Energy Intake, Macronutrient Profile and Food Sources of Spanish Children Aged One to <10 Years-Results from the EsNuPI Study.

The present study aimed to assess energy intake, nutrient profile and food sources in Spanish children participating in the EsNuPI ("Estudio Nutricional en Población Infantil Española") study. Plausibility of energy intake and adequacy of nutrient intakes to international recommendations were analyzed in a final sample of 1448 subjects (728 boys and 720 girls) and one group representative of the 1 to <10 years old urban Spanish children (reference sample (n = 707)) who consumed milk and one of the same age who consumed adapted milk over the last year (adapted milk consumers sample (n = 741)) were compared. Both groups completed data of a face-to-face and a telephone 24-h dietary recalls. Both the reference and the adapted milk consumers samples reported an adequate daily energy intake (1503 kcal/day and 1404 kcal/day); and a high contribution to total energy from protein (16.5% and 15.6%) and fat (36.5% and 35.9%). Also, a high percentage of children from both samples were below the lower limit of the recommendations for carbohydrates (47.8% and 39.3%). As the percentage of plausible energy reporters was high for both groups (84.7% and 83.5%, respectively), data for the whole sample were analyzed. Milk and dairy, cereals, meat and derived products, fats and oils, bakery and pastry, fruits and vegetables contributed to about 80% of the total energy intake in both groups. However, the reference sample reported significantly more contribution to energy from cereals, meat and meat products, bakery and pastry and ready to cook/eat foods; meanwhile, the adapted milk consumers sample reported significantly more energy from milk and dairy products, fruits and eggs. Those results suggest that adapted milk consumers have better adherence to the food-based dietary guidelines. Further analyses are warranted to characterize food patterns and the quality of the diet in the EsNuPI study population.

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.

Dietary and Lifestyle Patterns in the Spanish Pediatric Population (One to <10 Years Old): Design, Protocol, and Methodology of the EsNuPI Study.

The interest in a healthy diet and lifestyle during the early stages of life increased, pointing out its role in the development of noncommunicable chronic diseases throughout adult life. Dietary habits and dietary patterns begin to be established in early childhood and persist during adulthood. Therefore, the EsNuPI ("Nutritional Study in Spanish Pediatric Population") study aims to depict the dietary patterns, physical activity, and sedentary behaviors in Spanish children aged from one to <10 years old. This prospective, cross-sectional, observational study recruited a total of 1514 children from Spanish cities with >50,000 inhabitants, stratified by Nielsen areas. Participants were involved in one face-to-face survey, followed by a telephone survey after at least one week. Information about dietary intake and habits was obtained using a quantitative food frequency questionnaire and two 24-h dietary recalls. Physical activity and sedentary behaviors were registered using a specific questionnaire based on a seven-day record. Data were processed and stratified by categorical variables to be statistically analyzed in order to meet the study objectives. This study is the first of its kind in a Spanish reference population of this age range and the first to evaluate whether the consumption of adapted milk formulas and dairy products is associated with healthier dietary patterns and better diet quality and lifestyles in this group.

Breakfast Consumption in Spain: Patterns, Nutrient Intake and Quality. Findings from the ANIBES Study, a Study from the International Breakfast Research Initiative.

This study aimed to investigate energy, nutrient and food group intakes at breakfast in Spain and to examine for the first time, their relationship to the overall Diet Quality (DQ). The data used were from the Spanish ANIBES (anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain), a cross-sectional study using a nationally representative sample of the Spanish population (9⁻75 years old). DQ was assessed using the Nutrient Rich Foods Index, adapted to total diets (NRF9.3d). Most (>85%) of the Spanish population were regular breakfast consumers, although one in five adolescents were breakfast skippers. Breakfast provides just 16⁻19% of the daily intake of energy. Relative to its daily energy contribution, the Spanish breakfast contributed a higher proportion of daily total carbohydrates, added sugars, sodium, thiamin, riboflavin, folates, iron, potassium, magnesium, phosphorus and especially in calcium. By contrast, the breakfast is low in water intake, protein, dietary fibre, total fat, polyunsaturated fatty acids, beta-carotene and vitamins E and D. In children and teenagers, the most commonly consumed breakfast food was chocolate (mainly as chocolate-flavoured milk and powder), followed by bakery and pastry, whole milk and semi-skimmed milk. In the older groups, a bigger variety of foods were reported. Consumers in the highest NRF9.3d tertile for diet quality tended to have a higher intake of positive nutrients at breakfast than other tertiles, most notably among adults.

Macronutrient Distribution and Dietary Sources in the Spanish Population: Findings from the ANIBES Study.

Our aim was to analyze dietary macronutrient intake and its main sources according to sex and age. Results were derived from the ANIBES ("Anthropometry, Intake and Energy Balance in Spain") cross-sectional study using a nationally-representative sample of the Spanish population (9-75 years old). Mean dietary protein intake was 74.5 ± 22.4 g/day, with meat and meat products as the main sources (33.0%). Mean carbohydrate intake was 185.4 ± 60.9 g/day and was higher in children and adolescents; grains (49%), mainly bread, were the main contributor. Milk and dairy products (23%) ranked first for sugar intake. Mean lipid intake was 78.1 ± 26.1 g/day and was higher in younger age groups; contributions were mainly from oils and fats (32.5%; olive oil 25.6%) and meat and meat products (22.0%). Lipid profiles showed relatively high monounsaturated fatty acid intake, of which olive oil contributed 38.8%. Saturated fatty acids were mainly (>70%) combined from meat and meat products, milk and dairy products and oils and fats. Polyunsaturated fatty acids were mainly from oils and fats (31.5%). The macronutrient intake and distribution in the Spanish population is far from population reference intakes and nutritional goals, especially for children and adolescents.

Physical Activity Patterns of the Spanish Population Are Mostly Determined by Sex and Age: Findings in the ANIBES Study.

BACKGROUND: Representative data for the Spanish population regarding physical activity (PA) behaviors are scarce and seldom comparable due to methodological inconsistencies. AIM: Our objectives were to describe the PA behavior by means of the standardized self-reported International Physical Activity Questionnaire (IPAQ) and to know the proportion of the Spanish population meeting and not meeting international PA recommendations. MATERIAL AND METHODS: PA was assessed using the IPAQ in a representative sample of 2285 individuals (males, 50.4%) aged 9-75 years and living in municipalities of at least 2,000 inhabitants. Data were analyzed according to: age groups 9-12, 13-17, 18-64, and 65-75 years; sex; geographical distribution; locality size and educational levels. RESULTS: Mean total PA was 868.8±660.9 min/wk, mean vigorous PA 146.4±254.1 min/wk, and mean moderate PA 398.1±408.0 min/wk, showing significant differences between sexes (p<0.05). Children performed higher moderate-vigorous PA than adolescents and seniors (p<0.05), and adults than adolescents and seniors (p<0.05). Compared to recommendations, 36.2% of adults performed <150 min/week of moderate PA, 65.4% <75 min/week of vigorous PA and 27.0% did not perform any PA at all, presenting significant differences between sexes (p<0.05). A total of 55.4% of children and adolescents performed less than 420 min/week of MVPA, being higher in the later (62.6%) than in the former (48.4%). Highest non-compliance was observed in adolescent females (86.5%). CONCLUSION: Sex and age are the main influencing factors on PA in the Spanish population. Males engage in more vigorous and light PA overall, whereas females perform more moderate PA. PA behavior differs between age groups and no clear lineal increase with age could be observed. Twenty-seven percent of adults and 55.4% of children and adolescents do not meet international PA recommendations. Identified target groups should be addressed to increase PA in the Spanish population.

Energy Intake, Profile, and Dietary Sources in the Spanish Population: Findings of the ANIBES Study.

Energy intake, and the foods and beverages contributing to that, are considered key to understanding the high obesity prevalence worldwide. The relative contributions of energy intake and expenditure to the obesity epidemic, however, remain poorly defined in Spain. The purpose of this study was to contribute to updating data of dietary energy intake and its main sources from food and beverages, according to gender and age. These data were derived from the ANIBES ("Anthropometry, Intake, and Energy Balance in Spain") study, a cross-sectional study of a nationally representative sample of the Spanish population (from 9-75 years old). A three-day dietary record, collected by means of a tablet device, was used to obtain information about food and beverage consumption and leftovers. The final sample comprised 2009 individuals (1,013 men, 996 women). The observed mean dietary energy intake was 7.6 ± 2.11 MJ/day (8.2 ± 2.22 MJ/day for men and 6.9 ± 1.79 MJ/day for women). The highest intakes were observed among adolescents aged 13-17 years (8.4 MJ/day), followed by children 9-12 years (8.2 ± 1.80 MJ/day), adults aged 18-64 (7.6 ± 2.14 MJ/day) and older adults aged 65-75 years (6.8 ± 1.88 MJ/day). Cereals or grains (27.4%), meats and derivatives (15.2%), oils and fats (12.3%), and milk and dairy products (11.8%) contributed most to daily energy intake. Energy contributions from non-alcoholic beverages (3.9%), fish and shellfish (3.6%), sugars and sweets (3.3%) and alcoholic beverages (2.6%) were moderate to minor. Contributions to caloric profile were 16.8%E from proteins; 41.1%E from carbohydrates, including 1.4%E from fiber; 38.5%E from fats; and 1.9%E from alcohol intake. We can conclude that energy intake is decreasing in the Spanish population. A variety of food and beverage groups contribute to energy intake; however, it is necessary to reinforce efforts for better adherence to the traditional Mediterranean diet.

Methodology of dietary surveys, studies on nutrition, physical activity and other lifestyles

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Energy Balance, a new paradigm and methodological issues: the ANIBES study in Spain / Balance energético, un nuevo paradigma y aspectos metodológicos: Estudio ANIBES en España

Energy Balance (EB) is an important topic to understand how an imbalance in its main determinants (energy intake and consumption) may lead to inappropriate weight gain, considered to be 'dynamic' and not 'static'. There are no studies to evaluate EB in Spain and new technologies reveal as key tools to solve the common problems to precisely quantify energy consumption and expenditure at population level. Within this context, the increasing complexity of the diet, but also the common problems of under and over reporting in nutrition surveys have to be taken into account. The overall purpose of the ANIBES ('Anthropometry, Intake and Energy Balance in Spain') Study was to carry out an accurate updating of foods and beverages intake, dietary habits/ behaviour and anthropometric data of the Spanish population as well as the energy expenditure and physical activity patterns, by the use of new tested instruments (i.e. tablet device to assess energy intake and accelerometer to evaluate physical activity). This new ANIBES Study will contribute to a better knowledge of the different key factors contributing to EB in Spain (AU)

El balance energético (BE) o equilibrio energético se refiere 'simplemente' a que debemos ingerir la misma cantidad de energía que gastamos. Conocer el concepto de BE y aplicarlo a nuestras vidas es quizá el factor más importante para mantener una buena salud y tratar de prevenir la obesidad. Sin embargo, la teoría no es sencilla llevarla a la práctica ya que, por un lado, en este ya avanzado siglo XXI desconocemos todavía en gran medida lo que comemos, en definitiva, nuestra alimentación. Y ésta es cada vez más compleja, lo que dificulta sin duda controlar adecuadamente este lado de la 'balanza', la ingesta. Pero además, en el otro lado, el correspondiente al gasto energético, aún es peor conocido y hay muy escasa información en la cuantificación adecuada del mismo. Debe recordarse, además, que no debemos estudiar aisladamente los componentes del BE, sino de manera integrada, y como interaccionan. Problemas como la infravaloración de la ingesta de energía, y la sobrevaloración del gasto, son frecuentes en la mayoría de las encuestas nutricionales, impactando más en aquellos grupos de población en los que el control del BE resulta aún más necesario. El empleo de las nuevas tecnologías abre numerosas posibilidades para las encuestas de balance energético. Precisamente, la innovadora metodología (empleo de 'tablet' para cuantificación de la ingesta, y de acelerómetros para el nivel de actividad física) en el reciente Estudio ANIBES ('Antropometría, Ingesta, y Balance Energético en España'), representativo de la población española, y que hemos desarrollado, proporciona una herramienta útil y actualizada para un mejor conocimiento del balance energético de la población española, como se pone de manifiesto en el presente artículo (AU)

Energy balance, a new paradigm and methodological issues: the ANIBES study in Spain.

Energy Balance (EB) is an important topic to understand how an imbalance in its main determinants (energy intake and consumption) may lead to inappropriate weight gain, considered to be "dynamic"and not "static". There are no studies to evaluate EB in Spain and new technologies reveal as key tools to solve the common problems to precisely quantify energy consumption and expenditure at population level. Within this context, the increasing complexity of the diet, but also the common problems of under and over reporting in nutrition surveys have to be taken into account. The overall purpose of the ANIBES ("Anthropometry, Intake and Energy Balance in Spain") Study was to carry out an accurate updating of foods and beverages intake, dietary habits/ behaviour and anthropometric data of the Spanish population as well as the energy expenditure and physical activity patterns, by the use of new tested instruments (i.e. tablet device to assess energy intake and accelerometer to evaluate physical activity). This new ANIBES Study will contribute to a better knowledge of the different key factors contributing to EB in Spain.

El balance energético (BE) o equilibrio energético se refiere "simplemente" a que debemos ingerir la misma cantidad de energía que gastamos. Conocer el concepto de BE y aplicarlo a nuestras vidas es quizá el factor más importante para mantener una buena salud y tratar de prevenir la obesidad. Sin embargo, la teoría no es sencilla llevarla a la práctica ya que, por un lado, en este ya avanzado siglo XXI desconocemos todavía en gran medida lo que comemos, en definitiva, nuestra alimentación. Y ésta es cada vez más compleja, lo que dificulta sin duda controlar adecuadamente este lado de la "balanza", la ingesta. Pero además, en el otro lado, el correspondiente al gasto energético, aún es peor conocido y hay muy escasa información en la cuantificación adecuada del mismo. Debe recordarse, además, que no debemos estudiar aisladamente los componentes del BE, sino de manera integrada, y como interaccionan. Problemas como la infravaloración de la ingesta de energía, y la sobrevaloración del gasto, son frecuentes en la mayoría de las encuestas nutricionales, impactando más en aquellos grupos de población en los que el control del BE resulta aún más necesario. El empleo de las nuevas tecnologías abre numerosas posibilidades para las encuestas de balance energético. Precisamente, la innovadora metodología (empleo de "tablet" para cuantificación de la ingesta, y de acelerómetros para el nivel de actividad física) en el reciente Estudio ANIBES ("Antropometría, Ingesta, y Balance Energético en España"), representativo de la población española, y que hemos desarrollado, proporciona una herramienta útil y actualizada para un mejor conocimiento del balance energético de la población española, como se pone de manifiesto en el presente artículo.

The ANIBES Study on Energy Balance in Spain: design, protocol and methodology.

Energy Balance (EB) is an important topic to understand how an imbalance in its main determinants (energy intake and consumption) may lead to inappropriate weight gain, considered to be "dynamic" and not "static". There are no studies to evaluate EB in Spain, and new technologies reveal themselves as key tools to solve common problems to precisely quantify energy consumption and expenditure at population level. The overall purpose of the ANIBES ("Anthropometry, Intake and Energy Balance") Study was to carry out an accurate updating of food and beverage intake, dietary habits/behaviour and anthropometric data of the Spanish population (9-75 years, n=2009), as well as the energy expenditure and physical activity patterns. Anthropometry measurements (weight, height, body mass index, waist circumference, % body fat, % body water) were obtained; diet was evaluated throughout a three-day dietary record (tablet device) accompanied by a 24 h-dietary recall; physical activity was quantified by questionnaire and accelerometers were also employed. Finally, information about perception and understanding of several issues related to EB was also obtained. The ANIBES study will contribute to provide valuable useful data to inform food policy planning, food based dietary guidelines development and other health oriented actions in Spain.

Documento de consenso y conclusiones. La metodología de las encuestas alimentarias, estudios nutricionales, de estimación de la actividad física y otros estilos de vida / No disponible

No disponible

Balance energético, un nuevo paradigma y aspectos metodológicos: estudio ANIBES en España / Energy balance: a new paradigm and methodological issues: the anibes study in Spain

El balance energético (BE) o equilibrio energético se refiere 'simplemente' a que debemos ingerir la misma cantidad de energía que gastamos. Conocer el concepto de BE y aplicarlo a nuestras vidas es quizá el factor más importante para mantener una buena salud y tratar de prevenir la obesidad. Sin embargo, la teoría no es sencilla llevarla a la práctica ya que, por un lado, en este ya avanzado siglo XXI desconocemos todavía en gran medida lo que comemos, en definitiva, nuestra alimentación. Y ésta es cada vez más compleja, lo que dificulta sin duda controlar adecuadamente este lado de la 'balanza', la ingesta. Pero además, en el otro lado, el correspondiente al gasto energético, aún es peor conocido y hay muy escasa información en la cuantificación adecuada del mismo. Debe recordarse, además, que no debemos estudiar aisladamente los componentes del BE, sino de manera integrada, y como interaccionan. Problemas como la infravaloración de la ingesta de energía, y la sobrevaloración del gasto, son frecuentes en la mayoría de las encuestas nutricionales, impactando más en aquellos grupos de población en los que el control del BE resulta aún más necesario. El empleo de las nuevas tecnologías abre numerosas posibilidades para las encuestas de balance energético. Precisamente, la innovadora metodología (empleo de 'tablet' para cuantificación de la ingesta, y de acelerómetros para el nivel de actividad física) en el reciente Estudio ANIBES ('Antropometría, Ingesta, y Balance Energético en España'), representativo de la población española, y que hemos desarrollado, proporciona una herramienta útil y actualizada para un mejor conocimiento del balance energético de la población española, como se pone de manifiesto en el presente artículo (AU)

Energy Balance (EB) is an important topic to understand how an imbalance in its main determinants (energy intake and consumption) may lead to inappropriate weight gain, considered to be 'dynamic' and not 'static'. There are no studies to evaluate EB in Spain and new technologies reveal as key tools to solve the common problems to precisely quantify energy consumption and expenditure at population level. Within this context, the increasing complexity of the diet, but also the common problems of under and over reporting in nutrition surveys have to be taken into account. The overall purpose of the ANIBES ('Anthropometry, Intake and Energy Balance in Spain') Study was to carry out an accurate updating of foods and beverages intake, dietary habits/ behaviour and anthropometric data of the Spanish population as well as the energy expenditure and physical activity patterns, by the use of new tested instruments (i.e. tablet device to assess energy intake and accelerometer to evaluate physical activity). This new ANIBES Study will contribute to a better knowledge of the different key factors contributing to EB in Spain (AU)

The Spanish diet: an update.

BACKGROUND/AIMS: The Food Consumption Survey, conducted for over 20 years by the Spanish Ministry of Agriculture, Food and Environment (MAGRAMA), is the most reliable source of data to evaluate the food consumption and dietary patterns of Spain. The aim of the present article was to review the diet trends in Spain and its evolution. Food availability assessment per capita per day, which allows the calculation of energy and nutrient intake and comparison with the Recommended Nutrient Intakes for the Spanish population is described. In addition, different markers of the quality of the diet have been also evaluated. METHODS: The sample consisted of consumption and distribution data, obtained from the nationwide representative Food Consumption Survey for the period 2000- 2012. A two-stage sampling method was applied, where in the first stage the units to be sampled were towns or local entities, and in the second stage households which were going to be part of the final sample from those entities were selected. Units consisted of towns or local entities in the national territory. The data allowed the calculation of energy and nutrient intakes, using the Food Composition Tables (Moreiras et al, 2013). The quality of the diet was also evaluated: the adequacy of the diet in meeting the recommended intakes for energy and nutrients; energy profile; dietary fat quality; dietary protein quality; nutrient density; Mediterranean diet adequacy indices. The present data were compared with previous data obtained by our research group in 1964, 1981 and 1991. RESULTS: Using the most recent data, average intake comprised: milk and derivatives (356 g/person/day), fruits (323 g/person/day), vegetables and greens (339 g/ person/day), cereals and derivatives (197 g/person/day), meat and meat products (181 g/day), fish (88,6 g/person/ day), oils and fats (41,6 g/person/day), sugar and derivatives (25,6 g/person/day), eggs (27,1 g/person/day), legumes (13,9 g/person/day) . There was also a high consumption of non-alcoholic beverages (437 g/person/day) and decreasing for alcoholic beverages (192 g/person/day) compared to previous surveys. In consequence, meat and meat product consumption was higher than the recommendations, whereas for cereals and their derivatives, vegetables and greens, fruit, and legumes and pulses, consumption was below recommendations for the Spanish population (GRUNUMUR, 2004; SENC, 2007). Some staple and traditional Mediterranean foods (bread, potatoes and olive oil) showed a dramatic decline when compared to data from Household Budget Surveys in 1964 data. Energy intake showed a marked decline when compared to the 1960's mean consumption, and show marked differences for food groups contributors. Energy profile shows too much coming from lipids vs carbohydrates and slightly higher from proteins. CONCLUSION: Food consumption patterns in Spain and energy and nutrient intakes have changed markedly in the last forty years, differing somewhat at present from the traditional and healthy Mediterranean Diet.

Antecedentes/objetivos: La Encuesta de Consumo de Alimentos, realizada durante 20 años por el Ministerio de Agricultura, Alimentación y Medio Ambiente (MAGRAMA), es la fuente más fiable de datos para evaluar el consumo de alimentos y patrones dietéticos en España. El objetivo de este artículo fue revisar las tendencias dietéticas en España y su evolución. Se describe la evaluación de la disponibilidad de alimentos per cápita y día, que permite el cálculo de consumo de energía y nutrientes y su comparación con el Consumo Recomendado de Nutrientes para la población española. Además, se han evaluado diferentes marcadores de la calidad de la dieta. Métodos: La muestra consistió en los datos de consumo y distribución, obtenidos de la Encuesta Nacional de Consumo de Alimentos para el período 2000-2012. Se aplicó un método de muestreo en dos etapas en el que, en la primera etapa, las unidades que se muestreaban fueron ciudades y entidades locales y, en la segunda, se seleccionaron los hogares que conformaron la muestra final a partir de las entidades locales. Las unidades consistieron en ciudades o entidades locales del territorio nacional. Los datos permitieron el cálculo de consumo de energía y nutrientes utilizando las tablas de Consumo de Alimentos (Moreiras et al., 2013). También se evaluó la calidad de la dieta: la adecuación de la dieta para alcanzar los consumos de energía y nutrientes recomendados; perfil de energía; calidad de la grasa de la dieta; calidad de la proteína de la dieta; densidad de nutrientes; índices de adecuación de la dieta mediterránea. Los datos actuales se compararon con los datos previos obtenidos por nuestro grupo de investigación en 1964, 1981 y 1991. Resultados: Utilizando los datos más recientes, el consumo promedio comprendía: leche y derivados (356 g/persona/día), frutas (323 g/persona/día), verduras y hortalizas (339 g/persona/día), cereales y derivados (197 g/persona/día), carne y productos cárnicos (181 g/día), pescado (88,6 g/persona/día), aceites y grasas (41,6 g/persona/ día), azúcar y derivados (25,6 g/persona/día), huevos (27,1 g/persona/día), legumbres (13,9 g/persona/día) . También un consumo elevado de bebidas no alcohólicas (437 g/persona/día) y un descenso del consumo de bebidas alcohólicas (192 g/persona/día) en comparación con las encuestas previas. En consecuencia, el consumo de carne y productos cárnicos fue superior al recomendado mientras que el consumo de cereales y sus derivados, verduras y hortalizas, fruta y legumbres estaba por debajo de las recomendaciones para la población española (GRUNUMUR, 2004; SENC, 2007). Algunos alimentos mediterráneos de consumo habitual y tradicionales (pan, patatas y aceite de oliva) mostraron un declive notable en comparación con los datos de las Encuestas de Economía Doméstica de 1964. El consumo de energía mostró un marcado declive en comparación con el consumo medio de los años sesenta y mostró marcadas diferencias para los distintos grupos de alimentos contribuyentes. El perfil de energía mostró que una gran parte procedía de los lípidos, frente a los hidratos de carbono y algo superior con respecto a las proteínas. Conclusión: Los patrones de consumo de alimentos en España y los consumos de energía y nutrientes han cambiado notablemente en los últimos 40 años, difiriendo algo en la actualidad de la dieta mediterránea tradicional y saludable.

The Spanish diet: an update / La dieta española: una actualización

Background/Aims: The Food Consumption Survey, conducted for over 20 years by the Spanish Ministry of Agriculture, Food and Environment (MAGRAMA), is the most reliable source of data to evaluate the food consumption and dietary patterns of Spain. The aim of the present article was to review the diet trends in Spain and its evolution. Food availability assessment per capita per day, which allows the calculation of energy and nutrient intake and comparison with the Recommended Nutrient Intakes for the Spanish population is described. In addition, different markers of the quality of the diet have been also evaluated. Methods: The sample consisted of consumption and distribution data, obtained from the nationwide representative Food Consumption Survey for the period 2000-2012. A two-stage sampling method was applied, where in the first stage the units to be sampled were towns or local entities, and in the second stage households which were going to be part of the final sample from those entities were selected. Units consisted of towns or local entities in the national territory. The data allowed the calculation of energy and nutrient intakes, using the Food Composition Tables (Moreiras et al, 2013). The quality of the diet was also evaluated: the adequacy of the diet in meeting the recommended intakes for energy and nutrients; energy profile; dietary fat quality; dietary protein quality; nutrient density; Mediterranean diet adequacy indices. The present data were compared with previous data obtained by our research group in 1964, 1981 and 1991. Results: Using the most recent data, average intake comprised: milk and derivatives (356 g/person/day), fruits (323 g/person/day), vegetables and greens (339 g/ person/day), cereals and derivatives (197 g/person/day), meat and meat products (181 g/day), fish (88,6 g/person/ day), oils and fats (41,6 g/person/day), sugar and derivatives (25,6 g/person/day), eggs (27,1 g/person/day), legumes (13,9 g/person/day). There was also a high consumption of non-alcoholic beverages (437 g/person/day) and decreasing for alcoholic beverages (192 g/person/day) compared to previous surveys. In consequence, meat and meat product consumption was higher than the recommendations, whereas for cereals and their derivatives, vegetables and greens, fruit, and legumes and pulses, consumption was below recommendations for the Spanish population (GRUNUMUR, 2004; SENC, 2007). Some staple and traditional Mediterranean foods (bread, potatoes and olive oil) showed a dramatic decline when compared to data from Household Budget Surveys in 1964 data. Energy intake showed a marked decline when compared to the 1960's mean consumption, and show marked differences for food groups contributors. Energy profile shows too much coming from lipids vs carbohydrates and slightly higher from proteins. Conclusion: Food consumption patterns in Spain and energy and nutrient intakes have changed markedly in the last forty years, differing somewhat at present from the traditional and healthy Mediterranean Diet (AU)

Antecedentes/objetivos: La Encuesta de Consumo de Alimentos, realizada durante 20 años por el Ministerio de Agricultura, Alimentación y Medio Ambiente (MAGRAMA), es la fuente más fiable de datos para evaluar el consumo de alimentos y patrones dietéticos en España. El objetivo de este artículo fue revisar las tendencias dietéticas en España y su evolución. Se describe la evaluación de la disponibilidad de alimentos per cápita y día, que permite el cálculo de consumo de energía y nutrientes y su comparación con el Consumo Recomendado de Nutrientes para la población española. Además, se han evaluado diferentes marcadores de la calidad de la dieta. Métodos: La muestra consistió en los datos de consumo y distribución, obtenidos de la Encuesta Nacional de Consumo de Alimentos para el período 2000-2012. Se aplicó un método de muestreo en dos etapas en el que, en la primera etapa, las unidades que se muestreaban fueron ciudades y entidades locales y, en la segunda, se seleccionaron los hogares que conformaron la muestra final a partir de las entidades locales. Las unidades consistieron en ciudades o entidades locales del territorio nacional. Los datos permitieron el cálculo de consumo de energía y nutrientes utilizando las tablas de Consumo de Alimentos (Moreiras et al., 2013). También se evaluó la calidad de la dieta: la adecuación de la dieta para alcanzar los consumos de energía y nutrientes recomendados; perfil de energía; calidad de la grasa de la dieta; calidad de la proteína de la dieta; densidad de nutrientes; índices de adecuación de la dieta mediterránea. Los datos actuales se compararon con los datos previos obtenidos por nuestro grupo de investigación en 1964, 1981 y 1991 Resultados: Utilizando los datos más recientes, el consumo promedio comprendía: leche y derivados (356 g/persona/día), frutas (323 g/persona/día), verduras y hortalizas (339 g/persona/día), cereales y derivados (197 g/persona/día), carne y productos cárnicos (181 g/día), pescado (88,6 g/persona/día), aceites y grasas (41,6 g/persona/día), azúcar y derivados (25,6 g/persona/día), huevos (27,1 g/persona/día), legumbres (13,9 g/persona/día) . También un consumo elevado de bebidas no alcohólicas (437 g/persona/día) y un descenso del consumo de bebidas alcohólicas (192 g/persona/día) en comparación con las encuestas previas. En consecuencia, el consumo de carne y productos cárnicos fue superior al recomendado mientras que el consumo de cereales y sus derivados, verduras y hortalizas, fruta y legumbres estaba por debajo de las recomendaciones para la población española (GRUNU-MUR, 2004; SENC, 2007). Algunos alimentos mediterráneos de consumo habitual y tradicionales (pan, patatas y aceite de oliva) mostraron un declive notable en comparación con los datos de las Encuestas de Economía Doméstica de 1964. El consumo de energía mostró un marcado declive en comparación con el consumo medio de los años sesenta y mostró marcadas diferencias para los distintos grupos de alimentos contribuyentes. El perfil de energía mostró que una gran parte procedía de los lípidos, frente a los hidratos de carbono y algo superior con respecto a las proteínas. Conclusión: Los patrones de consumo de alimentos en España y los consumos de energía y nutrientes han cambiado notablemente en los últimos 40 años, difiriendo algo en la actualidad de la dieta mediterránea tradicional y saludable (AU)

Programa Thao-Salud Infantil en Villanueva de la Cañada (Madrid). Prevalencia de sobrepeso y obesidad en los escolares de 3 a 12 años / No disponible

Fundamentos: Enmarcado en los planteamientos de laEstrategia NAOS, en 2007 se puso en marcha en cincociudades piloto españolas el Programa THAO-Salud Infantil.Su objetivo es frenar la progresión de la obesidad infantila través de la promoción de una alimentación saludable ypráctica de actividad física regular, mediante un plan de accionesque implican transversalmente a toda la comunidady con gran refuerzo mediático.Objetivo: Establecer datos de prevalencia de sobrepesoy obesidad, de los escolares en Villanueva de la Cañada(Madrid), obtenidos durante el curso académico 2007-2008.Métodos: La evaluación de la efectividad del programa serealiza sobre la población escolar de 3-12 años del municipio.Fueron medidos y pesados 2347 escolares, se calcularon susIMC y se clasificaron según su estado ponderal (Orbegozo).Resultados: El 15.1% tiene sobrepeso u obesidad, siendomayor en niñas. Según edad, el 17.4% de los escolares entre3-5 años, el 14.9% de 6-9 y el 12.8% de 10-12 superansus recomendaciones. Existe una dependencia altamentesignificativa entre la prevalencia de sobrepeso y obesidad y eltipo de centro al que pertenecen los escolares, creciendo ensentido: privados, concertados y públicos, mayor en niñas.Conclusiones: Las prevalencias de sobrepeso, obesidad yconjunta son menores en los escolares de 3-12 años delmunicipio que a nivel nacional, y superior en niñas. Laprevalencia de sobrepeso disminuye conforme aumenta laedad. Existe una dependencia estadísticamente significativade las prevalencias de sobrepeso y obesidad y el tipo decolegio al que asisten los escolares(AU)

Background: In the context of the NAOS Strategy, in 2007the program THAO-Childhood health was pilot-tested in5 Spanish towns. The aim of the program is to stop theprogressive trend of childhood obesity through the promotionof healthier eating and regular physical activity bymeans of action plans which involve the whole communityand reinforced by mass media. The objective of this paperis to describe the prevalence of obesity and overweight inschoolchildren of Villanueva de la Cañada (Madrid), basedon data collected during the school ear 2007-2008.Methods: The effectiveness of the programs is evaluatedin school children aged 3-12 yr in the municipality. Bodyweight and height was individually measured in 2347children, BMI computed and classified according by weightdistribution (Orbegozo).Results: 15.1% was classified as being overweight or obese,a higher rate among girls. The prevalence by age groupwasas follows: 17.4% in the 3-5 yr olds; 14.9% in the 6-9 yrold group and 12.8% in the 10-12 yr old group. There isan association between overweight prevalence rates andthe type of school, increasing from private schools towardspublic schools, which show the highest rate, particularlyamong girls.Conclusions: The prevalence of overweight and obesity islower in school boys in the municipality under study comparedto the average national rate aged, but higher amonggirls. Prevalence of overweight decreases in older children.There is an association between the type of school andprevalence of obesity, with higher rates in public schools(AU)

Algoritmo del tratamiento para el trastorno por déficit de atención con hiperactividad en niños y adolescentes

resumen está disponible en el texto completo

Summary The diagnostic criteria for the Attention Deficit Hyperactivity Disorder (ADHD) have been changing according to international classifications. It is currently included in the ICD-10 as an hyperkinetic disorder and in the DSM-IV as a disorder having its onset during childhood and adolescence. The reported prevalence for ADHD is between 3% and 6%; up to 60% of the patients remain symptomatic through adolescence and adulthood. Population-based surveys of physicians who treat children and adolescents reveal that the rate and the proportion of office visits associated with ADHD are high and have increased over the past decade. This fact points to the need of elaborating clinical guidelines for the treatment of this disorder. Evidence from controlled clinical trials confirms the superiority of medication management for ADHD over behavioral therapy and the combination of medication and behavioral treatment. Stimulants are the most studied drugs for ADHD and constitute the first treatment of choice. Methylphenidate (MPH) is the only stimulant available in Mexico. Its mechanism of action is based on the blocking of the dopamine reuptake, which increases the availability of this neurotransmitter in the synaptic cleft. Based on the dopaminergic theories of ADHD, dopamine genes have been the initial candidates for molecular studies regarding response to MPH. Variations of the dopamine D4 receptor gene (DRD4) and the dopamine transporter gene (DAT1) have been related with the response to MPH. The short half life of this drug (less than three hours) supports the shift from once-a-day to twice-a-day or thrice-a-day dosing. The Osmotic Release Oral System (OROS) of MPH allows to maintain therapeutic plasmatic doses with once-a-day dose. Its efficacy and tolerability have been shown in clinical trials. Regarding the long-term effects of MPH, this drug has demonstrated efficacy in a two-year follow-up controlled study. In addition, animal models have shown that the chronic exposure to MPH during developmental periods produces changes in the function of brain dopaminergic cells, as well as changes in behavior. The association between MPH and substance abuse has also been explored. The pharmacokinetic and pharmacodinamic differences between MPH and cocaine, which also acts by blocking the dopamine transporter, were examined: When administered intravenously, MPH, like cocaine, has a reinforcing effects at doses that exceed a 60% dopamine transporter blockade threshold. When administered orally at clinical doses, the pharmacological effects of MPH also exceed this threshold, but reinforcing effects rarely occur. So, the pharmacokinetic properties of MPH in brain differ for oral and intravenous routes of administration, suggesting that the oral administration of MPH mimics the tonic dopamine cell firing, which may be a critical factor associated with clinical effects. In addition, therapeutic doses of MPH do not act at the nucleus accumbens, a brain structure highly associated with reinforcing. These data suggest that oral administration of MPH does not lead to abuse. Follow-up studies have also shown that stimulant therapy is not associated with increased risk of substance abuse. Since 30% of the patients do not respond to stimulant treatment, the efficacy and safety of other drugs have been evaluated. Among them, tricyclic antidepressants (TCAs) are considered a good choice for the management of ADHD and conduct disorders. Their half life is longer than that of MPH, which allows a once-a-day or twice-a-day dosing. It has also been described that TCAs are effective for the treatment of comorbid tics. The main disadvantage of these drugs is their effect on cardiac conduction, which has been associated with sudden death. Bupropion is another antidepressant having an effect on dopamine activity. It has shown efficacy for the treatment of ADHD in children, adolescents, and adults, particularly in patients with nicotine dependence, patients with comorbid conduct disorder, or depression. Bupropion is available in a extended-release, once-daily formulation (XL). The main side effects of this antidepressant are the increased risk of seizure development, rash and mild elevation of blood pressure. This drug is not recommended for the treatment of patients with comorbid eating disorders. Venlafaxine (a serotonin and norepinephrine reuptake inhibitor) and reboxetine (a norepinephrine reuptake inhibitor) are recently introduced antidepressants which have shown efficacy in open label trials on patients with and without comorbid depressive disorder. Atomoxetine is another non-stimulant medication; its main mechanism of action is the inhibition or the reuptake of norepinephrine. Several clinical trials have shown its efficacy for the treatment of ADHD in children, adolescents and adults. This drug can also be administered in a single dose; in addition, it has a low potential for cardiotoxicity and a reduction of tic frequency and severity has been reported with its use. It is also recommended for the ADHD comorbid with anxiety or depression. Nausea and decreased appetite are the most common side effects of atomoxetine. Modafinil is another non-stimulant drug which was initially described for the treatment of narcolepsy. This drug increases the dopamine and norepinephrine activity through its direct effect on glutamate and GABA, among other neuromodulators. Some clinical trials have shown its superiority over placebo on ADHD symptoms. The main side effects of modafinil are gastrointestinal distress and insomnia. Clonidine and risperidone are drugs considered as second treatment of choice or adjunctive treatments for patients with comorbidity. Although medication is the first treatment of choice, patients often get benefits from psychosocial interventions, particularly parent training in contingency management methods and classroom applications of contingency management techniques. The value of these measurements lies in the temporary reduction of symptom levels and/or in the reduction of related behavioral and emotional difficulties, such as defiance and conduct problems, depression, low self-esteem, or academic underachievement. Parents' training focus on general contingency management tactics, such as contingent application of reinforcement or punishment following appropriate/inappropriate behaviors. Reinforcement procedures have typically relied on praise or tokens, while punishment methods have usually been the loss of tokens or time-out from reinforcement. The classroom management include a continuous communication with teachers, in order to maintain them informed about the illness and its treatment, as well as training on contingency management tactics. The aforementioned information was used in the elaboration of clinical guidelines for the treatment of youngsters with ADHD, either alone or comorbid with internalizing or externalizing disorders. Another guideline for the management of preschool children with ADHD is included. Psychoeducation follows the assessment of the children in each case. The pharmacological treatment recommendations give priority to monotherapy. Stimulants are the first treatment of choice in each guideline. The use of non-stimulant medications as second choice will depend on the age and comorbidity of patients.