Prevalencia de obesidad y factores de riesgo cardiovascular asociados en la población general española: estudio ENPE / Prevalence of obesity and associated cardiovascular risk factors in the Spanish population: the ENPE study

Introducción y objetivos: La obesidad es un importante problema de salud pública y se asocia con mayor riesgo de adquirir factores de riesgo cardiovascular (FRCV). En este estudio se estima la prevalencia de sobrecarga ponderal y obesidad abdominal (OA) en población española de edad ≥ 3 años y se analiza la influencia de factores sociodemográficos y estilos de vida y la relación con los FRCV. Métodos: La muestra procede del estudio ENPE (n=6.800). El protocolo incluía mediciones antropométricas individuales, factores sociodemográficos, consumo alimentario (cuestionario sobre frecuencia de consumo), actividad física, estilos de vida y problemas de salud. Resultados: La prevalencia total estimada de obesidad (22,0%; IC95%, 21,0%-23,0%) y OA (64,7%; IC95%, 63,5%-65,8%) es mayor en varones, con edad ≥ 65 años y menor nivel socioeconómico y de la región sur. El perfil de estilos de vida se asocia significativamente con obesidad y OA (p=0,011), con menor probabilidad de obesidad en el perfil más activo (p<0,0001). La obesidad (OR=1,85; IC95%, 1,24-2,78) y la OA (OR=2,16; IC95%, 1,1-4,24) se asocian positivamente con FRCV. La coexistencia de FRCV con OA es mayor entre las mujeres (12,6%; IC95%, 11,4%-13,9%) y aquellos con edad ≥ 65 años (32,7%; IC95%, 30,0%-35,4%). Conclusiones: La prevalencia de obesidad y OA en población española es alta, mayor en varones, aumenta con la edad y presenta relación inversa con el nivel socioeconómico. El perfil de estilos de vida con mayor nivel de actividad física, sedentarismo moderado y patrón alimentario mediterráneo se asocia con menor probabilidad de obesidad, OA y FRCV (AU)

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 (AU)

The relationship between zinc intake and growth in children aged 1-8 years: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: It is estimated that zinc deficiency affects 17% of the world's population, and because of periods of rapid growth children are at an increased risk of deficiency, which may lead to stunting. This paper presents a systematic review and meta-analysis of the randomised controlled trials (RCTs) that assess zinc intake and growth in children aged 1-8 years. This review is part of a larger systematic review by the European Micronutrient Recommendations Aligned Network of Excellence that aims to harmonise the approach to setting micronutrient requirements for optimal health in European populations (www.eurreca.org). SUBJECT/METHODS: Searches were performed of literature published up to and including December 2013 using MEDLINE, Embase and the Cochrane Library databases. Included studies were RCTs in apparently healthy child populations aged from 1 to 8 years that supplied zinc supplements either as capsules or as part of a fortified meal. Pooled meta-analyses were performed when appropriate. RESULTS: Nine studies met the inclusion criteria. We found no significant effect of zinc supplementation of between 2 weeks and 12 months duration on weight gain, height for age, weight for age, length for age, weight for height (WHZ) or WHZ scores in children aged 1-8 years. CONCLUSIONS: Many of the children in the included studies were already stunted and may have been suffering from multiple micronutrient deficiencies, and therefore zinc supplementation alone may have only a limited effect on growth.

General parenting styles are not strongly associated with fruit and vegetable intake and social-environmental correlates among 11-year-old children in four countries in Europe.

OBJECTIVES: To investigate whether fruit and vegetable (F&V) intake in 11-year-olds, and social-environmental correlates of F&V intake such as parental modelling and encouragement, family food rules and home availability, differ according to general parenting styles in Belgium, The Netherlands, Portugal and Spain. DESIGN: Cross-sectional study. SETTING: Primary schools in four countries. SUBJECTS: Pupils and one of their parents completed questionnaires to measure F&V intake, related social-environmental correlates and general parenting styles. The sample size was 4555 (49.3 % boys); 1180 for Belgium, 883 for The Netherlands, 1515 for Portugal and 977 for Spain. Parenting styles were divided into authoritative, authoritarian, indulgent and neglectful. RESULTS: No differences were found in F&V intake across parenting styles and only very few significant differences in social-environmental correlates. The authoritarian (more parental encouragement and more demands to eat fruit) and the authoritative (more availability of fruit and vegetables) parenting styles resulted in more favourable correlates. CONCLUSION: Despite earlier studies suggesting that general parenting styles are associated with health behaviours in children, the present study suggests that this association is weak to non-existent for F&V intakes in four different European countries.

How many children and adolescents in Spain comply with the recommendations on physical activity?

AIM: Physical inactivity is likely one of the main causes of obesity and other chronic diseases. This study shows descriptive data on physical activity and compliance with the health enhancing physical activity recommendations for children and adolescents and the determining factors among the Spanish population. METHODS: The population of the study was enrolled for the enKid study, a cross-sectional study carried out on a representative sample of Spanish children, adolescents and youth to evaluate nutritional status and food intake. A subsample of the enKid study including individuals from 6 to 18 years was evaluated for compliance with the recommendation for health enhancing physical activity. RESULTS: The results showed that only 48% of individuals from 6 to 18 years did at least 60 minutes of physical activity daily. Forty nine percent of girls and 37% of boys did not practice any sports during their leisure time. The percentage of active people diminishes as they get older, especially with reference to girls. Social status and mother's educational level act positively on the level of physical activity of the population. CONCLUSION: Exercise is not a widespread leisure time activity in Spanish children and youth and few individuals did enough exercise for health promotion. Public health campaigns should take into account socio-economic variables and improve the access to sports facilities.

[School meals: state of the art and recommendations]. / El comedor escolar: situación actual y guía de recomendaciones.

School meals contribute substantially to overall energy and nutrient intake adequacy of children, but also play an important role in the development of child food habits and the socialisation process. Evidence shows that school based environmental actions, which include changes in school meals and school food policies related to increased availability and access to healthy foods and drinks while in the school are effective to foster healthy eating practices among children. A growing number of children engage in school meals. Available information to date shows that the quality of the food on offer is not always consistent with dietary guidelines. Vegetables and fish are served less often than desirable and excess added fats are used in food preparations. Norms and regulations are very detailed regarding food safety issues and administrative management of the service, including subcontracting of catering providers and care staff. Nutrition and health promotion issues should also be included in regulations by means of nutrition recommendations for school meals along with information on food based dietary guidelines and portion sizes. School meals should be part of the educational project using a whole school approach.

El comedor escolar: situación actual y guía de recomendaciones / School meals: state of the art and recommendations

Los comedores escolares desempeñan una función nutricional y educativa importante, contribuyen a la adquisición de hábitos alimentarios y son marco de socialización y convivencia. Existe evidencia de que las intervenciones ambientales que incorporan modificaciones en la composición de los menús ofertados en el colegio y en las políticas reguladoras son efectivas para fomentar la adquisición de hábitos alimentarios saludables entre los escolares. Cada vez es mayor el número de usuarios de este servicio. La información disponible en este momento indica que la oferta dietética no siempre es consistente con las guías alimentarias para este colectivo. Los aportes insuficientes de verduras, hortalizas, frutas y pescados son los errores más frecuentes, junto con el empleo excesivo de grasas añadidas en las preparaciones culinarias. La normativa reguladora actual observa meticulosamente los aspectos higiénicos y sanitarios y de gestión económica administrativa, incluida la contratación de empresas suministradoras y personal cuidador. Es necesario que incorpore también los aspectos nutricionales, educativos y de promoción de salud de estos aportes a través de un marco formal de recomendaciones nutricionales para las comidas escolares que incluya información sobre guías alimentarias, tamaño de las raciones, dinámica del servicio y atención a necesidades especiales. El comedor escolar debería incorporarse a los proyectos educativos de los centros docentes y gestionarse con una visión integral y profesionalizada (AU)

School meals contribute substantially to overall energy and nutrient intake adequacy of children, but also play an important role in the development of child food habits and the socialisation process. Evidence shows that school based environmental actions, which include changes in school meals and school food policies related to increased availability and access to healthy foods and drinks while in the school are effective to foster healthy eating practices among children. A growing number of children engage in school meals. Available information to date shows that the quality of the food on offer is not always consistent with dietary guidelines. Vegetables and fish are served less often than desirable and excess added fats are used in food preparations. Norms and regulations are very detailed regarding food safety issues and administrative management of the service, including subcontracting of catering providers and care staff. Nutrition and health promotion issues should also be included in regulations by means of nutrition recommendations for school meals along with information on food based dietary guidelines and portion sizes. School meals should be part of the educational project using a whole school approach (AU)

Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: the Pro Children Study.

The objective of the present study was to evaluate the effects of the Pro Children intervention on schoolchildren's fruit and vegetable (FV) intake after 1 and 2 years of follow-up. The intervention combined a FV curriculum with efforts to improve FV availability at schools and at home. Effects were examined in a group-randomised trial among 1,472 10-11-year-old children from sixty-two schools in Norway, the Netherlands and Spain. FV intake was assessed by means of validated self-administered questionnaires completed before the intervention (September 2003), immediately after the first year of the intervention (May 2004) and 1 year later (May 2005). Data were analysed using multilevel linear regression analyses with age and sex as covariates. Significant intervention effects for FV intake were found at first follow-up in the total sample. The adjusted FV intake reported by the children from intervention schools was 20 % higher than FV intake reported by children from control schools. At 1 year later, a significant impact was only observed in Norway. Positive intervention effects on FV intake occurred both at school and outside school. We conclude that the Pro Children intervention is a promising means to promote European schoolchildren's FV intakes, but mainly fruit intake, in the short term. As shown in Norway, where the intervention was best implemented, the intervention might also result in longer-term effects. Further strategies need to be developed that can improve implementation, have an impact on vegetable intake and can secure sustained effects.

Appreciation and implementation of a school-based intervention are associated with changes in fruit and vegetable intake in 10- to 13-year old schoolchildren--the Pro Children study.

The purpose was to investigate the degree of implementation and appreciation of a comprehensive school-randomized fruit and vegetable intervention program and to what extent these factors were associated with changes in reported fruit and vegetable intake. The study was conducted among 10- to 13-year old children exposed to the intervention during the school year 2003-04 in Norway, Spain and the Netherlands. Children, parents and teachers completed questionnaires regarding (i) the implementation of the school curriculum, (ii) parental involvement, (iii) distribution of fruit and vegetables at school, (iv) children's appreciation of the project and (v) children's intake levels. Univariate analyses of covariance and multilevel multivariate regression analyses indicated that teacher-reported level of implementation of the school curriculum and schoolchildren's appreciation of the project were important determinants of changes in intake. The results point to the importance of optimal implementation of an attractive school curriculum.

Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries.

OBJECTIVE: To investigate potential personal, social and physical environmental predictors of daily fruit intake and daily vegetable intake in 11-year-old boys and girls in nine European countries. SUBJECTS: The total sample size was 13 305 (90.4% participation rate). RESULTS: Overall, 43.2% of the children reported to eat fruit every day, 46.1% reported to eat vegetables every day. Daily fruit intake and daily vegetable intake was mainly associated with knowledge of the national recommendations, positive self-efficacy, positive liking and preference, parental modeling and demand and bringing fruit to school (odds ratio between 1.40 and 2.42, P<0.02). These factors were associated fairly consistently with daily fruit intake across all nine European countries, implying that a rather uniform intervention strategy to promote fruit can be used across Europe. For vegetables, the pattern was, however, less consistent. Differences between countries in cooking and preparing vegetables might be responsible for this larger diversity. CONCLUSIONS: This study showed that especially a combination of personal and social factors is related to daily fruit and vegetable intake in schoolchildren. This shows that a comprehensive multilevel intervention strategy based upon a series of individual and social correlates will be most promising in the promotion of daily fruit and vegetable intake in children.

Análisis de las encuestas de hábitos alimentarios realizadas en población escolar durante la 4ª edición del Día Nacional de la Nutrición (DNN) 2005 / No disponible

El día nacional de la nutrición (DNN) sigue siendo un marco importante y de mucho interés a nivel nacional. En el pasado año 2005, el 28de mayo estuvo dedicado a la alimentación infantil, bajo el lema “Ejercicio y buena alimentación para un futuro mejor”, donde se quiso profundizaren algunos aspectos de la alimentación de los niños españoles en edad escolar y transmitir el mensaje sobre la importancia de una buena nutrición en esta etapa de la vida, puesto que incide de forma decisiva en la salud del adulto. Para la evaluación del consumo alimentario habitual de los niños escolares en España, incluyendo el consumo de refrescos, golosinas, bollos y aperitivos, se han analizado los Datos de 2078 cuestionarios, auto-administrados, respondidos por los padres de los niños participantes de las charlas educativas sobre la alimentación infantil y la práctica de actividad física en esa edición del DNN. El cuestionario consistió en 14 preguntas cerradas de opción múltiple y una frecuencia de consumo habitual de alimentos. Los resultados observados corroboraron la importancia del desayuno como condicionante de un mejor patrón alimentario. Las frutas, verduras y legumbres, son las grandes olvidadas, paralelo a un consumo excesivo de fiambres. Sin embargo, el consumo de alimentos energéticos(arroz, pasta, patata, pan), de lácteos, huevos, carnes y pescado ha mostrado frecuencia y variabilidad aceptable en la mayoría de los niños. El hecho de disponer de dinero, así como la realización de la comida en el hogar implica un mayor consumo de chucherías, bollería, etc, y refuerza la importancia del rol de los padres en la adecuada oferta de alimentos. El elevado consumo de estos alimentos y, especialmente, de refrescos sigue siendo preocupante, porque parece estar repercutiendo negativamente en la elección de alimentos sanos. El consumo diario de alimentos de bajo valor nutricional pero de alto contenido calórico, añadido a la ingesta de alimentos y bebidas entre horas, pueden representar un riesgo para el desarrollo de sobrepeso, sobre todo si no existe una educación adecuada. Resulta importante aclarar conceptos de equivalencia nutricional de los alimentos, fundamentalmente en cuanto a vitaminas, minerales y fibra, así como la pérdida de nutrientes por la manipulación y procesos culinarios, puesto que se observó una marcada equivocación al elegir zumos de frutas en lugar de frutas frescas, verduras y patatas. Por todo ello, concluimos que si bien no debe excluirse ningún alimento, debemos seguir educando para una mejor selección de los mismos (AU)

The Nutrition National Day (DNN) has been representing an important educational event in Spain, being useful to population. In May 28th,2005, the DNN was dedicated to infant feeding with the slogan "Exercise and good food for a better future", in order to know some aspects of the feeding of children in scholar age and transmit the message about the importance of a good nutrition in this age, given that it affects, in a decisive manner, the adult health. To evaluate habitual nourishing consumption by Spanish children in scholar age, including beverages, sweets, buns and appetizers, 2078questionnaires were analyzed. These questionnaires were formed by 14 multiple-choice questions and a food frequency questionnaire; that were fulfilled by the parents of the children whose have participated in an educative conference about nutrition offered in selected schools in Spain. The results showed the importance of eating daily breakfast on better nourishing habits. The fruits, vegetables and grains, are less consumed, while cold cuts were much consumed. However, the energetic foods (like rice, mass, potatoes, bread), of dairy products, eggs, meats and fishes, demonstrated an acceptable frequency and variety of consumption in the majority of the children. When the children had money to spend by themselves and when they had a lunch at home, they used to eat more sweets, buns and appetizers, etc., emphasizing the importance of parents in the suitable education on the correct elections of foods. The high consumption of these foods, especially beverages, continues being worrisome, since it seems to be influencing negatively in the election of healthy foods. The daily consumption of food with low nutritional value, but with a high caloric content, together with an ingestion of foods and drinks out of meals time, may represent a risk of overweight, mainly if does not exist a suitable education. It would be interesting to elucidate some concepts of nutritional equivalency, specially based on vitamins, minerals, fibre, as well as loss of nutrients by manipulation and cooking process, because great mistakes was observed when a fruit juice was preferred to a fresh fruit, vegetables and potatoes. In conclusion, knowing that healthy people do not need to exclude any food of diet, it must benecessary to continue educating the population to get a better selection of foods (AU)

Epidemiology of obesity in Spain. Dietary guidelines and strategies for prevention.

Obesity is considered a major Public Health issue in most developed countries nowadays for its wide spread across population groups, as well as its contribution to the development of chronic diseases, particularly cardiovascular diseases and diabetes. Available population data in Spain from the SEEDO'2000 study show a prevalence of obesity (BMI > or = 30 kg/m(2)) of 14,5% in adults aged 25-60 years, estimates based on individual measurement of body weight and height. Obesity rates are higher among women aged 45 years and older, low social class, living in semi-urban places. Geographical distribution of the problem shows a trend for higher rates towards the South- SouthEast of the country, i.e. Andalucía, Murcia and the Canary Islands. Population data for Spanish children and young people based on the enKid study--cross-sectional study on a random national sample of the population aged 2-24 years--estimate a prevalence of obesity of 13.9% for the whole group. Geographical distribution draws a similar pattern to that described for adults. Higher peaks of the problem are identified between 9-13 years among boys from a low socioeconomical background. The analysis of determinants of obesity in Spanish children and young people show that overweight and obesity is related to absence of breastfeeding, low consumption of fruit and vegetables; high consumption of cakes and buns, soft drinks and butchery products, low physical activity levels and a positive association with time spent watching TV. The joint consensus document produced by the Spanish Association of Pediatrics (AEP), Spanish Society of Community Nutrition (SENC) and Spanish Society for the Study of Obesity (SEEDO) considers a global strategy for the prevention of obesity from early stages in life. The important role of the family and the school setting as well as the responsibility of the Health Administration and Pediatric care in the prevention of obesity is highlighted in the document.

[Community nutrition]. / Nutrición comunitaria.

A growing body of scientific and epidemiological evidence indicates that diet and health are related: diet may be a risk factor or have potential protective effects. As a consequence, the focus of nutrition research has experienced a shift towards qualitative aspects of diet which could influence chronic disease, longevity, quality of life and physical and cognitive performance, leading to the development of Community Nutrition. The main undertakings in a Community Nutrition Unit are related to the identification, assessment and monitoring of nutrition problems at the community level and to planning, design, implementation and evaluation of nutrition intervention programs. Such programs combine a number of suitable strategies in a whole population approach, a high risk approach or an approach targeted at specific population groups, and are implemented in different settings, such as the work place, schools or community organizations. Community nutrition interventions aim to gradually achieve change in eating patterns towards a healthier profile. Community Nutrition programs require the use of a combination of strategies and a working group of people from different backgrounds. Many factors influence the nutritional status of an individual or a population. In order to gain effective work output, sound understanding of these patterns and a practical surveillance system are required.

Nutrición comunitaria / Community nutrition

Cada vez es más sólida la evidencia científica y epidemiológica sobre la relación entre distintos aspectos de la dieta como factores de riesgo o bien con potencial protector para la salud. Este hecho ha suscitado un creciente interés por los aspectos cualitativos que pudieran repercutir en mayor medida en la génesis de las enfermedades crónicas, la calidad de vida, las potencialidades físicas e intelectuales y la longevidad y que han dado lugar al desarrollo de la Nutrición Comunitaria. Las principales funciones prácticas que se desarrollan en una Unidad de Nutrición Comunitaria consisten en identificar y evaluar problemas nutricionales de la comunidad y diseñar, organizar, implementar y evaluar programas de intervención nutricional mediante distintas estrategias orientados hacia el medio ocupacional, medio escolar, colectivos de riesgo o para la población general. Las intervenciones en la comunidad pretenden conseguir gradualmente una adecuación del modelo nutricional hacia un perfil más saludable. Los programas de Nutrición Comunitaria requieren el abordaje de estrategias de distinta naturaleza de manera simultánea en un equipo multidisciplinar. Son numerosos los aspectos que influyen en el estado nutricional de un individuo o de una población y que es necesario conocer y vigilar para conseguir un trabajo efectivo (AU)

A growing body of scientific and epidemiological evidence indicates that diet and health are related: diet may be a risk factor or have potential protective effects. As a consequence, the focus of nutrition research has experienced a shift towards qualitative aspects of diet which could influence chronic disease, longevity, quality of life and physical and cognitive performance, leading to the development of Community Nutrition. The main undertakings in a Community Nutrition Unit are related to the identification, assessment and monitoring of nutrition problems at the community level and to planning, design, implementation and evaluation of nutrition intervention programs. Such programs combine a number of suitable strategies in a whole population approach, a high risk approach or an approach targeted at specific population groups, and are implemented in different settings, such as the work place, schools or community organizations. Community nutrition interventions aim to gradually achieve change in eating patterns towards a healthier profile. Community Nutrition programs require the use of a combination of strategies and a working group of people from different backgrounds. Many factors influence the nutritional status of an individual or a population. In order to gain effective work output, sound understanding of these patterns and a practical surveillance system are required (AU)

Epidemiología y factores determinantes de la obesidad infantil y juvenil en España / No disponible

No disponible

[School-based education strategies to promote fruit and vegetable consumption: the Pro Children Project]. / Estrategias educativas para la promoción del consumo de frutas y verduras en el medio escolar: Proyecto Pro Children.

Available population data suggest that a high proportion of European children and young people eat less fruit and vegetables than desirable. School based health promotion strategies fostering healthy eating practices and regular physical activity has the potential for a major impact on health and wellbeing during childhood and later stages in life. The aim of Pro-Children project is to estimate the consumption of fruit and vegetables as well as its main determinants among 11 year old European children and their families. It also aims to develop and assess the effectiveness of a school-based intervention program to promote adequate consumption levels of fruit and vegetables among school children. In the first phase of the project, cross-sectional studies were carried out on random population samples in nine European countries. The study protocol included assessment of fruit and vegetable consumption and a questionnaire to ascertain key determinants. A school-based intervention program was designed based on the Attitude, Social Influence and Self-Efficacy model (ASE). Theoretically similar but culturally relevant interventions were designed to be tested in Norway, The Netherlands and Spain during two school years. Each intervention site follows-up 10 intervention schools implementing the program and 10 control schools. Intervention planning and design followed an intervention mapping procedure. Key behaviours and determinants to be addressed through the intervention were identified in order to develop a matrix of educational objectives. The provision of fruit and vegetables in the school is an outstanding element. Program activities include guided classroom activities, computer tailored messages for children, activities to be completed at home with the family and family targeted specific actions. Additionally, optional components for community reinforcement include mass media, school health services participation and implication of grocery stores in the project. Despite cultural and social diversity, common school-based strategies to increase fruit and vegetable consumption among children are feasible across Europe. Understanding specific situations will enhance implementation and gain support.

[Food habits of students using school dining rooms in Spain. "Tell Me How You Eat" Study]. / Hábitos alimentarios de los alumnos usuarios de comedores escolares en España. Estudio "Dime Cómo Comes"

OBJECTIVE: To describe food habits of school-aged population having school meals and to evaluate perceived quality of the service. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Community School lunchrooms in different Spanish regions. PARTICIPANTS: Random population sample of children and young people (3-16 year) having school meals in Spain. MEASUREMENTS: The study protocol included socio-economical data, food consumption and dietary habits at the school and out of the school. Information was collected by means of two questionnaires: one completed by children at school and a second one completed by the family at home. RESULTS: Valid response was collected from 322 children and 212 families, a response rate of 96.1% children and 63.3% of the families. 88% of the children reported daily consumption of breakfast, 45% used to have a midmorning snack, which consisted of a sandwich (29%); sweet bakery products (27%) or biscuits (15%). 45% of the 12-16-year-old old group reported eating only half of the portion served at lunch in the school, mainly due to disgusting taste or preparation (50%). In the school menus vegetables and fish were offered less frequently than other food groups. 81% of the children referred having an after-school snack in the afternoon, consisting of a sandwich (65%); bakery products (20%); bread and chocolate (20%); yoghurt or fruit (20%). CONCLUSIONS: School meals provide a wonderful opportunity to widen the variety of foods in the daily diet of children. Recommendations about school meals should address the quality and variety of the foods served for a healthy diet and stress the educational dimension.

Nutrient adequacy and Mediterranean Diet in Spanish school children and adolescents.

OBJECTIVE: To evaluate dietary habits and nutritional status of Spanish school children and adolescents, and their relationship with the Mediterranean Diet. DESIGN: Cross-sectional study by face-to-face interview. SETTING: Free living children and adolescents of all Spanish regions. SUBJECTS: A random sample of 3166 people aged 6-24 y. METHODS: Home interviews conducted by a team of 43 dietitians included 24-h recalls (a second 24-h recall in 25% of the sample) and a short frequency questionnaire to determine the quality of the Mediterranean Diet (KIDMED). RESULTS: The participation rate was 68%. In general, the adequacy of the Mediterranean Diet rose with increased mean intakes of the majority of vitamins and minerals and decreased percentages of inadequate intakes (&<2/3 of the RNI) for calcium, magnesium, vitamin B(6) and C in both sexes, and iron and vitamin A only in females. CONCLUSIONS: This study demonstrates that the Mediterranean Diet contributes to nutritional quality, and also shows concomitant risks as the Mediterranean Diet deteriorates.

Sociodemographic and lifestyle determinants of food patterns in Spanish children and adolescents: the enKid study.

OBJECTIVE: To analyse prevailing food patterns among Spanish children and young people and their relationship to sociodemographic and lifestyle factors. DESIGN: Cross-sectional population survey. SETTING: Population study. Data were collected at participants' home addresses. SUBJECTS: Random sample of the Spanish population aged 2-24 y (n=3534; 1629 boys and 1905 girls). INTERVENTIONS: Food consumption was assessed by means of a 24-h recall and a food frequency questionnaire. Sociodemographic and lifestyle related data were collected by specially designed questionnaires, previously pretested and validated. All the information was collected during a personal interview by trained dietitians. DATA COLLECTION: May 1998-April 2000. RESULTS: Average consumption of fruit and vegetables was low. The youngest age group (2-5 y) showed the lowest proportions of inadequacy for the dairy group (P<0,001; chi(2)=39.11 boys; chi(2)=49.60 girls). Factor analysis identified five main components of dietary patterns. The 'Snacky' pattern was characterised by more frequent and higher consumption of bakery products (buns, cakes and biscuits), sweets, salted snacks and soft drinks. Higher intakes of fruit, vegetables and fish were associated to the 'Healthy' pattern. Children whose mother had a low level of education and those who spent more than 2 h daily watching TV were more likely to follow the 'Snacky' pattern. Girls were more likely to follow the 'Healthy' pattern, while children and young people whose mother had a lower level of education were less likely. CONCLUSION: Results from this study highlight the importance of enhancing school-based and community-based actions to promote healthy eating and physical activity addressed to children and young people.

Food preferences of Spanish children and young people: the enKid study.

OBJECTIVE: To describe the profile of food preferences, likes and dislikes of Spanish children and young people and analyse its connection with prevailing food patterns. DESIGN: Cross-sectional population survey. SETTING: Population study. Data were collected at participants' home address. SUBJECTS: Random sample of the Spanish population aged 2-24 y (n=3534; 1629 boys and 1905 girls). INTERVENTIONS: Food preferences, food consumption and practices as well as nutrition-related information were assessed by means of a multiple choice questionnaire. A food preference score was computed considering food items ranked as first, second or third choice within each food group. Data collection was carried out during May 1998-April 2000. RESULTS: Bananas and apples were the fruit items preferred by Spanish children and young people across all age and gender groups. Within the vegetable group tomato sauce and salads, particularly lettuce and tomato salad scored highest, followed by carrots in all age and gender groups. However, 47% (95% confidence interval 46-48%) of the sample reported dislike for vegetables and an additional 5.7% (95% confidence interval 4.9-6.5%) a dislike for fruit. The proportion of individuals with low consumption of vegetables or fruit was significantly higher among those reporting a dislike either for vegetables (chi(2)=127.69; P<0.001); fruit (chi(2)=24.62; P<0.001) or for both groups (chi(2)=81.53; P<0.001). CONCLUSION: There is a significant relationship between the likes/dislikes for fruits and vegetables and usual consumption of this food group among children and young people. Strategies addressed to improve acceptance for this food group should be considered when designing interventions aimed at promoting adequate consumption of fruits and vegetables among children and young people.

Nutrition education in schools: experiences and challenges.

Health promotion from the early stages in life by fostering healthy eating practices and regular physical activity has the potential for a major impact on health and well-being during childhood and later stages in life.School-based nutrition education should consider the needs and interests of students, teachers and the school. Educational strategies include efforts to increase health awareness, communication and skill building. Previous literature reviews identified educational strategies directly relevant to a behavioural focus and theory-driven strategies among the elements conducive to successful programmes. Other features that contribute to gain effectiveness are the provision of adequate time and intensity for the intervention, involvement of families, particularly for younger children, and incorporation of self-assessment and feedback in interventions for older children. School meals provide a valuable opportunity for nutrition education. The emphasis on environmental and behavioural factors in successful school-based physical activity and nutrition interventions highlights the importance of involving parents and other community members.