Enhanced labelling on alcoholic drinks: reviewing the evidence to guide alcohol policy.

BACKGROUND: Consumer and public health organizations have called for better labelling on alcoholic drinks. However, there is a lack of consensus about the best elements to include. This review summarizes alcohol labelling policy worldwide and examines available evidence to support enhanced labelling. METHODS: A literature review was carried out in June-July 2012 on Scopus using the key word 'alcohol' combined with 'allergens', 'labels', 'nutrition information', 'ingredients', 'consumer information' and/or 'warning'. Articles discussing advertising and promotion of alcohol were excluded. A search through Google and the System for Grey Literature in Europe (SIGLE) identified additional sources on alcohol labelling policies, mainly from governmental and organizational websites. RESULTS: Five elements were identified as potentially useful to consumers: (i) a list of ingredients, (ii) nutritional information, (iii) serving size and servings per container, (iv) a definition of 'moderate' intake and (v) a health warning. Alcohol labelling policy with regard to these aspects is quite rudimentary in most countries, with few requiring a list of ingredients or health warnings, and none requiring basic nutritional information. Only one country (Australia) requires serving size and servings per container to be displayed. Our study suggests that there are both potential advantages and disadvantages to providing consumers with more information about alcohol products. CONCLUSIONS: Current evidence seems to support prompt inclusion of a list of ingredients, nutritional information (usually only kcal) and health warnings on labels. Standard drink and serving size is useful only when combined with other health education efforts. A definition of 'moderate intake' and recommended drinking guidelines are best suited to other contexts.

Fat intake influences the effect of the hepatic lipase C-514T polymorphism on HDL-cholesterol levels in children.

Polymorphisms in the hepatic lipase gene have been associated with variability in plasma HDL-C concentrations, but contradictory results have been reported regarding the effect of diet on this association in adults. In our study, we examined whether dietary fat intake modified the association between lipid levels and the C-514T polymorphism in the hepatic lipase gene (LIPC C-514T) in prepubescent children. The LIPC C-514T polymorphism was determined by PCR and restriction analysis in 1260 healthy school children, aged 6-8. Information on the children's nutrient intake was obtained by means of a validated food frequency questionnaire. We found that regardless of gender, carriers of the minor allele had significantly higher apo A-I levels compared to noncarrier subjects. The effect of the polymorphism, however, was modified by dietary fat intake. In boys, the presence of the LIPC C-514T polymorphism was associated with significantly higher HDL-C among children within the highest tertiles of total, saturated, monounsaturated, or polyunsaturated fat intake. Apo A-I levels were significantly higher in carriers of the LIPC C-514T polymorphism, but only among boys who consumed high total as well as monounsaturated fat and among girls who consumed high total, saturated, monounsaturated, and polyunsaturated fat. Our data show that dietary fat intake modifies the effect of the LIPC C-514T polymorphism on plasma HDL-C and apo A-I levels in prepubescent children, being associated with higher levels of HDL-C and apo A-I only when fat intake is high. This significant gene-nutrient interaction could help to explain inter-individual variations in the plasma lipid response to fat intake.

[Assessment of dietary intake at the population level through individual questionnaires: methodological shadows and lights]. / Valoración de la ingesta dietética a nivel poblacional mediante cuestionarios individuales: sombras y luces metodológicas.

The development of the modern methodology necessary to accurately characterize dietary intake in individuals and population only dates back two decades, when nutritional epidemiology first emerged. The reason for the recentness of this discipline lies in the fact that dietary assessment at the population level presents complex challenges which are only being overcome as we investigate and improve the available methodological instruments. In this paper, alternative methods to estimate food and nutritional intake are reviewed. Following a succinct description of direct and indirect methods to evaluate dietary consumption, including a brief reference to biomarkers and mixed techniques such as "total diet" studies, the article focuses on direct methods of quantifying dietary intake through questionnaires. The basis, advantages, and limitations of alternative options are considered, and subsequently the article summarizes the development of new survey designs and analytical/statistical techniques which aim to optimize the available methodology. The article finally concludes by affirming that the approximations indicated by the complementary introduction of biomarkers, together with the optimized use of combined methods with questionnaires, are potentially the most precise and trustworthy estimations of dietary intake at the population level. In light of both the advances achieved and the pending challenges, it is clear that there is a strong necessity to foster research which will lead to improvement in the methodology in this field.

Vegetable and Fruit Intakes Are Associated with hs-CRP Levels in Pre-Pubertal Girls.

The influence of diet on inflammation in children remains unclear. We aimed to analyze the influence of diet on high-sensitivity C-reactive protein (hs-CRP) levels in a pre-pubertal population free of other influences that may affect hs-CRP levels. We determined hs-CRP levels in 571 six- to eight-year-old children using an hs-CRP ELISA kit. Information on food and nutrient intake was obtained through a food-frequency questionnaire. Overall dietary quality was assessed using the Healthy Eating Index (HEI). We found that girls in the highest tertile of hs-CRP levels had a higher intake of saturated fatty acid, and lower intakes of fiber and vitamin E and a lower HEI score when compared to those in tertiles 1 and 2. We also observed a significant decrease in fruit and vegetable intakes by hs-CRP tertile. Factor analysis showed that a dietary pattern that was loaded most strongly with vegetable, fruit, fiber and vitamin A and E intakes correlated negatively (-0.132, p < 0.05) with hs-CRP. No such association was found in boys. In conclusion, our data show that girls with a poorer quality diet show higher hs-CRP levels already at a pre-pubertal age.

Toenail cerium levels and risk of a first acute myocardial infarction: the EURAMIC and heavy metals study.

The association between cerium status and risk of first acute myocardial infarction (AMI) was examined in a case-control study in 10 centres from Europe and Israel. Cerium in toenails was assessed by neutron activation analysis in 684 cases and 724 controls aged 70 years or younger. Mean concentrations of cerium were 186 and 173 microg/kg in cases and controls, respectively. Cerium was positively associated with low socio-economic status, smoking, mercury, zinc and scandium (p0.001). Cases had significantly higher levels of cerium than controls after adjustment for age and centre (case-control ratio 1.074; 95% CI 1.002-1.151) and increased in further adjustment for other cardiovascular risk factors 1.085; 95% CI 1.025-1.149. The risk after adjustment for age and centre was higher with increasing cerium levels (p for trend=0.02). After adjustment for BMI, history of hypertension, smoking, alcohol intake, diabetes, family history of CHD, beta-carotene, lycopene, alpha-tocopherol, selenium, mercury and scandium, the OR for the highest quintile was 1.43 (95% CI 0.85-2.41; p-trend 0.08). When we applied this same model in non-smokers the odds ratios in the 4th and 5th quintiles of cerium as compared with the lowest were 2.09 (95% CI 1.05-4.16) and 2.81 (95% CI 1.21-6.52), respectively, p-trend 0.011. Our results suggest that toenail cerium levels may be associated with an increased risk of AMI, but more research is warranted to shed further light and fully understand the plausibility and public health implications of these findings.

[Dietary variety and diversity of Spanish children: Four Provinces Study]. / Variedad y diversidad de la dieta de los niños españoles: Estudio Cuatro Provincias.

BACKGROUND AND OBJECTIVE: Diet variety is claimed for ensuring a healthy eating. Our objective was to analyze the relationship between the variety and diversity of the diet and its nutritional quality among Spanish children. SUBJECTS AND METHOD: Cross-sectional study where information on food and nutrition was obtained through a food frequency questionnaire. The sample included 1,112 children aged 6-7 years from 4 cities. Children were selected by random cluster-sampling in schools and stratified by sex and socioeconomic level. We calculated a diet variety index (DVI)--count of food items--and a diet diversity index (DDI)--count of food groups. To measure the overall diet quality, the Healthy Eating Index (HEI-f) was used. RESULTS: The percentage of children eating less than one daily food serving varied between 0% for the grain and 11.3% for the fruit groups. Diet variety and diversity were positively associated with the intake of fiber, vitamines B6 and E and folic acid, and the percentage of caloric intake resulting from polyinsaturated fatty acids and carbohydrates. In contrast, intakes of lipis and saturated fatty acids, vitamine C, sodium and calcium were all negatively associated with diet variety and diversity. Although both DVI and DDI were possitively associated with the HEI-f, the results from a regression model showed that it was only DDI that contributed significantly to the model fitting (p < 0.001). CONCLUSIONS: These results support the goodness of a varied diet that includes ingredients from different food groups and, at the same time, maintains the energy energy within recomended levels.

Effectiveness of the WC/rBS oral cholera vaccine in the prevention of traveler's diarrhea: a prospective cohort study.

OBJECTIVE: Traveler's diarrhea (TD) is the most frequent disease among people from industrialized countries who travel to less developed ones, especially sub-Saharan Africa, Southern Asia and South America. The most common bacteria causing TD is enterotoxigenic Escherichia coli (ETEC). The WC/rBS cholera vaccine (Dukoral) has been shown to induce cross-protection against ETEC by means of the B subunit of the cholera toxin. The aim of the study was to evaluate the effectiveness of the WC/rBS cholera vaccine in preventing TD. METHODS: Between May 1 and September 30 (2007), people seeking pre-travel advice in ten Spanish international vaccination centers were included in a prospective cohort study of travelers to cholera risk countries. The incidence rates of TD were adjusted for variables whose frequencies were statistically different (entry point 0.10) between the vaccinated and non-vaccinated cohorts. FINDINGS: The vaccinated cohort (n = 544 travelers) included people vaccinated with the WC/rBS cholera vaccine, and the non-vaccinated cohort (n = 530 travelers) by people not vaccinated. The cumulative incidence rate of TD was 1.69 in vaccinated and 2.14 in non-vaccinated subjects. The adjusted relative risk of TD in vaccinated travelers was 0.72 (95% CI: 0.58-0.88) and the adjusted vaccination effectiveness was 28% (95% CI: 12-42). CONCLUSIONS: The WC/rBS cholera vaccine prevents TD in 2 out of 7 travelers (preventive fraction: 28%). The number needed to vaccinate (NNV) to prevent 1 case of TD is 10.

Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis.

The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes.

Cholesterol and saturated fat intake determine the effect of polymorphisms at ABCG5/ABCG8 genes on lipid levels in children.

PURPOSE: Analysis of mutations in genes of the cholesterol metabolic pathway has not completely explained the interindividual variability of blood cholesterol concentrations attributed to gene-nutrient interactions. Thus, we analyzed polymorphisms in the ABCG5 and ABCG8 genes, involved in the regulation of intestinal cholesterol absorption, with special interest in a potential interaction with diet to determine lipid levels. METHODS: The polymorphisms ABCG5 C1950G (Gln604Glu) and ABCG8 C1895T (Ala640Val) were determined by polymerase chain reaction and restriction analysis in 1227 healthy school children, aged 6 to 8 years. RESULTS: No significant differences were found in blood lipid levels between subjects with different genotypes of the two analyzed polymorphisms. However, important differences appeared when separating subjects by their different lipid intake. The presence of the ABCG8 C1895T and ABCG5 C1950G polymorphisms was associated with different plasma total cholesterol, low-density lipoprotein cholesterol complex, and apolipoprotein B levels only in low-cholesterol consumers (significantly for the C1895T polymorphism), and among children within the lower tertile of saturated fat intake (significantly for the C1950G polymorphism). CONCLUSION: Polymorphisms at the half-transporter ABCG5 and ABCG8 genes affect blood cholesterol concentrations in prepubertal children by influencing dietary responsiveness. This highly significant gene-nutrient interaction could explain the great individual differences in the plasma lipid response to cholesterol and fat intake.

Consumption of bakery products, sweetened soft drinks and yogurt among children aged 6-7 years: association with nutrient intake and overall diet quality.

The present study tests the hypothesis that higher consumption of bakery products, sweetened soft drinks and yogurt is associated with higher intake of energy, saturated fats, sugars and worse overall diet quality among Spanish children. This is a cross-sectional study covering 1112 children aged 6.0-7.0 years in four Spanish cities. Nutrient and food intake were obtained through a food-frequency questionnaire, and overall diet quality calculated using the healthy-eating index (HEI) developed by Kennedy et al. (1995). Standardized methods were used to measure anthropometric variables. Associations of interest were summarized as the difference in nutrient and food consumption between the value of the fifth and the first quintile of consumption (dq) of bakery products, sweetened soft drinks or yogurt, adjusted for energy intake and BMI. Bakery products, sweetened soft drinks and yogurt supplied 15.5, 1.0 and 5.6 % energy intake respectively. Higher consumption of these three foods was associated with greater energy intake (P<0.001), but not with higher BMI. Consumption of bakery products was associated with the proportion of energy derived from intake of total carbohydrates (dq 4.5 %, P<0.001) and sugars (dq 2 %, P<0.001), but did not show association with the HEI. Consumption of sweetened soft drinks was associated with a lower consumption of milk (dq -88 ml, P<0.001) and Ca (dq -175 mg/d, P<0.001), and worse HEI (dq -2, P<0.01). Consumption of yogurt, while associated with higher energy intake from saturated fats (dq 1.77 %, P<0.001) and sugars (dq 2.02 %, P<0.001), showed no association with the HEI. Differences in the intake of nutrients and foods across quintiles of consumption of bakery products, sweetened soft drinks and yogurt were usually very small. We conclude that the impact of the consumption of bakery products, sweetened soft drinks and yogurt on the quality of the diet of Spanish children is only modest, although it may contribute to aggravating certain unhealthy characteristics of their diet, particularly excess energy, saturated fats and sugars. Therefore, consumption of bakery products and sweetened soft drinks should be moderated, and priority given to consumption of low-fat, low-sugar yogurt.

Association between toenail scandium levels and risk of acute myocardial infarction in European men: the EURAMIC and Heavy Metals Study.

The association between scandium status and risk of acute myocardial infarction (MI) was examined in a multicentre case control study in 10 centres from Europe and Israel. Scandium in toenails was assessed in 684 cases and 724 controls less than 70 years of age. Mean concentrations of toenail scandium were 6.74 micro/kg in cases and 7.75 microg/kg in controls. Scandium among controls, adjusted for age and centre was positively associated with concentrations of lycopene and oleic acid in adipose tissue (P = 0.002 for both nutrients). Pearson correlations adjusted for age and centre were significant (P < 0.05) between scandium and lycopene (r = 0.08), zinc (r = 0.08), mercury (r = 0.18) and oleic acid (r = 0.21). Overall, cases had lower levels of scandium than controls after adjustment for age and centre (case control ratio, 0.87; 95% CI 0.79-0.96). This association persisted after adjustment for other cardiovascular risk factors (case-control ratio 0.88; 95% CI, 0.79-0.98). The risk of MI at high scandium levels was reduced after adjustment for age and centre (P-trend = 0.04). Further adjustments for BMI, history of hypertension, smoking, alcohol intake, diabetes, family history of CHD, alpha-tocopherol, beta-carotene, lycopene, selenium and mercury slightly attenuated this trend (P = 0.055). Our results suggest that toenail scandium level is associated with a reduced risk of acute MI, but we are uncertain whether this element can really play a protective role in the development of CHD. Without an identified plausible mechanism, these results should be regarded as preliminary and should be tested in future studies.

Valoración de la ingesta dietética a nivel poblacional mediante cuestionarios individuales: sombras y luces metodológicas / Assessment of dietary intake at the population level through individual questionnaires: methodological shadows and lights

El desarrollo de la moderna metodología necesaria paracaracterizar con rigor la ingesta de individuos y poblacionesdata de hace sólo dos décadas, cuando germinó la epidemiologíanutricional. La razón del carácter reciente de esta disciplinaradica en el hecho de que la valoración de la ingesta dietéticaa nivel poblacional presenta retos complejos, que sólo vansiendo superados a medida que investigamos y mejoramos losinstrumentos metodológicos disponibles.En el presente artículo se revisan los métodos alternativospara estimar la ingesta de alimentos y nutrientes en los individuos.Tras una sucinta descripción de los métodos indirectos ydirectos de valoración del consumo alimentario, que incluye unabreve referencia a los biomarcadores y a técnicas mixtas comolas de estudios de “dieta total”, el artículo se centra en los métodosdirectos de cuantificación de ingesta alimentaria mediantecuestionarios. Aquí se plantean los fundamentos, ventajas y limitacionesde las opciones alternativas. Tras ello, se pone al día deforma resumida el desarrollo de nuevos diseños de cuestionariosy de técnicas analítico-estadísticas que tienen como fin optimizarla metodología disponible. Finalmente, tras reconocer los avancesrealizados a la par que las cuestiones pendientes, se concluyeafirmando que las aproximaciones que plantean la introduccióncomplementaria de biomarcadores junto a la utilizaciónoptimizada de métodos combinados con cuestionarios individualespresentan potencialmente mayor fiabilidad y precisión conjuntapara la estimación de la ingesta dietética a nivel poblacional,quedando patente la necesidad de impulsar la investigaciónque permita mejorar la metodología en este campo(AU)

The development of the modern methodology necessary toaccurately characterize dietary intake in individuals andpopulation only dates back two decades, when nutritionalepidemiology first emerged. The reason for the recentness ofthis discipline lies in the fact that dietary assessment at thepopulation level presents complex challenges which are onlybeing overcome as we investigate and improve the availablemethodological instruments.In this paper, alternative methods to estimate food andnutritional intake are reviewed. Following a succinctdescription of direct and indirect methods to evaluate dietaryconsumption, including a brief reference to biomarkers andmixed techniques such as “total diet” studies, the articlefocuses on direct methods of quantifying dietary intakethrough questionnaires. The basis, advantages, and limitationsof alternative options are considered, and subsequently thearticle summarizes the development of new survey designs andanalytical/statistical techniques which aim to optimize theavailable methodology. The article finally concludes byaffirming that the approximations indicated by thecomplementary introduction of biomarkers, together with theoptimized use of combined methods with questionnaires, arepotentially the most precise and trustworthy estimations ofdietary intake at the population level. In light of both theadvances achieved and the pending challenges, it is clear thatthere is a strong necessity to foster research which will lead toimprovement in the methodology in this field(AU)

Variedad y diversidad de la dieta de los niños españoles: Estudio Cuatro Provincias / Dietary variety and diversity of Spanish children: Four Provinces Study

FUNDAMENTO Y OBJETIVO: Las guías de alimentación saludable aconsejan una dieta variada. El objetivo de este estudio consistió en evaluar la relación entre la variedad de la dieta y la calidad nutricional de la misma en niños españoles. SUJETOS Y MÉTODO: Estudio de carácter transversal en el que la información alimentaria y nutricional se recogió mediante un cuestionario de frecuencia de consumo de alimentos. La muestra incluyó a 1.112 niños/as, de entre 6 y 7 años, de Cádiz, Madrid, Orense y Murcia. La selección se realizó mediante muestreo aleatorio, por conglomerados de centros escolares. Calculamos el índice de variedad de la dieta (IVD), o número de alimentos, y el índice de diversidad de la dieta (IDD), o número de grupos alimentarios. La calidad global de la dieta se evaluó mediante el índice de alimentación saludable (IAS-f). RESULTADOS: El porcentaje de niños que consumieron una cantidad inferior a una ración diaria varió entre el 0 per cent de los cereales y el 11,3 per cent de la fruta. La variedad y la diversidad de la dieta se asociaron de forma positiva con la ingestión de fibra, vitaminas B6, E y ácido fólico, y con el porcentaje de ingestión calórica procedente de los ácidos grasos insaturados e hidratos de carbono. Por el contrario, la asociación fue negativa en el caso de la ingestión de lípidos totales, ácidos grasos saturados, vitamina C, sodio y calcio. Aunque el IVD y el IDD presentaron una asociación positiva con el IAS-f, al introducir ambos índices simultáneamente en un modelo de regresión el IDD fue el único que contribuyó al ajuste del mismo (p < 0,001). CONCLUSIONES: Los resultados presentados apoyan las bondades de una dieta variada, entendida ésta como la que incluye componentes de diferentes grupos alimentarios y, a su vez, mantiene la ingestión energética en los niveles recomendados (AU)