Are the Dietary-Nutritional Recommendations Met? Analysis of Intake in Endurance Competitions.

BACKGROUND: In recent decades the number of endurance events has increased, as well as the number of athletes participating in them. Adequate nutritional and water planning is essential to maintain optimal sports performance and to reduce the incidence of gastrointestinal problems. The main objective of this study is to determine the dietary intake and compliance with nutritional recommendations of athletes in two endurance competitions, as well as to assess the incidence of gastrointestinal complaints. METHODS: An observational and cross-sectional study was carried out on the consumption of liquids, food, and supplements in 42 triathletes and mountain runners (MRs) participating in a Vi-Half-Gasteiz triathlon and the Ultra Sierra de Cazorla trail run. At the completion of the trials, participants completed a validated questionnaire (NIQEC). RESULTS: The mean caloric intake during the test of the participants in this study was 192.17 kcal/h, while the mean carbohydrate intake was 43.67 g/h, the mean sodium intake was 267.43 mg/h, and the mean caffeine intake was 15.53 mg/h, with no significant differences between the two sports. The amount of liquids consumed by the participants was 421.21 mL/h, with no significant differences between the triathletes and MRs. As for gastrointestinal problems, it was observed that the participants presented gastrointestinal discomfort in 61.9% of the cases. CONCLUSIONS: The intakes of energy, carbohydrates, water, sodium, and caffeine were lower than the current recommendations. There were no differences in the energy, carbohydrate, water, sodium, and caffeine intakes between the triathletes and mountain runners. Gastrointestinal problems showed a high prevalence in these athletes.

Development of an Instrument to Evaluate the Intake of Liquids, Food and Supplements in Endurance Competitions: Nutritional Intake Questionnaire for Endurance Competitions-NIQEC.

BACKGROUND: In the last few years endurance sports have experienced a great increase in the number of competitions and participants. Dietary-nutritional planning is key for performing well during such competitions. To date, there is no questionnaire expressly developed to be able to analyze the consumption of liquids, foods, and supplements, as well as gastrointestinal problems in these events. This study describes the development of the Nutritional Intake Questionnaire for Endurance Competitions (NIQEC). METHODS: The study was composed in the following phases: (1) Bibliographic search for the most important nutrients, (2) focus groups (17 dietitian-nutritionists and 15 experienced athletes) and generation of items, (3) Delphi surveys, and (4) cognitive interviews. RESULTS: After an initial shaping of the questionnaire with the items that emerged in the focus groups, their relevance was evaluated by means of the Delphi survey, which showed more than 80% approval for most items. Finally, the cognitive interviews indicated that the questionnaire was simple and complete for its purpose. The final NIQEC (n = 50 items) was divided in 5 sections: Demographic data; sports data; consumption of liquids, food and supplements before, during, and after the competition; gastrointestinal complaints, and dietary-nutritional planning for the competition. CONCLUSIONS: The NICEQ is a useful tool that allows collecting information from participants on sociodemographic factors and gastrointestinal complaints, and estimating the intake of liquid, food, and supplements, for endurance competitions.

Do Spanish Triathletes Consume Sports Supplements According to Scientific Evidence? An Analysis of the Consumption Pattern According to Sex and Level of Competition.

BACKGROUND: The use of sports supplements (SS) to improve sports performance is very common in athletes. In the case of triathletes, the physiological characteristics of the sport may require the use of certain SS. Although the consumption of SS is widespread in this sport, very few studies have investigated it thus far. The aim is to analyze the pattern of SS consumption by triathletes according to sex and the competitive level. METHODOLOGY: This is a descriptive cross-sectional study on the consumption and habitual use of SS of 232 Spanish-federated triathletes. Data were collected through a validated questionnaire. RESULTS: Overall, 92.2% of the athletes consumed SS, but no significant differences were found in terms of competition level or sex. Yet, significant differences were found regarding the level of competition for total SS (p = 0.021), the total number of Group A supplements from the AIS classification (p = 0.012), and for the ergogenic aids (p = 0.003). The most-consumed SS were bars, sports drinks, sports gels, and caffeine (83.6%, 74.1%, 61.2%, and 46.6%, respectively). CONCLUSIONS: The consumption of SS by triathletes is high, and the number of SS consumed rises from the regional to the national and international levels. The four SS most consumed were included in category A of the AIS (greatest scientific evidence).

Reproducibility and Validity of a Food Frequency Questionnaire Designed to Assess Diet in Children Aged 4-5 Years.

BACKGROUND: The food frequency questionnaire (FFQ) is the most efficient and cost-effective method to investigate the relationship between usual diet and disease in epidemiologic studies. Although FFQs have been validated in many adult populations worldwide, the number of valid FFQ in preschool children is very scarce. The aim of this study was to evaluate the reproducibility and validity of a semi-quantitative FFQ designed for children aged 4 to 5 years. MATERIALS AND METHODS: In this study, we have included 169 children aged 4-5 years from the INMA project in Valencia, a population-based prospective cohort study of mothers and children in Spain. The 105-items FFQ was administered twice to the parents or care-givers of children over a 9-month period. Reproducibility was explored by comparing intake of nutrients by the FFQs, while validity was examined by comparing the nutrient values from the FFQs with the average nutrient values of three 24 hour dietary recall (24hDR) taken in the period, and also, with the concentration in blood specimens for several vitamins (carotenoids, folate, vitamin B12, vitamin C and α-tocopherol). Pearson correlation coefficients and de-attenuated correlation coefficients were calculated and we also evaluated misclassification by quintile distribution. RESULTS: All correlation coefficients for reproducibility for nutrients and major food groups were statistically significant; the average correlation coefficients for daily intake were 0.43 for food groups and 0.41 for nutrients. The average correlation coefficients for validity for daily intakes against 24hDR was r = 0.30, and the average for de-attenuated correlation coefficients was r = 0.44. When evaluating validity against the blood concentration of vitamins, statistically significant correlations were observed for vitamin C (0.35), lycopene (0.31), ß-Cryptoxantin (0.40), and vitamin E (0.29); the average of correlation coefficients was r = 0.21. CONCLUSION: Despite some low to moderate correlations for reproducibility and validity, overall this study suggests that the FFQ may be a good method for assessing a wide range of food groups and nutrients intake in children aged 4-5 years.

Dietary Intake of Trans Fatty Acids in Children Aged 4-5 in Spain: The INMA Cohort Study.

Trans fatty acid (TFA) intake has been identified as a health hazard in adults, but data on preschool children are scarce. We analyzed the data from the Spanish INMA Project to determine the intake of total, industrial and natural TFA, their main sources and the associated socio-demographic and lifestyle factors in children aged 4-5 (n = 1793). TFA intake was estimated using a validated Food Frequency Questionnaire, and multiple linear regression was used to explore associated factors. The mean daily intakes of total, industrial and natural TFA were 1.36, 0.60, and 0.71 g/day, respectively. Ten percent of the children obtained >1% of their energy intake from TFA. The main sources of industrial TFA were fast food, white bread and processed baked goods. Milk, red and processed meat and processed baked goods were the main sources of natural TFA. Having parents from countries other than Spain was significantly associated with higher natural TFA (in mg/day) intake (ß 45.5) and television viewing was significantly associated with higher industrial TFA intake (ß 18.3). Higher fruits and vegetables intake was significantly associated with lower intakes of all TFAs, whereas higher sweetened beverages intake was significantly associated with lower total and natural TFA intake. Thus, total and industrial TFA intake was associated with less healthy food patterns and lifestyles in Spanish preschool children.

Alcohol consumption and Mediterranean Diet adherence among health science students in Spain: the DiSA-UMH Study / Consumo de alcohol y dieta mediterránea en estudiantes de ciencias de la salud en España: estudio DiSA-UMH

Objective: To describe the association between consumption of different alcoholic beverages and adherence to the Mediterranean diet. Methods: A cross-sectional analysis was conducted of the baseline data of the DiSA-UMH study, an ongoing cohort study with Spanish health science students (n=1098) aged 17-35 years. Dietary information was collected by a validated 84-item food frequency questionnaire. Participants were grouped into non-drinkers, exclusive beer and/or wine drinkers and drinkers of all types of alcoholic beverages. Mediterranean diet adherence was determined by using a modification of the relative Mediterranean Diet Score (rMED; score range: 0-16) according to consumption of 8 dietary components. We performed multiple linear and multinomial regression analyses. Results: The mean alcohol consumption was 4.3g/day (SD: 6.1). A total of 19.5%, 18.9% and 61.6% of the participants were non-drinkers, exclusive beer and/or wine drinkers and drinkers of all types of alcoholic beverages, respectively. Participants who consumed beer and/or wine exclusively had higher rMED scores than non-drinkers (β: 0.76, 95%CI: 0.25-1.27). Drinkers of all types of alcoholic beverages had similar rMED scores to non-drinkers. Non-drinkers consumed less fish and more meat, whereas drinkers of all types of alcoholic beverages consumed fewer fruits, vegetables and more meat than exclusive beer and/or wine drinkers. Conclusions: The overall alcohol consumption among the students in our study was low-to-moderate. Exclusive beer and/or wine drinkers differed regarding the Mediterranean diet pattern from non-drinkers and drinkers of all types of alcohol. These results show the need to properly adjust for diet in studies of the effects of alcohol consumption (AU)

Objetivo: Explorar la asociación entre el consumo de diferentes bebidas alcohólicas y la adherencia a la dieta Mediterránea. Métodos: Se analizaron transversalmente los datos basales del estudio DiSA-UMH (n=1098) de 17-35 años. Para recoger información dietética se utilizó un cuestionario de frecuencia de alimentos de 84 ítems validado previamente. Se agrupó a los participantes en no bebedores, bebedores exclusivos de cerveza o vino (o ambos), y bebedores de todo tipo de bebidas. La adherencia a la dieta mediterránea se determinó usando una modificación de la relative Mediterranean Diet Score (rMED). Se utilizó regresión lineal múltiple y multinomial. Resultados: La media de alcohol fue de 4,3 (6,1) g/día. El 19,5%, el 18,9% y el 61,6% de los participantes fueron clasificados en no bebedores, bebedores exclusivos de cerveza o vino, y bebedores de todo tipo de bebida, respectivamente. Los participantes clasificados en bebedores exclusivos de cerveza o vino tuvieron una mayor rMED que los no bebedores (β: 0,76; intervalo de confianza del 95%: 0,25-1,27). Los participantes clasificados en bebedores de todo tipo de bebidas tuvieron una rMED similar a los no bebedores. En comparación con los bebedores exclusivos de cerveza o vino, los no bebedores consumían menos pescado y más carne, mientras que los bebedores de todo tipo consumían menos frutas, vegetales y más carne. Conclusiones: La ingesta de alcohol entre los estudiantes de nuestro estudio fue en general baja-moderada. Los bebedores exclusivos de cerveza o vino presentaron un patrón dietético mediterráneo diferenciado del de los no bebedores y los bebedores de todo tipo de bebidas, lo que justificaría ajustar correctamente por la dieta en estudios sobre los efectos del consumo de alcohol (AU)

Alcohol consumption and Mediterranean Diet adherence among health science students in Spain: the DiSA-UMH Study.

OBJECTIVE: To describe the association between consumption of different alcoholic beverages and adherence to the Mediterranean diet. METHODS: A cross-sectional analysis was conducted of the baseline data of the DiSA-UMH study, an ongoing cohort study with Spanish health science students (n=1098) aged 17-35 years. Dietary information was collected by a validated 84-item food frequency questionnaire. Participants were grouped into non-drinkers, exclusive beer and/or wine drinkers and drinkers of all types of alcoholic beverages. Mediterranean diet adherence was determined by using a modification of the relative Mediterranean Diet Score (rMED; score range: 0-16) according to consumption of 8 dietary components. We performed multiple linear and multinomial regression analyses. RESULTS: The mean alcohol consumption was 4.3g/day (SD: 6.1). A total of 19.5%, 18.9% and 61.6% of the participants were non-drinkers, exclusive beer and/or wine drinkers and drinkers of all types of alcoholic beverages, respectively. Participants who consumed beer and/or wine exclusively had higher rMED scores than non-drinkers (ß: 0.76, 95%CI: 0.25-1.27). Drinkers of all types of alcoholic beverages had similar rMED scores to non-drinkers. Non-drinkers consumed less fish and more meat, whereas drinkers of all types of alcoholic beverages consumed fewer fruits, vegetables and more meat than exclusive beer and/or wine drinkers. CONCLUSIONS: The overall alcohol consumption among the students in our study was low-to-moderate. Exclusive beer and/or wine drinkers differed regarding the Mediterranean diet pattern from non-drinkers and drinkers of all types of alcohol. These results show the need to properly adjust for diet in studies of the effects of alcohol consumption.

Use of high doses of folic acid supplements in pregnant women in Spain: an INMA cohort study.

OBJECTIVES: We examined the use of low (<400 µg/day, including no use) and high folic acid supplement (FAS) dosages (≥1000 µg/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages. DESIGN: Population-based cohort study. SETTING: Spain. PARTICIPANTS: We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain. MAIN OUTCOME MEASURES: We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs). RESULTS: Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67). CONCLUSIONS: A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages ≥1000 µg/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors.

Una menor adherencia a la dieta mediterránea se asocia a una peor salud auto-percibida en población universitaria / A lower adherence to Mediterranean diet is associated with a poorer self-rated health in university population

Introducción y objetivo: Una mayor adherencia a la dieta mediterránea es un factor protector de la mortalidad atribuida principalmente a las enfermedades crónico-degenerativas en países desarrollados. La salud auto-percibida constituye un buen indicador para medir el estado de salud poblacional y como predictor de la mortalidad. Son escasos los estudios que han explorado la relación entre la adherencia a la dieta mediterránea y la salud auto- percibida especialmente en población joven. En este estudio analizamos los factores relacionados con el estado de salud auto-percibido en población joven universitaria, prestando especial atención a la adherencia a un patrón de dieta mediterránea definido a priori. Método: Se han analizado los datos de 1110 participantes recogidos en el momento de ingreso en el del Estudio Di- SA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández). La dieta se evaluó mediante cuestionario de frecuencia alimentaria validado y se estimó la adherencia a la dieta mediterránea mediante el índice relative Mediterranean Diet Score que incluye 9 componentes y un rango entre 0-18 puntos. El estado de salud auto-percibida se recogió mediante la pregunta 'En general, ¿cómo diría que es su salud?' con cinco opciones: muy buena, buena, regular, mala y muy mala. Se recogió información sobre variables sociodemográficas y estilos de vida. Se usó regresión logística multinomial (usando razón de riesgos relativos RRR) para analizar la asociación entre adherencia a la dieta mediterránea (rMED baja: 0-6; media: 7-10 puntos; alta: 11-18) y salud auto-percibida (muy buena (referencia), buena y regular/mala/muy mala). Resultados: Un 26.8%, 58.7% y 14.4% de los participantes presentaron respectivamente una adherencia a la dieta mediterránea baja, media o alta; un 23.1%, 65.1% y 11.8%, refirieron una salud muy buena, buena o regular/mala/muy mala, respectivamente. En el análisis multivariante, una menor adherencia a la dieta mediterránea se asoció significativamente a un peor estado de salud auto-percibido (p<0.05). Comparada con una baja adherencia a la dieta mediterránea (rMED bajo), una adherencia media se asoció a un menor riesgo de buen estado de salud (RRR= 0.81; IC 95%: 0.67-0.97) o de salud regular/ mala/muy mala (RRR= 0.70; 0.58-0.85); la mayor adherencia (rMED alto) se asoció a un menor riesgo de salud buena (RRR= 0.69; 0.61-0.79) o regular/mala/muy mala (RRR= 0.68; 0.65-0.72). El consumo de tabaco, una menor actividad física y un exceso de peso se asociaron significativamente a peor estado de salud (p<0.05). Conclusiones: Una proporción considerable de universitarios tienen baja adherencia a la dieta mediterránea (uno de cada cuatro). La baja adherencia a la dieta mediterránea se asoció significativamente con un peor estado de salud auto-percibido. Otros factores susceptibles de intervención como fumar, ser menos activo físicamente y el exceso de peso se asociaron también a un peor estado de salud (AU)

Introduction and objective: A higher adherence to Mediterranean diet is considered as a protective factor against the large number of deaths attributable to the main chronic degenerative diseases in developed countries. Self-rated health is established as a good indicator of population health status and as a predictor of mortality. Studies exploring the relationship between the adherence to Mediterranean diet and self-rated health are scarce, especially, in young adults. Our aim was to explore the factors related, specially the adherence to a priori-defined Mediterranean diet with self-rated health in a cohort of Spanish university students. Methods: We analyzed data from 1110 participants of Spanish DiSA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández) study. Diet was assessed using a validated food frequency questionnaire and the adherence to Mediterranean diet was calculated using the relative Mediterranean Diet Score (rMED; score range: 0-18) according to the consumption of 9 dietary components. Self-rated health was gathered from the question: 'In general, how do you consider your health to be? (Excellent, good, fair, poor, very poor). Information on sociodemographic and lifestyle characteristics was also collected. Multinomial logistic regression (using relative risk ratio, RRR) was used to analyze the association between the adherence to Mediterranean diet (low rMED: 0-6 points; medium: 7-10 points; high: 11-18 points) and self-rated health (Excellent (reference), good and fair/ poor/very poor). Results: A low, medium or high adherence to Mediterranean diet conformed to 26.8%, 58.7% and 14.4% of participants, which of them reported an excellent (23.1%), good (65.1%) and fair/poor or very poor health, respectively. In multivariate analysis, a lower adherence to Mediterranean diet was significantly (p<0.05) associated with a poorer self-rated health. Compared to a low adherence to Mediterranean diet (low rMED), a medium adherence was related to a lower risk of good (RRR= 0.81; 95% CI: 0.67-0.97) or fair/poor or very poor (RRR= 0.70; 0.58-0.85); the highest adherence (high rMED) was associated with a lower risk of good (RRR= 0.69; 0.61-0.79) or fair/poor or very poor (RRR= 0.68; 0.65-0.72) self-rated health. Smoking, low physical activity and excess weight were associated with a poorer self-rated health (p<0.05). Conclusions: A considerable proportion of university students (one in four) has a low adherence to Mediterranean diet, which was associated significantly with a poorer self-rated health. Other potential modifiable factors as smoking, low physical activity and excess weight were also associated with a poorer self-rated health (AU)

Asociación entre horas de televisión, actividad física, horas de sueño y exceso de peso en población adulta joven / Association between hours of television watched, physical activity, sleep and excess weight among young adults

Objetivo Analizar la asociación de las horas de televisión, la actividad física autorreferida y las horas de sueño con el exceso de peso corporal o el índice de masa corporal (IMC) en población universitaria. Métodos Se han analizado de forma transversal los datos basales de 1135 participantes de 17 a 35 años de edad del proyecto «Dieta, antropometría y salud en población universitaria». Se recogió información sobre las horas de televisión y de sueño, la actividad física, el peso y la talla autorreferidos, y otras variables de interés. Se calculó el IMC (kg/m2) y se definió el exceso de peso (IMC ≥25). Se usó regresión logística múltiple para analizar la asociación entre las variables de interés y el exceso de peso (no/sí), y regresión lineal múltiple para el IMC. Resultados La prevalencia de exceso de peso fue de 13,7% (11,2% sobrepeso y 2,5% obesidad). Se encontró una asociación significativa entre el exceso de peso y más horas de televisión. Tomando como referencia a los que veían televisión ≤1h al día, los que la veían >2h al día (categoría superior) presentaron una odds ratio de 2,13 (intervalo de confianza del 95%: 1,37-3,36; p tendencia: 0,002). Una menor actividad física autorreferida se asoció a un mayor riesgo de exceso de peso, aunque la asociación sólo resultó significativa en el análisis de regresión lineal múltiple (p=0,037). No se encontró asociación entre el exceso de peso y las horas de sueño. Conclusiones Más horas de televisión y una menor actividad física se asociaron significativamente con un aumento del IMC en la población universitaria estudiada. Ambos factores pueden modificarse con estrategias preventivas (AU)

Objective To explore the association between excess weight or body mass index (BMI) and the time spent watching television, self-reported physical activity and sleep duration in a young adult population. Methods We analyzed cross-sectional baseline data of 1,135 participants (17-35 years old) from the project Dieta, salud y antropometría en población universitaria (Diet, Health and Anthrompmetric Variables in Univeristy Students). Information about time spent watching television, sleep duration, self-reported physical activity and self-reported height and weight was provided by a baseline questionnaire. BMI was calculated as kg/m2 and excess of weight was defined as ≥25. We used multiple logistic regression to explore the association between excess weight (no/yes) and independent variables, and multiple linear regression for BMI. Results The prevalence of excess weight was 13.7% (11.2% were overweight and 2.5% were obese). A significant positive association was found between excess weight and a greater amount of time spent watching television. Participants who reported watching television >2h a day had a higher risk of excess weight than those who watched television ≤1h a day (OR=2.13; 95%CI: 1.37-3.36; p-trend: 0.002). A lower level of physical activity was associated with an increased risk of excess weight, although the association was statistically significant only in multiple linear regression (p=0.037). No association was observed with sleep duration. Conclusion A greater number of hours spent watching television and lower physical activity were significantly associated with a higher BMI in young adults. Both factors are potentially modifiable with preventive strategies (AU)

[Association between hours of television watched, physical activity, sleep and excess weight among young adults]. / Asociación entre horas de televisión, actividad física, horas de sueño y exceso de peso en población adulta joven.

OBJECTIVE: To explore the association between excess weight or body mass index (BMI) and the time spent watching television, self-reported physical activity and sleep duration in a young adult population. METHODS: We analyzed cross-sectional baseline data of 1,135 participants (17-35 years old) from the project Dieta, salud y antropometría en población universitaria (Diet, Health and Anthrompmetric Variables in Univeristy Students). Information about time spent watching television, sleep duration, self-reported physical activity and self-reported height and weight was provided by a baseline questionnaire. BMI was calculated as kg/m(2) and excess of weight was defined as ≥25. We used multiple logistic regression to explore the association between excess weight (no/yes) and independent variables, and multiple linear regression for BMI. RESULTS: The prevalence of excess weight was 13.7% (11.2% were overweight and 2.5% were obese). A significant positive association was found between excess weight and a greater amount of time spent watching television. Participants who reported watching television >2h a day had a higher risk of excess weight than those who watched television ≤1h a day (OR=2.13; 95%CI: 1.37-3.36; p-trend: 0.002). A lower level of physical activity was associated with an increased risk of excess weight, although the association was statistically significant only in multiple linear regression (p=0.037). No association was observed with sleep duration. CONCLUSION: A greater number of hours spent watching television and lower physical activity were significantly associated with a higher BMI in young adults. Both factors are potentially modifiable with preventive strategies.

[A lower adherence to Mediterranean diet is associated with a poorer self-rated health in university population]. / Una menor adherencia a la dieta Mediterránea se asocia a una peor salud auto-percibida en población universitaria.

INTRODUCTION AND OBJECTIVE: A higher adherence to Mediterranean diet is considered as a protective factor against the large number of deaths attributable to the main chronic degenerative diseases in developed countries. Self-rated health is established as a good indicator of population health status and as a predictor of mortality. Studies exploring the relationship between the adherence to Mediterranean diet and self-rated health are scarce, especially, in young adults. Our aim was to explore the factors related, specially the adherence to a priori-defined Mediterranean diet with self-rated health in a cohort of Spanish university students. METHODS: We analyzed data from 1110 participants of Spanish DiSA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández) study. Diet was assessed using a validated food frequency questionnaire and the adherence to Mediterranean diet was calculated using the relative Mediterranean Diet Score (rMED; score range: 0-18) according to the consumption of 9 dietary components. Self-rated health was gathered from the question: "In general, how do you consider your health to be? (Excellent, good, fair, poor, very poor). Information on sociodemographic and lifestyle characteristics was also collected. Multinomial logistic regression (using relative risk ratio, RRR) was used to analyze the association between the adherence to Mediterranean diet (low rMED: 0-6 points; medium: 7-10 points; high: 11-18 points) and self-rated health (Excellent (reference), good and fair/ poor/very poor). RESULTS: A low, medium or high adherence to Mediterranean diet conformed to 26.8%, 58.7% and 14.4% of participants, which of them reported an excellent (23.1%), good (65.1%) and fair/poor or very poor health, respectively. In multivariate analysis, a lower adherence to Mediterranean diet was significantly (p.

Introducción y objetivo: Una mayor adherencia a la dieta mediterránea es un factor protector de la mortalidad atribuida principalmente a las enfermedades crónico-degenerativas en países desarrollados. La salud auto-percibida constituye un buen indicador para medir el estado de salud poblacional y como predictor de la mortalidad. Son escasos los estudios que han explorado la relación entre la adherencia a la dieta mediterránea y la salud auto- percibida especialmente en población joven. En este estudio analizamos los factores relacionados con el estado de salud auto-percibido en población joven universitaria, prestando especial atención a la adherencia a un patrón de dieta mediterránea definido a priori. Método: Se han analizado los datos de 1110 participantes recogidos en el momento de ingreso en el del Estudio Di- SA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández). La dieta se evaluó mediante cuestionario de frecuencia alimentaria validado y se estimó la adherencia a la dieta mediterránea mediante el índice relative Mediterranean Diet Score que incluye 9 componentes y un rango entre 0-18 puntos. El estado de salud auto-percibida se recogió mediante la pregunta "En general, ¿cómo diría que es su salud?" con cinco opciones: muy buena, buena, regular, mala y muy mala. Se recogió información sobre variables sociodemográficas y estilos de vida. Se usó regresión logística multinomial (usando razón de riesgos relativos RRR) para analizar la asociación entre adherencia a la dieta mediterránea (rMED baja: 0-6; media: 7-10 puntos; alta: 11-18) y salud auto-percibida (muy buena (referencia), buena y regular/mala/muy mala). Resultados: Un 26.8%, 58.7% y 14.4% de los participantes presentaron respectivamente una adherencia a la dieta mediterránea baja, media o alta; un 23.1%, 65.1% y 11.8%, refirieron una salud muy buena, buena o regu lar/mala/muy mala, respectivamente. En el análisis multivariante, una menor adherencia a la dieta mediterránea se asoció significativamente a un peor estado de salud auto-percibido (p.

[Validation of self-reported weight and height university population and factors associated with differences between self reported and measured antropometrics]. / Validez del peso y talla auto-referido en población universitaria y factores asociados a las discrepancias entre valores declarados y medidos.

INTRODUCTION: Obesity is an important public health problem related to a higher risk of death from chronic degenerative diseases such as diabetes, cardiovascular diseases and several types of cancer. In epidemiological studies of big sample size, only self-reported weight and height can be collected for feasibility reasons and body mass index (BMI) estimates may be questioned. OBJECTIVES: In this study we compare self-reported and measured weight, height and BMI in a mostly young population of university students, and explore factors associated with discrepancies between self-reported and measured data. METHODS: In the period 2006-2012, 628 University students (476 women) from health sciences subject gave consent to participate in this study. Self-reported weight and height were collected by questionnaire and compared with weight and height measured afterward in health exams wearing light clothes and using standardized protocols. The validity of self-reported anthropometric estimates was explored by correlation coefficients and sensitivity, specificity, predictive values and kappa to detect measured overweight/obesity (BMI ≥ 25 kg/m²). Multiple linear regression was used to explore the factors related to the discrepancies between self-reported and measured data. RESULTS: The mean of self-reported weight, height and BMI was 62.5 kg, 167.6 cm and 22.1 kg/m² and the mean of measured data was 62.6 kg, 167.4 cm y 22.2 kg/m² respectively. Correlations between self-reported and measured data were r = 0.97 for weight, 0.96 for height and 0.95 for BMI. The sensitivity to detect overweight (IMC ≥ 25 kg/m²) using self-reported data was 81.0%, the specificity was 98.5%, the predictive value was 90.6% and the kappa index was 0.75. The discrepancy between measured and self-reported weight, height and BMI was associated with a higher age, and a higher sleeping time was also associated to discrepancies in self-reported and measured height. CONCLUSIONS: Despite the self-reported weight and BMI may underestimate the true weight and BMI, and self-reported height overestimate, the validity of self-reported anthropometric measures is adequate to use be used in epidemiological studies among young people with a high educational level.

Introducción: La obesidad es un problema de salud pública importante que se asocia a un mayor riesgo muerte por enfermedades crónico-degenerativas como diabetes, enfermedades cardiovasculares y varios cánceres. En estudios epidemiológicos de amplio tamaño donde a veces solo es posible obtener datos auto-referido de peso y talla, pueden surgir dudas sobre las estimaciones del índice de masa corporal (IMC). Objetivo: En este estudio se comparan datos auto-referido de peso, talla e IMC frente a datos obtenidos por medición directa en población adulta joven, y se analizan los factores asociados a la discrepancia entre datos referidos y medidos. Metodología: Entre 2006-2012 un total de 628 universitarios de ciencias de la salud (476 mujeres) aceptaron cumplimentar un cuestionario con preguntas sobre peso y talla y realizar posteriormente un examen físico con la toma del peso y talla siguiendo protocolos estandarizados en ropa ligera. El peso de la ropa ligera se sustrajo del peso medido en 1 kg para los hombres y 0,9 kg para las mujeres. Se analizó la validez de las estimaciones antropométricas auto-referidas frente a las medidas para peso, talla y obesidad mediante índices de sensibilidad, especificidad, valores predictivos y índice kappa y se usó regresión lineal múltiple para analizar los factores asociados a las discrepancias entre datos referidos y medidos. Resultado: La media del peso, talla e IMC auto-referido fueron 62,5 kg, 167,6 cm y 22,1 kg/m2, y de los medidos, 62,6 kg, 167,4 cm y 22,2 kg/m2 respectivamente. Las correlaciones entre datos declararos y medidos fueron de r = 0,97, 0,96 y 0,95 respectivamente. La sensibilidad para detectar exceso de peso (IMC ≥?25 kg/m2) mediante datos declarados fue del 81,0%, la especificidad del 98,5%, el valor predictivo positivo 90,6% y el índice kappa de 0,75. La discrepancia entre peso, talla e IMC medido y declarado se asoció significativamente con una mayor edad, y para la talla también con un mayor número de horas de sueño. Conclusiones: A pesar de una ligera infraestimación observada para el peso y el IMC y una sobreestimación para la talla auto-referidos, la validez de las medidas auto-referidas es adecuada para usar en estudios epidemiológicos en población joven.

[Mediterranean and Western dietary patterns in adult population of a Mediterranean area; a cluster analysis]. / Patrón de dieta mediterránea y occidental en población adulta de un área mediterránea; un análisis cluster.

OBJECTIVE: To identify dietary patterns among participants in a representative nutritional survey in the Valencia Community, and to analyze the association with socio-demographic characteristics and lifestyles. METHODS: Data for this study were from 1803 participants (973 women) in the Nutrition and Health Survey conducted in 1994 on a representative sample of adult population of Valencia Community. Diet was assessed by a validated food frequency questionnaire. Foods intakes were adjusted for 1,000 calories and grouped in 26 groups. Cluster analysis was used to identify dietary patterns using standardized values of the variables (z-scores). RESULTS: Three dietary patterns were identified and labeled as follows: the Prudent pattern (57.2%), characterized by a low-medium intake of most food of groups; the Mediterranean pattern (29.1%) characterized by high intake of fruits, vegetables, fish, poultry, cheese, and legumes; and the Western pattern (13.7%) characterized by high intake of meat and processed meats, high fat content foods, sweets and sugar, beverages, and alcoholic beverages. The Mediterranean pattern obtained higher scores for known diet quality index defined a priori. Using the Mediterranean pattern as reference, Western pattern included significantly more young people, higher number of men and smokers, and the Prudent pattern higher number of men, lower physical activity and lower alcohol consumption. CONCLUSION: Three dietary patterns were identified among participants in the Nutrition Survey of Valencia conducted in the mid-1990S: Prudent, Mediterranean and Western. The Prudent pattern was the most prevalent; the Mediterranean pattern was associated with healthier lifestyles and behaviors; and the Western pattern, the less prevalent although more frequently followed by youth, men and smokers. Further Nutrition Surveys should be carried out to make nutritional surveillance and analyze health effects of these observed patterns.

Antecedentes/objetivo: El objetivo de este estudio ha sido identificar patrones dietéticos a partir de los datos recogidos en la Encuesta de Nutrición y Salud de la Comunidad Valenciana realizada sobre una muestra representativa de población adulta y explorar los posibles factores asociados a los patrones identificados. Metodología: Un total de 1.803 individuos adultos (973 mujeres) participaron en la encuesta de Nutrición y Salud realizada en 1994 en la Comunidad Valenciana. La dieta fue evaluada mediante cuestionario de frecuencia alimentaria (CFA) validado de 93 ítems alimentarios. Las ingestas de alimentos se ajustaron por mil calorías y se crearon 26 grupos de alimentos usando valores estandarizados (z-scores) para la identificación de patrones dietéticos por el método análisis de k-medias prefijando 3 clúster. Se usó regresión logística multinomial múltiple para explorar la asociación entre patrones y variables sociodemográficas, antropométricas y de estilos de vida. Resultados: Se identificaron tres patrones dietéticos denominados como Prudente, Mediterráneo y Occidental. El patrón Prudente (57,2%) se caracterizó por un consumo intermedio de los principales grupos de alimentos; el Mediterráneo (29,1%) destacó por un elevado consumo de frutas, verduras y pescado; y el Occidental (13,7%) por un alto consumo de carnes rojas, embutidos, platos preparados, croquetas, bebidas azucaradas, dulces, chocolates y bebidas alcohólicas. El patrón Mediterráneo presentó las mayores puntuaciones para varios índices de calidad alimentaria analizados y definidos a priori en la literatura. Usando como referencia el patrón Mediterráneo, los que seguían un patrón Occidental fueron significativamente más jóvenes, un mayor número de hombres y fumadores; los que seguían un patrón Prudente presentaron un mayor número de hombres, no practicaban actividad física regular y menor consumo de alcohol. Conclusión: De los tres patrones dietéticos identificados como Prudente, Mediterráneo y Occidental en adultos de la Comunidad Valenciana a mediados de los noventa, el patrón Prudente fue el más prevalente, el Mediterráneo el que se asoció a conductas y hábitos de vida más saludables, y el Occidental el menos frecuente aunque fue más seguido entre jóvenes, hombres y fumadores. Se deberían realizar encuestas nutricionales que permitan hacer vigilancia nutricional y analizar la evolución de estos patrones dietéticos y sus posibles efectos sobre la mortalidad en población española.

Validez del peso y talla auto-referido en población universitaria y factores asociados a las discrepancias entre valores declarados y medidos / Validation of self-reported weight and height university population and factors associated with differences between self reported and measured antropometrics

Introducción: La obesidad es un problema de salud pública importante que se asocia a un mayor riesgo muerte por enfermedades crónico-degenerativas como diabetes, enfermedades cardiovasculares y varios cánceres. En estudios epidemiológicos de amplio tamaño donde a veces solo es posible obtener datos auto-referido de peso y talla, pueden surgir dudas sobre las estimaciones del índice de masa corporal (IMC). Objetivo: En este estudio se comparan datos auto-referido de peso, talla e IMC frente a datos obtenidos por medición directa en población adulta joven, y se analizan los factores asociados a la discrepancia entre datos referidos y medidos. Metodología: Entre 2006-2012 un total de 628 universitarios de ciencias de la salud (476 mujeres) aceptaron cumplimentar un cuestionario con preguntas sobre peso y talla y realizar posteriormente un examen físico con la toma del peso y talla siguiendo protocolos estandarizados en ropa ligera. El peso de la ropa ligera se sustrajo del peso medido en 1 kg para los hombres y 0,9 kg para las mujeres. Se analizó la validez de las estimaciones antropométricas auto-referidas frente a las medidas para peso, talla y obesidad mediante índices de sensibilidad, especificidad, valores predictivos y índice kappa y se usó regresión lineal múltiple para analizar los factores asociados a las discrepancias entre datos referidos y medidos. Resultado: La media del peso, talla e IMC auto-referido fueron 62,5 kg, 167,6 cm y 22,1 kg/m2, y de los medidos, 62,6 kg, 167,4 cm y 22,2 kg/m2 respectivamente. Las correlaciones entre datos declararos y medidos fueron de r = 0,97, 0,96 y 0,95 respectivamente. La sensibilidad para detectar exceso de peso (IMC > 25 kg/m2) mediante datos declarados fue del 81,0%, la especificidad del 98,5%, el valor predictivo positivo 90,6% y el índice kappa de 0,75. La discrepancia entre peso, talla e IMC medido y declarado se asoció significativamente con una mayor edad, y para la talla también con un mayor número de horas de sueño. Conclusiones: A pesar de una ligera infraestimación observada para el peso y el IMC y una sobreestimación para la talla auto-referidos, la validez de las medidas auto-referidas es adecuada para usar en estudios epidemiológicos en población joven (AU)

Introduction: Obesity is an important public health problem related to a higher risk of death from chronic degenerative diseases such as diabetes, cardiovascular diseases and several types of cancer. In epidemiological studies of big sample size, only self-reported weight and height can be collected for feasibility reasons and body mass index (BMI) estimates may be questioned. Objectives: In this study we compare self-reported and measured weight, height and BMI in a mostly young population of university students, and explore factors associated with discrepancies between self-reported and measured data. Methods: In the period 2006-2012, 628 University students (476 women) from health sciences subject gave consent to participate in this study. Self-reported weight and height were collected by questionnaire and compared with weight and height measured afterward in health exams wearing light clothes and using standardized protocols. The validity of self-reported anthropometric estimates was explored by correlation coefficients and sensitivity, specificity, predictive values and kappa to detect measured overweight/obesity (BMI > 25 kg/m2). Multiple linear regression was used to explore the factors related to the discrepancies between self-reported and measured data. Results: The mean of self-reported weight, height and BMI was 62.5 kg, 167.6 cm and 22.1 kg/m2 and the mean of measured data was 62.6 kg, 167.4 cm y 22.2 kg/m2 respectively. Correlations between self-reported and measured data were r = 0.97 for weight, 0.96 for height and 0.95 for BMI. The sensitivity to detect overweight (IMC > 25 kg/m2) using self-reported data was 81.0%, the specificity was 98.5%, the predictive value was 90.6% and the kappa index was 0.75. The discrepancy between measured and self-reported weight, height and BMI was associated with a higher age, and a higher sleeping time was also associated to discrepancies in self-reported and measured height. Conclusions: Despite the self-reported weight and BMI may underestimate the true weight and BMI, and self-reported height overestimate, the validity of self-reported anthropometric measures is adequate to use be used in epidemiological studies among young people with a high educational level (AU)

Patrón de dieta mediterráneo y occidental en población adulta de un área mediterránea; un análisis clúster / Mediterranean and western dietary patterns in adult population of a mediterranean area; a cluster analysis

Antecedentes/objetivo: El objetivo de este estudio ha sido identificar patrones dietéticos a partir de los datos recogidos en la Encuesta de Nutrición y Salud de la Comunidad Valenciana realizada sobre una muestra representativa de población adulta y explorar los posibles factores asociados a los patrones identificados. Metodología: Un total de 1.803 individuos adultos (973 mujeres) participaron en la encuesta de Nutrición y Salud realizada en 1994 en la Comunidad Valenciana. La dieta fue evaluada mediante cuestionario de frecuencia alimentaria (CFA) validado de 93 ítems alimentarios. Las ingestas de alimentos se ajustaron por mil calorías y se crearon 26 grupos de alimentos usando valores estandarizados (z-scores) para la identificación de patrones dietéticos por el método análisis de k-medias prefijando 3 clúster. Se usó regresión logística multinomial múltiple para explorar la asociación entre patrones y variables sociodemográficas, antropométricas y de estilos de vida. Resultados: Se identificaron tres patrones dietéticos denominados como Prudente, Mediterráneo y Occidental. El patrón Prudente (57,2%) se caracterizó por un consumo intermedio de los principales grupos de alimentos; el Mediterráneo (29,1%) destacó por un elevado consumo de frutas, verduras y pescado; y el Occidental (13,7%) por un alto consumo de carnes rojas, embutidos, platos preparados, croquetas, bebidas azucaradas, dulces, chocolates y bebidas alcohólicas. El patrón Mediterráneo presentó las mayores puntuaciones para varios índices de calidad alimentaria analizados y definidos a priori en la literatura. Usando como referencia el patrón Mediterráneo, los que seguían un patrón Occidental fueron significativamente más jóvenes, un mayor número de hombres y fumadores; los que seguían un patrón Prudente presentaron un mayor número de hombres, no practicaban actividad física regular y menor consumo de alcohol. Conclusión: De los tres patrones dietéticos identificados como Prudente, Mediterráneo y Occidental en adultos de la Comunidad Valenciana a mediados de los noventa, el patrón Prudente fue el más prevalente, el Mediterráneo el que se asoció a conductas y hábitos de vida más saludables, y el Occidental el menos frecuente aunque fue más seguido entre jóvenes, hombres y fumadores. Se deberían realizar encuestas nutricionales que permitan hacer vigilancia nutricional y analizar la evolución de estos patrones dietéticos y sus posibles efectos sobre la mortalidad en población española (AU)

OBJECTIVE: To identify dietary patterns among participants in a representative nutritional survey in the Valencia Community, and to analyze the association with socio-demographic characteristics and lifestyles. METHODS: Data for this study were from 1803 participants (973 women) in the Nutrition and Health Survey conducted in 1994 on a representative sample of adult population of Valencia Community. Diet was assessed by a validated food frequency questionnaire. Foods intakes were adjusted for 1,000 calories and grouped in 26 groups. Cluster analysis was used to identify dietary patterns using standardized values of the variables (z-scores).RESULTS: Three dietary patterns were identified and labeled as follows: the Prudent pattern (57.2%), characterized by a low-medium intake of most food of groups; the Mediterranean pattern (29.1%) characterized by high intake of fruits, vegetables, fish, poultry, cheese, and legumes; and the Western pattern (13.7%) characterized by high intake of meat and processed meats, high fat content foods, sweets and sugar, beverages, and alcoholic beverages. The Mediterranean pattern obtained higher scores for known diet quality index defined a priori. Using the Mediterranean pattern as reference, Western pattern included significantly more young people, higher number of men and smokers, and the Prudent pattern higher number of men, lower physical activity and lower alcohol consumption. CONCLUSION: Three dietary patterns were identified among participants in the Nutrition Survey of Valencia conducted in the mid-1990S: Prudent, Mediterranean and Western. The Prudent pattern was the most prevalent; the Mediterranean pattern was associated with healthier lifestyles and behaviors; and the Western pattern, the less prevalent although more frequently followed by youth, men and smokers. Further Nutrition Surveys should be carried out to make nutritional surveillance and analyze health effects of these observed patterns (AU)

Reproducibility and validity of a food frequency questionnaire among pregnant women in a Mediterranean area.

BACKGROUND: Studies exploring the role of diet during pregnancy are still scarce, in part due to the complexity of measuring diet and to the lack of valid instruments. The aim of this study was to examine the reproducibility and validity (against biochemical biomarkers) of a semi-quantitative food frequency questionnaire (FFQ) in pregnant women. METHODS: Participants were 740 pregnant women from a population-based birth cohort study in Valencia (INMA Study). We compared nutrient and food intakes from FFQs estimated for two periods of pregnancy (reproducibility), and compared energy-adjusted intake of several carotenoids, folate, vitamin B12, vitamin C and α-tocopherol of the FFQ in the first trimester with their concentration in blood specimens (validity). RESULTS: Significant correlations for reproducibility were found for major food groups and nutrients but not for lycopene (r=0.06); the average correlation coefficients for daily intake were 0.51 for food groups and 0.61 for nutrients. For validity, statistically significant correlations were observed for vitamin C (0.18), α-carotene (0.32), ß-carotene (0.22), lutein-zeaxantin (0.29) and ß-cryptoxantin(0.26); non-significant correlations were observed for retinol, lycopene, α-tocopherol, vitamin B12 and folate (r≤0.12). When dietary supplement use was considered, correlations were substantially improved for folate (0.53) and to a lesser extent for vitamin B12 (0.12) and vitamin C (0.20). CONCLUSION: This study supports that the FFQ has a good reproducibility for nutrient and food intake, and can provide a valid estimate of several important nutrients during pregnancy.

[Folic acid intake from diet and supplements in a population of pregnant women in Valencia, Spain]. / Ingesta dietética y de suplementos de ácido fólico en mujeres embarazadas de Valencia.

BACKGROUND AND OBJECTIVES: We examined the dietary intake and the use of supplements of folic acid (FA) in a cohort of pregnant women. We also explored the factors associated with non-compliance of both the recommended intake (RI) of 600 µg/day and the supplement use of 400 µg/day provided to prevent neural tube defects (NTD). PATIENTS AND METHODS: We studied 782 pregnant women from the INMA-Valencia cohort. The dietary intake was estimated using a food frequency questionnaire in two periods of pregnancy; from preconception to the second month and from the 3rd to the 7th month. Information on supplement use was also collected which allowed us to estimate the total FA intake (diet+supplements). We explored factors associated with non-compliance of the recommendations by logistic regression. RESULTS: The periconceptional mean daily FA intake was 304 µg/day. FA supplements were taken by 19.2, 30.2 and 66.2% of women in preconception, first and second month of pregnancy, respectively. Among women using supplements in periconception, 30% exceeded the tolerable upper intake level (UL) of 1.000 µg/day. Non-compliance with RI was more common among women of foreign origin, of low educational level, who smoked, with unplanned pregnancy, who did not visit a private gynaecologist, who had had children or without previous medical illness. CONCLUSIONS: Diet by itself is not sufficient to reach RI for FA during pregnancy and many women initiate supplement use after the recommended period and inadequately. The youngest women, with lowest educational attainment and unplanned pregnancies are more likely not to comply.

Ingesta dietética y de suplementos de ácido fólico en mujeres embarazadas de Valencia / Folic acid intake from diet and supplements in a population of pregnant women in Valencia, Spain

Fundamento y objetivos: Analizar la ingesta dietética y de suplementos de ácido fólico (AF) durante el embarazo y los factores asociados al incumplimiento de la ingesta recomendada (IR) de 600μg/d y al incumplimiento de 400μg/d de suplementos para prevenir los defectos del tubo neural. Pacientes y método: Se incluyeron a 782 embarazadas de la cohorte INMA-Valencia. La ingesta dietética se estimó mediante un cuestionario de frecuencia alimentaria en 2 períodos de embarazo, desde preconcepción al mes 2 y desde el mes 3–7. También se recogió información de la suplementación y se estimó la ingesta total de AF (dieta+suplementos). Usando regresión logística múltiple se exploraron los factores asociados al incumplimiento de las recomendaciones. Resultados: La ingesta dietética media periconcepcional de AF fue de 304μg/d. Un 19,2%, 30,2% y 66,2% de embarazadas tomaron suplementos de AF en preconcepción, primer y segundo mes, respectivamente. Por otra parte, alrededor del 30% de las mujeres que tomaban suplementos de AF en periconcepción superó el límite superior tolerable de 1.000μg/d. El ser no española, de bajo nivel de estudios, fumadora, no planificar el embarazo, no haber visitado a ginecólogo privado, haber tenido hijos y no haber tenido antecedentes médicos previos, se asoció al incumplimiento de la IR. Conclusiones: La dieta sola es insuficiente para alcanzar las IR de AF, puesto que la suplementación se hace tarde y mal. La situación se agrava en mujeres jóvenes, de menor nivel educativo y embarazo no planificado (AU)

Background and objectives: We examined the dietary intake and the use of supplements of folic acid (FA) in a cohort of pregnant women. We also explored the factors associated with non-compliance of both the recommended intake (RI) of 600μg/day and the supplement use of 400μg/day provided to prevent neural tube defects (NTD). Pacients and methods: We studied 782 pregnant women from the INMA-Valencia cohort. The dietary intake was estimated using a food frequency questionnaire in two periods of pregnancy; from preconception to the second month and from the 3rd to the 7th month. Information on supplement use was also collected which allowed us to estimate the total FA intake (diet+supplements). We explored factors associated with non-compliance of the recommendations by logistic regression. Results: The periconceptional mean daily FA intake was 304μg/day. FA supplements were taken by 19.2, 30.2 and 66.2% of women in preconception, first and second month of pregnancy, respectively. Among women using supplements in periconception, 30% exceeded the tolerable upper intake level (UL) of 1.000μg/day. Non-compliance with RI was more common among women of foreign origin, of low educational level, who smoked, with unplanned pregnancy, who did not visit a private gynaecologist, who had had children or without previous medical illness. Conclusions: Diet by itself is not sufficient to reach RI for FA during pregnanc and many women initiate supplement use after the recommended period and inadequately. The youngest women, with lowest educational attainment and unplanned pregnancies are more likely not to comply (AU)