Prevalencia de obesidad y obesidad abdominal en la población española de 65 y más años de edad: estudio ENPE / Prevalence of obesity and abdominal obesity in Spanish population aged 65 years and over: ENPE study

Antecedentes y objetivos: Evaluar la prevalencia de obesidad y obesidad abdominal (OA) en población española ≥65años, analizar la influencia de algunos factores sociodemográficos y su asociación con factores de riesgo.MétodosLa muestra procede del estudio ENPE, estudio transversal en muestra aleatoria representativa de la población no institucionalizada (2014-2015). Este análisis se refiere a población ≥65años (n=1.233). Observadores entrenados realizaron mediciones antropométricas en los domicilios según protocolos internacionales estandarizados. Se consideró obesidad (índice de masa corporal [IMC] ≥30); OA (cintura >102cm varones; >88cm mujeres).ResultadosSe ha estimado una alta prevalencia de obesidad en adultos ≥65años, mayor en mujeres (40,1% [IC95% 36,4-43,8]) que en hombres (32,5% [IC95% 28,5-36,8]). La prevalencia de OA también es mayor en mujeres (69,9% [IC95% 66,4-73,1]) que en hombres (40,7% [IC95% 36,5-44,8]), y es aún mayor al definir OA considerando el índice cintura-cadera o el índice cintura-talla. El 39,8% de tipificados como OA tienen IMC entre 25-29. Obesidad y OA son más frecuentes en el sur respecto al este, norte-este y centro y tienen relación inversa con el nivel educativo. Obesidad y OA se asocian con mayor probabilidad de hipercolesterolemia e hipertensión arterial. La obesidad sarcopénica también se asocia, además, con diabetes.ConclusiónLa prevalencia de obesidad y OA en adultos ≥65años es alta, mayor en mujeres, en personas con menor nivel educativo y en la región sur respecto al este, norte-este y centro. Es especialmente preocupante la alta prevalencia de OA por su asociación con complicaciones cardiovasculares, metabólicas y deterioro de la calidad de vida.

Prevalence of obesity and abdominal obesity in Spanish population aged 65 years and over: ENPE study. / Prevalencia de obesidad y obesidad abdominal en la población española de 65 y más años de edad: estudio ENPE.

BACKGROUND AND OBJECTIVES: To assess the prevalence of obesity and abdominal obesity (AO) in the Spanish population aged ≥65 years, to analyse the influence of selected sociodemographic factors and association with risk factors. METHODS: The sample comes from the ENPE study, a cross-sectional study of a representative sample of the non-institutionalized population (2014-2015). This analysis refers to the population ≥65 years (n=1,233). Trained observers performed anthropometric measurements at participants' homes following standard international protocols. Obesity was defined as body mass index (BMI) ≥30; AO waist>102cm men; >88cm women. RESULTS: Estimated prevalence of obesity in adults ≥65 years was high, higher in women (40.1% [95% CI 36.4-43.8]) than in men (32.5% [95% CI 28.5-36.8]). The prevalence of AO was also higher in women (69.9% [95% CI 66.4-73.1]) than in men (40.7% [95% CI 36.5-44.8]), and estimates were even higher when defining AO by waist-hip ratio or waist-height ratio. Of those classified as AO, 39.8% have a BMI between 25-29. Obesity and AO are higher in the South region compared to East, North-East and Central regions and showed inverse association with educational level. Obesity and AO were associated with increased probability of hypercholesterolaemia and high blood pressure, sarcopenic obesity, and diabetes. CONCLUSION: The prevalence of obesity and AO in adults aged ≥65 years is high, higher in women, in people of lower educational level and in the South region compared to East, North-East and Central regions. The high prevalence of OA is especially worrying due to its association with cardiovascular and metabolic complications and poorer quality of life.

Prevalence of obesity and associated cardiovascular risk factors in the Spanish population: the ENPE study.

INTRODUCTION AND OBJECTIVES: Obesity is a significant public health problem associated with an increased risk of cardiovascular risk factors (CVRF). The aim of this study was to determine the prevalence of overweight and abdominal obesity (AO) in the Spanish population aged ≥ 3 years and to analyze the influence of sociodemographic and lifestyle factors and their association with CVRF. METHODS: The sample was drawn from the ENPE study (n=6800). The study protocol included individual anthropometric measurements, sociodemographic factors, food intake (food frequency questionnaire), physical activity, lifestyles, and health problems. RESULTS: The estimated overall prevalence of obesity (22.0%; 95%CI, 21.0-23.0) and AO (64.7%; 95%CI, 63.5-65.8) was higher in men, in persons aged ≥ 65 years, and in those with a lower socioeconomic level or from southern regions. Lifestyle pattern was significantly associated with obesity and AO (P=.011), which were less likely in people with an active lifestyle pattern (P <.0001). Obesity (OR, 1.85; 95%CI, 1.24-2.78) and AO (OR, 2.16; 95%CI, 1.1-4.24) were positively associated with CVRF. Clustering of CVRF with obesity and/or AO was higher in women (12.6%; 95%CI, 11.4-13.9) and in persons aged ≥ 65 years (32.7%; 95%CI, 30.0-35.4). CONCLUSIONS: The prevalence of obesity and AO in the Spanish population is high; it is higher in men, increases with age, and is inversely related to socioeconomic status. A lifestyle pattern combining a higher level of physical activity, moderate sedentariness and a Mediterranean dietary pattern is associated with a lower probability of obesity, AO, and CVRF.

Food-based dietary guidelines in Spain: an assessment of their methodological quality.

BACKGROUND & OBJECTIVES: Food-based dietary guidelines (FBDGs) have been developed to promote healthy diets and prevent chronic diseases. However, the methodological quality of Spanish FBDGs has not been systematically assessed yet. The objective of this review is to identify and assess the methodological quality of Spanish FBDGs, as well as to describe their food guides and key recommendations. METHODS: We conducted a systematic search to identify Spanish FBDGs targeted at the general population using multiple sources. Two authors independently screened the references, extracted data, and assessed the quality of the FBDGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Recommendation Excellence (AGREE-REX) instruments. We performed a descriptive analysis of the FBDGs. RESULTS: We included 19 FBDGs, published between 2007 and 2019. The median scores for each AGREE II domain were: "scope and purpose" 44% (Q1-Q3: 33-61%); "Stakeholder involvement" 31% (11-44%), "rigor of development" 3% (1-14%); "clarity of presentation" 42% (33-47%), "applicability" 0% (0-6%); and "editorial independence" 0% (0-8%). Six FBDGs (32%; 6/19) were categorized as "recommended with modifications", and the rest (68%; 13/19) as "not recommended". None of the FBDGs scored ≥60% in three or more domains, including the "rigor of development" domain. FBDGs indexed in literature databases scored significantly higher in overall rating than those not indexed (P = 0.023). The majority of FBDGs (74%; 14/19) used the pyramid as a food guide representation with a larger number of food levels (3-7 levels). The majority of FBDGs recommended a daily intake of cereals and grains, vegetables, fruits, olive oil and dairy products; a weekly intake of vegetable and animal proteins; and the occasional and limited intake of other food groups (e.g., ultraprocessed foods). CONCLUSIONS: Overall, the methodological quality of FBDGs is poor showing that only 32% of FBDGs are "recommended for use with modifications". Our results highlight the need to revise, systematize and improve FBDG development processes in Spain.

Patterns of Change in Dietary Habits and Physical Activity during Lockdown in Spain Due to the COVID-19 Pandemic.

BACKGROUND: Lockdown due to COVID-19 influenced food habits and lifestyles with potential negative health impact. This study aims to identify patterns of change in eating habits and physical activity during COVID-19 lockdown in Spain and to identify associations with sociodemographic factors and usual habits. METHODS: This cross-sectional study included 1155 adults recruited online to answer a 10-section questionnaire. The protocol assessed usual diet by means of a semi-quantitative food frequency questionnaire, usual physical activity (PA) and supplement use, dietary changes, sedentary time, PA, exposure to sunlight, sleep quality, and smoking during confinement. Patterns of dietary change were identified by factor analysis. Factor scores were included in cluster analysis together with change in PA. RESULTS: Six patterns of dietary change were identified that together with PA changes during lockdown defined three clusters of lifestyle change: a cluster less active, a more active cluster, and a third cluster as active as usual. People who were usually less active were more likely to be classified in the cluster that increased physical activity in confinement. Scores of the Healthy Mediterranean-Style dietary pattern were higher in this group. Conclusions: Different patterns of change in lifestyles in confinement suggest the need to tailor support and advice to different population groups.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns.

BACKGROUND: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets. OBJECTIVE: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. METHODS: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. CONCLUSIONS: The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

Plate Waste Generated by Spanish Households and Out-of-Home Consumption: Results from the ANIBES Study.

Food waste is a major environmental issue that must be tackled in order to achieve a sustainable food supply chain. Currently, in Spain there are no studies that examine the amounts and sources of plate waste (PW) produced by both household and out-of-home consumption. The present study aims to provide this information from a representative sample from the Spanish population. A total of 2009 individuals aged 9-75 years, from the ANIBES study ("anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain"), completed a three-day dietary record, collected by a tablet device. Photographs of all foods and beverages consumed both at home and outside were taken before and after meals. Median PW across the total population was 7.3 (0.0-37.3) g/day and was significantly higher in females than males (p < 0.05) and in children vs. adolescents, adults, and elderly (p < 0.01). Regarding meals, PW across all age groups was higher at lunch (40%), dinner (27%), and breakfast (11%). The highest PW was observed for bread (25%) main courses (16%), first and second courses (15%), vegetables and fruits (12%), ready-to-eat meals (10%), cereals and grains (10%), oils and fats (10%), pulses (10%), meat products (8%), sauces and condiments (8%), and starters (8%). Our results reinforce the need for new strategies to focus on reducing plate leftovers, which are crucial from a nutritional, economic, and environmental point of view. Additionally, this evidence is important for relying on more accurate information on actual intakes when using dietary surveys.

Cambios en los hábitos alimentarios durante el periodo de confinamiento por la pandemia COVID-19 en España / Changes in eating habits during lockdown period due to the COVID-19 pandemic in Spain

FUNDAMENTOS: El cierre de fronteras, el confinamiento de la población y el distanciamiento físico han sido las principales medidas instauradas en muchos países para contener el alcance y gravedad de la pandemia COVID-19. En este estudio se analizan los cambios en los hábitos alimentarios y en otros estilos de vida durante el periodo de confinamiento en un grupo de población en España. MATERIAL Y MÉTODOS: Se ha realizado un estudio transversal, observacional en una muestra de conveniencia de personas mayores de 18 años de edad, reclutada de forma electrónica entre el 21 de abril y 8 de mayo de 2020 (semanas 6-8 de confinamiento) en España (n= 1036). El protocolo contemplaba datos sociodemográficos, características del confinamiento, hábitos de consumo alimentario y actividad física usuales, y modificaciones durante el periodo de confinamiento. RESULTADOS: Los cambios más frecuentes se refieren a mayor consumo de fruta (27%), huevos (25,4%), legumbres (22,5%), verduras (21%) y pescado (20%) y reducción en el consumo de carnes procesadas (35,5%), cordero o conejo (32%), pizza (32,6%), bebidas alcohólicas destiladas (44,2%), bebidas azucaradas (32,8%) o chocolate (25,8%), con algunas diferencias sobre todo en función de la edad y el grado de adecuación de la dieta usual. Un 14,1% que habitualmente no cocina, lo hace en este periodo. El 15% no realiza ejercicio físico, 24,6% pasa sentado más de 9 horas diarias y el 30,7% de las personas fumadoras (14,7%) fuma más. Un 37% refiere no dormir bien. CONCLUSIONES: Los participantes en este estudio refieren cambios alimentarios en el periodo de confinamiento en España con tendencia hacia mayor consumo de alimentos saludables, menor consumo de alimentos de menos interés nutricional y aumento de la práctica de cocinar en casa

BACKGROUND: The lockout of borders, lockdown of the population and social isolation are key measures adopted in many countries to contain the COVID-19 pandemic. This study describes changes in eating habits and other lifestyles during confinement in a population group in Spain. METHODS: A cross-sectional, observational study was conducted on a convenience sample of people aged 18 yr. and over, recruited online between April 21 and May 8, 2020 (weeks 6-8 of lockdown) in Spain (n = 1036). The protocol considered sociodemographic data, characteristics of confinement, usual food consumption and physical activity, and changes during confinement. RESULTS: Most frequently reported changes in dietary habits are increased consumption of fruit (27%), eggs (25.4%), legumes (22.5%), vegetables (21%) and fish (20%) and reduced consumption of processed meats (35.5%), lamb or rabbit (32%), pizza (32.6%), distilled alcoholic beverages (44.2%), sugary drinks (32.8%) or chocolate (25.8%). Some differences were observed depending on age and adequacy of the usual diet. Some 14.1% who do not usually cook do so during this period; 15% do not do physical exercise, 24.6% sit more than 9 hours a day and 30.7% of smokers (14.7%) report increased tobacco use. 37% reported not sleeping well. CONCLUSIONS: Participants in this study report dietary changes during lockdown in Spain with a trend towards greater consumption of healthier foods, less consumption of foods of poor nutritional interest and an increase in the practice of cooking at home

Prevalencia de sobrepeso, obesidad y obesidad abdominal en población española entre 3 y 24 años. Estudio ENPE / Prevalence of overweight, obesity and abdominal obesity in the Spanish population aged 3 to 24 years. The ENPE study

INTRODUCCIÓN Y OBJETIVOS: El objetivo de este estudio es evaluar la prevalencia de exceso de peso y obesidad abdominal (OA) con base en mediciones antropométricas individuales, según diferentes criterios, en población española entre 3 y 24 años y analizar su distribución según la edad y el sexo. MÉTODOS: La muestra procede del estudio ENPE. Este análisis se refiere a población entre 3 y 24 años (n=1.601). Las mediciones antropométricas se realizaron en los domicilios por observadores entrenados según protocolos internacionales estandarizados. Se definió el sobrepeso y la obesidad según los criterios del International Obesity Task Force, la Organización Mundial de la Salud y Orbegozo 2011 y la OA según el índice cintura-talla ≥ 0,5, criterios de Taylor y percentil 90 de Orbegozo 2011. RESULTADOS: La prevalencia de sobrecarga ponderal (sobrepeso+obesidad) supera el 30% con todos los criterios utilizados. Se estima la prevalencia de sobrepeso (International Obesity Task Force) en el 34,1% (IC95%, 31,8-36,4) y la obesidad en el 10,3% (IC95%, 8,9-11,9). La prevalencia de OA (índice cintura-talla ≥ 0,5) se estima del 31,2% (IC95%, 29,0-33,5) y coindicen los 3 criterios en el 20,9% (IC95%, 18,1-22,1) del colectivo. El 16% (IC95%, 13,8-17,8) tiene sobrecarga ponderal y OA concomitante. CONCLUSIONES: La prevalencia de sobrepeso, obesidad y OA en la población española entre 3 y 24 años es alta, mayor en varones que en mujeres. Con diferentes criterios, la prevalencia de OA se aproxima al 30%. El 71,6% de los que se tipifican como obesos por los 3 criterios se clasifican también como OA por los diferentes puntos de corte

INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the prevalence of excess weight and abdominal obesity (AO), based on individual anthropometric measurements, according to various criteria in the Spanish population aged 3 to 24 years and to analyze their distribution by age and sex. METHODS: We analyzed data from the ENPE study. This analysis included the population aged 3 to 24 years (n=1601). Anthropometric measurements were taken in participants' homes by trained observers following standardized international protocols. We defined overweight and obesity according to the International Obesity Task Force, World Health Organization, and Orbegozo 2011 criteria, and AO according to a waist-to-height index ≥ 0.5, Taylor criteria, and the 90th percentile of Orbegozo 2011. RESULTS: The prevalence of excess weight (overweight+obesity) exceeded 30% with all the criteria used. The prevalence of overweight (International Obesity Task Force) was estimated at 34.1% (95%CI, 31.8-36.4) and obesity at 10.3% (95%CI, 8.9-11.9). The estimated prevalence of AO (waist-to-height index ≥ 0.5) was 31.2% (95%CI, 29.0-33.5), and 20.9% (95%CI, 18.1-22.1) satisfied all 3 criteria. A total of 16% (95%CI, 13.8-17.8) had excess weight and concomitant AO. CONCLUSIONS: The prevalence of overweight, obesity and AO in the Spanish population aged 3 to 24 years old is high and is higher in men than in women. When distinct criteria were used, the prevalence of AO was approximately 30%. Among persons classified as obese by the 3 criteria, 71.6% were also classified as having AO according to distinct cutoffs

Prevalence of overweight, obesity and abdominal obesity in the Spanish population aged 3 to 24 years. The ENPE study.

INTRODUCTION AND OBJECTIVES: The aim of this study was to assess the prevalence of excess weight and abdominal obesity (AO), based on individual anthropometric measurements, according to various criteria in the Spanish population aged 3 to 24 years and to analyze their distribution by age and sex. METHODS: We analyzed data from the ENPE study. This analysis included the population aged 3 to 24 years (n=1601). Anthropometric measurements were taken in participants' homes by trained observers following standardized international protocols. We defined overweight and obesity according to the International Obesity Task Force, World Health Organization, and Orbegozo 2011 criteria, and AO according to a waist-to-height index ≥ 0.5, Taylor criteria, and the 90th percentile of Orbegozo 2011. RESULTS: The prevalence of excess weight (overweight+obesity) exceeded 30% with all the criteria used. The prevalence of excess overweight (International Obesity Task Force) was estimated at 34.1% (95%CI, 31.8-36.4) and obesity at 10.3% (95%CI, 8.9-11.9). The estimated prevalence of AO (waist-to-height index ≥ 0.5) was 31.2% (95%CI, 29.0-33.5), and 20.9% (95%CI, 18.1-22.1) satisfied all 3 criteria. A total of 16% (95%CI, 13.8-17.8) were overweight and had concomitant AO. CONCLUSIONS: The prevalence of overweight, obesity and AO in the Spanish population aged 3 to 24 years old is high and is higher in men than in women. When distinct criteria were used, the prevalence of AO was approximately 30%. Among persons classified as obese by the 3 criteria, 71.6% were also classified as having AO according to distinct cutoffs.

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.

Updating the Food-Based Dietary Guidelines for the Spanish Population: The Spanish Society of Community Nutrition (SENC) Proposal.

Diet-related risk factors and physical inactivity are among the leading risk factors for disability and are responsible for a large proportion of the burden of chronic non-communicable diseases. Food-based dietary guidelines (FBDGs) are useful tools for nutrition policies and public health strategies to promote healthier eating and physical activity. In this paper, we discuss the process followed in developing the dietary guidelines for the Spanish population by the Spanish Society of Community Nutrition (SENC) and further explain the collaboration with primary healthcare practitioners as presented in the context of the NUTRIMAD 2018 international congress of SENC. From a health in all policies approach, SENC convened a group of experts in nutrition and public health to review the evidence on diet-health, nutrient intake and food consumption in the Spanish population, as well as food preparation, determinants and impact of diet on environmental sustainability. The collaborative group drafted the document and designed the graphic icon, which was then subject to a consultation process, discussion, and qualitative evaluation. Next, a collaborative group was established to plan a dissemination strategy, involving delegates from all the primary healthcare scientific societies in Spain. A product of this collaboration was the release of an attractive, easy-to-understand publication.

Current Food Consumption amongst the Spanish ANIBES Study Population.

Dietary habits amongst the Spanish population are currently a relevant cause for concern, as macronutrient profiles and micronutrient intakes seem to be inadequate and globally moving away from the traditional Mediterranean dietary pattern. However, recent food consumption patterns have not been fully assessed. In the present study, our aim was therefore to describe the current food consumption from the "anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain" (ANIBES) study population by assessing data defined by age and gender. The ANIBES study is a cross-sectional study of a nationally representative sample of the Spanish population. A three-day dietary record was used to obtain information about food and beverage consumption. The sample comprised 2009 individuals aged 9-75 years, plus a boost sample for the youngest age groups (9-12, 13-17, and 18-24 years, n = 200 per age group). The most consumed food group across all age segments were non-alcoholic beverages followed by milk and dairy products and vegetables. Consumption of cereals and derivatives, milk and dairy products, sugars and sweets, and ready-to-eat meals by children was significantly higher than those by the adult and older adult populations (p ≤ 0.05). Conversely, intakes of vegetables, fruits, and fish and shellfish were significantly higher in adults and older adults (p ≤ 0.05). In order to comply with recommendations, adherence to the Mediterranean dietary patterns should be strengthened, especially amongst younger population groups. Therefore, substantial nutritional interventions may be targeted to improve the Spanish population's dietary patterns nowadays.

Adequacy of Critical Nutrients Affecting the Quality of the Spanish Diet in the ANIBES Study.

Diet is one of the key modifiable behaviors that can help to control and prevent non-communicable chronic diseases. Therefore, it is important to evaluate the overall diet composition of the population through non-invasive and independent indexes or scores as diet quality indexes (DQIs). The primary aim of the present work was to estimate the adequacy of the intake of critical nutrients in the Spanish "Anthropometry, Intake, and Energy Balance Study" (ANIBES) (n = 2285; 9-75 years), considering, as a reference, the European Food Scientific Authority (EFSA) values for nutrients for the European Union. We also assessed the quality of the diet for adults and older adults using four internationally accepted DQIs, namely the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), the Mediterranean Diet Score-modified (MDS-mod), and the Mediterranean-Diet Quality Index (MED-DQI), as well as the ANIBES-DQI, stratified by education and income. The ANIBES-DQI was based on compliance with EFSA and Food and Agriculture Organization recommendations for a selected group of nutrients (i.e., total fat, saturated fatty acids (SFAs), simple sugars, fiber, calcium, vitamin C, and vitamin A), with a total range of 0-7. Misreporting was assessed according to the EFSA protocol, which allowed us to assess the DQIs for both the general population and plausible reporters. The majority of the Spanish population had high intakes of SFAs and sugars and low intakes of fiber, folate, and vitamins A and C. In addition, about half of the population had low DQI scores and exhibited low adherence to the Mediterranean diet pattern. Overall, older adults (>65-75 years) showed better DQIs than adults (18-64 years), without major differences between men and women. Moreover, primary education and low income were associated with low MDS and ANIBES-DQI scores. For the ANIBES-DQI, the percentage of the population with low scores was higher in the whole population (69.5%) compared with the plausible energy reporters (49.0%), whereas for medium and high scores the percentages were higher in plausible reporters (41.2% vs. 26.2% and 9.8% vs. 4.3%, respectively). In conclusion, the present study adds support to marked changes in the Mediterranean pattern in Spain, and low education and income levels seem to be associated with a low-quality diet. Additionally, the misreported evaluation in the ANIBES population suggests that this analysis should be routinely included in nutrition surveys to give more precise and accurate data related to nutrient intake and diet quality.

Sodium Intake from Foods Exceeds Recommended Limits in the Spanish Population: The ANIBES Study.

Excessive sodium consumption is associated with adverse health effects. An elevated dietary intake of salt (sodium chloride) has been related to high blood pressure or hypertension, a major but modifiable risk factor for cardiovascular disease, as well as to other ill health conditions. In the present work, our aim was to describe the contribution of foods to sodium consumption within the Spanish population in a representative sample from the "anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain" (ANIBES) study (9-75 years), to identify high consumer groups, as well as the major food groups that contribute to sodium intake in the Spanish diet. Intakes were assessed by 3-day food records collected on a tablet device. Sodium intakes across the ANIBES study population exceeded recommendations, as total intakes reached 2025 ± 805 mg of sodium per day, that is approximately 5.06 g/day of salt (excluding discretionary salt, added at the table or during cooking). Sodium intakes were higher in males than in females and within the youngest groups. Main dietary sources of sodium were meat and meat products (27%), cereals and grains (26%), milk and dairy products (14%) and ready-to-eat meals (13%). Given the established health benefits of dietary salt reduction, it would be advisable to continue and even improve the current national initiatives of awareness and educational campaigns and particularly food reformulation to decrease overall salt intakes across the Spanish population.

[Conclusions. Nutrition and gastronomy in the different autonomous communities. Gastronomy from Segovia in national context]. / Conclusiones. Nutrición y gastronomía en las distintas comunidades autónomas. La gastronomía segoviana en el contexto nacional.

INTRODUCCIÓN: Desde el Grupo de Expertos es posible plantear las siguientes conclusiones siguiendo el modelo DAFO de análisis (debilidades, amenazas, fortalezas y oportunidades).

[Nutrition and gastronomy in the Basque Country]. / Nutrición y gastronomía en el País Vasco.

INTRODUCTION: For centuries the traditional ingredients of food patterns in Basque Country were millet, chestnuts, cabbage, beans, lentils, fish, pork and beef especially, as well as a variety of fruits such as apples, pears and grapes. Later, the potato replaced chestnuts, corn replaced millet and beans replaced broad beans. In addition, tomatoes and peppers added to the vegetable repertoire. Cocoa also found great acceptance from the eighteenth century and the consumption of cider, especially among seamen, played a very important role in the prevention of scurvy. During the nineteenth century, the rise of industrialization led to important social changes and in food habits. The great romantic travelers and their stories contributed to the diffusion of uses and customs, among others, those related to culinary preparations and eating habits. Later, the growing interest in thermal baths also attracted visitors from France, Germany, Italy or Great Britain to the Basque Country, sometimes accompanied by their chefs and servants, who brought with them their own culinary practices to the Basque kitchens and restaurants. From 1977 and inspired by the Nouvelle cuisine, the new Basque cuisine emerged led by great chefs such as Juan Marí Arzak and Pedro Subijana, who soon brought together a large group that has led the current Basque cuisine to internationally recognized excellence. The new tendencies coexist with the cult to traditions and to specific forms of conviviality around the food: txokos and gastronomic societies; pintxos, pintxopote and cider houses.

INTRODUCCIÓN: Durante siglos, los ingredientes tradicionales de la alimentación en el País Vasco fueron el mijo, las castañas, la berza, las habas, las lentejas, el pescado y los mariscos y modestas cantidades de carne de cerdo y de ganado vacuno, sobre todo, además de frutas como manzanas, peras y uvas. Más tarde, la patata desplazó a las castañas, el maíz al mijo y las alubias a las habas, además de incorporar tomates y pimientos al repertorio de hortalizas. El cacao también encontró una gran aceptación a partir del siglo xviii, y el consumo de sidra, especialmente entre los marinos, desempeñó un papel muy importante en la prevención del escorbuto. Durante el siglo xix, el auge de la industrialización conllevó importantes transformaciones sociales, y también en la alimentación. Los grandes viajeros románticos y sus relatos contribuyeron a la difusión de usos y costumbres, entre otros, los relacionados con las preparaciones culinarias y los hábitos alimentarios. Poco más tarde, el creciente interés por los baños termales atrajo también hacia el País Vasco viajeros procedentes de Francia, Alemania, Italia o Gran Bretaña, acompañados en ocasiones por sus cocineros y sirvientes que acercaron prácticas culinarias de sus lugares de origen a las cocinas y restaurantes vascos. A partir de 1977, e inspirada en la denominada nouvelle cuisine, emerge la nueva cocina vasca de la mano de grandes cocineros como Juan Marí Arzak y Pedro Subijana, que pronto aglutinarán a un nutrido grupo de profesionales que han llevado a la actual cocina vasca a la excelencia reconocida internacionalmente. Las nuevas tendencias y restaurantes con estrellas o soles conviven con el culto a las tradiciones y a formas específicas de convivialidad en torno al alimento: txokos y sociedades gastronómicas; pintxos y pintxopote; sidrerías y tabernas de nuestra tierra verde.

[Gastronomy and nutrition in Catalonia]. / Gastronomía y nutrición en Cataluña.

INTRODUCTION: Objectives: the culture and the eating habits of a territory give shape its gastronomy and determine the nutritional and health status of its population. We set the goal of reviewing food, culture, gastronomy and the nutritional and health status of the Catalan population. Methods: bibliographic and documentation search. Results: the origin of Catalan gastronomy dates back to the classical era. From Greek and Roman times, when olive oil and wine were incorporated into our cuisine, until today, multiple civilizations have influenced it, being the Arab contribution and the discovery of America fundamental events in the increase of Spanish wealth and its gastronomic variety. At Catalan level, the geographical, cultural and social characteristics of Catalonia, with a marked Mediterranean influence, were incorporated and creating Catalan cuisine and gastronomy, which currently have international recognition and prestige. The food consumption of the Catalan population has been studied since 1983. Nowadays, it shows a food consumption and an energy and nutrients intake similar to the national average, similarly to the prevalence of morbidity and lifestyles. Conclusion: in order to that the union of gastronomy and food consumption favors also the health of population, we must encourage the recovery of the healthiest and easiest to prepare dishes from their gastronomy and boost modifications that improve technically the more complex and/or less healthy dishes.

INTRODUCCIÓN: Objetivos: la cultura y los hábitos alimentarios de un territorio configuran su gastronomía y determinan el estado nutricional y de salud de su población. Nos planteamos el objetivo de revisar la alimentación, la cultura, la gastronomía y el estado nutricional y de salud de la población catalana. Métodos: búsqueda de documentación y bibliográfica. Resultados: el origen de la gastronomía catalana se remonta a la época clásica. Desde la época griega y romana, cuando se incorpora a nuestra cocina el aceite de oliva y el vino, hasta la actualidad, múltiples civilizaciones han influido en ella, con la influencia árabe y el descubrimiento de América como momentos fundamentales en el incremento de la riqueza y de la variedad gastronómica española. A nivel catalán, las características geográficas, culturales y sociales de Cataluña, con un marcado sello mediterráneo, fueron incorporándose y creando la cocina y la gastronomía catalanas, que actualmente tiene reconocimiento y prestigio internacionales. El consumo alimentario de la población catalana fue estudiado desde 1983. En la actualidad, presenta un consumo de alimentos y una ingesta de energía y nutrientes similares a la media nacional, al igual que ocurre con la prevalencia de morbilidad y estilos de vida. Conclusión: para que la unión de gastronomía y consumo alimentario favorezca también la salud de la población, debemos favorecer los platos más saludables y fáciles de preparar de su gastronomía y potenciar modificaciones que mejoren los platos técnicamente más complejos y/o pocos saludables.

Nutrición y gastronomía en el País Vasco / Nutrition and gastronomy in the Basque Country

Durante siglos, los ingredientes tradicionales de la alimentación en el País Vasco fueron el mijo, las castañas, la berza, las habas, las lentejas, el pescado y los mariscos y modestas cantidades de carne de cerdo y de ganado vacuno, sobre todo, además de frutas como manzanas, peras y uvas. Más tarde, la patata desplazó a las castañas, el maíz al mijo y las alubias a las habas, además de incorporar tomates y pimientos al repertorio de hortalizas. El cacao también encontró una gran aceptación a partir del siglo xviii, y el consumo de sidra, especialmente entre los marinos, desempeñó un papel muy importante en la prevención del escorbuto. Durante el siglo xix, el auge de la industrialización conllevó importantes transformaciones sociales, y también en la alimentación. Los grandes viajeros románticos y sus relatos contribuyeron a la difusión de usos y costumbres, entre otros, los relacionados con las preparaciones culinarias y los hábitos alimentarios. Poco más tarde, el creciente interés por los baños termales atrajo también hacia el País Vasco viajeros procedentes de Francia, Alemania, Italia o Gran Bretaña, acompañados en ocasiones por sus cocineros y sirvientes que acercaron prácticas culinarias de sus lugares de origen a las cocinas y restaurantes vascos. A partir de 1977, e inspirada en la denominada nouvelle cuisine, emerge la nueva cocina vasca de la mano de grandes cocineros como Juan Marí Arzak y Pedro Subijana, que pronto aglutinarán a un nutrido grupo de profesionales que han llevado a la actual cocina vasca a la excelencia reconocida internacionalmente. Las nuevas tendencias y restaurantes con estrellas o soles conviven con el culto a las tradiciones y a formas específicas de convivialidad en torno al alimento: txokos y sociedades gastronómicas; pintxos y pintxopote; sidrerías y tabernas de nuestra tierra verde

For centuries the traditional ingredients of food patterns in Basque Country were millet, chestnuts, cabbage, beans, lentils, fish, pork and beef especially, as well as a variety of fruits such as apples, pears and grapes. Later, the potato replaced chestnuts, corn replaced millet and beans replaced broad beans. In addition, tomatoes and peppers added to the vegetable repertoire. Cocoa also found great acceptance from the eighteenth century and the consumption of cider, especially among seamen, played a very important role in the prevention of scurvy. During the nineteenth century, the rise of industrialization led to important social changes and in food habits. The great romantic travelers and their stories contributed to the diffusion of uses and customs, among others, those related to culinary preparations and eating habits. Later, the growing interest in thermal baths also attracted visitors from France, Germany, Italy or Great Britain to the Basque Country, sometimes accompanied by their chefs and servants, who brought with them their own culinary practices to the Basque kitchens and restaurants. From 1977 and inspired by the Nouvelle cuisine, the new Basque cuisine emerged led by great chefs such as Juan Marí Arzak and Pedro Subijana, who soon brought together a large group that has led the current Basque cuisine to internationally recognized excellence. The new tendencies coexist with the cult to traditions and to specific forms of conviviality around the food: txokos and gastronomic societies; pintxos, pintxopote and cider houses