Reduction of sugar, salt and fat content in foods over the period 2016-2021 in Spain: the National Food Reformulation Plan.

BACKGROUND/OBJECTIVES: Population´s dietary intake of saturated fat, sodium, and sugars is higher than the current recommendations in Spain and most European countries. Nationwide food reformulation strategies have the potential to improve nutritional quality; however, evaluations are only available in a few countries and are difficult to compare. This study shows the degree of compliance with the nutrient reduction objectives included in a 4-year (2016-2020) Spanish food reformulation initiative. METHODS: In 2016, baseline median nutrient content was established for 57 food subcategories. Agreed reduction (%) expressed as the median content to be reached by 2020 was set as the objective. In 2021, Spanish Food Safety and Nutrition Agency (AESAN) collected mandatory nutritional information from 3118 products belonging to the food subcategories included in the PLAN. Median nutrient content was calculated and compared with baseline data established in 2016 and PLAN objectives. RESULTS: Median nutrient content reduction was observed in all food subcategories. Relative reductions (%) ranged from 0.6 to 60% for added sugars, 4.8 to 33.3% for salt, 4.5 to 78.3% for saturated fat, and 24.9 to 36% for total fat. PLAN objectives were achieved in all subcategories except for one. The number of products involved, belonging to the highly consumed food categories, shows the potential of national reformulation strategies to improve the nutritional quality of the diet. CONCLUSION: Compliance with nutrient reduction agreements was 99%; however, the variability of nutrient content within subcategories shows that there is room for further reduction in selected nutrients and food subcategories.

Effect of olive oil consumption on cardiovascular disease, cancer, type 2 diabetes, and all-cause mortality: A systematic review and meta-analysis.

BACKGROUND: Some large prospective studies on olive oil consumption and risk of chronic disease suggested protective effects. OBJECTIVE: We conducted an outcome-wide systematic review and meta-analysis of prospective cohort studies and randomized controlled trials (RCT) assessing the association between olive oil consumption and the primary risk of 4 different outcomes: cardiovascular disease (CVD), cancer, type 2 diabetes (T2D) or all-cause mortality through January 2022. METHODS: Thirty-six studies were included in the systematic review and twenty-seven studies (24 prospective cohorts and 3 different reports from one RCT) were assessed in 4 quantitative random-effects meta-analyses. They included a total of 806,203 participants with 49,223 CVD events; 1,285,064 participants with 58,892 incident cases of cancer; 680,239 participants with 13,389 incident cases of T2D; and 733,420 participants with 174,081 deaths. Olive oil consumption was most frequently measured with validated food frequency questionnaires. Studies follow-up ranged between 3.7 and 28 years. RESULTS: A 16% reduced risk of CVD (relative risk [RR]: 0.84; 95% confidence interval [CI]: 0.76 to 0.94), standardized for every additional olive oil consumption of 25 g/d was found. No significant association with cancer risk was observed (RR: 0.94; 95% CI: 0.86 to 1.03, per 25 g/d). Olive oil consumption was associated with a 22% lower relative risk of T2D (RR: 0.78; 95% CI: 0.69 to 0.87, per 25 g/d) without evidence of heterogeneity. Similarly, it was inversely associated with all-cause mortality (RR: 0.89; 95% CI: 0.85 to 0.93, per 25 g/d). Only the results for T2D were homogeneous. Specific sources of heterogeneity for the other 3 outcomes were not always apparent. CONCLUSIONS: Prospective studies supported a beneficial association of olive oil consumption with CVD, T2D and all-cause mortality, but they did not show any association with cancer risk.

Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2019 / Weight status in the 6- to 9-year-old school population in Spain: results of the ALADINO 2019 Study

Introducción: la obesidad infantil es un problema de salud pública cuya prevalencia no ha dejado de crecer en las últimas décadas. Objetivo: describir la situación ponderal de los escolares de 6 a 9 años en España en 2019, y sus factores asociados. Métodos: ALADINO es un estudio transversal en escolares de 6 a 9 años, representativo de la población española, aplicando la metodología de la Child Obesity Surveillance Initative de la Oficina Regional para Europa de la OMS. Se midieron el peso, la talla y el perímetro abdominal de los participantes, definiendo la situación ponderal según diferentes estándares (OMS, IOTF y Orbegozo). Se pasó a los progenitores un cuestionario sobre estilo de vida y características sociodemográficas. Resultados: se midieron 16.665 escolares de 276 colegios. El 40,6 % presentaban exceso de peso -23,3 % sobrepeso y 17,3 % obesidad- , siendo la obesidad más prevalente en los niños y el sobrepeso en las niñas, y aumentando ambos con la edad. La prevalencia de la obesidad abdominal era del 22,6 %. El exceso de peso disminuyó 3,9 puntos porcentuales desde 2011, principalmente el sobrepeso de los niños. La obesidad permaneció estable. El exceso de peso fue más prevalente en los escolares con hábitos menos saludables de alimentación y actividad física, y en las familias con menor nivel socioeconómico. Conclusiones: la prevalencia del exceso de peso es elevada, aunque ha descendido desde 2011 y permanece estable desde 2015 entre los escolares de 6 a 9 años en España, debiéndose esta reducción fundamentalmente al descenso del sobrepeso en los niños. Es necesario seguir fomentando hábitos saludables desde las etapas más tempranas, reduciendo las desigualdades en salud. (AU)

Introduction: childhood obesity is a public health problem whose prevalence has grown steadily in recent decades. Objective: to describe the weight status of schoolchildren aged 6 to 9 years in Spain in 2019, and their associated factors. Methods: ALADINO is a cross-sectional study in schoolchildren aged 6 to 9 years, representative of the Spanish population, and aligned with the Child Obesity Surveillance Initative of the WHO Regional Office for Europe. Participants’ weight, height, and abdominal circumference were measured, defining weight status according to different standards (WHO, IOTF, and Orbegozo). A questionnaire on lifestyle and socio-demographic characteristics was administered to parents. Results: a total of 16,665 schoolchildren from 276 schools were measured. Excess weight was observed in 40.6 %: 23.3 % overweight and 17.3 % obesity, with obesity being more prevalent in boys and overweight in girls, both increasing with age. The prevalence of abdominal obesity was 22.6 %. Excess weight decreased by 3.9 percentage points since 2011, mainly due to overweight in boys. Obesity remained stable. Excess weight was more prevalent in schoolchildren with less healthy eating and physical activity habits, and in families with a lower socioeconomic status. Conclusions: the prevalence of excess weight is high, although it has declined since 2011 and remains stable since 2015 among schoolchildren aged 6-9 years in Spain, this reduction being mainly due to a decrease in overweight in children. It is necessary to continue promoting healthy habits from the earliest stages of life, thus reducing health inequalities. (AU)

[Weight status in the 6- to 9-year-old school population in Spain: results of the ALADINO 2019 Study]. / Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2019.

INTRODUCTION: Introduction: childhood obesity is a public health problem whose prevalence has grown steadily in recent decades. Objective: to describe the weight status of schoolchildren aged 6 to 9 years in Spain in 2019, and their associated factors. Methods: ALADINO is a cross-sectional study in schoolchildren aged 6 to 9 years, representative of the Spanish population, and aligned with the Child Obesity Surveillance Initative of the WHO Regional Office for Europe. Participants' weight, height, and abdominal circumference were measured, defining weight status according to different standards (WHO, IOTF, and Orbegozo). A questionnaire on lifestyle and socio-demographic characteristics was administered to parents. Results: a total of 16,665 schoolchildren from 276 schools were measured. Excess weight was observed in 40.6 %: 23.3 % overweight and 17.3 % obesity, with obesity being more prevalent in boys and overweight in girls, both increasing with age. The prevalence of abdominal obesity was 22.6 %. Excess weight decreased by 3.9 percentage points since 2011, mainly due to overweight in boys. Obesity remained stable. Excess weight was more prevalent in schoolchildren with less healthy eating and physical activity habits, and in families with a lower socioeconomic status. Conclusions: the prevalence of excess weight is high, although it has declined since 2011 and remains stable since 2015 among schoolchildren aged 6-9 years in Spain, this reduction being mainly due to a decrease in overweight in children. It is necessary to continue promoting healthy habits from the earliest stages of life, thus reducing health inequalities.

INTRODUCCIÓN: Introducción: la obesidad infantil es un problema de salud pública cuya prevalencia no ha dejado de crecer en las últimas décadas. Objetivo: describir la situación ponderal de los escolares de 6 a 9 años en España en 2019, y sus factores asociados. Métodos: ALADINO es un estudio transversal en escolares de 6 a 9 años, representativo de la población española, aplicando la metodología de la Child Obesity Surveillance Initative de la Oficina Regional para Europa de la OMS. Se midieron el peso, la talla y el perímetro abdominal de los participantes, definiendo la situación ponderal según diferentes estándares (OMS, IOTF y Orbegozo). Se pasó a los progenitores un cuestionario sobre estilo de vida y características sociodemográficas. Resultados: se midieron 16.665 escolares de 276 colegios. El 40,6 % presentaban exceso de peso ­23,3 % sobrepeso y 17,3 % obesidad­, siendo la obesidad más prevalente en los niños y el sobrepeso en las niñas, y aumentando ambos con la edad. La prevalencia de la obesidad abdominal era del 22,6 %. El exceso de peso disminuyó 3,9 puntos porcentuales desde 2011, principalmente el sobrepeso de los niños. La obesidad permaneció estable. El exceso de peso fue más prevalente en los escolares con hábitos menos saludables de alimentación y actividad física, y en las familias con menor nivel socioeconómico. Conclusiones: la prevalencia del exceso de peso es elevada, aunque ha descendido desde 2011 y permanece estable desde 2015 entre los escolares de 6 a 9 años en España, debiéndose esta reducción fundamentalmente al descenso del sobrepeso en los niños. Es necesario seguir fomentando hábitos saludables desde las etapas más tempranas, reduciendo las desigualdades en salud.

Weight status in the 6 to 9 year-old school population in Spain: Results of the ALADINO 2015 study.

INTRODUCTION: Overweight and obesity in childhood and adolescence has grown alarmingly in the last twenty years or so in many countries of Europe, including Spain. This study presents the prevalences of overweight and obesity in 6-9 year-old schoolchildren in 2015, and their associated characteristics. METHODOLOGY: ALADINO (Its initials in Spanish for Diet, physical activity, child development and obesity) is a cross-sectional study of a representative sample of 6-9 year-old schoolchildren in Spain, in line with the Childhood Obesity Surveillance Initiative (COSI) of the World Health Organisation (WHO). The height and weight of the participants, defining the weight status according to WHO standards, and a questionnaire was given to the parents on lifestyle and sociodemographic characteristics. RESULTS: Anthropometric measurements were taken on 10,899 schoolchildren for 168 primary education centres. Excess weight was observed in 41.3% (95% CI: 40.0-42.6), overweight in 23.2% (95% CI: 22.1-24.3) and obesity in 18.1% (95% CI: 17.2-19.1), with obesity being more prevalent in boys, overweight in girls. The prevalence of abdominal obesity was 23.2% (95% CI: 21.8-24.6). The prevalence of overweight and obesity increased with age. Excess weight decreased by 3.2% compared to 2011, mainly due to the decrease in overweight in boys, while that of obesity remained stable. Excess weight was more prevalent in schoolchildren from families with a lower socioeconomic level. CONCLUSIONS: The prevalence of excess weight in 6-9 year-old schoolchildren in Spain has decreased by 3.2% since 2011, due to the decrease in overweight, whilst obesity remained stable. Action must be taken in the obesogenic environment, by promoting healthy eating habits and physical activity, bearing in mind the inequalities in health.

Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2015 / Weight status in the 6 to 9 year-old school population in Spain: Results of the ALADINO 2015 Study

Introducción: El sobrepeso y la obesidad en la infancia y en la adolescencia han crecido alarmantemente en las últimas décadas en muchos países de Europa, incluido España. Este estudio presenta las prevalencias de sobrepeso y obesidad en escolares de 6 a 9 años en 2015 y sus características asociadas. Metodología: ALADINO es un estudio transversal de una muestra representativa de escolares de 6 a 9 años en España, alineado con la iniciativa COSI de la OMS. Se talló y pesó a los participantes, definiendo la situación ponderal según los estándares de la OMS, y se pasó un cuestionario a los progenitores sobre el estilo de vida y las características sociodemográficas. Resultados: Se tomaron medidas antropométricas a 10.899 escolares de 168 centros de educación primaria. El 41,3% (IC 95%: 40,0-42,6) presentaba exceso de peso, el 23,2% sobrepeso (IC 95%: 22,1-24,3) y el 18,1% obesidad (IC 95%: 17,2-19,1), siendo la obesidad más prevalente en niños y el sobrepeso en niñas. La prevalencia de obesidad abdominal era del 23,2% (IC 95%: 21,8-24,6). La prevalencia de sobrepeso y obesidad aumentaba con la edad. El exceso de peso disminuyó un 3,2% respecto a 2011, principalmente por la disminución del sobrepeso en niños, mientras que la obesidad permaneció estable. El exceso de peso era más prevalente en los escolares de familias con menor nivel socioeconómico. Conclusiones: La prevalencia de exceso de peso entre los escolares de 6 a 9 años en España ha disminuido un 3,2% desde 2011 por la disminución del sobrepeso, mientras que la obesidad permanece estable. Se debe intervenir en el entorno obesogénico, promocionando hábitos alimentarios saludables y la actividad física, incidiendo en las desigualdades en salud. (AU)

Introduction: Overweight and obesity in childhood and adolescence has grown alarmingly in the last twenty years or so in many countries of Europe, including Spain. This study presents the prevalences of overweight and obesity in 6 to 9 year-old schoolchildren in 2015, and their associated characteristics. Methodology: ALADINO (Its initials in Spanish for Diet, physical activity, child development and obesity) is a cross-sectional study of a representative sample of 6 to 9 year-old schoolchildren in Spain, in line with the Childhood Obesity Surveillance Initiative (COSI) of the World Health Organisation (WHO). The height and weight of the participants, defining the weight status according to WHO standards, and a questionnaire was given to the parents on lifestyle and sociodemographic characteristics. Results: Anthropometric measurements were taken on 10,899 schoolchildren for 168 primary education centres. Excess weight was observed in 41.3% (95% CI: 40.0-42.6), overweight in 23.2% (95% CI: 22.1-24.3) and obesity in 18.1% (95% CI: 17.2-19.1), with obesity being more prevalent in boys, overweight in girls. The prevalence of abdominal obesity was 23.2% (95% CI: 21.8-24.6). The prevalence of overweight and obesity increased with age. Excess weight decreased by 3.2% compared to 2011, mainly due to the decrease in overweight in boys, while that of obesity remained stable. Excess weight was more prevalent in schoolchildren from families with a lower socioeconomic level. Conclusions: The prevalence of excess weight in 6 to 9 year-old schoolchildren in Spain has decreased by 3.2% since 2011, due to the decrease in overweight, whilst obesity remained stable. Action must be taken in the obesogenic environment, by promoting healthy eating habits and physical activity, bearing in mind the inequalities in health. (AU)

Sugar Content in Processed Foods in Spain and a Comparison of Mandatory Nutrition Labelling and Laboratory Values.

To reduce the sugar content of processed foods through reformulation, the first step is to determine the content of the largest sources of sugars in each country's diet. The aim of this work was to describe the sugar content in the most commonly consumed processed foods in Spain and to compare that sugar's labelling and laboratory analysis values (LVs and AVs, respectively) to confirm its adequacy. A sample of the 1173 most commonly consumed processed foods in Spain (28 groups; 77 subcategories) was collected. For each product, the total sugar content was compared according to its AV and LV. The median (25th -75th percentiles, interquartile range) sugar content by group was calculated for the total sample, and the groups were classified as "high sugar content" when this value was above 22.5 g/100g of product. The adequacy of the LV, according to the European Union (EU) tolerance requirements, was then evaluated, and each subcategory median was compared with the AV to determine its appropriateness via a median test for independent samples (p < 0.05). In total, 10 out of 28 groups presented high sugar content. Moreover, 98.4% of the products met the EU tolerance ranges. Finally, only one subcategory ("cured ham") presented significant differences between the AV and LV median values (0.4 g vs. 0.1 g sugar/100g, p < 0.05). The groups of food products whose sugar content reduction could have the greatest impact on public health were identified. In addition, our study showed the high adequacy of LV with the EU labeling tolerance requirements, as well as the LV's appropriateness as a tool to implement actions aimed at reducing sugar consumption.

Adequacy of usual macronutrient intake and macronutrient distribution in children and adolescents in Spain: A National Dietary Survey on the Child and Adolescent Population, ENALIA 2013-2014.

OBJECTIVES: To describe the nutritional profile and assess the National Dietary Survey on the Child and Adolescent Population project in Spain (ENALIA) regarding usual total energy and macronutrient intake. METHODS: A cross-sectional nationally representative sample of 1862 children and adolescents (age 6 months to 17) was surveyed between 2013 and 2014 following European methodology recommendations. Dietary information was collected using two methods, dietary records (for children from age 6 months to 9 years) and 24-h dietary recall (participants age 10 and older). Usual intake was estimated by correcting for within-person intake variance using the Iowa State University (ISU) method. A probability analysis was used to assess compliance with dietary reference intakes in the target population. RESULTS: Protein consumption in the age 1-3 group as a percentage of total energy exceeded the upper limit of the Acceptable Macronutrient Distribution Range (AMDR) by 4.7% for boys and 12.1% for girls. 42.9% of girls age 4-8 were under the lower limit of the AMDR for carbohydrates. 43.4% of boys and 46.9% of girls between 4 and 17 exceeded the AMDR in total fat intake, saturated fatty acids (SFAs) accounting for 12.3% of total energy. CONCLUSIONS: The results suggest that Spanish children and adolescents could improve macronutrient distribution by reducing fat and increasing carbohydrate intake across all age groups, and decreasing protein intake, especially in young children.