Low Adherence to Dietary Guidelines in Spain, Especially in the Overweight/Obese Population: The ANIBES Study.

OBJECTIVE: The objective of this study was to analyze the dietary intake of the Spanish population according to ponderal status and body fat distribution. METHODS: Data were obtained from ANIBES (Anthropometry, Intake, and Energy Balance in Spain), a cross-sectional study of a nationally representative sample (1013 men, 996 women) of the Spanish population (18-64 years). The final fieldwork was carried out from mid-September to November (three months) 2013. A 3-day dietary record provided information about food and beverage consumption. Height, weight, and waist circumference were assessed, and body mass index (BMI) and waist-height ratio (WHtR) calculated. RESULTS: The Spanish population had a low consumption of fruits and vegetables, cereals, whole cereals, and dairy and high consumption of meat products. Individuals with overweight/obesity (BMI ≥ 25 kg/m2) and abdominal adiposity (WHtR ≥ 0.5) showed lower compliance with dietary guidelines. In the male group, adjusting by age, inadequate consumption of cereals (<4 servings/day) and vegetables and fruit (<5 servings/day) was associated with higher risk of overweight (odds ratio [OR] = 1.704, 95% confidence interval [CI], 1.187-2.447, p = 0.001, for cereals and OR = 3.816, 95% CI, 1.947-7.480, p = 0.001, for vegetables and fruits) and abdominal adiposity (OR = 2.081, 95% CI, 1.419-3.053, p = 0.000 and OR = 4.289, 95% CI, 2.108-8.726, p = 0.001, respectively). CONCLUSION: Nutritional campaigns should be conducted to improve the dietary habits of the Spanish population in general, especially men, who have poorer ponderal status and abdominal adiposity, due to their lower adherence to dietary guidelines.

Differences in meal patterns and timing with regard to central obesity in the ANIBES ('Anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain') Study.

OBJECTIVE: To study the association of meal patterns and timing with central obesity to identify the best dietary strategies to deal with the increasing obesity prevalence. DESIGN: A cross-sectional study performed on data from a representative sample of the Spanish population. Height and waist circumference were measured using standardized procedures and waist-to-height ratio (WHtR) was calculated. The sample was divided into those without central obesity (WHtR<0·5) and those with central obesity (WHtR≥0·5). SETTING: ANIBES ('Anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain') Study. SUBJECTS: Adults aged 18-64 years (n 1655; 798 men and 857 women). RESULTS: A higher percentage of people ate more than four meals daily in the group without central obesity and those with central obesity more frequently skipped the mid-afternoon snack than those without. Breakfasts containing >25 % of total energy intake and lunches containing >35 % of total energy intake were associated with increased likelihood of central obesity (OR=1·874, 95 % CI 1·019, 3·448; P15 % of total energy were associated with decreased likelihood of central obesity (OR=0·477, 95 % CI 0·313, 0·727; P<0·001 and OR=0·650, 95 % CI 0·453, 0·932; P<0·05, respectively). The variety of cereals, wholegrain cereals and dairy was higher in the population without central obesity. CONCLUSIONS: Our results suggest that 'what and when we eat' should be considered dietary strategies to reduce central obesity.

Sedentary behavior among Spanish children and adolescents: findings from the ANIBES study.

BACKGROUND: An increase of sedentary behaviors far from the Mediterranean lifestyle is happening in spite of the impact on health. The aims of this study were to describe sedentary behaviors in children and adolescents. METHODS: A representative sample of 424 Spanish children and adolescents (38% females) involved in the ANIBES study was analyzed regarding their sedentary behaviors, together with the availability of televisions, computers, and consoles by means of the HELENA sedentary behavior questionnaire. RESULTS: For the total sample of children, 49.3% during weekdays and 84% during weekends did not meet the recommendation of less than 2 hours of screen viewing per day. The use of TV was higher during weekdays (p < 0.05) and there were significant differences between adolescents and children (16.9 vs. 25.1%, p < 0.05). The use of computer, console games and of internet for non-study reasons was higher during weekends (p < 0.001). Adolescents played more computer games and used more internet for non-study reasons than children during both weekdays and weekends (p < 0.05 and p < 0.001, respectively). The use of internet for academic reasons was lower in children (p < 0.001) than adolescents during weekends; however, no significant differences were found between sexes. In addition, more than 30% of the children and adolescents had at least one electronic device in their bedrooms. CONCLUSIONS: Spanish children and adolescents are not meeting the recommendations regarding the maximum of screen viewing (<2 h/day), especially during the weekend, for all of sedentary behaviors. Urgent strategies and intervention studies are needed to reduce sedentary behavior in young people.

[Validity of Pro Children Project questionnaire for assessing psychosocial factors of fruit and vegetable intake in Mexico]. / Validación del cuestionario Pro Children Project para evaluar factores psicosociales del consumo de fruta y verdura en México.

OBJECTIVE: To determine content and construct validity for the Mexican version of Pro Children Project questionnaire for assessing psychosocial factors, related to fruit and vegetable intake in samples of 10-12 year-old schoolchildren. MATERIALS AND METHODS: The questionnaire consisted of 87 items. It was administered to 2084 children in an instrumental study conducted in 2011 in Ciudad Juarez, Chihuahua, Mexico. RESULTS: Kappa statistic resulted in good agreement between experts (kappa=0.69), very good agreement in children (kappa=0.93). Seven factors were obtained that explained 37.87% of the variance in fruit and 48.18% of the variance in vegetable. Cronbach's alpha values were low to moderate (range 0.55 to 0.83). An internal structure of seven first order factors was confirmed in fruits and six linked to vegetables. CONCLUSION: The questionnaire provides sufficient validity for assessing psychosocial factors related to fruit and vegetable intake in 10-12 year old schoolchildren. Finally, implications of the findings in the test adaptation process for assessing psychosocial factors of fruit and vegetable intake and for future research in this instrument are discussed.

Prevalence of obesity and abdominal obesity in Spanish population aged 65 years and over: ENPE study. / Prevalencia de obesidad y obesidad abdominal en la población española de 65 y más años de edad: estudio ENPE.

BACKGROUND AND OBJECTIVES: To assess the prevalence of obesity and abdominal obesity (AO) in the Spanish population aged ≥65 years, to analyse the influence of selected sociodemographic factors and association with risk factors. METHODS: The sample comes from the ENPE study, a cross-sectional study of a representative sample of the non-institutionalized population (2014-2015). This analysis refers to the population ≥65 years (n=1,233). Trained observers performed anthropometric measurements at participants' homes following standard international protocols. Obesity was defined as body mass index (BMI) ≥30; AO waist>102cm men; >88cm women. RESULTS: Estimated prevalence of obesity in adults ≥65 years was high, higher in women (40.1% [95% CI 36.4-43.8]) than in men (32.5% [95% CI 28.5-36.8]). The prevalence of AO was also higher in women (69.9% [95% CI 66.4-73.1]) than in men (40.7% [95% CI 36.5-44.8]), and estimates were even higher when defining AO by waist-hip ratio or waist-height ratio. Of those classified as AO, 39.8% have a BMI between 25-29. Obesity and AO are higher in the South region compared to East, North-East and Central regions and showed inverse association with educational level. Obesity and AO were associated with increased probability of hypercholesterolaemia and high blood pressure, sarcopenic obesity, and diabetes. CONCLUSION: The prevalence of obesity and AO in adults aged ≥65 years is high, higher in women, in people of lower educational level and in the South region compared to East, North-East and Central regions. The high prevalence of OA is especially worrying due to its association with cardiovascular and metabolic complications and poorer quality of life.

Prevalence of obesity and associated cardiovascular risk factors in the Spanish population: the ENPE study.

INTRODUCTION AND OBJECTIVES: Obesity is a significant public health problem associated with an increased risk of cardiovascular risk factors (CVRF). The aim of this study was to determine the prevalence of overweight and abdominal obesity (AO) in the Spanish population aged ≥ 3 years and to analyze the influence of sociodemographic and lifestyle factors and their association with CVRF. METHODS: The sample was drawn from the ENPE study (n=6800). The study protocol included individual anthropometric measurements, sociodemographic factors, food intake (food frequency questionnaire), physical activity, lifestyles, and health problems. RESULTS: The estimated overall prevalence of obesity (22.0%; 95%CI, 21.0-23.0) and AO (64.7%; 95%CI, 63.5-65.8) was higher in men, in persons aged ≥ 65 years, and in those with a lower socioeconomic level or from southern regions. Lifestyle pattern was significantly associated with obesity and AO (P=.011), which were less likely in people with an active lifestyle pattern (P <.0001). Obesity (OR, 1.85; 95%CI, 1.24-2.78) and AO (OR, 2.16; 95%CI, 1.1-4.24) were positively associated with CVRF. Clustering of CVRF with obesity and/or AO was higher in women (12.6%; 95%CI, 11.4-13.9) and in persons aged ≥ 65 years (32.7%; 95%CI, 30.0-35.4). CONCLUSIONS: The prevalence of obesity and AO in the Spanish population is high; it is higher in men, increases with age, and is inversely related to socioeconomic status. A lifestyle pattern combining a higher level of physical activity, moderate sedentariness and a Mediterranean dietary pattern is associated with a lower probability of obesity, AO, and CVRF.

Food-based dietary guidelines in Spain: an assessment of their methodological quality.

BACKGROUND & OBJECTIVES: Food-based dietary guidelines (FBDGs) have been developed to promote healthy diets and prevent chronic diseases. However, the methodological quality of Spanish FBDGs has not been systematically assessed yet. The objective of this review is to identify and assess the methodological quality of Spanish FBDGs, as well as to describe their food guides and key recommendations. METHODS: We conducted a systematic search to identify Spanish FBDGs targeted at the general population using multiple sources. Two authors independently screened the references, extracted data, and assessed the quality of the FBDGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Recommendation Excellence (AGREE-REX) instruments. We performed a descriptive analysis of the FBDGs. RESULTS: We included 19 FBDGs, published between 2007 and 2019. The median scores for each AGREE II domain were: "scope and purpose" 44% (Q1-Q3: 33-61%); "Stakeholder involvement" 31% (11-44%), "rigor of development" 3% (1-14%); "clarity of presentation" 42% (33-47%), "applicability" 0% (0-6%); and "editorial independence" 0% (0-8%). Six FBDGs (32%; 6/19) were categorized as "recommended with modifications", and the rest (68%; 13/19) as "not recommended". None of the FBDGs scored ≥60% in three or more domains, including the "rigor of development" domain. FBDGs indexed in literature databases scored significantly higher in overall rating than those not indexed (P = 0.023). The majority of FBDGs (74%; 14/19) used the pyramid as a food guide representation with a larger number of food levels (3-7 levels). The majority of FBDGs recommended a daily intake of cereals and grains, vegetables, fruits, olive oil and dairy products; a weekly intake of vegetable and animal proteins; and the occasional and limited intake of other food groups (e.g., ultraprocessed foods). CONCLUSIONS: Overall, the methodological quality of FBDGs is poor showing that only 32% of FBDGs are "recommended for use with modifications". Our results highlight the need to revise, systematize and improve FBDG development processes in Spain.

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.

Prevalence of overweight, obesity and abdominal obesity in the Spanish population aged 3 to 24 years. The ENPE study.

INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the prevalence of excess weight and abdominal obesity (AO), based on individual anthropometric measurements, according to various criteria in the Spanish population aged 3 to 24 years and to analyze their distribution by age and sex. METHODS: We analyzed data from the ENPE study. This analysis included the population aged 3 to 24 years (n=1601). Anthropometric measurements were taken in participants' homes by trained observers following standardized international protocols. We defined overweight and obesity according to the International Obesity Task Force, World Health Organization, and Orbegozo 2011 criteria, and AO according to a waist-to-height index ≥ 0.5, Taylor criteria, and the 90th percentile of Orbegozo 2011. RESULTS: The prevalence of excess weight (overweight+obesity) exceeded 30% with all the criteria used. The prevalence of excess overweight (International Obesity Task Force) was estimated at 34.1% (95%CI, 31.8-36.4) and obesity at 10.3% (95%CI, 8.9-11.9). The estimated prevalence of AO (waist-to-height index ≥ 0.5) was 31.2% (95%CI, 29.0-33.5), and 20.9% (95%CI, 18.1-22.1) satisfied all 3 criteria. A total of 16% (95%CI, 13.8-17.8) were overweight and had concomitant AO. CONCLUSIONS: The prevalence of overweight, obesity and AO in the Spanish population aged 3 to 24 years old is high and is higher in men than in women. When distinct criteria were used, the prevalence of AO was approximately 30%. Among persons classified as obese by the 3 criteria, 71.6% were also classified as having AO according to distinct cutoffs.

Plate Waste Generated by Spanish Households and Out-of-Home Consumption: Results from the ANIBES Study.

Food waste is a major environmental issue that must be tackled in order to achieve a sustainable food supply chain. Currently, in Spain there are no studies that examine the amounts and sources of plate waste (PW) produced by both household and out-of-home consumption. The present study aims to provide this information from a representative sample from the Spanish population. A total of 2009 individuals aged 9-75 years, from the ANIBES study ("anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain"), completed a three-day dietary record, collected by a tablet device. Photographs of all foods and beverages consumed both at home and outside were taken before and after meals. Median PW across the total population was 7.3 (0.0-37.3) g/day and was significantly higher in females than males (p < 0.05) and in children vs. adolescents, adults, and elderly (p < 0.01). Regarding meals, PW across all age groups was higher at lunch (40%), dinner (27%), and breakfast (11%). The highest PW was observed for bread (25%) main courses (16%), first and second courses (15%), vegetables and fruits (12%), ready-to-eat meals (10%), cereals and grains (10%), oils and fats (10%), pulses (10%), meat products (8%), sauces and condiments (8%), and starters (8%). Our results reinforce the need for new strategies to focus on reducing plate leftovers, which are crucial from a nutritional, economic, and environmental point of view. Additionally, this evidence is important for relying on more accurate information on actual intakes when using dietary surveys.

Active Commuting, Physical Activity, and Sedentary Behaviors in Children and Adolescents from Spain: Findings from the ANIBES Study.

Active commuting (AC) has been proposed as a great opportunity to increase physical activity level (PA) in children and adolescents. The aim of the present study is to determine the associations between AC (walk and cycle commuting) and non-AC (motor vehicle commuting) with PA levels, and with AC and sedentarism in Spanish children and adolescents. A representative Spanish sample of 424 children and adolescents (38% females) was involved in the ANIBES (Anthropometry, Dietary Intake and Lifestyle in Spain) Study in 2013. Data on the levels of AC, non-AC, PA, and sedentarism were obtained using the International Physical Activity Questionnaire for adolescents. Stepwise backward univariate generalized linear and linear regression models were performed. In girls, walking was associated with playground PA, moderate PA, and moderate to vigorous PA (MVPA) (ß = 0.007, p < 0.05; both ß = 0.007, p < 0.01), respectively. In boys, walking was associated with all PA levels (p < 0.05); while cycling was related to moderate PA and MVPA (both ß = 0.007, p < 0.05). A negative significant association was observed between AC and time spent studying without Internet use in boys (ß = -0.184, p < 0.05). Commuting by walking contributes to increased daily PA in both sexes, whereas cycling was only related to moderate PA and MVPA in boys. Sedentary behaviors are not related to AC, but studying without Internet use was negatively associated with AC in boys.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns.

BACKGROUND: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets. OBJECTIVE: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. METHODS: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. CONCLUSIONS: The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

[Nutrition and gastronomy in the Basque Country]. / Nutrición y gastronomía en el País Vasco.

INTRODUCTION: For centuries the traditional ingredients of food patterns in Basque Country were millet, chestnuts, cabbage, beans, lentils, fish, pork and beef especially, as well as a variety of fruits such as apples, pears and grapes. Later, the potato replaced chestnuts, corn replaced millet and beans replaced broad beans. In addition, tomatoes and peppers added to the vegetable repertoire. Cocoa also found great acceptance from the eighteenth century and the consumption of cider, especially among seamen, played a very important role in the prevention of scurvy. During the nineteenth century, the rise of industrialization led to important social changes and in food habits. The great romantic travelers and their stories contributed to the diffusion of uses and customs, among others, those related to culinary preparations and eating habits. Later, the growing interest in thermal baths also attracted visitors from France, Germany, Italy or Great Britain to the Basque Country, sometimes accompanied by their chefs and servants, who brought with them their own culinary practices to the Basque kitchens and restaurants. From 1977 and inspired by the Nouvelle cuisine, the new Basque cuisine emerged led by great chefs such as Juan Marí Arzak and Pedro Subijana, who soon brought together a large group that has led the current Basque cuisine to internationally recognized excellence. The new tendencies coexist with the cult to traditions and to specific forms of conviviality around the food: txokos and gastronomic societies; pintxos, pintxopote and cider houses.

INTRODUCCIÓN: Durante siglos, los ingredientes tradicionales de la alimentación en el País Vasco fueron el mijo, las castañas, la berza, las habas, las lentejas, el pescado y los mariscos y modestas cantidades de carne de cerdo y de ganado vacuno, sobre todo, además de frutas como manzanas, peras y uvas. Más tarde, la patata desplazó a las castañas, el maíz al mijo y las alubias a las habas, además de incorporar tomates y pimientos al repertorio de hortalizas. El cacao también encontró una gran aceptación a partir del siglo xviii, y el consumo de sidra, especialmente entre los marinos, desempeñó un papel muy importante en la prevención del escorbuto. Durante el siglo xix, el auge de la industrialización conllevó importantes transformaciones sociales, y también en la alimentación. Los grandes viajeros románticos y sus relatos contribuyeron a la difusión de usos y costumbres, entre otros, los relacionados con las preparaciones culinarias y los hábitos alimentarios. Poco más tarde, el creciente interés por los baños termales atrajo también hacia el País Vasco viajeros procedentes de Francia, Alemania, Italia o Gran Bretaña, acompañados en ocasiones por sus cocineros y sirvientes que acercaron prácticas culinarias de sus lugares de origen a las cocinas y restaurantes vascos. A partir de 1977, e inspirada en la denominada nouvelle cuisine, emerge la nueva cocina vasca de la mano de grandes cocineros como Juan Marí Arzak y Pedro Subijana, que pronto aglutinarán a un nutrido grupo de profesionales que han llevado a la actual cocina vasca a la excelencia reconocida internacionalmente. Las nuevas tendencias y restaurantes con estrellas o soles conviven con el culto a las tradiciones y a formas específicas de convivialidad en torno al alimento: txokos y sociedades gastronómicas; pintxos y pintxopote; sidrerías y tabernas de nuestra tierra verde.

[Gastronomy and nutrition in Catalonia]. / Gastronomía y nutrición en Cataluña.

INTRODUCTION: Objectives: the culture and the eating habits of a territory give shape its gastronomy and determine the nutritional and health status of its population. We set the goal of reviewing food, culture, gastronomy and the nutritional and health status of the Catalan population. Methods: bibliographic and documentation search. Results: the origin of Catalan gastronomy dates back to the classical era. From Greek and Roman times, when olive oil and wine were incorporated into our cuisine, until today, multiple civilizations have influenced it, being the Arab contribution and the discovery of America fundamental events in the increase of Spanish wealth and its gastronomic variety. At Catalan level, the geographical, cultural and social characteristics of Catalonia, with a marked Mediterranean influence, were incorporated and creating Catalan cuisine and gastronomy, which currently have international recognition and prestige. The food consumption of the Catalan population has been studied since 1983. Nowadays, it shows a food consumption and an energy and nutrients intake similar to the national average, similarly to the prevalence of morbidity and lifestyles. Conclusion: in order to that the union of gastronomy and food consumption favors also the health of population, we must encourage the recovery of the healthiest and easiest to prepare dishes from their gastronomy and boost modifications that improve technically the more complex and/or less healthy dishes.

INTRODUCCIÓN: Objetivos: la cultura y los hábitos alimentarios de un territorio configuran su gastronomía y determinan el estado nutricional y de salud de su población. Nos planteamos el objetivo de revisar la alimentación, la cultura, la gastronomía y el estado nutricional y de salud de la población catalana. Métodos: búsqueda de documentación y bibliográfica. Resultados: el origen de la gastronomía catalana se remonta a la época clásica. Desde la época griega y romana, cuando se incorpora a nuestra cocina el aceite de oliva y el vino, hasta la actualidad, múltiples civilizaciones han influido en ella, con la influencia árabe y el descubrimiento de América como momentos fundamentales en el incremento de la riqueza y de la variedad gastronómica española. A nivel catalán, las características geográficas, culturales y sociales de Cataluña, con un marcado sello mediterráneo, fueron incorporándose y creando la cocina y la gastronomía catalanas, que actualmente tiene reconocimiento y prestigio internacionales. El consumo alimentario de la población catalana fue estudiado desde 1983. En la actualidad, presenta un consumo de alimentos y una ingesta de energía y nutrientes similares a la media nacional, al igual que ocurre con la prevalencia de morbilidad y estilos de vida. Conclusión: para que la unión de gastronomía y consumo alimentario favorezca también la salud de la población, debemos favorecer los platos más saludables y fáciles de preparar de su gastronomía y potenciar modificaciones que mejoren los platos técnicamente más complejos y/o pocos saludables.

Current Food Consumption amongst the Spanish ANIBES Study Population.

Dietary habits amongst the Spanish population are currently a relevant cause for concern, as macronutrient profiles and micronutrient intakes seem to be inadequate and globally moving away from the traditional Mediterranean dietary pattern. However, recent food consumption patterns have not been fully assessed. In the present study, our aim was therefore to describe the current food consumption from the "anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain" (ANIBES) study population by assessing data defined by age and gender. The ANIBES study is a cross-sectional study of a nationally representative sample of the Spanish population. A three-day dietary record was used to obtain information about food and beverage consumption. The sample comprised 2009 individuals aged 9-75 years, plus a boost sample for the youngest age groups (9-12, 13-17, and 18-24 years, n = 200 per age group). The most consumed food group across all age segments were non-alcoholic beverages followed by milk and dairy products and vegetables. Consumption of cereals and derivatives, milk and dairy products, sugars and sweets, and ready-to-eat meals by children was significantly higher than those by the adult and older adult populations (p ≤ 0.05). Conversely, intakes of vegetables, fruits, and fish and shellfish were significantly higher in adults and older adults (p ≤ 0.05). In order to comply with recommendations, adherence to the Mediterranean dietary patterns should be strengthened, especially amongst younger population groups. Therefore, substantial nutritional interventions may be targeted to improve the Spanish population's dietary patterns nowadays.

Adequacy of Critical Nutrients Affecting the Quality of the Spanish Diet in the ANIBES Study.

Diet is one of the key modifiable behaviors that can help to control and prevent non-communicable chronic diseases. Therefore, it is important to evaluate the overall diet composition of the population through non-invasive and independent indexes or scores as diet quality indexes (DQIs). The primary aim of the present work was to estimate the adequacy of the intake of critical nutrients in the Spanish "Anthropometry, Intake, and Energy Balance Study" (ANIBES) (n = 2285; 9-75 years), considering, as a reference, the European Food Scientific Authority (EFSA) values for nutrients for the European Union. We also assessed the quality of the diet for adults and older adults using four internationally accepted DQIs, namely the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), the Mediterranean Diet Score-modified (MDS-mod), and the Mediterranean-Diet Quality Index (MED-DQI), as well as the ANIBES-DQI, stratified by education and income. The ANIBES-DQI was based on compliance with EFSA and Food and Agriculture Organization recommendations for a selected group of nutrients (i.e., total fat, saturated fatty acids (SFAs), simple sugars, fiber, calcium, vitamin C, and vitamin A), with a total range of 0-7. Misreporting was assessed according to the EFSA protocol, which allowed us to assess the DQIs for both the general population and plausible reporters. The majority of the Spanish population had high intakes of SFAs and sugars and low intakes of fiber, folate, and vitamins A and C. In addition, about half of the population had low DQI scores and exhibited low adherence to the Mediterranean diet pattern. Overall, older adults (>65-75 years) showed better DQIs than adults (18-64 years), without major differences between men and women. Moreover, primary education and low income were associated with low MDS and ANIBES-DQI scores. For the ANIBES-DQI, the percentage of the population with low scores was higher in the whole population (69.5%) compared with the plausible energy reporters (49.0%), whereas for medium and high scores the percentages were higher in plausible reporters (41.2% vs. 26.2% and 9.8% vs. 4.3%, respectively). In conclusion, the present study adds support to marked changes in the Mediterranean pattern in Spain, and low education and income levels seem to be associated with a low-quality diet. Additionally, the misreported evaluation in the ANIBES population suggests that this analysis should be routinely included in nutrition surveys to give more precise and accurate data related to nutrient intake and diet quality.

Sodium Intake from Foods Exceeds Recommended Limits in the Spanish Population: The ANIBES Study.

Excessive sodium consumption is associated with adverse health effects. An elevated dietary intake of salt (sodium chloride) has been related to high blood pressure or hypertension, a major but modifiable risk factor for cardiovascular disease, as well as to other ill health conditions. In the present work, our aim was to describe the contribution of foods to sodium consumption within the Spanish population in a representative sample from the "anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain" (ANIBES) study (9-75 years), to identify high consumer groups, as well as the major food groups that contribute to sodium intake in the Spanish diet. Intakes were assessed by 3-day food records collected on a tablet device. Sodium intakes across the ANIBES study population exceeded recommendations, as total intakes reached 2025 ± 805 mg of sodium per day, that is approximately 5.06 g/day of salt (excluding discretionary salt, added at the table or during cooking). Sodium intakes were higher in males than in females and within the youngest groups. Main dietary sources of sodium were meat and meat products (27%), cereals and grains (26%), milk and dairy products (14%) and ready-to-eat meals (13%). Given the established health benefits of dietary salt reduction, it would be advisable to continue and even improve the current national initiatives of awareness and educational campaigns and particularly food reformulation to decrease overall salt intakes across the Spanish population.

Updating the Food-Based Dietary Guidelines for the Spanish Population: The Spanish Society of Community Nutrition (SENC) Proposal.

Diet-related risk factors and physical inactivity are among the leading risk factors for disability and are responsible for a large proportion of the burden of chronic non-communicable diseases. Food-based dietary guidelines (FBDGs) are useful tools for nutrition policies and public health strategies to promote healthier eating and physical activity. In this paper, we discuss the process followed in developing the dietary guidelines for the Spanish population by the Spanish Society of Community Nutrition (SENC) and further explain the collaboration with primary healthcare practitioners as presented in the context of the NUTRIMAD 2018 international congress of SENC. From a health in all policies approach, SENC convened a group of experts in nutrition and public health to review the evidence on diet-health, nutrient intake and food consumption in the Spanish population, as well as food preparation, determinants and impact of diet on environmental sustainability. The collaborative group drafted the document and designed the graphic icon, which was then subject to a consultation process, discussion, and qualitative evaluation. Next, a collaborative group was established to plan a dissemination strategy, involving delegates from all the primary healthcare scientific societies in Spain. A product of this collaboration was the release of an attractive, easy-to-understand publication.

[Role of gastronomy and new technologies in shaping a healthy diet]. / Papel de la gastronomía y de las nuevas tecnologías en la configuración de una alimentación saludable.

The gastronomy and the Omic sciences are having a great influence on the present and the future of the habitual food intake of the population. A very large percentage of the population makes at least one meal outside the home and this food impact is maintained over an extended period of time. Food production, food industry and food distribution (including hotels and restaurants, HORECA channel) have a great importance in the supply of food and beverages, its composition and suitability in quantity, quality and price. Based on this availability of food, the consumer will make-up the shopping basket and will choose foods in many cases considering price, comfort, sensory perception and even for its potential impact on health. Omic sciences can be of great importance in the near future by specifying the configuration of the precision feed and stimulating the investigation of new foods and components that help contribute to better health, better functionality and longer life expectancy without disability. This whole panorama needs a legislative framework that ensures the precautionary principle and an optimal food safety. In this complicated way the collaboration between science, industry, consumer organizations and the administration must facilitate the objective of making food a tool for promoting health and well-being.

La gastronomía y las ciencias ómicas están teniendo una gran influencia sobre el presente y el futuro de la ingesta alimentaria habitual de la población.Un porcentaje muy importante de la población realiza al menos una comida fuera del hogar, y este impacto alimentario se mantiene durante un periodo prolongado de tiempo. La producción y la distribución de alimentos, así como la industria alimentaria (incluidos la hostelería y la restauración: el canal horeca), tienen una gran trascendencia en la oferta de alimentos y bebidas y en su composición e idoneidad en cantidad, calidad y precio. Sobre esta disponibilidad de alimentos el consumidor configurará su cesta de la compra y la elección de alimentos, en muchos casos por precio, comodidad, percepción sensorial e incluso por su impacto potencial en la salud.Las ciencias ómicas pueden tener una gran trascendencia en un futuro cercano, concretando la configuración de la alimentación de precisión y estimulando la investigación de nuevos alimentos y componentes que posibiliten un mejor estado de salud, una mejor funcionalidad y una mayor esperanza de vida sin discapacidad. Todo este panorama necesita un marco legislativo que asegure el principio de precaución y una óptima situación de seguridad alimentaria. En este complicado camino, la colaboración entre la ciencia, la industria, las organizaciones de consumidores y la Administración debe facilitar el objetivo de que el alimento sea una herramienta de promoción de la salud y del bienestar.