Social support, adherence to Mediterranean diet and physical activity in adults: results from a community-based cross-sectional study.

There is a growing recognition that social support can potentially exert consistent or opposing effects in influencing health behaviours. The present paper presents a cross-sectional study, including 2,064 adults from Italy, Spain and Greece, who were participants in a multi-centre randomised controlled trial (C4H study), aiming to examine whether social support is correlated with adherence to a healthy Mediterranean diet and physical activity. Social support data were available for 1,572 participants. The majority of the sample reported emotional support availability (84·5 %), financial support availability (72·6 %) and having one or more close friends (78·2 %). Mediterranean diet adherence was significantly associated with emotional support (P = 0·009) and social network support (P = 0·021). No statistically significant associations were found between participant physical activity and the social support aspects studied. In conclusion, emotional and social network support may be associated with increased adherence to the Mediterranean diet. However, further research is needed to evaluate the role of social support in adherence to healthy Mediterranean diet.

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

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Dietary intake and anthropometric reference values in population studies / Valores de referencia de ingesta dietética y de antropometría en estudios poblacionales

In nutritional epidemiology it is essential to have reference values for nutrition and anthropometry in order to compare individual and population data. With respect to reference nutritional intake, the new concept of Dietary Reference Intakes is generated based more on the prevention of chronic diseases than on covering nutritional deficiencies, as would occur in the early Recommendations. As such, the more relevant international organizations incorporated new concepts in their tables, such as the Adequate Intake levels or the Tolerable Upper Intake levels. Currently, the EURRECA recommendations (EURopean micronutrient RECommendations Aligned) are generating reference values for Europe in a transparent, systematic and scientific manner. Using the DRI, health-care authorities formulated nutritional objectives for countries or territories and Dietary Guides to disseminate the dietary advice to the population. Anthropometric assessment continues to be one of the most-used methods for evaluating and monitoring health status, nutritional state and growth in children, not only individuals but also communities. Different organizations have established anthropometric reference patterns of body mass index (BMI) with cut-off points to define overweight and obesity. In children, growth curves have been revised and adapted to the characteristics of healthy children in order to obtain anthropometric reference standards that better reflect optimum growth in children. The Growth Standards for children below 5 years of age of the WHO are a response to these principles, and are widely accepted and used worldwide (AU)

En epidemiologia nutricional son fundamentales las referencias nutricionales y antropométricas para comparar los datos de individuos o colectivos. En relación a las ingestas nutricionales de referencia, el nuevo concepto de Ingestas Dietéticas de Referencia se realizó basándose más en la prevención de las enfermedades crónicas actuales, que en cubrir deficiencias nutricionales, como ocurría con las primeras Recomendaciones. Así, las Organizaciones Internacionales más relevantes han incorporado nuevos conceptos en sus tablas, como el de Ingestas Adecuadas o el Límite Superior de Ingesta Tolerable. Actualmente, la (EURopean micronutrien REComendations Aligned) (EURRECA) está creando valores de referencia para Europa, de manera transparente, sistemática y científicaA partir de las IDR, las autoridades de salud formulan los objetivos nutricionales para un país o territorio y las Guías Alimentarias, que transmiten el consejo alimentario para la población La valoración antropométrica sigue siendo uno de los métodos más utilizados para evaluar y vigilar el estado de salud, el estado nutricional y el crecimiento de los niños, tanto en los individuos, como en las comunidades. Diferentes organismos establecen los patrones de referencia antropométrica del IMC y definen los puntos de corte para definir sobrepeso y obesidad. En los niños, se han revisado las curvas de crecimiento adaptándolas a las características de niños sanos desarrollados en ambientes saludables para obtener estándares antropométricos de referencia que reflejen mejor el crecimiento óptimo de los niños. A estos principios responden los Estandares de Crecimiento para niños menores de cinco años de edad de la OMS, los cuales han sido ampliamente aceptados y utilizados a nivel mundial (AU)

Dietary intake and anthropometric reference values in population studies.

In nutritional epidemiology it is essential to have reference values for nutrition and anthropometry in order to compare individual and population data. With respect to reference nutritional intake, the new concept of Dietary Reference Intakes is generated based more on the prevention of chronic diseases than on covering nutritional deficiencies, as would occur in the early Recommendations. As such, the more relevant international organizations incorporated new concepts in their tables, such as the Adequate Intake levels or the Tolerable Upper Intake levels. Currently, the EURRECA recommendations (EURopean micronutrient RECommendations Aligned) are generating reference values for Europe in a transparent, systematic and scientific manner. Using the DRI, health-care authorities formulated nutritional objectives for countries or territories and Dietary Guides to disseminate the dietary advice to the population. Anthropometric assessment continues to be one of the most-used methods for evaluating and monitoring health status, nutritional state and growth in children, not only individuals but also communities. Different organizations have established anthropometric reference patterns of body mass index (BMI) with cut-off points to define overweight and obesity. In children, growth curves have been revised and adapted to the characteristics of healthy children in order to obtain anthropometric reference standards that better reflect optimum growth in children. The Growth Standards for children below 5 years of age of the WHO are a response to these principles, and are widely accepted and used worldwide.

En epidemiologia nutricional son fundamentales las referencias nutricionales y antropométricas para comparar los datos de individuos o colectivos. En relación a las ingestas nutricionales de referencia, el nuevo concepto de Ingestas Dietéticas de Referencia se realizó basándose más en la prevención de las enfermedades crónicas actuales, que en cubrir deficiencias nutricionales, como ocurría con las primeras Recomendaciones. Así, las Organizaciones Internacionales más relevantes han incorporado nuevos conceptos en sus tablas, como el de Ingestas Adecuadas o el Límite Superior de Ingesta Tolerable. Actualmente, la (EURopean micronutrien REComendations Aligned) (EURRECA) está creando valores de referencia para Europa, de manera transparente, sistemática y científicaA partir de las IDR, las autoridades de salud formulan los objetivos nutricionales para un país o territorio y las Guías Alimentarias, que transmiten el consejo alimentario para la población La valoración antropométrica sigue siendo uno de los métodos más utilizados para evaluar y vigilar el estado de salud, el estado nutricional y el crecimiento de los niños, tanto en los individuos, como en las comunidades. Diferentes organismos establecen los patrones de referencia antropométrica del IMC y definen los puntos de corte para definir sobrepeso y obesidad. En los niños, se han revisado las curvas de crecimiento adaptándolas a las características de niños sanos desarrollados en ambientes saludables para obtener estándares antropométricos de referencia que reflejen mejor el crecimiento óptimo de los niños. A estos principios responden los Estandares de Crecimiento para niños menores de cinco años de edad de la OMS, los cuales han sido ampliamente aceptados y utilizados a nivel mundial.

Valores de referencia de ingesta dietética y de antropometría en estudios poblacionales / Dietary intake and anthropometric reference values in population studies

En epidemiologia nutricional es fundamental tener valores de referencia nutricionales y antropométricos para comparar los datos de individuos o de colectivos. En relación a las ingestas nutricionales de referencia, el nuevo concepto de Ingestas Dietéticas de Referencia (IDR) se basa principalmente en la prevención de las enfermedades crónicas actuales más que en cubrir deficiencias nutricionales. Así, las Organizaciones Internacionales más relevantes han incorporado nuevos conceptos en sus tablas de referencia, como el de Ingestas Adecuadas o el Nivel Máximo de Ingesta Tolerable. Actualmente, EURRECA (EURopean micronutrien REComendations Aligned) está creando valores de referencia para el conjunto de Europa, con una metodología transparente, sistemática y científica. Las autoridades de salud, a partir de las IDR, formulan los objetivos nutricionales para un país o territorio, y las Guías Alimentarias para transmitir el consejo alimentario a la población. La valoración antropométrica sigue siendo uno de los métodos más utilizados para evaluar y vigilar el estado de salud, el estado nutricional y el crecimiento de los niños, tanto en individuos, como las comunidades. Diferentes organismos establecen patrones de referencia antropométrica del IMC y definen los puntos de corte para definir sobrepeso y obesidad. En los niños, se han revisado recientemente las curvas de crecimiento adaptándolas a las características de niños sanos desarrollados en ambientes saludables para obtener estándares antropométricos de referencia que reflejen mejor el crecimiento óptimo de los niños. A estos principios responden los Estándares de Crecimiento de la OMS para niños menores de cinco años de edad, los cuales han sido ampliamente aceptados y utilizados a nivel mundial (AU)

In nutritional epidemiology it is essential to have reference values for nutrition and anthropometry in order to compare individual and population data. With respect to reference nutritional intake, the new concept of Dietary Reference Intakes is generated based more on the prevention of chronic diseases than on covering nutritional deficiencies, as would occur in the early Recommendations. As such, the more relevant international organizations incorporated new concepts in their tables, such as the Adequate Intake levels or the Tolerable Upper Intake levels. Currently, the EURRECA recommendations (EURopean micronutrient RECommendations Aligned) are generating reference values for Europe in a transparent, systematic and scientific manner. Using the DRI, health-care authorities formulated nutritional objectives for countries or territories and Dietary Guides to disseminate the dietary advice to the population. Anthropometric assessment continues to be one of the most-used methods for evaluating and monitoring health status, nutritional state and growth in children, not only individuals but also communities. Different organizations have established anthropometric reference patterns of body mass index (BMI) with cut-off points to define overweight and obesity. In children, growth curves have been revised and adapted to the characteristics of healthy children in order to obtain anthropometric reference standards that better reflect optimum growth in children. The Growth Standards for children below 5 years of age of the WHO are a response to these principles, and are widely accepted and used worldwide (AU)

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

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Caloric beverage drinking patterns are differentially associated with diet quality and adiposity among Spanish girls and boys.

UNLABELLED: The present study assesses the impact of beverage consumption pattern on diet quality and anthropometric proxy measures for abdominal adiposity in Spanish adolescents. Data were obtained from a representative national sample of 1,149 Spanish adolescents aged 10-18 years. Height, weight, and waist circumferences were measured. Dietary assessment was performed with a 24-h recall. Beverage patterns were identified by cluster analysis. Adherence to the Mediterranean diet was measured by the KIDMED index. Three beverage clusters were identified for boys--"whole milk" (62.5 %), "low-fat milk" (17.5 %) and "soft drinks" (20.1 %)-and for girls--"whole milk" (57.8 %), "low-fat milk" (20.8 %) and juice (21.4 %), accounting for 8.3, 9.6, 13.9, 8.6, 11.5 and 12.9 % of total energy intake, respectively. Each unit of increase in the KIDMED index was associated with a 14.0 % higher (p = 0.004) and 11.0 % lower (p = 0.048) probability of membership in the "low-fat milk" and "soft drinks" cluster in girls and boys, respectively, compared with the "whole milk" cluster. Boys in the "soft drinks" cluster had a higher risk of 1-unit increase in BMI z score (29.0 %, p = 0.040), 1-cm increase in waist circumference regressed on height and age (3.0 %, p = 0.027) and 0.1-unit increase in waist/height ratio (21.4 %, p = 0.031) compared with the "whole milk" cluster. CONCLUSION: A caloric beverage pattern dominated by intake of "soft drinks" is related to general and abdominal adiposity and diet quality in Spanish male adolescents.

Prevalence of abdominal obesity in Spanish children and adolescents. Do we need waist circumference measurements in pediatric practice?

BACKGROUND: Evidence indicates that central adiposity has increased to a higher degree than general adiposity in children and adolescents in recent decades. However, waist circumference is not a routine measurement in clinical practice. OBJECTIVE: This study aimed to determine the prevalence of abdominal obesity based on waist circumferences (WC) and waist to height ratio (WHtR) in Spanish children and adolescents aged 6 to 17 years. Further, the prevalence of abdominal obesity (AO) among normal and overweight individuals was analyzed. DESIGN: Data were obtained from a study conducted from 1998 to 2000 in a representative national sample of 1521 children and adolescents aged 6 to 17 years (50.0% female) in Spain. WC and WHtR measurements were obtained in addition to BMI. AO was defined as WHtR ≥0.50 (WHtR-AO), sex and age specific WC≥90(th) percentile (WC-AO1), and sex and age specific WC cut-off values associated with high trunk fat measured by by dual-energy X-ray absorptiometry (WC-AO2). RESULTS: IOTF- based overweight and obsity prevalence was 21.5% and 6.6% in children and 17.4% and 5.2% in adolescents, respectively. Abdominal obesity (AO) was defined as WHtR≥0.50 (WHtR-AO), sex- and age-specific WC≥90th percentile (WC-AO1), and sex- and age-specific WC cut-off values associated with high trunk fat measured by dual-energy X-ray absorptiometry (WC-AO2). The respective prevalence of WHtR-AO, WC-AO1, and WC-AO2 was 21.3% (24.6% boys; 17.9% girls), 9.4% (9.1% boys; 9.7% girls), and 26.8% (30.6% boys;22.9% girls) in children and 14.3% (20.0% boys; 8.7% girls), 9.6% (9.8% boys; 9.5% girls), and 21.1% (28.8% boys; 13.7% girls) in adolescents. CONCLUSION: The prevalence of AO in Spanish children and adolescents is of concern. The high proportion of AO observed in young patients who are normal weight or overweight indicates a need to include waist circumference measurements in routine clinical practice.

Energy density, diet quality, and central body fat in a nationwide survey of young Spaniards.

OBJECTIVES: To determine the impact of energy density on diet quality and anthropometric proxy measures for central body fat in young Spaniards. METHODS: Data were obtained from a representative national sample of 2513 young Spaniards aged 10 to 24 y. Dietary assessment was performed with a 24-h recall. Adherence to the Mediterranean diet was measured by the KIDMED index. Reduced rank regression analysis was used to identify energy-density dietary patterns. Waist circumferences and height were measured. RESULTS: Pastries and sausages showed the strongest loading for the dietary energy density factor score (DED-FS), with fruits and vegetables at the opposite end of the scale. Multiple linear regression analysis showed a positive association (P < 0.01) of dietary energy density (DED) and the DED-FS with waist circumferences regressed on height and age (WCheight+age) and waist-to-height ratio (WHtR). The adjusted odds ratio for elevated WCheight+age and WHtR increased across quartile distribution of DED (P < 0.001) and DED-FS (P < 0.05). Diet quality characterized by the KIDMED index was negatively associated (P < 0.001) with DED and the DED-FS. CONCLUSIONS: Higher DED is a risk for increased central fat distribution and is associated with low adherence to the Mediterranean diet.

The contribution of ready-to-eat cereals to daily nutrient intake and breakfast quality in a Mediterranean setting.

OBJECTIVES: To examine if and how ready-to-eat cereals (RTEC) contribute to the quality of the diet of children, adolescents and young adults in a Mediterranean setting. METHODS: A random sample of 3534 subjects aged 2 to 24 years in Spain was studied. Food and nutrient intakes were determined by a 24 hour recall. RTEC consumption was assessed by a quantitative food frequency questionnaire. Additional questions on socioeconomic level and nutritional knowledge were administered. Cereal consumption was classified into non-consumers and daily intakes between 1 and 20g, 21 and 40g, and more than 40g. After excluding the underreporters the final sample consisted of 2852 individuals. RESULTS: About half of the population (49.8%) reported eating RTEC. Macronutrient profile improved with increasing cereal consumption. Intakes of thiamine, riboflavin and vitamin B6 increased significantly with increasing consumption of RTEC in all age-sex groups, whereas niacin and folate intake improved in almost all groups and calcium, iron and vitamin D in at least half of the groups. Except for magnesium, vitamin B12 and vitamin E in males, consumption of RTEC was significantly associated with increased coverage of the daily nutrient requirements for all micronutrients studied. Higher levels of RTEC consumption was associated with a greater consumption of dairy products, and related to better breakfast quality. CONCLUSIONS: Level of RTEC consumption is associated with a better nutritional profile in the diets of Spanish children, adolescents and young adults and a lower risk for inadequate micronutrient intakes. RTEC consumers have better quality breakfasts, in terms of both food choices as well as energy and nutrient content.

Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents.

OBJECTIVE: To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns. DESIGN: Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered). SETTING: Spain. SUBJECTS: In total, 3850 children and youths aged 2-24 years residing in Spain. RESULTS: Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age. CONCLUSIONS: The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.