Carbohydrate quality changes and concurrent changes in cardiovascular risk factors: a longitudinal analysis in the PREDIMED-Plus randomized trial.

BACKGROUND: Overall quality of dietary carbohydrate intake rather than total carbohydrate intake may determine the risk of cardiovascular disease (CVD). OBJECTIVE: We examined 6- and 12-mo changes in carbohydrate quality index (CQI) and concurrent changes in several CVD risk factors in a multicenter, randomized, primary-prevention trial (PREDIMED-Plus) based on an intensive weight-loss lifestyle intervention program. METHODS: Prospective analysis of 5373 overweight/obese Spanish adults (aged 55-75 y) with metabolic syndrome (MetS). Dietary intake information obtained from a validated 143-item semiquantitative food-frequency questionnaire was used to calculate 6- and 12-mo changes in CQI (categorized in quintiles), based on 4 criteria (total dietary fiber intake, glycemic index, whole grain/total grain ratio, and solid carbohydrate/total carbohydrate ratio). The outcomes were changes in intermediate markers of CVD. RESULTS: During the 12-mo follow-up, the majority of participants improved their CQI by increasing their consumption of fruits, vegetables, legumes, fish, and nuts and decreasing their consumption of refined cereals, added sugars, and sugar-sweetened beverages. After 6 mo, body weight, waist circumference (WC), systolic and diastolic blood pressure (BP), fasting blood glucose, glycated hemoglobin (HbA1c), triglyceride levels, triglycerides and glucose (TyG) index, and TyG-WC decreased across successive quintiles of improvement in the CQI. After 12 mo, improvements were additionally observed for HDL cholesterol and for the ratio of total to HDL cholesterol. Favorable improvements (expressed in common units of SD and 95% CI) for quintile 5 compared with quintile 1 of CQI change were observed for most risk factors, including TyG-WC (SD -0.20; 95% CI -0.26, -0.15), HbA1c (SD -0.16; 95% CI -0.23, -0.10), weight (SD -0.12; 95% CI -0.14, -0.09), systolic BP (SD -0.11; 95% CI -0.19, -0.02) and diastolic BP (SD -0.11; 95% CI -0.19, -0.04). CONCLUSIONS: Improvements in CQI were strongly associated with concurrent favorable CVD risk factor changes maintained over time in overweight/obese adults with MetS. This trial was registered as ISRCTN 89898870.

A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN Project.

BACKGROUND: Some studies have pointed out that several dietary patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations. The objective of the study was to compare and to establish the type of relationship between three diet quality scores and depression in the SUN (Seguimiento Universidad de Navarra) Cohort study. METHODS: We performed a dynamic cohort study based on Spanish university graduates free of depression at baseline. Dietary intake was repeatedly assessed at baseline and after 10 years of follow-up with a validated semi-quantitative food-frequency questionnaire. Three previously described diet quality scores: Mediterranean Diet Score (MDS), Pro-vegetarian Dietary Pattern (PDP) and Alternative Healthy Eating Index-2010 (AHEI-2010) were built. Participants were classified as having depression if they reported a new clinical diagnosis of depression by a physician or initiated the use of an antidepressant drug during follow-up. Time-dependent Cox regression models with cumulative averages of diet and restricted cubic splines were used to estimate hazard ratios of depression according to quintiles of adherence to the MDS, PDP and AHEI-2010. RESULTS: One thousand and fifty one incident cases of depression were observed among 15,093 participants from the SUN Cohort after a median follow-up of 8.5 years. Inverse and significant associations were observed between the three diet quality scores and depression risk. The hazard ratios and 95 % confidence intervals for extreme quintiles (fifth versus first) of updated adherence to MDS, PDP and AHEI-2010 were 0.84 (0.69-1.02), 0.74 (0.61-0.89) and 0.60 (0.49-0.72), respectively. The dose-response analyses showed non-linear associations, suggesting that suboptimal adherence to these dietary patterns may partially be responsible for increased depression risk. CONCLUSIONS: Better adherence to the MDS, PDP and AHEI-2010 was associated with a reduced risk of depression among Spanish adults. However, our data suggested a threshold effect so that although the risk of depression was reduced when comparing moderate versus lower adherence, there was not much extra benefit for the comparison between moderate and high or very high adherence.

Geographical and climatic factors and depression risk in the SUN project.

BACKGROUND: Depression incidence has been related with seasonal periodicity and climate. The aim of the study was to estimate the possible association between depression and specific meteorological factors, namely temperature, light and rain. METHODS: In total, 13,938 participants from the SUN (Seguimiento Universidad de Navarra) cohort study were included in the analysis. Subjects were classified according to daily mean temperature, number of daylight hours and amount of rain, by year, at their geographical area of residence, data supplied by the Spanish Agency of Meteorology. Participants were considered as incident cases of depression whenever they reported a physician diagnosis of depression or the use of antidepressant medication in any of the follow-up questionnaires. Cox regression models were fit to assess the relationship between climatic and geographical factors and the incidence of depression. RESULTS: Male subjects living in the south and centre areas of Spain showed a higher risk to develop depression compared with those living in the north area (hazard ratio = 1.6, 95% CI = 1.16-2.23 and hazard ratio = 1.41, 95% CI = 1.06-1.87, respectively). Moreover, among males, a direct association between the number of daily light hours and mean temperature and the risk of depression was also found. For men, living in rainy areas was associated with a lower risk of developing depression. CONCLUSION: Our results suggest that climate-depression relationship is more complex than previously thought, and strongly different between men and women.

Maternal obesity in early pregnancy and risk of adverse outcomes.

OBJECTIVES: To assess the role of the health consequences of maternal overweight and obesity at the start of pregnancy on gestational pathologies, delivery and newborn characteristics. METHODS: A cohort of pregnant women (n = 6.558) having delivered at the Maternal & Child University Hospital of Gran Canaria (HUMIGC) in 2008 has been studied. Outcomes were compared using multivariate analyses controlling for confounding variables. RESULTS: Compared to normoweight, overweight and obese women have greater risks of gestational diabetes mellitus (RR = 2.13 (95% CI: 1.52-2.98) and (RR = 2.85 (95% CI: 2.01-4.04), gestational hypertension (RR = 2.01 (95% CI: 1.27-3.19) and (RR = 4.79 (95% CI: 3.13-7.32) and preeclampsia (RR = 3.16 (95% CI: 1.12-8.91) and (RR = 8.80 (95% CI: 3.46-22.40). Obese women have also more frequently oligodramnios (RR = 2.02 (95% CI: 1.25-3.27), polyhydramnios. (RR = 1.76 (95% CI: 1.03-2.99), tearing (RR = 1.24 (95% CI: 1.05-1.46) and a lower risk of induced deliveries (RR = 0.83 (95% CI: 0.72-0.95). Both groups have more frequently caesarean section (RR = 1.36 (95% CI: 1.14-1.63) and (RR = 1.84 (95% CI: 1.53-2.22) and manual placenta extraction (RR = 1.65 (95% CI: 1.28-2.11) and (RR = 1.77 (95% CI: 1.35-2.33). Newborns from overweight and obese women have higher weight (p<0.001) and a greater risk of being macrosomic (RR = 2.00 (95% CI: 1.56-2.56) and (RR = 2.74 (95% CI: 2.12-3.54). Finally, neonates from obese mother have a higher risk of being admitted to special care units (RR = 1.34 (95% CI: 1.01-1.77). Apgar 1 min was significantly higher in newborns from normoweight mothers: 8.65 (95% CI: 8.62-8.69) than from overweight: 8.56 (95% CI: 8.50-8.61) or obese mothers: 8.48 (95% CI: 8.41-8.54). CONCLUSION: Obesity and overweight status at the beginning of pregnancy increase the adverse outcomes of the pregnancy. It is important to promote the normalization of bodyweight in those women who intend to get pregnant and to provide appropriate advice to the obese women of the risks of obesity at the start of the pregnancy.

Effect of zinc intake on serum/plasma zinc status in infants: a meta-analysis.

A systematic review and meta-analysis of available randomised controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on serum/plasma Zn status in infants. Out of 5500 studies identified through electronic searches and reference lists, 13 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on serum/plasma Zn concentration was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status and risk of bias. The pooled ß of status was 0.09 [confidence interval (CI) 0.05 to 0.12]. However, a substantial heterogeneity was present in the analyses (I(2) = 98%; P = 0.00001). When we performed a meta-regression, the effect of Zn intake on serum/plasma Zn status changed depending on the duration of the intervention, the dose of supplementation and the nutritional situation (P ANCOVA = 0.054; <0.001 and <0.007, respectively). After stratifying the sample according to the effect modifiers, the results by duration of intervention showed a positive effect when Zn intake was provided during medium and long periods of time (4-20 weeks and >20 weeks). A positive effect was also seen when doses ranged from 8.1 to 12 mg day(-1). In all cases, the pooled ß showed high evidence of heterogeneity. Zn supplementation increases serum/plasma Zn status in infants, although high evidence of heterogeneity was found. Further standardised research is urgently needed to reach evidence-based conclusions to clarify the role of Zn supplementation upon infant serum/plasma Zn status, particularly in Europe.

Effect of zinc intake on mental and motor development in infants: a meta-analysis.

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on mental and motor development in infants. Out of 5500 studies identified through electronic searches and reference lists, 5 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on mental and motor development was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional situation, and risk of bias. Indices of mental and motor development assessed were the Mental Development Index (MDI) and Psychomotor Development Index (PDI). Additionally we carried out a sensitivity analysis. The pooled ß was -0.01 (95 %CI -0.02, 0) for MDI and 0 (95 %CI -0.03, 0.02) for PDI, with a substantial heterogeneity in both analyses. When we performed a meta-regression, the effect of Zn supplementation on MDI changed depending on the dose of supplementation. Regarding PDI, there was a differential effect of Zn intake depending on intervention duration, dose of supplementation, nutritional situation, and risk of bias. Zn supplementation showed a negative, weak and significant effect on PDI score in those studies with a length of 4 to 20 weeks (ß= -0.05; CI 95 % -0.06 to -0.04). In conclusion, no association was found between Zn intake and mental and motor development in infants. Further standardized research is urgently needed to clarify the role of Zn supplementation upon infant mental and motor development, particularly in Europe.

Correction: Maternal Obesity in Early Pregnancy and Risk of Adverse Outcomes.

[This corrects the article DOI: 10.1371/journal.pone.0080410.].

Dietary assessment methods for micronutrient intake: a systematic review on vitamins.

The EURRECA Network of Excellence is working towards the development of aligned micronutrient recommendations across Europe. The purpose of the present study was to define how to identify dietary intake validation studies in adults pertaining to vitamins. After establishing a search strategy, we conducted a MEDLINE and EMBASE literature review. A scoring system was developed to rate the quality of each validation study according to sample size, statistical methods, data collection procedure, seasonality and vitamin supplement use. This produced a quality index with possible scores obtained ranging from 0.5 to 7. Five thousand four-hundred and seventy-six papers were identified. The numbers meeting the inclusion criteria were: for vitamin A, 76; vitamin C, 108; vitamin D, 21; vitamin E, 75; folic acid, 47; vitamin B12, 19; vitamin B6, 21; thiamine, 49; riboflavin, 49; and niacin, 32. The most frequently used method to ascertain dietary intake was the Food Frequency Questionnaire (FFQ), whereas dietary records (DR) and 24-h recalls were the most used reference methods. The correlation coefficients (CC) between vitamin intakes estimated by FFQ and the reference method were weighted according to the study's quality index and ranged from 0.41 to 0.53 when the reference method was the DR and from 0.43 to 0.67 when the reference was 24-h recalls. A minority of studies (n 33) used biomarkers for validation and in these the CC ranged from 0.26 to 0.38. The FFQ is an acceptable method of assessing vitamin intake. The present review provides new insights regarding the characteristics that assessment methods for dietary intake should fulfil.

Dietary assessment methods for intakes of iron, calcium, selenium, zinc and iodine.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence is working towards developing aligned micronutrient recommendations across Europe. The purpose of the present study was to conduct a review of methods used in validation studies carried out in adults assessing dietary intake of EURRECA priority minerals. A search strategy and inclusion criteria were defined and a scoring system was developed to rate the quality of each validation study that produced a quality index with possible scores obtained ranging from 0.5 to 7. A MEDLINE and EMBASE literature review was conducted. Articles/validation studies meeting the inclusion criteria included: 79/88 for Fe; 95/104 for Ca; 13/15 for Se; 29/30 for Zn; 7/9 for iodine. The most frequently used method to ascertain dietary intake was the Food Frequency Questionnaire (FFQ), whereas dietary records (DR) and 24 h recalls were the most used reference methods. The correlation coefficients (CC) between study mineral intakes estimated by FFQ and the reference method were weighted according to the study's quality index and obtained acceptable to good ratings, ranging from 0.36 to 0.60 when the reference method was DR and from 0.41 to 0.58 when the reference was 24 h recalls. A minority of studies (n 9) used biomarkers for validation and among these, five included iodine obtaining a CC of 0.47. The FFQ was seen as a valid method for assessing mineral intake, particularly for Ca and, to a lower extent, for iodine and Zn. Se and Fe showed only acceptable correlations. The present review provides new insights regarding the characteristics that assessment methods for dietary mineral intakes should fulfil.

Dietary assessment methods for micronutrient intake in pregnant women: a systematic review.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence needs clear guidelines for assessing the validity of reported micronutrient intakes among vulnerable population groups. A systematic literature search identified studies validating the methodology used for measuring usual dietary intake during pregnancy. The quality of each validation study selected was assessed using a EURRECA-developed scoring system. The validation studies were categorised according to whether the study used a reference method that reflected short-term intake ( < 7 d) long-term intake ( > or = 7 d) or used biomarkers (BM). A correlation coefficient for each micronutrient was calculated from the mean of the correlation coefficients from each study weighted by the quality of the study. Seventeen papers were selected, which included the validation of fifteen FFQ, two dietary records (DR), one diet history and a Fe intake checklist. Estimates of twenty-six micronutrients by six FFQ were validated against 24-h recalls indicating good correlation for six micronutrients. Estimates of twenty-four micronutrients by two FFQ were validated against estimated DR and all had good or acceptable correlations. Estimates of fourteen micronutrients by three FFQ were validated against weighed DR indicating good correlations for five. Six FFQ were validated against BM, presenting good correlations only for folic acid. FFQ appear to be most reliable for measuring short-term intakes of vitamins E and B6 and long-term intakes of thiamin. Apart from folic acid, BM do not add any more certainty in terms of intake method reliability. When frequency methods are used, the inclusion of dietary supplements improves their reliability for most micronutrients.

Dietary assessment methods for micronutrient intake in infants, children and adolescents: a systematic review.

A systematic literature search identified studies validating the methodology used for measuring the usual dietary intake in infants, children and adolescents. The quality of each validation study selected was assessed using a European micronutrient Recommendations Aligned-developed scoring system. The validation studies were categorised according to whether the study used a reference method that reflected short-term intake ( < 7 d), long-term intake ( > or = 7 d) or used biomarkers. A correlation coefficient for each nutrient was calculated from the mean of the correlation coefficients from each study weighted by the quality of the study. Thirty-two articles were included in the present review: validation studies from infants (1-23 months); child preschool (2-5 years); children (6-12 years); adolescents (13-18 years). Validation of FFQ studies in infants and preschool children using a reference method that reflected short-term intake showed good correlations for niacin, thiamin, vitamins B6, D, C, E, riboflavin, Ca, K, Mg, Fe and Zn (with correlations ranging from 0.55 for vitamin E to 0.69 for niacin).Regarding the reference method reflecting short-term intake in children and adolescents, good correlations were seen only for vitamin C (r 0.61) and Ca (r 0.51). Using serum levels of micronutrient demonstrated that the 3 d weighed dietary records was superior to the FFQ as a tool to validate micronutrient intakes. Including supplement users generally improved the correlations between micronutrient intakes estimated by any of the dietary intake methods and respective biochemical indices.

[Prevalence of obesity and overweight in adolescents from Canary Islands, Spain. Relationship with breakfast and physical activity]. / Prevalencia de obesidad y sobrepeso en adolescentes canarios. Relación con el desayuno y la actividad física.

BACKGROUND AND OBJECTIVE: To estimate the prevalence of obesity and overweight in Canary adolescents, evaluating its association with breakfast intake and physical activity. SUBJECTS AND METHOD: Cross-sectional study of a representative sample of children aged 12-14 years living in the island of Gran Canaria. They were weighed and measured and the prevalence of overweight and obesity was determined according to the 85th and 97th percentiles of the Spanish body mass index tables. Breakfast and physical activity characteristics were also studied using questionnaires. RESULTS: The overall prevalence of obesity and overweight was 26.1%, higher in females (29.5%) than in males (22.8%). Obesity affects 14.8% of all teenagers (17.6% of girls and 12.0% of boys). Highest overweight and obesity levels affect those aged 12 years, decreasing progressively with age. Those boys who have a more complete breakfast have lower prevalence rates. There was no association between obesity and overweight with physical activity, as measured by the number of hours devoted to watching television or playing videogames as opposed to hours devoted to sport. CONCLUSIONS: The prevalence of overweight and obesity is high, especially in girls. We observed an inverse relationship between breakfast and its quality and obesity.

Serum copper and zinc concentrations in a representative sample of the Canarian population.

Serum copper (Cu) and zinc (Zn) concentrations of 395 individuals (187 males + 208 females) living in Canary Islands were determined by flame atomic absorption spectrometry. The mean copper and zinc concentrations were 1.10 +/- 0.25 mg/L and 1.16 +/- 0.52 mg/L respectively. Our data were similar to other data published in other Spanish regions. Individuals from Lanzarote presented a mean Cu and Zn concentrations higher (p < 0.05) than individuals from the rest of islands; Individuals from EL Hierro showed the lowest (p < 0.05) mean Zn concentration. These differences could be attributed a differences in Cu and Zn contents of soil and/or differences in dietary habits of the populations. The mean serum Cu concentration in females was higher (p < 0.05) than in males, however serum Zn concentration did not vary with the sex of the subjects. No relation to socio-economic status and educational level were found with respect to the serum Cu and Zn concentrations. The serum Cu concentration varied with age of individuals, observing the highest (p < 0.05) Cu concentration in the 20-30 year old interval. A higher serum Cu concentration in females within 20-30 year old interval was observed. This could be due to a higher use of oral contraceptives or to the higher number of pregnancies. Boys (younger than 15) showed a decrease (p < 0.05) of the serum Cu concentration with age. The mean Zn concentrations in serum did not change (p > 0.05) among the different age intervals. No clear trends in the serum Cu and Zn concentrations were observed when drinking and smoking habits were considered. The increase of physical exercise reduced (p < 0.05) the serum Cu concentrations.

Epidemiología de la anemia ferropénicaen Canarias (ENCA 97-98) / Epidemiology of iron-deficiency anemia in the Canarian Islands (ENCA 97-98)

Fundamentos: El déficit de hierro es uno de los déficits nutricionales más frecuentes. Este trabajo describe la situación de la anemia ferropénica en Canarias mediante de los marcadores bioquímicos que definen cada etapa (ferritina; volumen corpuscular medio y hemoglobina).Métodos: Se obtuvieron muestras de sangre de los 782 participantes (de 6 a 75 años) en la fase de evaluación bioquímica de la Encuesta de Nutrición de Canarias (ENCA 97-98). Se muestran los porcentajes de la población que tienen valores inferiores a los rangos de normalidad para las variables seleccionadas (ferritina <12 mg/dl; VCM<80 fl.; hemoglobina <12 g/dl; <13 g/dl para hombres mayores de 11 años).Resultados: Ferritina: Por debajo del nivel de normalidad se encuentra el 15 por ciento de los participantes (4 por ciento de los hombres, 25 por ciento de las mujeres). El grupo más afectado son las mujeres menores de 49 años (31 por ciento). VCM: El 5 por ciento de los participantes está bajo el rango de normalidad. Eritropoyesis deficitaria en hierro: (ferritina baja + VCM bajo). En esta etapa se encuentra el 2,4 por ciento de los participantes (0,6 por ciento de los hombres, 4 por ciento de las mujeres). El grupo más afectado son, de nuevo, las mujeres menores de 49 años (5,4 por ciento). Hemoglobina: hay un 7 por ciento de individuos por debajo de su rango. Anemia ferropénica: (ferropenia + hemoglobina baja). En esta situación se encuentra el 1,5 por ciento de la población estudiada (0,3 por ciento de los hombres y 2,5 por ciento de las mujeres).Conclusiones: Los criterios que definen cada etapa varían según el estudio. La prevalencia de anemia ferropénica en ENCA supera ligeramente a otros estudios nacionales. La ferritina es el parámetro que está más afectado. El grupo más vulnerable son las mujeres de 18 a 49 años (AU)

Evaluación bioquímica del estado nutricional de la población canaria (1998) / Biochemical assessment of nutritional status in the Canary Island population (1998)

La evaluación del estado nutricional de una población debe incorporar una valoración dietética, bioquímica, clínica y antropométrica. Evaluar el estado nutricional de la población canaria mediante indicadores bioquímicos y hematológicos. Se realizó un estudio transversal sobre una submuestra representativa de 6 a 75 años que participó en la Encuesta Nutricional de Canarias, 1997-98 (ENCA). Se determinaron ferritina, vitamina B12 (enzimoinmunoensayo), ácido fólico sérico y eritrocitario (captura iónica automatizada), retinol, tocoferol y carotenos (cromatografía líquida de alta resolución) y minerales (espectrofotometía de absorción atómica). La participación fue del 48,8 por ciento con una distribución similar a la población incluída en la ENCA por edad, sexo y variables socioeconómicas. El 25 por ciento de las mujeres tenían niveles deficitarios de ferritina y la prevalencia de anemia en las mujeres mayores de 18 años fue del 2,9 por ciento. El 13 por ciento de la población tenía niveles de ácido fólico eritrocitario bajos, niveles que aumentan con la edad, y un 3,4 por ciento niveles bajos de vitamina B12, que por el contrario va disminuyendo. Un 15 por ciento de la población presentó déficit de alfa-tocoferol y un 5,2 por ciento de retinol, siendo más frecuentes en los más jóvenes, y el 56,4 por ciento y el 41,1 por ciento tenían niveles bajos de beta-caroteno y de licopeno respectivamente. Entre los minerales y elementos traza destacarón, por su elevada prevalencia de niveles bajos, el manganeso y, en menor medida, el selenio. A pesar de la complejidad de su interpretación, los datos aportan una precisa estimación del estado nutricional en algunas vitaminas y minerales para la población canaria