Association between coffee consumption and total dietary caffeine intake with cognitive functioning: cross-sectional assessment in an elderly Mediterranean population.

PURPOSE: Coffee is rich in compounds such as polyphenols, caffeine, diterpenes, melanoidins and trigonelline, which can stimulate brain activity. Therefore, the possible association of coffee consumption with cognition is of considerable research interest. In this paper, we assess the association of coffee consumption and total dietary caffeine intake with the risk of poor cognitive functioning in a population of elderly overweight/obese adults with metabolic syndrome (MetS). METHODS: PREDIMED-plus study participants who completed the Mini-Mental State Examination test (MMSE) (n = 6427; mean age = 65 ± 5 years) or a battery of neuropsychological tests were included in this cross-sectional analysis. Coffee consumption and total dietary caffeine intake were assessed at baseline using a food frequency questionnaire. Logistic regression models were fitted to evaluate the association between total, caffeinated and decaffeinated coffee consumption or total dietary caffeine intake and cognitive impairment. RESULTS: Total coffee consumers and caffeinated coffee consumers had better cognitive functioning than non-consumers when measured by the MMSE and after adjusting for potential confounders (OR 0.63; 95% CI 0.44-0.90 and OR 0.56; 95% CI 0.38-0.83, respectively). Results were similar when cognitive performance was measured using the Clock Drawing Test (CDT) and Trail Making Test B (TMT-B). These associations were not observed for decaffeinated coffee consumption. Participants in the highest tertile of total dietary caffeine intake had lower odds of poor cognitive functioning than those in the reference tertile when screened by the MMSE (OR 0.64; 95% CI 0.47-0.87) or other neurophysiological tests evaluating a variety of cognitive domains (i.e., CDT and TMT-A). CONCLUSIONS: Coffee consumption and total dietary caffeine intake were associated with better cognitive functioning as measured by various neuropsychological tests in a Mediterranean cohort of elderly individuals with MetS. TRIAL REGISTRATION: ISRCTN89898870. Registration date: July 24, 2014.

Coffee Consumption and the Risk of Depression in a Middle-Aged Cohort: The SUN Project.

Coffee is one of the most widely consumed drinks around the world, while depression is considered the major contributor to the overall global burden of disease. However, the investigation on coffee consumption and depression is limited and results may be confounded by the overall dietary pattern. We assessed the relationship between coffee intake and the risk of depression, controlling for adherence to the Mediterranean diet. We studied 14,413 university graduates of the 'Seguimiento Universidad de Navarra' (SUN) cohort, initially free of depression. We evaluated coffee consumption using a validated food-frequency questionnaire (FFQ). Incident depression cases were adjudicated only if the participant met two criteria simultaneously: (a) validated physician-diagnosed depression together with (b) new onset of habitual antidepressant use. Both criteria were needed; participants meeting only one of them were not classified as cases. Participants who drank at least four cups of coffee per day showed a significantly lower risk of depression than participants who drank less than one cup of coffee per day (HR: 0.37 (95% CI 0.15⁻0.95)). However, overall, we did not observe an inverse linear dose⁻response association between coffee consumption and the incidence of depression (p for trend = 0.22).

Food patterns and the prevention of depression.

An emerging field of research in nutritional epidemiology is the assessment of several links between nutritional quality and mental health. Specifically, some studies have pointed out that several food patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations according to several systematic reviews and meta-analyses of observational studies. Some previously described food patterns, specifically the Mediterranean Food Pattern, the Alternative Healthy Eating Index, the Prudent diet or the Provegetarian Food Pattern may be effective to reduce the future risk of depression. Among them, only the Mediterranean Food Pattern has been tested for primary prevention in a large randomised trial, but the inverse association found was not statistically significant. The scientific report of the 2015 Dietary Guidelines for Americans Advisory Committee concluded that current evidence is still limited. Notwithstanding, this field is promising and, according to large and well-conducted observational studies, food patterns potentially associated with reduced risk of depression are those emphasising seafood, vegetables, fruits and nuts. There is a need to assess whether differences in the intake of some micro or macronutrients between these dietary patterns can make a difference in their association with a lower risk of depression. Moreover, the shape of the dose-response curve and the potential existence of a nonlinear threshold effect have not yet been established.

Dietary patterns and total mortality in a Mediterranean cohort: the SUN project.

BACKGROUND: Different dietary patterns have been associated with several health outcomes, including morbidity and mortality. There is little evidence on the association between empirically derived dietary patterns and all-cause mortality in Southern European populations. OBJECTIVE: The aim of our study was to prospectively evaluate the association between an empirically derived dietary pattern and all-cause mortality. DESIGN: The Seguimiento Universidad de Navarra (SUN) Project is an ongoing, multipurpose, prospective and dynamic Spanish cohort. PARTICIPANTS/SETTING: Participants were a prospective cohort of 16,008 middle-aged Spanish adults. All of them were university graduates (alumni) (59.6% women, mean age 38 years). Usual diet was assessed at baseline with a validated semiquantitative food frequency questionnaire. MAIN OUTCOME MEASURES: Deaths were confirmed by review of medical records and of the National Death Index. STATISTICAL ANALYSIS: Dietary patterns were ascertained through a factor (principal component) analysis based on 30 predefined food groups. Participants were classified according to tertiles of adherence to the three main dietary patterns identified with factor analysis. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios and 95% CIs for mortality. RESULTS: Three major dietary patterns were identified. They were labelled Western dietary pattern (rich in red and processed meat, potatoes, and fast food), Mediterranean dietary pattern (rich in vegetables, fish and seafood, fruits, and olive oil), and alcoholic beverages dietary pattern. During follow-up, 148 deaths were reported (mean age at death 54.5 years). After adjustment for potential confounders, the lowest risk of all-cause mortality was found in the tertile of highest adherence to the Mediterranean dietary pattern (adjusted hazard ratio for third vs first tertile 0.53, 95% CI 0.34 to 0.84) (P for trend <0.01). The Western dietary pattern and alcoholic beverages dietary pattern showed no significant association with mortality. CONCLUSIONS: Greater adherence to an empirically derived dietary pattern approaching the traditional Mediterranean diet was associated with a reduction in the risk of all-cause mortality among middle-aged Mediterranean adults.

Mediterranean dietary pattern and depression: the PREDIMED randomized trial.

BACKGROUND: A few observational studies have found an inverse association between adherence to a Mediterranean diet and the risk of depression. Randomized trials with an intervention based on this dietary pattern could provide the most definitive answer to the findings reported by observational studies. The aim of this study was to compare in a randomized trial the effects of two Mediterranean diets versus a low-fat diet on depression risk after at least 3 years of intervention. METHODS: This was a multicenter, randomized, primary prevention field trial of cardiovascular disease (Prevención con Dieta Mediterránea (PREDIMED Study)) based on community-dwelling men aged 55 to 80 years and women aged 60 to 80 years at high risk of cardiovascular disease (51% of them had type 2 diabetes; DM2) attending primary care centers affiliated with 11 Spanish teaching hospitals. Primary analyses were performed on an intention-to-treat basis. Cox regression models were used to assess the relationship between the nutritional intervention groups and the incidence of depression. RESULTS: We identified 224 new cases of depression during follow-up. There was an inverse association with depression for participants assigned to a Mediterranean diet supplemented with nuts (multivariate hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.55 to 1.10) compared with participants assigned to the control group, although this was not significant. However, when the analysis was restricted to participants with DM2, the magnitude of the effect of the intervention with the Mediterranean diet supplemented with nuts did reach statistical significance (multivariate HR = 0.59; 95% CI 0.36 to 0.98). CONCLUSIONS: The result suggest that a Mediterranean diet supplemented with nuts could exert a beneficial effect on the risk of depression in patients with DM2. TRIAL REGISTRATION: This trial has been registered in the Current Controlled Trials with the number ISRCTN 35739639.

Effect of zinc intake on serum/plasma zinc status in infants: a meta-analysis.

A systematic review and meta-analysis of available randomised controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on serum/plasma Zn status in infants. Out of 5500 studies identified through electronic searches and reference lists, 13 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on serum/plasma Zn concentration was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status and risk of bias. The pooled ß of status was 0.09 [confidence interval (CI) 0.05 to 0.12]. However, a substantial heterogeneity was present in the analyses (I(2) = 98%; P = 0.00001). When we performed a meta-regression, the effect of Zn intake on serum/plasma Zn status changed depending on the duration of the intervention, the dose of supplementation and the nutritional situation (P ANCOVA = 0.054; <0.001 and <0.007, respectively). After stratifying the sample according to the effect modifiers, the results by duration of intervention showed a positive effect when Zn intake was provided during medium and long periods of time (4-20 weeks and >20 weeks). A positive effect was also seen when doses ranged from 8.1 to 12 mg day(-1). In all cases, the pooled ß showed high evidence of heterogeneity. Zn supplementation increases serum/plasma Zn status in infants, although high evidence of heterogeneity was found. Further standardised research is urgently needed to reach evidence-based conclusions to clarify the role of Zn supplementation upon infant serum/plasma Zn status, particularly in Europe.

Effect of zinc intake on mental and motor development in infants: a meta-analysis.

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on mental and motor development in infants. Out of 5500 studies identified through electronic searches and reference lists, 5 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on mental and motor development was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional situation, and risk of bias. Indices of mental and motor development assessed were the Mental Development Index (MDI) and Psychomotor Development Index (PDI). Additionally we carried out a sensitivity analysis. The pooled ß was -0.01 (95 %CI -0.02, 0) for MDI and 0 (95 %CI -0.03, 0.02) for PDI, with a substantial heterogeneity in both analyses. When we performed a meta-regression, the effect of Zn supplementation on MDI changed depending on the dose of supplementation. Regarding PDI, there was a differential effect of Zn intake depending on intervention duration, dose of supplementation, nutritional situation, and risk of bias. Zn supplementation showed a negative, weak and significant effect on PDI score in those studies with a length of 4 to 20 weeks (ß= -0.05; CI 95 % -0.06 to -0.04). In conclusion, no association was found between Zn intake and mental and motor development in infants. Further standardized research is urgently needed to clarify the role of Zn supplementation upon infant mental and motor development, particularly in Europe.

Dietary fat intake and quality of life: the SUN project.

BACKGROUND: Few studies have related nutritional factors with quality of life in healthy populations. The purpose of the study was to assess whether dietary fat intake is associated to mental and physical quality of life. METHODS: This analysis included 8,430 participants from the SUN (Seguimiento Universidad de Navarra) Project. The intake of saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA), trans unsaturated fatty acids (TFA), and monounsaturated fatty acids (MUFA) was assessed through a 136-item food frequency questionnaire at baseline. Quality of life was measured with the SF-36 Health Survey after 4 years of follow-up. Generalized Linear Models were fitted to assess the regression coefficients (b) and their 95% confidence intervals (95% CI) for the 8 domains of the SF-36 according to successive quintiles of each kind of fatty acids intake. RESULTS: The multivariate-adjusted models revealed a significant inverse association for SFA intake (in quintiles) and two of the physical domains (physical functioning and general health). E.g. for general health domain: (highest quintile of intake (Q5) vs. lowest quintile (Q1), b = -1.6; 95% CI = -3.1, -0.1. General health also showed a dose-response relationship (p for trend < 0.05). For TFA intake (in quintiles), a significant inverse association was found for most of the mental domains (vitality, social functioning and role emotional). E.g. for vitality domain (Q5) vs. (Q1), b = -2.0, 95% CI = -3.4 to -0.6. We also found an inverse association between TFA intake and the bodily pain domain: (Q5 vs. Q1), b = -2.6; 95% CI = -4.4 to -0.8, with a statistically significant dose-response relationship (p for trend < 0.05). Except for TFA intake and the mental domains, the rest of the associations were attenuated when we repeated the analysis adjusting for adherence to the Mediterranean diet. CONCLUSIONS: A detrimental relationship between TFA intake at baseline and most of the SF-36 mental domains measured 4 years later were found, whereas weak inverse associations were found for SFA intake and some physical domains.

The effect of the Mediterranean diet on plasma brain-derived neurotrophic factor (BDNF) levels: the PREDIMED-NAVARRA randomized trial.

OBJECTIVES: There are no human studies assessing the effect of nutritional interventions on plasma brain-derived neurotrophic factor (BDNF) concentrations. The aim of this study was to assess the role of a nutritional intervention based on a Mediterranean diet (MeDiet) on plasma BDNF levels. METHODS: PREvención con Dieta MEDiterránea (PREDIMED) is a randomized clinical trial designed to assess the effect of a Mediterranean diet (MeDiet) on the primary prevention of cardiovascular disease. For this analysis, 243 participants from the Navarra centre were randomly selected. Participants were assigned to one of three dietary interventions: control (low-fat) diet, MeDiet supplemented with virgin olive oil (MeDiet+VOO), or MeDiet supplemented with nuts (MeDiet+Nuts). Plasma BDNF levels were measured after 3 years of intervention. Multivariate-adjusted means of BDNF for each intervention were compared using generalized linear models. Logistic regression models were fit to assess the association between the dietary intervention and the likelihood to have low plasma BDNF values (<13 µg/ml, 10th percentile). Analyses were repeated after stratifying the sample according to baseline prevalence of different diseases. RESULTS: Higher but non-significant plasma BDNF levels were observed for participants assigned to both MeDiets. Participants assigned to MeDiet+Nuts showed a significant lower risk (odds ratios (OR)=0.22; 95% confidence intervals (CI)=0.05-0.90) of low plasma BDNF values (<13 µg/ml) as compared to the control group. Among participants with prevalent depression at baseline, significantly higher BDNF levels were found for those assigned to the MeDiet+Nuts. DISCUSSION: Adherence to a MeDiet was associated to an improvement in plasma BDNF concentrations in individuals with depression.

Dietary fat intake and the risk of depression: the SUN Project.

UNLABELLED: Emerging evidence relates some nutritional factors to depression risk. However, there is a scarcity of longitudinal assessments on this relationship. OBJECTIVE: To evaluate the association between fatty acid intake or the use of culinary fats and depression incidence in a Mediterranean population. MATERIAL AND METHODS: Prospective cohort study (1999-2010) of 12,059 Spanish university graduates (mean age: 37.5 years) initially free of depression with permanently open enrolment. At baseline, a 136-item validated food frequency questionnaire was used to estimate the intake of fatty acids (saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA), trans unsaturated fatty acids (TFA) and monounsaturated fatty acids (MUFA) and culinary fats (olive oil, seed oils, butter and margarine) During follow-up participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and/or initiated the use of antidepressant drugs. Cox regression models were used to calculate Hazard Ratios (HR) of incident depression and their 95% confidence intervals (CI) for successive quintiles of fats. RESULTS: During follow-up (median: 6.1 years), 657 new cases of depression were identified. Multivariable-adjusted HR (95% CI) for depression incidence across successive quintiles of TFA intake were: 1 (ref), 1.08 (0.82-1.43), 1.17 (0.88-1.53), 1.28 (0.97-1.68), 1.42 (1.09-1.84) with a significant dose-response relationship (p for trend = 0.003). Results did not substantially change after adjusting for potential lifestyle or dietary confounders, including adherence to a Mediterranean Dietary Pattern. On the other hand, an inverse and significant dose-response relationship was obtained for MUFA (p for trend = 0.05) and PUFA (p for trend = 0.03) intake. CONCLUSIONS: A detrimental relationship was found between TFA intake and depression risk, whereas weak inverse associations were found for MUFA, PUFA and olive oil. These findings suggest that cardiovascular disease and depression may share some common nutritional determinants related to subtypes of fat intake.

Methodological aspects of the study of dietary patterns during pregnancy and maternal and infant health outcomes. A systematic review.

The objective of the present study was to systematically review the literature exploring the associations between different dietary patterns obtained from Food Frequency Questionnaires during pregnancy and the development of health-related maternal and infant outcomes in the Framework of the EURRECA Network of Excellence. A systematic search was conducted on Pubmed for literature published up to September 2009. The search strategy resulted in an initial amount of 2048 articles. After applying the selection criteria, seven studies were finally identified. Five articles were based on prospective cohort studies and the other two were case-control studies. The methods used to elaborate the dietary pattern could be classified as hypothesis-oriented (three studies) or empirically-derived (four studies). The different food frequency questionnaires used for diet assessment were self-administered, semi-quantitative and had been previously validated, but just four studies employed questionnaires validated specifically for their use in a pregnant population. The divergent methods used to assess the dietary patterns make it difficult to compare results. However, some resulting recommendations can be applied when dietary patterns during pregnancy are analyzed: to employ a validated food frequency questionnaire designed for use in pregnancy, to consider the special role exerted by mineral and vitamin supplements in this particular population group, to adequately select the time in which dietary data is collected, to adjust the results for life-style and educational characteristics, and in the case of hypothesis-oriented dietary patterns, to correctly choose the components comprising the score.

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.

[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.

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.

Evaluating the quality of dietary intake validation studies.

Within the EURopean micronutrient RECommendations Aligned Network of Excellence (EURRECA), a scoring system was developed to assess the quality of dietary intake validation studies. The scoring system included three steps. The first step was to give each study a quality score, which included five components: sample size, statistics used, data collection procedure, consideration of seasonality and supplement use. Scores ranged from 0 to 7, and validation studies classified as very good ( > or = 5), good (5-3.5), acceptable/reasonable (3.5-2.5) and poor ( < 2.5). The second and third steps included an adjustment/weighting of the correlation coefficient according to the quality score and moreover a rating of the adjusted/weighted correlation. The scoring system was tested in 124 validation studies that included at least one vitamin. Only 5.6 % of the 124 studies were judged to be of very good quality according to the quality score, 41.9 % of good quality and 16.9 % had a poor rating. When adjusting for the study quality scores, crude and adjusted mean correlations of vitamins A, C, D and E intakes were similar, but the percentage of correlation values classified as poor or very good was higher after adjustment. These results show the importance of considering the quality of studies validating dietary assessment methods and the correlations obtained for the micronutrient of interest when interpreting effects observed in epidemiological studies using dietary assessment methods. Without a doubt, this subject constitutes a key topic for research in nutritional epidemiology.

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.

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.

Olive oil consumption and risk of breast cancer in the Canary Islands: a population-based case-control study.

BACKGROUND: Breast cancer mortality and incidence rates in the Canary Islands, and particularly in Gran Canaria, are higher than those in the rest of Spain. OBJECTIVES AND DESIGN: A case-control study was designed to assess the role of differential fatty acid intakes and olive oil consumption on breast cancer risk in the Canary Islands. The study was conducted between 1999 and 2001, including a total of 755 women: 291 incident cases with confirmed breast cancer and 464 controls randomly selected from the Canary Island Nutrition Survey (ENCA). A semi-quantitative food-frequency questionnaire was completed and potential confounders were adjusted using unconditional logistic regression. RESULTS: Compared to the first quintile of intake, the highest quintile of monounsaturated fat intake was significantly related to a lower risk of breast cancer (odds ratio = 0.52; 95% CI 0.30-0.92). Regarding olive oil, the odds ratio for women in the three upper quintiles of consumption (> or =8.8 g/day) was 0.27 (95% CI 0.17-0.42). CONCLUSION: Our results support the protective role of olive oil consumption on breast cancer among Canaries women.