Sugar-sweetened beverages, low/no-calorie beverages, fruit juice and non-alcoholic fatty liver disease defined by fatty liver index: the SWEET project.

BACKGROUND: Sweetened beverage intake may play a role in non-alcoholic fatty liver disease (NAFLD) development, but scientific evidence on their role is limited. This study examined associations between sugar-sweetened beverages (SSB), low/no-calorie beverages (LNCB) and fruit juice (FJ) intakes and NAFLD in four European studies. METHODS: Data for 42,024 participants of Lifelines Cohort, NQPlus, PREDIMED-Plus and Alpha Omega Cohort were cross-sectionally analysed. NAFLD was assessed using Fatty Liver Index (FLI) (≥60). Restricted cubic spline analyses were used to visualize dose-response associations in Lifelines Cohort. Cox proportional hazard regression analyses with robust variance were performed for associations in individual cohorts; data were pooled using random effects meta-analysis. Models were adjusted for demographic, lifestyle, and other dietary factors. RESULTS: Each additional serving of SSB per day was associated with a 7% higher FLI-defined NAFLD prevalence (95%CI 1.03-1.11). For LNCB, restricted cubic spline analysis showed a nonlinear association with FLI-defined NAFLD, with the association getting stronger when consuming ≤1 serving/day and levelling off at higher intake levels. Pooled Cox analysis showed that intake of >2 LNCB servings/week was positively associated with FLI-defined NAFLD (PR 1.38, 95% CI 1.15-1.61; reference: non-consumers). An inverse association was observed for FJ intake of ≤2 servings/week (PR 0.92, 95% CI: 0.88-0.97; reference: non-consumers), but not at higher intake levels. Theoretical replacement of SSB with FJ showed no significant association with FLI-defined NAFLD prevalence (PR 0.97, 95% CI 0.95-1.00), whereas an adverse association was observed when SSB was replaced with LNCB (PR 1.12, 95% CI 1.03-1.21). CONCLUSIONS: Pooling results of this study showed that SSB and LNCB were positively associated with FLI-defined NAFLD prevalence. Theoretical replacement of SSB with LNCB was associated with higher FLI-defined NAFLD prevalence. An inverse association was observed between moderate intake of FJ and FLI-defined NAFLD. Our results should be interpreted with caution as reverse causality cannot be ruled out.

[Executive summary of the consensus document for the prevention of the eating disorders SENPE-SENC-SEPEAP-SEMERGEN]. / Resumen ejecutivo del documento de consenso para la prevención de los trastornos de la conducta alimentaria SENPE-SENC-SEPEAP-SEMERGEN.

Introduction: Los TCA configuran un grupo de problemas de salud en los que la insatisfacción con la imagen corporal se combina con alteraciones en la conducta alimentaria, baja autoestima, problemas de perfeccionismo, depresión o ansiedad social, entre otros. Estos trastornos pueden ser graves y acompañarse de serias complicaciones y comorbilidades. Se presentan generalmente en adolescentes y adultos jóvenes y los mejor caracterizados son la anorexia nerviosa (AN), la bulimia nerviosa (BN) y el trastorno por atracón (TA). Analizando los programas de prevención de estos trastornos, se observa que en su mayor parte se dirigen a mujeres adolescentes en educación secundaria y jóvenes. Son escasas las intervenciones en edades tempranas, en adultos y en varones. Los programas con buenos resultados se han centrado en uno o más factores de riesgo, se basan en enfoques cognitivos o conductuales e incluyen contenidos sobre alimentación saludable o nutrición, alfabetización mediática o presiones socioculturales y aceptación corporal o satisfacción corporal. Muchos de ellos, incorporan nuevas tecnologías y son interactivos. Se necesita más investigación y programas de prevención de TCA innovadores dirigidos a niños pequeños, adultos y varones.

Introducción: Los TCA configuran un grupo de problemas de salud en los que la insatisfacción con la imagen corporal se combina con alteraciones en la conducta alimentaria, baja autoestima, problemas de perfeccionismo, depresión o ansiedad social, entre otros. Estos trastornos pueden ser graves y acompañarse de serias complicaciones y comorbilidades. Se presentan generalmente en adolescentes y adultos jóvenes y los mejor caracterizados son la anorexia nerviosa (AN), la bulimia nerviosa (BN) y el trastorno por atracón (TA). Analizando los programas de prevención de estos trastornos, se observa que en su mayor parte se dirigen a mujeres adolescentes en educación secundaria y jóvenes. Son escasas las intervenciones en edades tempranas, en adultos y en varones. Los programas con buenos resultados se han centrado en uno o más factores de riesgo, se basan en enfoques cognitivos o conductuales e incluyen contenidos sobre alimentación saludable o nutrición, alfabetización mediática o presiones socioculturales y aceptación corporal o satisfacción corporal. Muchos de ellos, incorporan nuevas tecnologías y son interactivos. Se necesita más investigación y programas de prevención de TCA innovadores dirigidos a niños pequeños, adultos y varones.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bone Health and Its Relationship with Impact Loading and the Continuity of Physical Activity throughout School Periods.

Bone is influenced by physical activity (PA) throughout life, but childhood and adolescence provide a key opportunity to maximize peak bone mass. Thus, it is important to identify the relationship between PA practiced in childhood and young adulthood to design a promotion plan for bone health. The purpose of this study was to analyze the relationship between different impact-loading PAs (and their continuity throughout school periods from childhood to young adulthood) and bone stiffness index (SI). In this cross-sectional study, which was conducted on 145 university students aged 18-21 years, bone measurements were measured by quantitative ultrasonometry (QUS), and PA information was recalled using a self-administered questionnaire. Associations between the SI and the impact of PA performed during secondary school (p = 0.027), high school (p = 0.002), and university (p = 0.016) periods were observed. The continuity of PA over a longer period of time was related to a higher SI (p = 0.007). Those who practiced PA throughout all school periods had a higher SI than those who practiced during primary school only (p = 0.038) or through primary and secondary schools (p = 0.009). These results suggest that impact-loading PA practiced during different school periods is related to higher values of the SI. Therefore, continuous PA from an early age may be an important contributing factor to achieving and maintaining adequate bone health.

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

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

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

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

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

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

La obesidad infantil: una asignatura pendiente / Childhood obesity: an unresolved issue

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Alimentación 3.0: aspectos de interés en la práctica diaria / Diet 3.0: practical issues in everyday life

Internet y las nuevas tecnologías han cambiado la forma de obtener información de todo tipo, también información relacionada con la alimentación y la salud. Se han multiplicado las fuentes de información y los generadores de contenidos. El médico, seguido por otros profesionales de la salud, son los profesionales en quien más confían los ciudadanos para consultar sus dudas sobre alimentación y salud, pero internet y las redes sociales se utilizan cada vez con mayor frecuencia. La información disponible en la red sobre alimentación, nutrición y salud procede de muy distintas fuentes y ámbitos: revistas científicas, instituciones académicas, organismos sanitarios, asociaciones (científicas, profesionales, de consumidores...), empresas de distintos sectores que ofrecen información y venden sus productos o bien particulares con distintos perfiles que pueden estar o no cualificados y presentar opiniones personales independientes o interesadas. El hecho de que al buscar en la red temas de salud los ciudadanos accedan, junto a fuentes contrastadas, a sitios con información de dudosa calidad ha preocupado a las autoridades, Administraciones y organismos competentes y profesionales sanitarios. Hace tiempo que se han impulsado iniciativas para desarrollar sistemas que permitan reconocer webs que ofrezcan contenidos de salud de confianza y de calidad para los usuarios y consumidores. Es necesario que profesionales sanitarios cualificados contribuyan a la difusión en la red de información de calidad y fácil de comprender y que faciliten el acceso a fuentes de información fiables por medio de repertorios. Los ciudadanos-pacientes-consumidores necesitan información fiable y accesible para poder tomar decisiones informadas sobre su alimentación, sobre su cuidado o el de su familia y para poder participar en iniciativas comunitarias

Internet and the new technologies have changed the way of obtaining information of all kinds; also, information related to food and health. The sources of information and content generators have multiplied Doctors followed by other health professionals are the professional's citizens trust most to consults their doubts regarding health, food and nutrition, but the internet and social networks are increasingly used. The information on food, nutrition and health available on the net comes from very different sources and areas; from scientific journals, academic institutions, health organizations, scientific societies, professional, consumer or other kind of associations, companies from an array of sector who offer information and sell their products, or individuals with different profiles, who may or may not be qualified and present personal opinions, either independent or interested. The fact that when searching the internet for health issues citizens can access together with contrasted sources, other sites which publish information of uncertain quality has worried competent bodies and health professionals. A number of initiatives have been promoted to develop systems that allow the identification of websites that offer trusted quality health content, useful for patients and consumers. It is necessary that qualified health professionals contribute to the dissemination of quality information, easy to understand, in the internet and facilitate access to reliable information sources through directories. Citizens-active patients- active consumers need trusted information a reach in order to adopt informed decisions related to food consumption, own care or that of their families as well as to be able to participate in community actions