would result in 1398 extra DALY considering the consumption by pregnant women and the respective risk on fetal neurodevelopment. Our findings support a recommendation to increase fish/seafood consumption up to 7 times/week. However, for pregnant women and children, special considerations must be proposed to avoid potential risks on fetal neurodevelopment due to methylmercury exposure.

Energy intake misreport: how different methods affect its prevalence and nutrient intake estimates.

BACKGROUND: Although different methods for the evaluation of energy intake (EI) misreport have been described, it is unclear which one is the most appropriate. AIM: To assess the performance of these methods in the prevalence of EI misreports and accuracy of nutrient intake estimates. METHODS: Reports of 3,639 adults from the Portuguese National Food, Nutrition and Physical Activity Survey 2015-2016 were classified using univariate (Willett; interquartile range) and multivariate (Goldberg; predicted total energy expenditure [pTEE], testing different standard deviations [SD]) methods. Self-reported intakes were compared to their respective estimates by urinary excretion in a sub-sample of 80. The effect of the exclusion of misreporters on nutrient estimates was assessed by the differences in linear regression coefficients between plausible and total sample. RESULTS: The highest prevalence of EI misreport was observed using pTEE 1SD (63.9%). Differences in the associations between nutrient self-reported intake and estimated intake using urinary biomarkers were verified with misreporters' exclusion by pTEE 1SD method (ß-protein = 0.209; 95% CI = 0.074-0.529; ß-potassium = 0.276; 95% CI = 0.060-0.560) and Goldberg 2SD (ß-protein = 0.080; 95% CI = 0.025-0.235; ß-potassium = 0.106; 95% CI = -0.048-0.246). CONCLUSIONS: Multivariate methods lead to a higher prevalence of misreports and larger differences in nutrient estimates. The application of the pTEE 1SD and Goldberg 2SD methods resulted in more accurate nutrient estimates.

Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study.

BACKGROUND: Excessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal. METHODS AND FINDINGS: We performed a national market analysis and population-wide modelling study using market data for the years 2014-2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015-2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40-78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases-despite our efforts to mitigate them-related to the methodological differences between these sources. CONCLUSIONS: The tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels among frequent consumers of SSBs. Such taxation is an effective population-wide intervention. Reformulation alone, without the decrease in sales, would have had a far smaller effect on obesity incidence in the Portuguese population.

Characterizing energy intake misreporting and its effects on intake estimations, in the Portuguese adult population.

OBJECTIVE: The aim of the current study was to evaluate energy intake misreporting prevalence, its associated factors and its effects on nutrient intake, in the Portuguese population aged from 18 to 84 years. DESIGN: Cross-sectional study. SETTING: Portugal. SUBJECTS: Adults participants from the National Food, Nutrition and Physical Activity Survey, IAN-AF, 2015-2016, who provided two complete 24 h dietary recall and complete covariate information. RESULTS: Under, plausible and over-reporters were identified according to the Goldberg method. Total misreporting prevalence was 29·9 %, being 28·5 % of under-reporting and 1·4 % of over-reporting. The current study found higher odds of being classified as an under-reporter especially in participants with higher BMI and in those who self-reported health perception status as non-favourable. Energy intake estimation increases by 853.5 kJ/d (204 kcal/d) when misreporters are excluded, and the same tendency is observed for macro and micronutrients. It is worth mentioning that the prevalence of inadequacy for protein intake decreases by about 5 % when considering plausible reporters. CONCLUSIONS: The exclusion of misreporters has a small impact on the crude energy and nutrient estimates as well as on assessing the contribution of nutrients to total energy intake. However, a moderate impact was observed in the estimation of nutrient inadequacy prevalence.

Validation of a new software eAT24 used to assess dietary intake in the adult Portuguese population.

OBJECTIVE: The aim of the current study was to evaluate the accuracy of the new software eAT24 used to assess dietary intake in the National Food, Nutrition and Physical Activity Survey (IAN-AF) against urinary biomarkers: N (nitrogen), K (potassium) and Na (sodium). DESIGN: We conducted a cross-sectional study. Two non-consecutive 24-h dietary recalls (24-HDR) were applied, and a 24-h urine sample was collected. We examined differences between estimates from dietary and urine measures, Pearson correlation coefficients were calculated and the Bland-Altman plots were drawn. Multiple linear regression was used to evaluate the factors associated with the difference between estimates. SETTING: Sub-sample from the Portuguese IAN-AF sampling frame. PARTICIPANTS: Ninety-five adults (men and women) aged 18-84 years. RESULTS: The estimated intake calculated using the dietary recall data was lower than that estimated from urinary excretion for the three biomarkers studied (protein 94·3 v. 100·4 g/d, K 3212 v. 3416 mg/d and Na 3489 v. 4003 mg/d). Considering 2 d of recall, the deattenuated correlation coefficients were 0·33, 0·64 and 0·26 for protein, K and Na, respectively. For protein, differences between dietary and urinary estimates varied according to BMI (ß = -1·96, P = 0·017). The energy intake and 24-h urine volume were significantly associated with the difference between estimates for protein (ß = 0·03, P < 0·001 and ß = -0·02, P = 0·002, respectively), K (ß = 0·71, P < 0·001 and ß = -0·42, P = 0·040, respectively) and Na (ß = 1·55, P < 0·001 and ß = -0·81, P = 0·011, respectively). CONCLUSIONS: The new software eAT24 performed well in estimating protein and K intakes, but lesser so in estimating Na intake, using two non-consecutive 24-HDR.

Total, added and free sugar intakes, dietary sources and determinants of consumption in Portugal: the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016).

OBJECTIVE: To assess total sugar (TS), added sugar (AS) and free sugar (FS) intakes, dietary sources, adherence to recommendations and determinants of consumption, in a Portuguese national sample. DESIGN: Cross-sectional study. Dietary assessment was obtained by two food diaries in children aged <10 years and two non-consecutive 24 h recalls for other age groups. TS, AS and FS intakes were estimated by using SPADE software. TS content in food was estimated at the ingredient level. AS content in food was assessed through a systematic methodology and FS was based on the WHO definition. SETTING: National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016), Portugal. PARTICIPANTS: Representative sample from the Portuguese population, aged from 3 months to 84 years (n 5811). RESULTS: Mean daily intake and contribution to total energy intake (E%) were 84·3 g/d (18·5 E%) for TS, 32·1 g/d (6·8 E%) for AS and 35·3 g/d (7·5 E%) for FS. Of the population, 76 % adhered to the FS recommendation (FS < 10 E%). The lowest adherence was in children (51·6 %) and adolescents (51·3 %). The main dietary source of TS was fruit across all ages, except in adolescents which was soft drinks. In children, the main dietary sources of FS were yoghurts and sweets, soft drinks in adolescents and table sugar in adults/elderly. FS intake was lower in children with more educated parents and in adults who practised physical activity regularly, and higher among smokers. CONCLUSIONS: Interventions ought to be planned towards decreasing intakes of added and free sugars considering population-specific characteristics.

Eating frequency and weight status in Portuguese children aged 3-9 years: results from the cross-sectional National Food, Nutrition and Physical Activity Survey 2015-2016.

OBJECTIVE: To evaluate daily eating frequency (main meals and snacks) in relation to weight status in children aged 3-9 years, representative of the Portuguese population. DESIGN: Cross-sectional study. Dietary intake was estimated as the mean of two non-consecutive days of food diaries, followed by face-to-face interviews. Weight and height were measured by trained observers. Eating occasions (EO) were defined by the children's caregiver; an EO was considered separate if the time of consumption was different from other EO and it provided at least 209 kJ (50 kcal). Main meals defined as 'breakfast', 'lunch' and 'dinner' could be selected only once per day. The remaining EO were considered snacks. The association between eating frequency and overweight/obesity was evaluated through logistic regressions weighted for the population distribution. SETTING: National Food, Nutrition and Physical Activity Survey of the Portuguese population, 2015-2016. PARTICIPANTS: Portuguese children aged 3-9 years with complete dietary data and anthropometric measurements (n 517). RESULTS: Overall, the number of daily EO ranged from 3·5 to 11, and on average children had 5·7 daily EO. After adjustment for child's sex, age and total energy intake, and considering only plausible energy intake reporters, having < 3 snacks/d was positively associated with being overweight/obese (OR = 1·98; 95 % CI 1·00, 3·90), compared with having ≥ 3 snacks/d. CONCLUSIONS: Lower daily frequency of EO was associated with increased odds of being overweight or obese in children. A higher eating frequency, maintaining the same energy intake, seems to contribute to a healthy body weight in children.

Effects of soluble copper and copper oxide nanoparticle exposure on the immune system of mussels, Mytilus galloprovincialis.

Copper and copper oxide nanomaterials (nCuO) can enter the marine environment negatively impacting mussels, an environmental and commercially relevant organism. We analyzed the effects on the immune system of adult mussels exposed to soluble copper (CuSO4 , 20-50 µg/L) or nCuO (100-450 µg/L). CuSO4 caused significant copper accumulation in gills and cell-free hemolymph, while nCuO caused cell damage to gills and significant copper accumulation in hemocytes, the most abundant cells in the hemolymph. Both sources of copper caused cellular toxicity in hemocytes by increasing reactive oxygen species production and lysosome abundance, and decreasing multi-drug resistance transporter activity. Though hemocyte abundance was not affected, their in-vitro phagocytic activity decreased, explaining the slight (but not statistically significant) increase in bacterial proliferation in mussels exposed to the pathogenic bacteria Vibrio tubiashii following copper exposure. Thus, exposure to non-lethal concentrations of CuSO4 or nCuO can potentially increase mussel susceptibility to bacterial infections.

Validation of a picture book to be used in a pan-European dietary survey.

OBJECTIVE: To validate a picture book for estimation of food portion sizes using two approaches: (i) 'perception' of food portions by comparison with a series of food photos; and (ii) 'conceptualization and memory', using the same photos to estimate the amount of served food one hour after self-served food portions. DESIGN: Each partner developed a country-specific picture book based on the so-called EPIC-Soft picture book. Representative and common photo series were chosen achieving approximately 25 % of the original picture book (n 23). Three portions from each photo series were randomly selected. SETTING: The study was performed within the Pilot study in the view of a Pan-European dietary survey - Adolescents, adults and elderly (PILOT-PANEU) project. SUBJECTS: A sample of adolescents and adults was recruited in five countries: Bulgaria (n 103), Finland (n 34), Germany (n 69), Hungary (n 62) and Portugal (n 77). RESULTS: Among the portions of the corresponding photo series and depending on the type of food, from 18 % (cheese) to 96 % (ratatouille) of participants chose the correct portions. In the perception study, agreement between the portions shown and reported was substantial (intraclass correlation coefficient (ICC)=0·805) and the mean difference was very low. In the memory study, agreement between the served and reported portions was lower than in the perception study (ICC=0·536). Agreement also seemed to decrease as the appearance of food on the plate differed from food in the picture. CONCLUSIONS: Overall, the picture series selected can be applied in future intake surveys to quantify foods similar to those depicted in the pictures.

Prevalence of general and abdominal obesity in Portugal: comprehensive results from the National Food, nutrition and physical activity survey 2015-2016.

BACKGROUND: This study includes, for the first time, estimates of general and abdominal obesity prevalence for all ages of the Portuguese population, using common standardized methodologies. Results are compared by sex, age groups, educational level and geographical regions. METHODS: Participants were a representative sample of the Portuguese population aged between 3 months and 84 years of age (n = 6553), enrolled in the National Food, Nutrition and Physical Activity Survey, 2015-2016. Objective anthropometric measurements included length/height, weight and body circumferences, performed according to standard procedures. Body mass index (BMI) was classified according to the World Health Organization (WHO) growth charts for children and adolescents, and WHO criteria for adults. Abdominal obesity was defined in adults as waist-hip ratio ≥ 0.85 in women or ≥ 0.90 in men. Prevalence estimates and 95% confidence intervals (95%CI) were weighted according to a complex sampling design, considering stratification by seven geographical regions and cluster effect for the selected Primary Health Care Unit. RESULTS: The national prevalence of obesity is 22.3% (95%CI: 20.5-24.0), significantly higher in women. Obesity prevalence is much higher in the elderly (39.2%, 95%CI. 34.2-44.2), while children and adolescents have the lowest prevalence around 8-9%. In a regression model, three knot points denoting an inflection of obesity prevalence across the life span were observed around 5, 15 and 75 years. The prevalence of pre-obesity at national level is 34.8% (95%CI: 32.9-36.7), higher in men, and almost 18% of children and 24% of adolescents have pre-obesity. The sex- and age-standardized prevalence of obesity ranged from 38.3% (95%CI: 34.6-42.1) to 13.1% (95%CI: 10.3-15.9) for the less and the most educated individuals, respectively. Although some geographical region disparities, obesity prevalence did not significantly differed across regions (p = 0.094). The national prevalence of abdominal obesity in adults is 50.5% (95%CI: 47.9-53.1), particularly high in the elderly (80.2%). CONCLUSION: Almost 60% of the general Portuguese population is obese or pre-obese. Women, elderly and less educated individuals present the highest obesity prevalence. Abdominal obesity, in particular, seems to be a relevant public health problem among the elderly men.

Copper oxide and zinc oxide nanomaterials act as inhibitors of multidrug resistance transport in sea urchin embryos: their role as chemosensitizers.

The ability of engineered nanomaterials (NMs) to act as inhibitors of ATP-binding cassette (ABC) efflux transporters in embryos of white sea urchin (Lytechinus pictus) was studied. Nanocopper oxide (nano-CuO), nanozinc oxide (nano-ZnO), and their corresponding metal ions (CuSO4 and ZnSO4) were used as target chemicals. The results showed that nano-CuO, nano-ZnO, CuSO4, and ZnSO4, even at relatively low concentrations (0.5 ppm), significantly increased calcein-AM (CAM, an indicator of ABC transporter activity) accumulation in sea urchin embryos at different stages of development. Exposure to nano-CuO, a very low solubility NM, at increasing times after fertilization (>30 min) decreased CAM accumulation, but nano-ZnO (much more soluble NM) did not, indicating that metal ions could cross the hardened fertilization envelope, but not undissolved metal oxide NMs. Moreover, nontoxic levels (0.5 ppm) of nano-CuO and nano-ZnO significantly increased developmental toxicity of vinblastine (an established ABC transporter substrate) and functioned as chemosensitizers. The multidrug resistance associated protein (MRP, one of ABC transporters) inhibitor MK571 significantly increased copper concentrations in embryos, indicating ABC transporters are important in maintaining low intracellular copper levels. We show that low concentrations of nano-CuO and nano-ZnO can make embryos more susceptible to other contaminants, representing a potent amplification of nanomaterial-related developmental toxicity.

Association between bisphenol A exposure and cardiometabolic outcomes: A longitudinal approach.

Increased cardiometabolic risk is associated with abnormalities in blood biomarkers profile and adiposity measurements. Some substances found in the food matrix and the environment, called endocrine-disrupting chemicals, may impair cardiometabolic health in the early and later stages of life. Bisphenol A (BPA) is a food contaminant that migrates from food contact materials and may act as an endocrine disruptor, negatively affecting human health. The present work aims to longitudinally assess the association between BPA exposure and cardiometabolic outcomes, considering data from Portuguese population-based birth cohort Generation XXI. Blood insulin (0.06stdß; 95 %CI:0.03,0.09) and insulin resistance (0.05stdß; 95 %CI:0.02,0.08) presented a significant longitudinal association with BPA daily exposure after adjustment for important variables and energy. The same findings were observed for fat mass (0.03stdß; 95 %CI 0.01,0.06) and waist circumference (0.06stdß; 95 %CI:0.04,0.08). For z-BMI, a significant cross-sectional (0.03stdß; 95 %CI:0.01,0.04) and longitudinal (0.02stdß; 95 %CI:0.00,0.04) association was found. This was the first study assessing the association between BPA exposure and health outcomes from childhood to adolescence. We found an association between BPA exposure and increased blood insulin level, insulin resistance, fat mass percentage, waist circumference and z-BMI. Our results point to the need to reduce exposure to BPA in the early stages of life.

Exploring dietary patterns and their association with environmental sustainability and body mass index in children and adolescents: Insights from the National Food, Nutrition and Physical Activity Survey 2015-2016.

OBJECTIVE: To adapt four dietary patterns for children and adolescents, and study their associations with sustainability (greenhouse-gas emissions-GHGE and land use-LU), and health (body mass index-BMI) indicators. RESEARCH METHODS & PROCEDURES: Dietary intake of children (3-9y) and adolescents (10-17y) from the National Food, Nutrition and Physical Activity Survey 2015-2016, Portugal (n = 1153) was assessed through two non-consecutive interviews: one-day food diaries (children), and 24-h recalls (adolescents), using an automated multiple-pass method, including a picture book for portion sizes estimation. Adherence to the Eat-Lancet and World Health Organization (WHO) recommendations, Mediterranean and Atlantic diets were evaluated using adapted versions for pediatrics of the World Index for Sustainability and Health (WISH), Diet Quality Index (DQI), Mediterranean Diet Score (MDS) and Southern-European Atlantic Diet (SEAD), respectively. Diet-related GHGE and LU were estimated using the SHARP-Indicators database. BMI (measured) z-scores were classified according to WHO criteria. A standardized weighted health-sustainability composite index was created (BMI + 0.5*GHGE+0.5*LU). Adjusted linear regression models were computed. RESULTS: WISH, DQI, MDS, and SEAD had weighted mean scores (range) of 50 (0-130), 24 (9-36), 20 (8-32), and 17 (8-32), respectively. All dietary patterns were associated with lower environmental impact, particularly in children, but not with BMI. Only MDS explained both health and sustainability indicators in childhood (composite index: sd.ß = -0·223,95%CI:-0·347,-0·072,R2 = 25.1 %), and adolescence (composite index: sd.ß = -0·159,95%CI:-0·315,-0·003,R2 = 31.3 %). CONCLUSION: The Mediterranean diet was the most related to (higher) environmental sustainability and (lower) BMI. However, in children (not adolescents), the WISH, DQI, and SEAD showed then same associations.

Factors associated with the consumption of voluntarily fortified foods with micronutrients by the Portuguese population.

This study aimed to identify the sociodemographic and health-related factors associated with the consumption of voluntarily fortified foods with micronutrients (Mn-FF) by the Portuguese population, using data from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016). Food consumption, sociodemographic and other health-related factors, and physical activity data were computerised using the You Eat & Move e-platform. Foods consumed by participants and labelled foods reported as consumed were included in the database. Mn-FF were considered all foods containing added micronutrients legally authorised, and MN-FF users were those who consumed at least one Mn-FF on at least one of the dietary recall days. Approximately 57% of the population consumed at least one Mn-FF. Children and adolescents consumed significantly more Mn-FF than older age groups. The primary contributors to Mn-FF consumption were breakfast cereals and fat spreads. Being a child (female OR 2.07 [95% CI: 1.52, 2.83]; male OR 4.80 [95% CI: 3.23, 7.14]) or adolescent (female OR 1.62 [95% CI: 1.78, 2.22]; male OR 4.59 [95% CI: 3.26, 6.47]), having a higher level of education (female OR 1.52 [95% CI: 1.17, 1.99]; male OR 1.85 [95% CI: 1.42, 2.42]) and engaging in regular physical activity (female OR 1.31 [95% CI: 1.09, 1.58]; male OR 1.36 [95% CI: 1.11, 1.68]) were factors positively associated with Mn-FF consumption. Conversely, obesity (female OR 0.76 [95% CI: 0.60, 0.96]), living in predominantly rural areas (male OR 0.70 [95% CI: 0.49, 0.91]) and eating fewer mid-meals per day (female OR 0.60 [95% CI: 0.48, 0.76]; male OR 0.64 [95% CI: 0.49, 0.84]) were associated with lower Mn-FF consumption. Younger age, higher education and physical activity practice were positively associated with Mn-FF consumption. These findings provide important insights on priority factors to be considered when deciding on nutrient fortification policies from both public health and food industry perspectives.

Multicriteria Measures to Assess the Sustainability of Diets: A Systematic Review.

CONTEXT: Assessing the overall sustainability of a diet is a challenging undertaking requiring a holistic approach capable of addressing the multicriteria nature of this concept. OBJECTIVE: The aim was to identify and summarize the multicriteria measures used to assess the sustainability characteristics of diets reported at the individual level by healthy adults. DATA SOURCES: Articles were identified via PubMed, Scopus, and Web of Science. The search strategy consisted of key words and MeSH terms, and was concluded in September 2022, covering references in English, Spanish, and Portuguese. DATA EXTRACTION: This systematic review followed the PRISMA guidelines. The search identified 5663 references, from which 1794 were duplicates. Two reviewers independently screened the titles and abstracts of each of the 3869 records and the full-text of the 144 references selected. Of these, 7 studies met the inclusion criteria. DATA ANALYSIS: A total of 6 multicriteria measures were identified: 3 different Sustainable Diet Indices, the Quality Environmental Costs of Diet, the Quality Financial Costs of Diet, and the Environmental Impact of Diet. All of these incorporated a health/nutrition dimension, while the environmental and economic dimensions were the second and the third most integrated, respectively. A sociocultural sustainability dimension was included in only 1 of the measures. CONCLUSION: Despite some methodological concerns in the development and validation process of the identified measures, their inclusion is considered indispensable in assessing the transition towards sustainable diets in future studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42022358824.

Multiresidues Multiclass Analytical Methods for Determination of Antibiotics in Animal Origin Food: A Critical Analysis.

Veterinary drugs are widely used to prevent and treat diseases. The European Union has forbidden the use of antibiotics as growth promoters since 2006. Its abusive use leads to the presence of antibiotic residues (AR) in foods of animal origin which is associated with antibiotic resistance. The monitoring of AR in food intended for human consumption is of utmost importance to assure Food Safety. A systematic bibliographic review was carried out on the analytical methodologies, published in 2013, for the determination of AR in foods of animal origin. The food processing effect in the AR detected in animal products is also addressed. However, there is a preference for multiresidues multiclass methods, i.e., methodologies that allow determining simultaneously different classes of antibiotics, which is still a challenge for researchers. The wide diversity of physico-chemical properties of these drugs is an obstacle to achieving excellent analytical performance for a vast number of molecules analyzed concurrently. New techniques in sample preparation continue to be developed in order to obtain a compromise between good recoveries and extracts without interferences (clean extracts). The most widely used analytical methodology for the determination of AR is liquid chromatography coupled with mass spectrometry. However, the current trend is focused on the use of powerful high-resolution MS detectors such as Time of Flight and Orbitrap with modern chromatographic systems. Cooking time and temperature control are the key processing conditions influencing the reduction of AR in foods.