Consumption of seafood and its estimated heavy metals are associated with lipid profile and oxidative lipid damage on healthy adults from a Spanish Mediterranean area: A cross-sectional study.

The association between the consumption of seafood and its benefits on cardiovascular (CVD) risk can be challenged by its heavy metal (HM) content. This study aimed to explore the association of seafood consumption and its estimated HM contents with the lipid profile and lipid oxidation biomarkers in adults from a Spanish Mediterranean area who do not present risk factors for CVD. In this cross-sectional study, the clinical history, three-day dietary record, lipid profile (LDLc, HDLc, APOB/A, and triglyceride levels), plasma oxidised LDL (oxLDL) and 8-isoprostane levels of 81 adults without risk factors for CVD [43% men, with a mean age of 43.6 years (95%CI: 40.1-47.1)] were assessed. The HM [arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb)] contents of seafood were estimated according to data from analyses of marine species in the same Mediterranean area. Moderate adherence to the Mediterranean diet (score: 4.6 of 9) with a mean seafood consumption of 74.9g/day (95%CI: 59.9-89.9), including 22.7g of shellfish per day (95%CI: 13.5-31.9), was observed. The estimated HM contents were lower than the provisional tolerable weekly intakes (PTWIs): 21.12µg/kg/week As, 0.57µg/kg/week InAs, 0.15µg/kg/week Cd, 1.11µg/kg/week Hg and 0.28µg/kg/week Pb. After adjusting by confounder variables, an increase in shellfish consumption was associated with increases in the levels of LDLc (P=0.013), non-HDLc (P=0.015), APOB/A (P=0.02) and plasma oxLDL (P=0.002). Moreover, an increase in the estimated As and Hg levels in shellfish was associated with an increase in LDLc (P=0.015 and P=0.018, respectively), non-HDLc (P<0.008 and P<0.008, respectively), APOB/A ratio (P=0.008 and P=0.009, respectively), and oxLDL (P≤0.001 and P≤0.001, respectively) levels. In conclusion, in adults without risk factors for CVD, increasing shellfish consumption, even by a moderate amount, could favour a pro-atherogenic lipid profile and a higher level of oxidised LDL. These associations are likely influenced by the estimated exposure to As and Hg from shellfish despite these values are lower than the PTWIs.

The role of emotion regulation in childhood obesity: implications for prevention and treatment.

Stress and negative emotions pose a major threat to public health, by increasing the risk of obesity. Since the management process for emotions (emotion regulation; ER) is developed in childhood, we present a novel conceptual framework model for the role of ER in the prevention and treatment of childhood obesity. A narrative review of the literature by electronic database search (MEDLINE, Web of Knowledge and Scopus) was conducted of observational and interventional/experimental literature on ER and obesity and the underlying concepts. We also present an overview of ER intervention techniques. Our model indicates that childhood ER is a link between stress and obesity. Stress along with ineffective ER leads to abnormal cortisol patterns, emotional eating, sedentary lifestyle, reduction of physical activity, and sleep problems. Simultaneously, a healthy lifestyle could show benefits on ER and in developing adaptive ER strategies. In the development of obesity and ER, parents also play a role. By contrast, effective ER skills decrease obesity-related unhealthy behaviour and enhance protective factors, which boost health. The literature contains some observational studies of children but very few intervention studies, most of which are pilot or on-going studies. In conclusion, encouraging effective ER could be a useful new approach for combating and treating childhood obesity. Future ER intervention studies are needed to confirm the validity of this model in children.

Mediterranean dietary pattern in pregnant women and offspring risk of overweight and abdominal obesity in early childhood: the INMA birth cohort study.

BACKGROUND: Animal models have suggested that maternal diet quality may reduce offspring obesity risk regardless of maternal body weight; however, evidence from human studies is scarce. OBJECTIVE: The aim of this study was to evaluate associations between adherence to the Mediterranean diet (MD) during pregnancy and childhood overweight and abdominal obesity risk at 4 years of age. METHODS: We analysed 1827 mother-child pairs from the Spanish 'Infancia y Medio Ambiente' cohort study, recruited between 2003 and 2008. Diet was assessed during pregnancy using a food frequency questionnaire and MD adherence by the relative Mediterranean diet score (rMED). Overweight (including obesity) was defined as an age-specific and sex-specific body mass index ≥85th percentile (World Health Organization referent), and abdominal obesity as a waist circumference (WC) >90th percentile. Multivariate adjusted linear and logistic regression models were used to evaluate associations between pregnancy rMED and offspring overweight and abdominal obesity. RESULT: There was no association between rMED and body mass index z-score, whereas there was a significant association between higher adherence to MD and lower WC (ß of high vs. low rMED: -0.62 cm; 95% confidence interval: -1.10, -0.14 cm, P for trend = 0.009). CONCLUSION: Pregnancy adherence to the MD was not associated with childhood overweight risk, but it was associated with lower WC, a marker of abdominal obesity.

Dietary intake in the dependent elderly: evaluation of the risk of nutritional deficit.

BACKGROUND: Malnutrition is a frequent problem in elderly dependent patients and their prognosis is adversely affected. Assessment of food consumption and adequacy of energy and nutrient intake of dependent elderly is needed to plan any selected actions for this population. METHODS: The study comprised a multicentre cross-sectional study of 190 users (≥65 years) of a home care programme provided by primary care centers in Tarragona (Spain), at nutritional risk (Mini Nutritional Assessment: 17-23.5 points). Food consumption was assessed using a semiquantitative validated food frequency questionnaire. Energy intake was compared with the Spanish dietary reference intake (DRI) and nutritional intakes with the DRI of the American Institute of Medicine. RESULTS: Mean (SD) age was 85.0 (7.2) years (67.5% female). The food items consumed were varied but lower than the recommended portions for cereals, fruits, vegetables and legumes. Energy intake was 7454.2 (1553.9 kJ day(-1)) [1781.6 (371.4) kcal day(-1)] (97.7% of recommended dietary allowance; RDA) and protein intake was 1.0 (0.4) g kg(-1) of weight (121.4% of RDA). Proteins provided 13.3%, carbohydrates provided 39.9% and fats provided 45.8% of energy intake. The intakes of calcium, vitamin D, vitamin E and folates were less than two-thirds of the RDA and their probability of inadequate intake was >85%. CONCLUSIONS: Dietary intakes of elderly dependent patients at nutritional risk were well balanced. In general, energy and protein intakes meet the recommendations. The diet was high in energy density, low in complex carbohydrates, high in simple carbohydrates and excessive in fats. The dependent elderly had inadequate intake of micronutrients often related to fragility, such as calcium, vitamin D, vitamin E and folates.

Predictors of haemoconcentration at delivery: association with low birth weight.

PURPOSE: [corrected] To assess the factors associated with risk of haemoconcentration at delivery, such as initial haemoglobin levels and alterations in the HFE gene, and its effect on low birth weight in pregnant women supplemented with moderate doses of iron. METHODS: Case-control study nested in a longitudinal study conducted on 217 healthy pregnant women taking moderate iron supplementation and their newborns. Women were classified according to the risk of haemoconcentration at delivery, defined as Hb > 130 g/L. Each subject's obstetric and clinical history, smoking habit, and iron biochemical parameters (haemoglobin (Hb), serum ferritin and transferrin saturation) were recorded at 1st, 2nd and 3rd trimester and at delivery. Polymorphisms of the HFE gene (C282Y, H63D and S65C) were also measured. RESULTS: The average of iron supplementation of all the women was 43.9 mg/dia (geometric mean, 95 % CI: 43.6-44.1). Higher levels of Hb at early gestation and the presence of HFE mutations were associated with greater risk of haemoconcentration at delivery, adjusted odds ratios of 1.14 (95 % CI: 1.05-1.25) and 5.35 (95 % CI: 1.6-17.8). Haemoconcentration at delivery was associated with a greater risk of low birth weight, adjusted odd ratio of 11.48 (95 % CI: 1.13-116.6). CONCLUSIONS: Moderate daily doses of supplementary iron may be harmful for foetal growth in women with alterations in HFE gene and who started pregnancy with good haemoglobin levels. Overall, this suggests the importance of determining a woman's iron status early in her pregnancy in order to establish a more appropriate pattern of supplementation.

[Early of late supplementation: similar evolution of the iron status during pregnancy]. / Suplementación temprana o tardía: similar evolución del estado de hierro durante el embarazo.

The highest iron demands during pregnancy occur in the third trimester, although preventive iron supplementation is recommended from early stages of the pregnancy. The aim of the study was to compare whether early supplementation with moderate iron doses better prevents the decrease of iron levels during gestation than the late supplementation. One hundred and eighty-four pregnant women participated. They received iron supplements before or after week 20 of pregnancy. At each quarter, serum ferritin (SF), transferrin saturation (TS) and hemoglobin (Hb) were determined. Gestational age-standardized hemoglobin (zHb) was calculated. The early supplementation group received a mean of 40.5 ± 15.7 mg/day and the late group 43.1 ± 11.9 mg/day. Iron deficiency (impaired SF and TS) iron deficiency anemia increased as pregnancy progressed without significant differences between the early and late supplementation groups. More than half of the women ended up their pregnancy with iron deficiency and more than 20% with iron deficiency anemia. In conclusion, although early intake of iron supplements is recommended in pregnancy, no better preventive effect is observed on the decrease of iron levels with early supplementation as compared to late supplementation when moderate iron doses are used.

Depleted iron stores without anaemia early in pregnancy carries increased risk of lower birthweight even when supplemented daily with moderate iron.

BACKGROUND: Gestational iron-deficiency anaemia has adverse pregnancy outcomes. Antenatal iron supplementation can be beneficial in anaemic women, but the effects in non-anaemic women are controversial. This observational study assessed the relationship of maternal iron stores (depleted or non-depleted) at gestational Weeks 8-12 with birthweight, in non-anaemic pregnant women following the guidelines of the Ministry of Health of Spain. METHODS: Healthy, non-anaemic pregnant women (n = 205) were studied. At the first antenatal visit, a general clinical assessment was conducted, and basal blood taken. Women were classified as having non-depleted or depleted iron stores [serum ferritin (SF) < 12 µg/l)]. Daily antenatal iron supplements (48 mg on average) were started at 17 (range: 16-18) weeks. Blood haemoglobin, SF and transferrin saturation (TS) were measured in each trimester. RESULTS: Of the study sample, 20, 54 and 66% had SF < 12 µg/l in the first, second and third trimesters, respectively. The prevalence of iron-depletion (SF < 12 µg/l) and iron-deficiency (SF < 12 µg/l and TS < 16%) was greater during the entire pregnancy in women with initial iron depletion versus no depletion (81.6 and 73.7% versus 61.7 and 55.4%, respectively, in the third trimester, P < 0.05). Women with initial iron-depletion delivered babies weighing on average 192 g less than that with initial iron stores, after adjusting for confounding variables (P = 0.028). CONCLUSIONS: Beginning pregnancy with non-depleted iron stores is beneficial for the maternal iron status during pregnancy and infant birthweight. These findings reaffirm the importance of health promotion to ensure that women have adequate iron stores prior to, or early in, pregnancy when supplemented with moderate daily iron doses.

Suplementación temprana o tardía: similar evolución del estado de hierro durante el embarazo / Early of late supplementation: similar evolution of the iron status during pregnancy

Las mayores necesidades de hierro durante el embarazo se sitúan en el tercer trimestre, no obstante se recomienda la suplementación preventiva con hierro desde fases más tempranas. El objetivo del estudio fue comparar si la suplementación temprana con dosis moderadas de hierro previene mejor la caída de los niveles de hierro durante la gestación que la más tardía. Participaron 184 mujeres embarazadas. Recibieron suplementos de hierro desde antes de la semana 20 de gestación o posteriormente. Se determinó ferritina sérica (FS), saturación de transferrina (ST) y hemoglobina (Hb) en cada trimestre de la gestación. Se calculó la hemoglobina estandarizada por la edad gestacional (zHb). El grupo de suplementación temprana tomó una media de 40,5 ± 15,7 mg/día y el de tardía 43,1 ± 11,9mg/día. El déficit de hierro (FS y ST alteradas) y la anemia por déficit de hierro aumentaron al avanzar la gestación, sin diferencias significativas entre los grupos de suplementación temprana y tardía. Más de la mitad de las mujeres finalizaron el embarazo con déficit de hierro y cerca de un 20% con anemia por déficit de hierro. En conclusión, aunque en la gestación se recomienda el inicio temprano de la toma de suplementos de hierro, no se observa mejor efecto preventivo sobre la caída de los niveles de hierro con la suplementación temprana respecto de la tardía, cuando se utilizan dosis de hierromoderadas (AU)

The highest iron demands during pregnancy occur in the third trimester, although preventive iron supplementation is recommended from early stages of the pregnancy. The aim of the study was to compare whether early supplementation with moderate iron doses better prevents the decrease of iron levels during gestation than the late supplementation. One hundred and eighty-four pregnant women participated. They received iron supplements before or after week 20 of pregnancy. At each quarter, serum ferritin (SF), transfer in saturation (TS)and hemoglobin (Hb) were determined. Gestational age standardized hemoglobin (zHb) was calculated. The early supplementation group received a mean of 40.5 ± 15.7mg/day and the late group 43.1 ± 11.9 mg/day. Iron deficiency (impaired SF and TS) iron deficiency anemia increased as pregnancy progressed without significant differences between the early and late supplementation groups. More than half of the women ended up their pregnancy with iron deficiency and more than 20% with iron deficiency anemia. In conclusion, although early intake of iron supplements is recommended in pregnancy, no better preventive effect is observed on the decrease of iron levels with early supplementation as compared to late supplementation when moderate iron doses are used (AU)

Vacunación antigripal y mortalidad invernal en pacientes diabéticos mayores de 65 años / Influenza vaccination and winter mortality in diabetic patients over 65 years

Introducción: Analizar el impacto de la vacunación antigripal anual sobre la mortalidad invernal en una cohorte de diabéticos mayores de 65 años seguidos durante 4 años. Material y métodos: Cohorte de 2.650 individuos mayores de 65 años con diabetes mellitus, no institucionalizados, seguidos desde enero de 2002 hasta abril de 2005, pertenecientes a 8 áreas básicas de salud. El estado vacunal antigripal se consideró como una condición cambiante en el tiempo y la variable principal fue la muerte por todas las causas en los períodos enero-abril del cuatrienio de estudio. Resultados: Globalmente, durante los períodos enero–abril de 2002–2005, la mortalidad invernal (por 100.000 personas/semana) fue de 97,0 para vacunados y de 110,5 para no vacunados, con un riesgo atribuible de 13,5 muertes invernales por 100.000 personas/semana (IC 95%: −11,4 a 38,4). La recepción de la vacuna antigripal se asoció con una reducción no significativa del 12% en el riesgo de mortalidad invernal por cualquier causa (riesgo relativo: 0,88; IC 95%: 0,67–1,19). Conclusión: Nuestros datos apuntan hacia un pequeño beneficio de la vacunación antigripal para disminuir la mortalidad invernal en pacientes diabéticos mayores de 65 años, aunque la posibilidad de un efecto nulo no puede ser excluida totalmente (AU)

Introduction: To analyze the effectiveness of annual influenza vaccination on winter mortality in a cohort of diabetic patients over 65 years followed-up for 4 years. Methods: Cohort of 2650 non-institutionalized, individuals older than 65 years with Diabetes Mellitus, followed-up from January 2002 until April 2005, from 8 primary health care centers. The vaccination status was considered as a condition changing over time and the endpoint was death from all causes in the period from January to April of the 4-year study period. Results: Overall, during the January to April periods including the years 2002–2005, the winter mortality (per 100,000 person-week) was 97.0 for vaccinated and 110.5 for non-vaccinated subjects, with an attributable risk of 13.5 deaths per 100,000 person-weeks in winter (95% CI: −11.4 to 38.4). The reception of the influenza vaccine was associated with a non-significant reduction of 12% in the risk of mortality from all causes during winter in the 2002–2005 overall period (relative risk 0.88; 95% CI: 0.67–1.19). Conclusion: Our data suggest a small benefit of influenza vaccination to reduce winter mortality in diabetic patients over 65 years, although the possibility of no effect cannot be excluded completely (AU)

A two-phase population study: relationships between overweight, body composition and risk of eating disorders.

BACKGROUND: Overweight and eating disorder (ED) are major public health problems in adolescents. AIMS: To assess the association of overweight, body composition and anthropometric characteristics with the probability being at risk of ED. METHODS: A two-phase study was used. 329 girls and 96 boys (aged 12-18 years) from an initial sample of 2967 adolescents were studied. The BMI, percentage of fat mass estimated by bioimpedance (FM(BIA)), waist circumference, waist-to-height ratio, and waist-to-hip ratio (WHipr) were calculated. The Eating Attitudes Test, Youth's Inventory-4 and a questionnaire to evaluate social influences were administered. RESULTS: A total of 34.7% of girls and 53.6% of boys at risk of ED were overweight (including obesity). For girls, overweight frequency was significantly higher in risk ED group than in control group. Increases of one point in the BMI or FM(BIA) increased the probability of being at risk of ED by 12% (3.0-19.0) and 4% (0.0-8.0), respectively. An increase in WHipr was negatively associated with ED risk. Smoking and symptoms of dysthymia and the genralized anxiety disorder also increase the probability of being at risk of ED in adolescent girls. In adolescent boys, these relations were not observed. CONCLUSIONS: The higher BMI and the percentage of FM(BIA) are associated with greater risk of ED in adolescent girls, when psychological factors are present. Increases in the WHipr, characteristic of childhood body is negatively associated with that risk.

A two-phase population study: relationships between overweight, body composition and risk of eating disorders / Estudio a doble fase: relación entre el sobrepeso, la composición corporal y el riesgo de trastorno de la conducta alimentaria

Background: Overweight and eating disorder (ED) are major public health problems in adolescents. Aims: To assess the association of overweight, body composition and anthropometric characteristics with the probability being at risk of ED. Methods: A two-phase study was used. 329 girls and 96 boys (aged 12-18 years) from an initial sample of 2967 adolescents were studied. The BMI, percentage of fat mass estimated by bioimpedance (FM(BIA)), waist circumference, waist-to-height ratio, and waist-to-hip ratio (WHipr) were calculated. The Eating Attitudes Test, Youth's Inventory-4 and a questionnaire to evaluate social influences were administered. Results: A total of 34.7% of girls and 53.6% of boys at risk of ED were overweight (including obesity). For girls, overweight frequency was significantly higher in risk ED group than in control group. Increases of one point in the BMI or FM(BIA) increased the probability of being at risk of ED by 12% (3.0-19.0) and 4% (0.0-8.0), respectively. An increase in Whipr was negatively associated with ED risk. Smoking and symptoms of dysthymia and the genralized anxiety disorder also increase the probability of being at risk of ED in adolescent girls. In adolescent boys, these relations were not observed. Conclusions: The higher BMI and the percentage of FM(BIA) are associated with greater risk of ED in adolescent girls, when psychological factors are present. Increases in the WHipr, characteristic of childhood body is negatively associated with that risk (AU)

Introducción: El sobrepeso y los Trastornos de la Conducta Alimentaria (TCA) son problemas importantes de salud pública entre los adolescentes. Objetivos: Valorar la asociación del sobrepeso, la composición corporal y otras características antropométricas con la probabilidad de estar en riesgo de desarrollar un TCA. Métodos: Se realizó un estudio con un diseño en doble fase. Se estudiaron 329 chicas y 96 chicos (de 12-18 años) procedentes de una muestra inicial de 2967 adolescentes. Se calcularon el índice de masa corporal (IMC), el porcentaje de masa grasa (% MG(BIA)), la circunferencia de la cintura, los cocientes cintura-talla y cintura-cadera. Se administraron el Eating Attitudes Test, el Youth's Inventory-4 y un cuestionario para evaluar influencia sociocultural. Resultados: El 34,7% de las chicas y el 53,6% de los chicos con riesgo de TCA presentan sobrepeso (incluyendo obesidad). La frecuencia de sobrepeso es significativamente más alta en las chicas del grupo de riesgo de TCA que las del grupo control. En las adolescentes, el aumento de un punto en el IMC o en el % MG(BIA) incrementa el riesgo de estar en riesgo de TCA en 12% (3,0-19,0) y 4% (0,0-8,0), respectivamente; un incremento en el cociente cintura-cadera se asocia negativamente con el riesgo de TCA. Fumar, presentar síntomas de distimia y de trastornos de ansiedad generalizada también se asociaron con la probabilidad de estar en riesgo de TCA, en las adolescentes. En los varones, no se han observado esas relaciones. Conclusiones: El mayor IMC y de % MG(BIA) se asocian con mayor riesgo de TCA en las adolescentes cuando los factores psicológicos están presentes. Un aumento en el cociente cintura-cadera, característico de un cuerpo infantil, se asocia negativamente con el riesgo de TCA (AU)

Non-clinical adolescent girls at risk of eating disorder: under-reporters or restrained eaters?

BACKGROUND: To evaluate the plausibility of self-reported energy intake, Goldberg et al proposed a technique to identify the miss-reporters. SUBJECTS: After screening 2,967 adolescents by EAT-40 test, 132 at risk of ED and 151 as a control group were studied. AIM: To determine whether subjects at risk of eating disorders that are identified as under reporters can be considered as UR or in turn as restrained eaters. METHODS: We determined dietary energy intake, body mass index, body satisfaction, physical activity, psychopathology, dietary restraint factor, weight loss and diagnoses of eating disorders. We applied Goldberg's equations to identify under reporters. RESULTS: 40.9% of girls at risk of eating disorders were identified as under reporters and only 7.3% were in the control group. A total of 64.4% of the Eating Disorders Not Otherwise Specified were under reporters. The body mass index of under reporters was significantly higher than in the other of subjects regardless of whether they were at risk of eating disorders. Girls at risk of eating disorders and under reporter had significantly lower body satisfaction than other groups. Multiple logistic regressions in all subjects showed that the risk of being UR was associated with an increase in the body mass index, increase in dietary restraint scores and weight loss; whereas, that only the body mass index was associated with the control group. CONCLUSION: The prevalence of under reporter increases with the severity of the eating disorders several adolescent girls at risk of eating disorder and identified by Goldberg cut-off technique as under reporter may to be restricting their intake and therefore they would not be under reporter.

Non-clinical adolescent girls at risk of eating disorder: under-reporters or restrained eaters? / Mujeres adolescentes en riesgo de trastorno de la conducta alimentaria, no clínicas: ¿infra-declaran o restringen el consumo?

Background: To evaluate the plausibility of self-reported energy intake, Goldberg et al proposed a technique to identify the miss-reporters. Subjects: After screening 2,967 adolescents by EAT-40 test, 132 at risk of ED and 151 as a control group were studied. Aim: To determine whether subjects at risk of eating disorders that are identified as under reporters can be considered as UR or in turn as restrained eaters. Methods: We determined dietary energy intake, body mass index, body satisfaction, physical activity, psychopathology, dietary restraint factor, weight loss and diagnoses of eating disorders. We applied Goldberg's equations to identify under reporters. Results: 40.9% of girls at risk of eating disorders were identified as under reporters and only 7.3% were in the control group. A total of 64.4% of the Eating Disorders Not Otherwise Specified were under reporters. The body mass index of under reporters was significantly higher than in the other of subjects regardless of whether they were at risk of eating disorders. Girls at risk of eating disorders and under reporter had significantly lower body satisfaction than other groups. Multiple logistic regressions in all subjects showed that the risk of being UR was associated with an increase in the body mass index, increase in dietary restraint scores and weight loss; whereas, that only the body mass index was associated with the control group. Conclusion: The prevalence of under reporter increases with the severity of the eating disorders several adolescent girls at risk of eating disorder and identified by Goldberg cut-off technique as under reporter may to be restricting their intake and therefore they would not be under reporter (AU)

Antecedentes: Para validar la ingesta valorada a través de encuestas alimentarias, Goldberg y cols., propusieron ecuaciones para detectar a sujetos que informan mal de su consumo alimentario. Sujetos: Después de realizar un cribado entre 2.967 escolares adolescentes mediante el cuestionario EAT-40, se estudiaron 132 mujeres en riesgo de Trastorno del Comportamiento Alimentario (TCA) y 151 como grupo control. Objetivo: Determinar si las adolescentes en riesgo de TCA que son identificadas como infra-declarantes de su consumo alimentario (IDCA) pueden considerarse como casos IDCA o por el contrario restringen la ingesta. Métodos: Se determinó la ingesta energética, el índice de masa corporal (IMC), la satisfacción corporal, la actividad física, la psicopatología, el factor de restricción dietética, la pérdida de peso y los diagnósticos de TCA. Se aplicaron las ecuaciones de Goldberg para identificar los sujetos IDCA. Resultados: El 40,9% de las adolescentes en riesgo de TCA fueron identificadas como IDCA y solamente el 7,3% del grupo control. Un total de 64,4% de los TCA no especificados fueron IDCA. El IMC de las IDCA fue significativamente más alto que en los otros grupos, tanto si estaban o no en riesgo de TCA. Las adolescentes en riesgo de TCA e IDCA presentaron significativamente menor satisfacción corporal que ningún otro grupo. Mediante análisis de regresión logística múltiple en el conjunto de los sujetos se observó que ser IDCA estaba asociado con un aumento del IMC, un aumento de las puntuaciones de restricción dietética y con pérdida de peso; sin embargo, en el grupo control, solamente se asociaba con el IMC. Conclusiones: La prevalencia de IDCA aumenta con la severidad de los TCA en las mujeres adolescentes en riesgo de TCA y su identificación como IDCA mediante la técnica de Goldberg podrían ser debidas a la restricción de su ingesta y por tanto no ser IDCA (AU)

Dietary calcium and body mass index in a Mediterranean population.

This cross-sectional study evaluated the association between daily calcium intake and body mass index (BMI) in 647 subjects from Reus, Spain. 261 men and 313 women, aged 18 to 70 years, were randomly selected from the population census. Food intake was quantified by the 24-hour recall method, for three non-consecutive days including one holiday. Weight and height were measured. The study sample was divided into quartiles of calcium intake adjusted for age, energy, and total fat and fiber intake in both men and women. Average calcium intake was low (557.6 +/- 234.0 mg/day). Calcium intake was significantly (p < 0.0001) and positively associated with energy intake (r = 0.50 for men; r = 0.49 for women; p < 0.0001) and dietary fiber consumption (r = 0.27 for men; r = 0.25 for women; p < 0.0001). After adjusting for age, energy intake, fat intake, and dietary fiber, the odds ratio of being in the highest quartile of BMI was significantly reduced in the highest quartile of calcium intake [men: 0.63 (0.30-1.29); women: 0.36 (0.17-0.79)] compared to the lowest quartile in both sexes. We conclude that our study showed a negative relationship between calcium intake and BMI in a Mediterranean community.

Association of maternal protein intake before conception and throughout pregnancy with birth weight.

BACKGROUND: The aim of this study is to analyze how the maternal intake of macronutrients before conception and in the 6th, 10th, 26th, and 38th weeks of pregnancy affects birth weight. METHODS: A longitudinal study of food consumption to assess the nutritional status of 77 healthy female volunteers (age range: 24-36) who were planning immediate pregnancy was performed in Reus between 1992 and 1996. A seven-consecutive-day dietary record was used in order to evaluate the dietary intake. We fitted multiple linear regression models of macronutrients on birth weight adjusted for energy intake, maternal age, pre-conceptional body mass index, sex of the newborn, length of pregnancy, parity, physical activity in leisure time, and smoking. RESULTS: In the 6th, 10th, and 26th weeks of pregnancy, 7.2-12.7% of the variability of the birth weight can be explained by the intake of macronutrients. In the protein and fat model, a 1 g increase in maternal protein intake during preconception and in the 10th, 26th, and 38th weeks of pregnancy leads to a significant increase of 7.8-11.4 g in birth weight. CONCLUSIONS: The diet of well-nourished women in the preconception period and throughout most of pregnancy has a significant effect on birth weight, and proteins are the macronutrient that has the greatest influence.

Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum.

OBJECTIVE: To identify dietary patterns in women who are planning immediate pregnancy in preconception, weeks 6, 10, 26 and 38 of pregnancy, and 6 months postpartum, and to describe how particular lifestyles, the body mass index (BMI) and sociodemographic factors are associated to these patterns. DESIGN: Longitudinal study throughout the reproductive cycle of food consumption carried out in a Spanish Mediterranean city. SETTING: Faculty of Medicine and Health Sciences, Rovira i Virgili University. SUBJECTS: In total, 80 healthy female volunteers who were planning immediate pregnancy. INTERVENTIONS: A seven-consecutive-day dietary record was used to evaluate the dietary intake. Exploratory factor analysis was used to identify the main dietary patterns in each of the periods. Fitted multiple linear regression models were used to study the associations between the lifestyle and sociodemographic variables, and each dietary pattern. RESULTS: The 'sweetened beverages and sugars' pattern was identified from preconception to 6 months postpartum and the 'vegetables and meat' pattern to the end of pregnancy. The 'sweetened beverages and sugars' pattern is positively associated with smoking and negatively associated with physical activity before conception and in the first trimester of pregnancy. The 'vegetables and meat' pattern is negatively associated with the BMI during the preconception period and positively associated with age in weeks 10 and 38 of pregnancy. It is shown that the patterns do not change significantly throughout the period studied. CONCLUSIONS: We have identified two stable dietary patterns from preconception to postpartum. The 'sweetened beverages and sugars' pattern is associated with habits of risk for the health of the pregnant woman and her offspring. SPONSORSHIP: 'Comisión Interministerial de Ciencia y Tecnología' (CICYT: ALI89-0388) and 'Instituto de Salud Carlos III', RCMN (C03/08), Madrid, Spain'.

Food and nutritional profile of high energy density consumers in an adult Mediterranean population.

OBJECTIVE: To test if an adult Mediterranean population consumes different food volumes while spontaneously ingesting diets of different energy density and to estimate which are the food and nutritional profiles of these diets. DESIGN: A cross-sectional study of food consumption. SETTING: Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus. SUBJECTS: Five hundred and seventy two adult individuals (25 65 y) randomly selected from the population census of Reus. INTERVENTION: 24 hour recall method for 3 non-consecutive days including one holiday. The population was classified into three groups of differing energy densities by simple linear regression analysis. Means were compared by ANOVA. RESULTS: Both sexes consume similar food volumes across the different levels of energy density. High energy density consumers ingest significantly more red meat, olive oil, sweet cereals, cereals and sugars and less reduced fat milk, green vegetables and fruit compared to low energy density consumers. Male and female high energy density consumers show a significantly higher consumption of energy (1686 kJ and 2200 kJ, respectively) (P < 0.001), a 5.2% (P < 0.001) and 2.3% (P < 0.05) respectively higher energy intake derived from fat and a 1.3% (P < 0.05) and 1.3% (P < 0.05) respectively higher energy intake derived from saturated fatty acids compared to low energy density consumers. CONCLUSIONS: Our adult Mediterranean population normally consumes similar food volumes, independently of the energy density ingested. High energy dense diets in our population could represent an important health risk because they are excessively rich in energy, fats and saturated fatty acids.

Energy density of the diet, food volume and energy intake by age and sex in a healthy population.

OBJECTIVE: To assess the changes in energy intake (EI), food intake volume (FV) and energy density (ED) related to age and gender in a population in the Mediterranean area of Spain, and to determine the different role of FV and ED on the consecution of the adequate EI throughout lifespan. SUBJECTS: One thousand and eighty-eight individuals (1-65 y) randomly selected from the population census. DESIGN: Cross-sectional study in which food intake was quantified by 24 h dietary recall, three non-consecutive days. Height and weight measurements were taken in 885 individuals. RESULTS: EI, FV and ED increased progressively (P < 0.001) between 1-2 y and 10-12 y of age in both sexes. At 1-2 y the EI is 5.8+/-1.5 MJ/d, FV 1195+/-275 g/d and ED 4.8+/-0.9 kJ/g. Between 1-2 and 3-4 y, coinciding with an EI that increased up to 7.2+/-1.5 MJ/d, there was an increase in ED up to 6.1+/-0.8 kJ/g (P < 0.001), while the FV did not vary significantly. At the start of puberty, between 7-9 and 10-12 y, when the EI increased to 9.7+/-0.9 MJ/d (P < 0.001) in males, the ED rose to 7.1+/-0.9 kJ/g (P < 0.001) while the FV did not vary significantly. At this age, a significant difference between the genders was observed in the EI (P = 0.04), and in the ED (P = 0.02) but not, as yet, in the FV. During adulthood, a significant trend towards decrease (P < 0.001 in both sexes) was observed in EI and ED. However, FV decreased significantly only in females. CONCLUSIONS: The changes in energy intake that were observed with respect to age and gender were accommodated-for by changes in the ED of the diet rather than by variations in food volume intake. Autoregulation of the ED of the diet, sufficient for energy intake requirement changes, appears to be an essential human capacity for efficient nutrition.

Effect of malabsorption on nutritional status and resting energy expenditure in HIV-infected patients.

OBJECTIVE: To assess the influence of malabsorption on nutritional status and energy expenditure in patients at different stages of HIV infection. DESIGN AND METHODS: Fifty HIV patients were classified into three groups: Group 1, HIV asymptomatic patients (n=17); Group 2, AIDS without opportunistic infection (n=16); Group 3, AIDS patients with active infection (n=17). Clinically-healthy subjects (n=19) were used as controls. Parameters measured were: anthropometry, body composition by tetrapolar bioelectrical impedance; resting energy expenditure (REE) by open-circuit indirect calorimetry; malabsoption by D-xylose absorption and triolein breath tests. RESULTS: Malabsorption (defined as abnormality of xylose and/or fat absorption test) was found in 34 (68%) of patients: 9 (53%) Group 1; 11 (69%) Group 2; 14 (82%) Group 3. Twenty-seven (54%) had sugar malabsorption and 21 (42%) fat malabsorption. A significant relationship was observed between malabsorption and weight loss. REE measured was significantly lower in malabsorptive patients than in non-malabsorptive patients and controls (6006.3+/-846.5 versus 6443.4 + 985.5 versus 6802.1+/-862.7 kJ/day, respectively; P < 0.05). The REE adjusted for fat-free mass was lower in malabsorptive than in non-malabsorptive patients and slightly higher than in controls, although the differences were not statistically significant. CONCLUSIONS: The results suggest that malabsorption is a frequent feature in HIV infection and is related to the HIV-related weight loss. Hypermetabolism is not a constant phenomenon in HIV infection since, in the presence of malabsorption, our patients show an appropriate metabolic response with a compensatory decrease in REE.

Participation in a pharmacological hypolipidaemic trial does not alter participants' dietary habits.

OBJECTIVE: The aim of this study was to observe whether the act of participation in a well-controlled clinical trial can, co-incidentally, modify the dyslipaemic patient's adherence to his/her diet. DESIGN AND SUBJECT: Food diaries of 55 men and 51 women (aged 46.4 +/- 10.6 and 55.8 +/- 12.1 years respectively) were analyzed at the beginning and the end of the double-blind stage of treatment (12 weeks). STATISTICS: Variance analysis and multi-variant analysis with repeated data by SPSS/PC statistical package. RESULTS: In neither sex were there any statistically significant differences between the start and end of the study with respect to the intake of energy, proteins, total lipids, carbohydrates, saturated fatty acids, polyunsaturated fatty acids, cholesterol, fibre and alcohol. CONCLUSIONS: Although in individual cases some changes in dietary awareness can occur, on a larger scale, the hypocholesterolaemic intervention trial induced no significant overall changes in the participants dietary/lifestyle patterns and, as such, augurs well for other such trials in which the effect of the therapy may sometimes be confounded by changes in the patients' life-style patterns coincidental to the act of participation in the trial.