Dietary intake, nutritional adequacy and food sources of vitamins involved in the methionine-methylation cycle from Spanish children aged one to <10 years: results from the EsNuPI study.

Background: Methionine-methylation cycle and the derived critical functions during infancy are key regulated by folates, vitamins B12, and B6. At present in Spain, there is an absence of studies that assess the intakes and dietary sources of total folates and B12 by children consuming all types of milks and those regularly consuming adapted milk formulas. Thus, our aim was to evaluate folates intakes alongside with vitamins B6 and B12 while describing their major dietary contributors in Spanish children aged one to <10 years. Methods: A total of 1,448 children aged between 1 and 10 years (49.7% girls and 50.3% boys) from the EsNuPI, a prospective cross-sectional study, were allocated into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707), and another including children consuming adapted milks called Adapted Milk Consumers Cohort (AMS) (n = 741) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Population Reference Intakes. Results: The median intake of vitamin B6 was 1.35 (1.06-1.70) mg/day in the SRS and 1.45 (1.17-1.79) mg/day in the AMS, being significantly higher in the AMS for all age-groups. Prevalence of adequacy for vitamin B6 in the SRS and AMS was 97.7 and 98.7%, respectively. Total folates intakes in the AMS were significantly higher (p ≤ 0.001) in all age groups than in the SRS, independently of age. In addition, the prevalence of adequacy for folates intakes in all groups was more than 60%. Vitamin B12 intake increased with age independently of the type of milk consumed. The prevalence of adequacy for vitamin B12 was highly compliant by all population groups. The major contributors to vitamin B6 were milk and dairy products being significantly higher in AMS than SRS (p ≤ 0.001). The highest contributors to folates intakes were milk and dairy products, cereals, vegetables, and fruits in both groups whereas for vitamin B12 in the SRS sample were milk and dairy products followed by meat and meats products and for adapted milks, were milk and dairy products, followed by eggs, then meat and meats products. Conclusion: A satisfactory prevalence of adequacy for vitamins B6, and B12 amongst the Spanish children population was observed, which was not the case for folates, regardless of the dietary group evaluated. Nevertheless, a possible strategy to increase folate intake among the youngest children is to increase the consumption of milk and dairy products within a healthier dietary pattern, as these may contribute significantly to the vitamin needs of the infant population.

Omega-3 and Omega-6 Polyunsaturated Fatty Acid Intakes, Determinants and Dietary Sources in the Spanish Population: Findings from the ANIBES Study.

The multiple roles of polyunsaturated fatty acids (PUFA) in growth and general health are well documented. However, available intake data for the Spanish population are limited and lack gender and age considerations. Therefore, our goal was to assess dietary intake adequacy of omega-3 and omega-6 PUFA, their determinants and their major food sources among the Spanish population. Due to their influence on various beneficial functions attributed to omega-3 PUFA, combined intake adequacy with folic acid (FA), vitamin B12 and choline was also assessed. Intake data were obtained from the ANIBES cross-sectional study on a representative sample of the Spanish population (9-75 years; n = 2009), where dietary intake was analysed with a three-day dietary record. Median intake of total omega-3 PUFA stood at 0.81 g/day (0.56-1.19 g/day), with α-linolenic acid (ALA) at 0.61 g/day (0.45-0.85 g/day), eicosapentaenoic acid (EPA) at 0.03 g/day (0.01-0.12 g/day) and docosahexaenoic acid (DHA) at 0.06 g/day (0.0-0.20 g/day). Accordingly, 65% of the Spanish population showed insufficient intakes for total omega-3 PUFA; 87% for ALA, and 83% for combined EPA and DHA. Inadequate intakes were significantly higher in children, adolescents, and younger women of childbearing age (18-30 years). In contrast, inadequacy due to excessive intakes was almost negligible. Regarding omega-6 PUFA, total intake was 10.1 g/day (7.0-14.0 g/day), 10.0 g/day (6.9-13.9 g/day) for linoleic acid (LA) and 0.08 g/day (0.05-0.13 g/day) for arachidonic acid (AA). Non-compliance due to either insufficient or excessive intakes of LA stood at around 5% of the sample, with the elderly showing significantly higher degrees of inadequacy due to insufficient intakes (10%; p ≤ 0.05). Median omega-6 to omega-3 ratio was 12:1, and significantly higher in men compared to women (p ≤ 0.05); in children, adolescents and adults compared to the elderly (p ≤ 0.05); and in younger women of childbearing age compared to the older group (31-45 years) (p ≤ 0.001). Oils and fats and meat and meat products were the main dietary sources for the essential fatty acids LA and ALA, respectively. Meat and meat products were as well the main providers of AA, while fish and shellfish were almost exclusively the only sources of EPA and DHA. However, main food sources identified showed important differences across age groups. Finally, the total combined degree of inadequacy observed for omega-3 PUFA, FA, vitamin B12 and choline reached 21.3% of the ANIBES population. The observed degree of inadequacy of omega-3 PUFA intakes among the Spanish population makes it urgent to increase its consumption and to consider the need for supplementation. This should also be the main strategy for the optimization of the omega-6/omega-3 ratio, as the adequacy observed for omega-6 intakes is relatively acceptable. Additional improvement of the dietary intake of FA, vitamin B12 and choline could contribute to the beneficial effects of omega-3 PUFA.

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 Adequacy and Food Sources of Nutrients Involved in the Methionine-Methylation Cycle in Women of Childbearing Age from the ANIBES Spanish Population.

Growing evidence confirms choline as a critical perinatal nutrient. However, intake levels of choline and betaine among the Spanish fertile population remain unknown. Given their role in one-carbon metabolism with potential epigenetic effects, the aim of the present study was to evaluate the dietary intakes, their adequacy to existing guidelines and the main food sources together with other micronutrients involved in the methylation-methionine cycle (vitamin B6, folates and vitamin B12) in women of childbearing age. The ANIBES study, a cross-sectional study of a representative sample of women of childbearing age (18-45 years, n = 641) resident in Spain, was used. The sample was divided into younger women (18-30 years, n = 251) and older women (31-45 years, n = 390). Dietary intake was assessed by a three-day dietary record by using a tablet device. Total median intakes for the total sample were 303.9 mg/d for choline; 122.6 mg/d for betaine; 1.3 mg/d for vitamin B6; 140.8 µg/d for folates, and 3.8 µg/d for vitamin B12. The older subgroup showed significantly higher choline (p < 0.05), betaine (p < 0.001) and folates (p < 0.05) intakes than younger women. Main food sources for the whole sample were meat and meat products for choline (28.3%), vitamin B6 (25.7%) and vitamin B12 (22.8%); cereals and derivatives (79.9%) for betaine; vegetables (20.0%) for folates. Overall intake adequacy was only observed for vitamin B12, with a very limited number of participants showing adequate intakes for all the other micronutrients. These results illustrate there is a relevant need to raise awareness about optimizing the status of the methionine cycle-related vitamins and cofactors in this potentially vulnerable population.

Fifty years of beverages consumption trends in Spanish households.

OBJECTIVES: To describe the evolution of non-alcoholic and alcoholic beverages consumption in the Spanish households from the 60's to nowadays. METHODS: This study is based on beverages and food consumption in Spanish households; the data sample consisted of consumption and distribution data, obtained from the Household Budget Survey (HBS) since 1964 to 1991 and from the Food Consumption Survey (FCS) since 2000 to 2014, in collaboration with the Spanish Nutrition Foundation (FEN). RESULTS: In 2014 the average consumption of non-alcoholic beverages was 332 g/person/day, whereas alcoholic beverages consumption represented 72.6 g/person/day. Consumption of non-alcoholic beverages has increased 721% (1964: 46 g/person/day; 1991: 96 g/person/day; 2000: 240 g/person/day and 2014: 332 g/person/day), whereas alcoholic beverages consumption has decreased roughly a 50% (1964: 145 g/person/day; 1991: 113 g/person/day; 2000: 78.4 g/person/day and 2014: 72.6 g/person/day). The most consumed alcoholic beverage in 2014 was beer (41.3 g/day), followed by wine (23.0 g/day). Regarding non-alcoholic beverages, the most consumed was water (144 g/day), followed by cola (ordinary: 30.7 g/day and diet: 20.5 g/day).According to Spanish regions, in 2014 non-alcoholic beverages were the most consumed in the islands (Balearic Islands 521 grams/person/day; Canary Islands 515 grams/person/day), as it was in the nineties (Balearic Islands 148 grams/person/day and Canary Islands 281 grams/person/day). However in 1980-81 the largest consumption of alcoholic beverages was that of Galicia, 408 g/person per day, and the lower in the Canary Islands, 63 g/person per day. In 2014, Murcia and Andalucía represented the regions with the highest consumption of alcoholic beverages. In 2014, alcoholic beverages provided roughly 1.89% of the total energy and 1.47% of sugars, whereas non-alcoholic beverages provided 3.28% of energy and 15.72% of sugars and, in 2000, alcoholic beverages contributed 2.29% of the energy and 1.47% of sugars and non-alcoholic drinks provided 3.76% of the energy and 22.7% of sugars. CONCLUSION: There have been signifi cant changes in the eating patterns at the Spanish homes, especially regarding beverages consumption, over the last five decades. In general, a higher consumption and variety for non-alcoholic drinks has occurred, especially in the islands. In parallel, a decline in alcoholic beverages consumption has been clearly observed.

Macronutrients contribution from beverages according to sex and age: findings from the ANIBES Study in Spain.

Methodologies and procedures used in dietary surveys have been widely developed with the aim of evaluating the nutritional status of a population. However, beverages are often either disregarded at national and international assessment of nutrients intake or poorly mentioned. Moreover, there is no standardized questionnaire developed as a research tool for the evaluation of beverages intake in the general population. Moreover, the contribution of different beverages to macronutrients intake is rarely provided. The latter in the context of a continuous expansion and innovation of the beverages market in Spain. Therefore, the main goal of the present study was to evaluate non-alcoholic and alcoholic beverages macronutrients contribution in the ANIBES study in Spain (9-75 years old).As expected, those contributed to dietary macronutrient intake mainly as total carbohydrates and sugar. The contribution to other macronutrients (proteins and lipids) by the beverage groups was of much less importance. For non-alcoholic beverages, contribution to carbohydrates was much higher in younger populations (children: 10.91 ± 9.49%, mean ± SD for boys and 9.46 ± 8.83% for girls; adolescents: 11.97 ± 11.26% for men and 13.77 ± 10.55% in women) than in adults: 9.01 ± 9.84% for men and 7.77 ± 8.73% in women. Finally, a much lower contribution was observed in the elderly: 4.22 ± 6.10% for men and 4.46 ± 6.56% for women. No sex differences, however, across all age groups were found. Results for sugar contribution showed a similar trend: children (23.14 ± 19.00% for boys and 19.77 ± 17.35% for girls); adolescents (28.13 ± 24.17% for men and 29.83 ± 21.82% in women); adults 20.42 ± 20.35% for men and 16.95 ± 17.76% in women, p ≤ 0.01; and elderly: 14.63% ± 9.97 for men and 9.33 ± 12.86% in women. The main contribution corresponded to sugared soft drinks, juices and nectars, more relevant and significant in the younger populations. As for alcoholic beverages, the contribution of macronutrients to the total diet is low for carbohydrates and sugar. The main contribution of this group, as expected, is alcohol, being higher from low alcohol content beverages, and in men vs women (p ≤ 0.001).

A new educational tool to learn about hydration: taste workshops for children.

INTRODUCTION: Nutrition education contributes to children´s understanding and practice of healthy lifestyles behaviors. Having a well hydration status is an essential topic, especially since children are a vulnerable population who are much more  prone to dehydration than adults are. The approval of the Report on the European Gastronomic Heritage: Cultural and Educational Aspects in 2014 served as starting point to work on innovative audio-visual and multimedia materials for children. The Spanish Nutrition Foundation (FEN) and the Royal Academy of Gastronomy (RAG), in collaboration with the Ministry of Education, Culture and Sport in Spain (MECD),  developed educational videos for schoolchildren to learn about food, nutrition and gastronomy, specially, the importance of being hydrated. OBJECTIVES: To develop a serial of videos for children between 3 and 9 years old with nutrition and cooking lessons to be used as educational resources in the official curricula. METHODS: Fourteen chapters related to food, nutrition, gastronomy, physical activity and hydration to be used to record videos were designed and tested. A nutritionist, a chef and two puppets were the main characters acting in the videos.  RESULTS: The chapters were assembled in nine videos that included five sections: introduction, video lesson, recipes -in case of hydration, recipes with different water content foods were recorded-, what have you learntand check your knowledge. A summary of the new educational material was officially presented at the Spain Pavilion during the Expo Milano 2015. Moreover, they are included as education  tool for teachers in the new PANGEI Programme (Food, Nutrition and Gastronomy for Infantile Education) conjointly launched by FEN, RAG and MEDC. CONCLUSION: Taste workshops are useful as innovative nutrition education tools to reinforce language, listening and motor skills as well as food and nutrition concepts, and specially, the importance of being well hydrated.

Sources of information on food consumption in Spain and Europe.

Estimation of food consumption and nutrient intake is a topic of growing interest. Currently, both in Europe and in Spain, there are numerous sources of information on food consumption, that we provide information on different levels: national, household and individual, all of them are useful, but including some limitations, mainly arising from the lack of accurate data on food purchased but not consumed. The data obtained allow, among other things, meet dietary habits, explore the food quality, study the energy and nutrient intake and / or assessing exposure to food risks. Among the existing sources in Spain can highlight two surveys especially useful: the Household Budget Survey of the National Statistics Institute (INE) and Food Consumption Panel Ministry of Agriculture, Food and Environment (MAGRAMA). Both provide for many years food consumption but, lately, only in households. Both European and Spanish would be necessary to improve the usefulness of the data, standardize the type of survey used and could be comparable between them.

La estimación del consumo de alimentos y la ingesta de nutrientes es un tema de creciente interés. Actualmente, tanto en Europa como en España, existen fuentes de información sobre el consumo de alimentos, que nos ofrecen esta información a distintos niveles: nacional, familiar o individual, todas ellas son de gran utilidad, pero incluyen algunas limitaciones, principalmente derivadas de la falta de datos precisos sobre los alimentos comprados pero no consumidos. Los datos obtenidos permiten, entre otras, conocer los hábitos alimentarios, explorar la calidad de la alimentación, estudiar la ingesta de energía y nutrientes y/o evaluar la exposición a riesgos alimentarios. Entre las fuentes existentes en España se pueden resaltar dos encuestas de especial utilidad: la encuesta de presupuestos familiares del Instituto Nacional de Estadística (INE) y el panel de consumo de alimentos del Ministerio de Agricultura, Alimentación y Medio Ambiente (MAGRAMA). Ambas proporcionan desde hace bastantes años la información relativa al consumo de alimentos pero, últimamente, sólo en hogares. Tanto a nivel europeo como español sería necesario, para mejorar la utilidad de los datos, estandarizar el tipo de encuestas utilizadas, para ser comparables entre ellas.