Dietary intake, nutritional adequacy and food sources of vitamins involved in the methionine-methylation cycle from Spanish children aged one to <10 years: results from the EsNuPI study.

Background: Methionine-methylation cycle and the derived critical functions during infancy are key regulated by folates, vitamins B12, and B6. At present in Spain, there is an absence of studies that assess the intakes and dietary sources of total folates and B12 by children consuming all types of milks and those regularly consuming adapted milk formulas. Thus, our aim was to evaluate folates intakes alongside with vitamins B6 and B12 while describing their major dietary contributors in Spanish children aged one to <10 years. Methods: A total of 1,448 children aged between 1 and 10 years (49.7% girls and 50.3% boys) from the EsNuPI, a prospective cross-sectional study, were allocated into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707), and another including children consuming adapted milks called Adapted Milk Consumers Cohort (AMS) (n = 741) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Population Reference Intakes. Results: The median intake of vitamin B6 was 1.35 (1.06-1.70) mg/day in the SRS and 1.45 (1.17-1.79) mg/day in the AMS, being significantly higher in the AMS for all age-groups. Prevalence of adequacy for vitamin B6 in the SRS and AMS was 97.7 and 98.7%, respectively. Total folates intakes in the AMS were significantly higher (p ≤ 0.001) in all age groups than in the SRS, independently of age. In addition, the prevalence of adequacy for folates intakes in all groups was more than 60%. Vitamin B12 intake increased with age independently of the type of milk consumed. The prevalence of adequacy for vitamin B12 was highly compliant by all population groups. The major contributors to vitamin B6 were milk and dairy products being significantly higher in AMS than SRS (p ≤ 0.001). The highest contributors to folates intakes were milk and dairy products, cereals, vegetables, and fruits in both groups whereas for vitamin B12 in the SRS sample were milk and dairy products followed by meat and meats products and for adapted milks, were milk and dairy products, followed by eggs, then meat and meats products. Conclusion: A satisfactory prevalence of adequacy for vitamins B6, and B12 amongst the Spanish children population was observed, which was not the case for folates, regardless of the dietary group evaluated. Nevertheless, a possible strategy to increase folate intake among the youngest children is to increase the consumption of milk and dairy products within a healthier dietary pattern, as these may contribute significantly to the vitamin needs of the infant population.

[Relationship between diet, nutritional aspects and sleep quality in a pediatric population]. / Relación entre la dieta, aspectos nutricionales y la calidad del sueño en población pediátrica.

The relationship between diet and sleep has been studied in adults. However, there is little evidence in the pediatric population. The objective of this review was to analyze in a narrative way the relationship between diet, some nutritional aspects and sleep quality in population under 14 years. A quick review was performed in MEDLINE (PubMed) and Cochrane with a search strategy combining MeSH terms and keywords. Studies were selected to estimate diet and evaluate nutritional status and sleep in children using different tools. The risk of bias from the 14 selected studies was determined with validated tools (AMSTAR 2, Newcastle Ottawa scale [NOS] and Risk of Bias [Rob2]). Adherence to some dietary patterns such as the Mediterranean, high consumption of fruits and vegetables, tryptophan intake or substitution of saturated fatty acids by unsaturated fats were associated with better sleep quality. The consumption of ultra-processed products, the "unhealthy fast food" or the high intake of simple sugars hinder an adequate rest. On the other hand, an association between a high body mass index and lack of sleep was observed in young people under 14. In conclusion, the collected studies showed a significant association between some dietary patterns, food groups and nutrients with sleep quality. "Unhealthy" dietary factors were associated with poorer sleep quality. However, healthier and recommended habits and diets were associated with improved sleep hygiene. On the other hand, the lack of hours of rest in the youth population increases height, weight and BMI. Further research is needed in this direction.

Effect of the ketogenic diet as a treatment for refractory epilepsy in children and adolescents: a systematic review of reviews.

CONTEXT: Epilepsy is one of the most prevalent neurological disorders in childhood. Antiepileptic drugs are the preferred treatment. However, 30% of children continue suffering seizures. A ketogenic diet (KD) is one of the emerging alternative treatments. OBJECTIVE: This review aims to analyze the current evidence regarding the use of a KD for the treatment of refractory epilepsy (RE) in childhood. DATA SOURCES: A systematic review of reviews was performed, based on MEDLINE (PubMed) as at January 2021. DATA EXTRACTION: The data extracted included the first author's last name; the year of publication; the country; the study design; the population; the diagnosis, concept, and description of KD types; and major outcome. RESULTS: Twenty-one reviews were included, 8 with systematic methodology (2 of them included a meta-analysis) and 13 with unsystematic methodology. The main difference between the 2 types of reviews is the reproducibility of their methodology. Therefore, the results of each type of review were analyzed separately. Each type of review described 4 categories of KD: classic KD, modified Atkins diet (MAD), use of medium-chain triglycerides (MCTs), and low glycemic index treatment (LGIT). In terms of effectiveness, the considered systematic reviews reported reductions in the frequency of seizures greater than 50% in about half of the patients. Reviews without systematic methodology reported that 30%-60% of the children showed a 50% or greater reduction in seizures. The most frequently described adverse effects in the 8 systematic reviews were: vomiting (6/8), constipation (6/8), and diarrhea (6/8); and in the unsystematic reviews: vomiting and nausea (10/13), constipation (10/13), and acidosis (9/13). CONCLUSION: KD can be an effective treatment for RE, with a more than 50% reduction in the frequency of seizures and cognitive improvement being achieved in half of the pediatric patients. The effectiveness of the various types of KD is comparable, and the KD can be adapted to the needs of the patient. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021244142.

The Quality Index for Nutrition in Nursing Homes (QUINN). A new tool for evaluating diet quality in long-term care homes.

Introduction: Background: the assessment of diet quality (DQ) is fundamental to the study of disease-diet associations, and it is necesary to implement an easy to-apply tool in nursing homes (NHs). Our objective was to propose and apply a novel diet quality indicator (DQIn) using an a priori approach for NHs. Methods: the QUality Index for Nutrition in Nursing homes (QUINN) was implemented in a public NH located in Valladolid, Spain, during a 5-week period (n = 137 subjects). The choice of the QUINN components was based on a rapid review. The QUINN was based on 15 dietary components - 12 were basic (vegetables, fruits, legumes, olive oil, cereals, dairy, white fish and seafood, white-meat, eggs/positive; other fats, red and processed meat, and sweets/negative), and 3 were supplementary (fruits and vegetables variety, oily-fish, and whole-grains/positive). Each component was classified into 4-categories (0, 1, 2 o 3 points; range: 0-45 points). Results: the QUINN was tested on a menu offered by a NH giving a result of 34 points (good diet). The components with the highest scores were related to the Mediterranean diet (high consumption of legumes, olive oil, white fish and shellfish; low intake of other fats; and a wide variety of fruits and vegetables), together with cereals, white meat, dairy, and eggs. The components that required a major change were red- and processed-meats, sweets, and whole grains. Conclusion: the menu of this Spanish NH showed a good DQ according to the QUINN. The assessment of the DQ in NHs using QUINN will allow the proposal of interventions aimed at improving their diet.

Introducción: Antecedentes: la valoración de la calidad de la dieta es fundamental para el estudio de las asociaciones enfermedad-dieta, y es necesario implantar una herramienta de fácil aplicación en las residencias de ancianos. Nuestro objetivo fue proponer y aplicar un nuevo indicador de calidad de la dieta (diet quality indicator, DQIn) utilizando un enfoque a priori para su utilización en residencias de ancianos. Métodos: el Índice de Calidad Nutricional en Residencias de Ancianos (QUality Index for Nutrition in Nursing homes, QUINN) se aplicó en una residencia pública de Valladolid durante un periodo de 5 semanas (n = 137 sujetos). La elección de los componentes del QUINN se basó en una revisión rápida. En el QUINN se consideraron 15 componentes dietéticos, 12 básicos (verduras, frutas, legumbres, aceite de oliva, cereales, lácteos, pescado blanco y marisco, carnes blancas, huevos/positivos; otras grasas, carnes rojas y procesadas, y dulces/negativos) y 3 adicionales (variedad de frutas y verduras, pescado azul, y cereales integrales/positivos). Cada componente se clasificó en 4 categorías (0, 1, 2 o 3 puntos; rango: 0-45 puntos). Resultados: el QUINN se aplicó en el menú ofertado por una residencia de ancianos dando un resultado de 34 puntos (dieta de buena calidad). Los componentes con mayor puntuación estaban relacionados con la dieta mediterránea (alto consumo de legumbres, aceite de oliva, pescado blanco y marisco, bajo consumo de otras grasas y variedad de frutas y verduras), junto con los cereales, las carnes blancas, los lácteos y los huevos. Los componentes que requerían un cambio importante fueron las carnes rojas y procesadas, los dulces y los cereales integrales. Conclusión: el menú de esta residencia de ancianos situada en España mostró una calidad de la dieta buena según el QUINN. La evaluación de la calidad de la dieta en las residencias de ancianos mediante el QUINN permitirá proponer intervenciones para mejorar la dieta.

The Quality Index for Nutrition in Nursing Homes (QUINN). A new tool for evaluating diet quality in long-term care homes / El índice de calidad de la nutrición en las residencias de ancianos (QUINN). Una nueva herramienta para evaluar la calidad de la dieta en las residencias de ancianos

Antecedentes: la valoración de la calidad de la dieta es fundamental para el estudio de las asociaciones enfermedad-dieta, y es necesario implantar una herramienta de fácil aplicación en las residencias de ancianos. Nuestro objetivo fue proponer y aplicar un nuevo indicador de calidad de la dieta (diet QUALITY indicator, DQIn) utilizando un enfoque a priori para su utilización en residencias de ancianos. Métodos: el Índice de Calidad Nutricional en Residencias de Ancianos (QUALITY Index for NUTRITION in NURSING homes, QUINN) se aplicó en una residencia pública de Valladolid durante un periodo de 5 semanas (n = 137 sujetos). La elección de los componentes del QUINN se basó en una revisión rápida. En el QUINN se consideraron 15 componentes dietéticos, 12 básicos (verduras, frutas, legumbres, aceite de oliva, cereales, lácteos, pescado blanco y marisco, carnes blancas, huevos/positivos; otras grasas, carnes rojas y procesadas, y dulces/negativos) y 3 adicionales (variedad de frutas y verduras, pescado azul, y cereales integrales/positivos). Cada componente se clasificó en 4 categorías (0, 1, 2 o 3 puntos; rango: 0-45 puntos). Resultados: el QUINN se aplicó en el menú ofertado por una residencia de ancianos dando un resultado de 34 puntos (dieta de buena calidad). Los componentes con mayor puntuación estaban relacionados con la dieta mediterránea (alto consumo de legumbres, aceite de oliva, pescado blanco y marisco, bajo consumo de otras grasas y variedad de frutas y verduras), junto con los cereales, las carnes blancas, los lácteos y los huevos. Los componentes que requerían un cambio importante fueron las carnes rojas y procesadas, los dulces y los cereales integrales. Conclusión: el menú de esta residencia de ancianos situada en España mostró una calidad de la dieta buena según el QUINN. La evaluación de la calidad de la dieta en las residencias de ancianos mediante el QUINN permitirá proponer intervenciones para mejorar la dieta. (AU)

Background: the assessment of diet QUALITY (DQ) is fundamental to the study of disease-diet associations, and it is necesary to implement an easy to-apply tool in NURSING homes (NHs). Our objective was to propose and apply a novel diet QUALITY indicator (DQIn) using an a priori approach for NHs. Methods: the QUALITY Index for NUTRITION in NURSING homes (QUINN) was implemented in a public NH located in Valladolid, Spain, during a 5-week period (n = 137 subjects). The choice of the QUINN components was based on a rapid review. The QUINN was based on 15 dietary components — 12 were basic (vegetables, fruits, legumes, olive oil, cereals, dairy, white fish and seafood, white-meat, eggs/positive; other fats, red and processed meat, and sweets/negative), and 3 were supplementary (fruits and vegetables variety, oily-fish, and whole-grains/positive). Each component was classified into 4-categories (0, 1, 2 o 3 points; range: 0-45 points). Results: the QUINN was tested on a menu offered by a NH giving a result of 34 points (good diet). The components with the highest scores were related to the Mediterranean diet (high consumption of legumes, olive oil, white fish and shellfish; low intake of other fats; and a wide variety of fruits and vegetables), together with cereals, white meat, dairy, and eggs. The components that required a major change were red- and processed-meats, sweets, and whole grains. Conclusion: the menu of this Spanish NH showed a good DQ according to the QUINN. The assessment of the DQ in NHs using QUINN will allow the proposal of interventions aimed at improving their diet. (AU)

Dietary Intake, Nutritional Adequacy, and Food Sources of Selected Antioxidant Minerals and Vitamins; and Their Relationship with Personal and Family Factors in Spanish Children Aged 1 to <10 Years: Results from the EsNuPI Study

Minerals and vitamins involved in the antioxidant defense system are essential for healthy growth and proper development during infancy. Milk and dairy products are of particular importance for improving the supply of these nutrients to children. Indeed, the present study aimed to evaluate the nutrient intake and food sources of zinc (Zn), selenium (Se), retinol and carotenoids (sources of vitamin A), and vitamins C and E, and to analyze their relationships with personal and familiar factors in Spanish children from the EsNuPI study. One subpopulation representative of the Spanish population from 1 to <10 years old (n = 707) (reference group, REF) who reported consuming all types of milk over the last year, and another subpopulation of the same age who reported consuming fortified milk formulas (FMFs) (including follow-on formula, young child formula, growing up milk, toddler's milk, and enriched and fortified milk) (n = 741) (fortified milk consumers, FMCs) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Dietary Reference Values (DRVs). The REF reported higher median intakes than FMCs for Se (61 µg/kg vs. 51 µg/kg) and carotenoids (1079 µg/day vs. 998 µg/day). Oppositely, FMCs reported higher intakes than REF for Zn (7.9 mg/day vs. 6.9 mg/day), vitamin A (636 µg/day vs. 481 µg/day), vitamin E (8.9 mg/day vs. 4.5 mg/day), vitamin C (113 mg/day vs. 71 mg/day), and retinol (376 µg/day vs. 233 µg/day). In the REF group, more than 50% of the children met the EFSA recommendations for Zn (79.6%), Se (87.1%), vitamin A (71.3%), and vitamin C (96.7%), respectively. On the other hand, 92.2% were below the EFSA recommendations for vitamin E. In the FMC group, more than 50% of the children met the EFSA recommendations for Zn (55.2%), Se (90.8%), vitamin A (75.7%), vitamin E (66.7%), and vitamin C (100%). We found statistically significant differences between subpopulations for all cases except for Se. In both subpopulations, the main sources of all antioxidant nutrients were milk and dairy products. For carotenoids, the main sources were vegetables and fruits followed by milk and dairy products. A high percentage of children had vitamins A and E intakes below the recommendations, information of great importance to stakeholders. More studies using intakes and biomarkers are needed, however, to determine an association with diverse factors of oxidative damage.

Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years­Results from the EsNuPI Study

Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One "Spanish Reference Sample" (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler's or growing up milk and fortified and enriched milks, here called "Adapted Milk Consumers Sample" (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.

Challenges and perspectives of the double burden of malnutrition in Latin America.

Nutrition is a key factor in the development of non-communicable chronic diseases (NCCDs), especially cardiovascular diseases (CVD) and their risk factors. The "double burden of malnutrition" (DBM) is the coexistence of undernutrition and overnutrition in the same population across the life-course. In Latin America, the transition from a predominantly underweight to an overweight and obese population has increased more rapidly than in other regions in the world. Undernutrition and the micronutrient deficiencies particularly iron, zinc, and vitamins A and D, present high heterogeneity in Latin American countries, and are currently considered important public health problems. In this region, NCCDs account for 50% of the disability-adjusted life-years, led by CVD. The most prevalent cardiovascular risk factors are overweight, obesity, hypertension, dyslipidemia and type 2 diabetes mellitus. Because of the cost of treatment and the potential years of life lost due to premature death, CVD is known to affect the poorest segments of the population, affecting communities, and governments. More than 80% of CVD deaths occur in low- and middle-income countries. The persistence of damage in some cells due to undernutrition may explain certain findings regarding the increase in NCCD. These aspects together with epigenetic changes have highlighted the importance of a lifelong approach to nutritional policy development. Reducing DBM requires major societal interventions in public health and nutrition to achieve holistic change that can be sustained over the long term and spread throughout the global food system. The implementation of effective state policies of double impact actions should influence both sides of the burden and be considered an urgent priority, considering country-specific inequalities and socio-demographic differences in the Latin American region, using diverse and multidisciplinary strategies.

Personalized Diet in Obesity: A Quasi-Experimental Study on Fat Mass and Fat-Free Mass Changes.

Considering that the prevalence of overweight and obesity in Southeast of Spain is high, the aim of this work was to analyze the relation between the adherence to a personalized diet and the effectiveness of changes in the body composition in overweight and obese adults in this region. This quasi-experimental study presents the following selection criteria: attendance at the consultation between 2006 and 2012, subjects ≥ 19 years of age with overweight or obesity. In total, 591 overweight or obese individuals were involved in this study, attending 4091 clinic consultations in total. Most of the sample consisted of subjects who attended >3 consultations (>1.5 months), and were females aged 19-64 years who obtained clinically significant changes in fat mass (FM, ≥5%) and recommended changes in fat-free mass (FFM, ≥0%). Based on the results obtained and the experience gained from this research, the following recommendations are established: (i) record fat mass and fat-free mass index as a complement to body mass index; (ii) use FM and FFM to evaluate effectiveness of interventions with the aim of obtaining body composition changes; (iii) use personalized diet to achieve significant changes in FM and avoid non-recommended changes in FFM.

[Nutritional Study in Spanish Pediatric Population (EsNuPI): updated findings and initial conclusions]. / Estudio Nutricional en Población Infantil Española (EsNuPI): actualización de hallazgos y primeras conclusiones.

INTRODUCTION: Introduction: eating habits and lifestyles during early childhood are important due to their association with chronic diseases in adulthood. Objectives: to evaluate energy and nutrient intake, main food sources, and dietary patterns in the EsNuPI study participants. Methods: a sociodemographic questionnaire, food frequency questionnaire, two 24 h recalls, and a physical activity questionnaire were used in two cohorts of Spanish children aged 1 to < 10 years, who were non-vegans living in municipalities > 50,000 inhabitants - one representative cohort of consumers of all types of milks (SRS = 707) and one other cohort consuming adapted milks (AMS = 741). Results: 84.7 % in SRS and 83.5 % in AMS showed a plausible, adequate energy (EI) (1503 and 1404 kcal/day, respectively). The percentage of children with protein intake > 20 % of EI was 12 % for SRS, and 6 % for AMS. Both cohorts exceeded the recommendations for total fat (36.5 % in SRS, 35.9 % in AMS) and saturated fat (13.1 % vs 12.1 %, respectively); DHA intake was significantly lower in SRS (20 mg vs 90 mg). Vitamin D intake was significantly lower in SRS, although both cohorts did not meet the recommendation. When analyzing dietary patterns, one of palatable energy-dense foods and two of Mediterranean type were highlighted. Conclusions: it is recommended that consumption of saturated fatty acids and protein be reduced, but calcium, vitamin D, and magnesium intakes should be increased, especially in children > 4 years. These findings are important for designing interventions in the Spanish child population. The findings of the EsNuPI study provide useful information for the design and promotion of appropriate interventions for Spanish children.

INTRODUCCIÓN: Introducción: los hábitos de alimentación y los estilos de vida durante las primeras etapas de la infancia son importantes por su asociación a enfermedades crónicas durante la vida adulta. Objetivos: evaluar la ingesta de energía, el aporte de nutrientes, las principales fuentes alimentarias y los patrones dietéticos de los participantes en el estudio EsNuPI. Métodos: se utilizaron un cuestionario sociodemográfico, un cuestionario de frecuencia de consumo de alimentos, dos recuerdos de 24 h y un cuestionario de actividad física en dos cohortes de niños españoles de 1 a < 10 años, no veganos, residentes en municipios > 50.000 habitantes: una representativa de los consumidores de todo tipo de leches (SRS = 707) y otra consumidora de leches adaptadas (AMS = 741). Resultados: el 84,7 % de la cohorte SRS y el 83,5 % de la AMS mostraron una ingesta energética (IE) plausible y adecuada (1503 y 1404 kcal/día, respectivamente) en ambas cohortes. El porcentaje de niños con ingesta proteica > 20 % de la IE fue del 12 % en la SRS y el 6 % en la AMS. Ambas cohortes sobrepasaron las recomendaciones de grasa total (36,5 % en la SRS; 35,9 % en la AMS) y de grasas saturadas (13,1 % vs. 12,1 %, respectivamente); la ingesta de DHA fue significativamente menor en la SRS (20 mg/d vs. 90 mg/d). La ingesta de vitamina D fue significativamente menor en la SRS, aunque ambas cohortes no alcanzaron las recomendaciones de los organismos internacionales. Al analizar los patrones alimentarios, destacan uno de alimentos apetitosos e hipercalóricos y dos de tipo mediterráneo. Conclusiones: es recomendable reducir la ingesta de grasas saturadas y proteínas, e incrementar la de calcio, vitamina D y magnesio, esto último especialmente en los niños > 4 años. Estos hallazgos son importantes para el diseño de intervenciones en la población infantil española.

Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review.

Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.

Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study.

Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to <10 years old (n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler's milk, and enriched and fortified milks) (n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to <10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.

Estudio Nutricional en Población Infantil Española (EsNuPI): actualización de hallazgos y primeras conclusiones / Nutritional Study in Spanish Pediatric Population (EsNuPI): updated findings and initial conclusions

Introducción: los hábitos de alimentación y los estilos de vida durante las primeras etapas de la infancia son importantes por su asociación a enfermedades crónicas durante la vida adulta. Objetivos: evaluar la ingesta de energía, el aporte de nutrientes, las principales fuentes alimentarias y los patrones dietéticos de los participantes en el estudio EsNuPI. Métodos: se utilizaron un cuestionario sociodemográfico, un cuestionario de frecuencia de consumo de alimentos, dos recuerdos de 24 h y un cuestionario de actividad física en dos cohortes de niños españoles de 1 a < 10 años, no veganos, residentes en municipios > 50.000 habitantes: una representativa de los consumidores de todo tipo de leches (SRS = 707) y otra consumidora de leches adaptadas (AMS = 741). Resultados: el 84,7 % de la cohorte SRS y el 83,5 % de la AMS mostraron una ingesta energética (IE) plausible y adecuada (1503 y 1404 kcal/día, respectivamente) en ambas cohortes. El porcentaje de niños con ingesta proteica > 20 % de la IE fue del 12 % en la SRS y el 6 % en la AMS. Ambas cohortes sobrepasaron las recomendaciones de grasa total (36,5 % en la SRS; 35,9 % en la AMS) y de grasas saturadas (13,1 % vs. 12,1 %, respectivamente); la ingesta de DHA fue significativamente menor en la SRS (20 mg/d vs. 90 mg/d). La ingesta de vitamina D fue significativamente menor en la SRS, aunque ambas cohortes no alcanzaron las recomendaciones de los organismos internacionales. Al analizar los patrones alimentarios, destacan uno de alimentos apetitosos e hipercalóricos y dos de tipo mediterráneo. Conclusiones: es recomendable reducir la ingesta de grasas saturadas y proteínas, e incrementar la de calcio, vitamina D y magnesio, esto último especialmente en los niños > 4 años. Estos hallazgos son importantes para el diseño de intervenciones en la población infantil española. (AU)

Introduction: eating habits and lifestyles during early childhood are important due to their association with chronic diseases in adulthood. Objectives: to evaluate energy and nutrient intake, main food sources, and dietary patterns in the EsNuPI study participants. Methods: a sociodemographic questionnaire, food frequency questionnaire, two 24 h recalls, and a physical activity questionnaire were used in two cohorts of Spanish children aged 1 to < 10 years, who were non-vegans living in municipalities > 50,000 inhabitants - one representative cohort of consumers of all types of milks (SRS = 707) and one other cohort consuming adapted milks (AMS = 741). Results: 84.7 % in SRS and 83.5 % in AMS showed a plausible, adequate energy (EI) (1503 and 1404 kcal/day, respectively). The percentage of children with protein intake > 20 % of EI was 12 % for SRS, and 6 % for AMS. Both cohorts exceeded the recommendations for total fat (36.5 % in SRS, 35.9 % in AMS) and saturated fat (13.1 % vs 12.1 %, respectively); DHA intake was significantly lower in SRS (20 mg vs 90 mg). Vitamin D intake was significantly lower in SRS, although both cohorts did not meet the recommendation. When analyzing dietary patterns, one of palatable energy-dense foods and two of Mediterranean type were highlighted. Conclusions: it is recommended that consumption of saturated fatty acids and protein be reduced, but calcium, vitamin D, and magnesium intakes should be increased, especially in children > 4 years. These findings are important for designing interventions in the Spanish child population. The findings of the EsNuPI study provide useful information for the design and promotion of appropriate interventions for Spanish children. (AU)

Carbohydrates, Starch, Total Sugar, Fiber Intakes and Food Sources in Spanish Children Aged One to <10 Years-Results from the EsNuPI Study.

Diet quality is a modifiable factor that may contribute to the onset of diet-related chronic diseases. Currently, in Spain there are no studies that examine the intakes and sources for total carbohydrates, starch, total sugar, and fiber by both children consuming all kind of milks and children regularly consuming adapted milk formulas. Our goal was to evaluate the contribution of different food groups to total carbohydrates, starch, total sugar, and fiber consumption within the EsNuPI study participants by assessing their usual intakes by applying two 24 h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707) and another cohort which included children consuming adapted milks including follow-on milk, toddler's or growing up milk, fortified and enriched milks, here called Adapted Milk Consumers Cohort" (AMS) (n = 741). Estimation of the usual intake showed that nutrient intake increased with age for all nutrients except for fiber. The percentage of children by age and gender who met the reference intake (RI) range for total carbohydrates, was in all groups more than 50% of individuals, except for girls aged 6 to <10 years from the reference cohort in which only 46.9% complied the RI. Median fiber intake, both in the SRS and the AMS, was well below the adequate intake (AI) for children between 3 and 10 years. Main total carbohydrates sources were cereals, followed by milk and dairy products, fruits, bakery and pastry, vegetables and sugars and sweets. The highest contributors to starch intakes were cereals, bakery and pastry, vegetables, and fruits. Major sources of total sugar intakes were milk and dairy products, fruits, bakery and pastry, sugars and sweets, vegetables, and cereals. Nonetheless, milk and dairy products, and fruits, mainly provided lactose and fructose, respectively, which are not considered free sugars. Higher contribution to fiber intakes was provided by fruits, cereals, vegetables and bakery and pastry. There were no significant differences in relation with the total sugar intake according to the body mass index (BMI) between SRS and AMS. The present study suggests a high proportion of children had total carbohydrates intakes in line with recommendations by public health authorities, but still a significant number presented insufficient total carbohydrate and fiber intakes, while total sugar consumption was high, with no major differences between SRS and AMS cohorts.

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †.

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler's milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.

Dietary Intake, Nutritional Adequacy and Food Sources of Total Fat and Fatty Acids, and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Results of the EsNuPI Study.

We aimed to determine the usual intake of total fat, fatty acids (FAs), and their main food sources in a representative cohort of the Spanish pediatric population aged 1 to <10 years (n = 707) who consumed all types of milk and an age-matched cohort who consumed adapted milk over the last year (including follow-on formula, toddler's milk, growing-up milk, and fortified and enriched milks) (n = 741) who were participants in the EsNuPI study (in English, Nutritional Study in the Spanish Pediatric Population). Dietary intake, measured through two 24 h dietary recalls, was compared to the European Food Safety Authority (EFSA) and the Food and Agriculture Organization of the United Nations (UN-FAO) recommendations. Both cohorts showed a high intake of saturated fatty acids (SFAs), according to FAO recommendations, as there are no numerical recommendations for SFAs at EFSA. Also, low intake of essential fatty acids (EFAs; linoleic acid (LA) and α-linolenic acid (ALA)) and long-chain polyunsaturated fatty acids (LC-PUFA) of the n-3 series, mainly docosahexaenoic acid (DHA) were observed according to EFSA and FAO recommendations. The three main sources of total fat and different FAs were milk and dairy products, oils and fats, and meat and meat products. The consumption of adapted milk was one of the main factors associated with better adherence to the nutritional recommendations of total fat, SFAs, EFAs, PUFAs; and resulted as the main factor associated with better adherence to n-3 fatty acids intake recommendations. Knowledge of the dietary intake and food sources of total fat and FAs in children could help in designing and promoting effective and practical age-targeted guidelines to promote the consumption of EFA- and n-3 PUFA-rich foods in this stage of life.

Usual Dietary Intake, Nutritional Adequacy and Food Sources of Calcium, Phosphorus, Magnesium and Vitamin D of Spanish Children Aged One to <10 Years. Findings from the EsNuPI Study.

Bone problems in the population begin to be establish in childhood. The present study aims to assess the usual calcium, phosphorus, magnesium, and vitamin D intakes, along with the food sources of these nutrients, in Spanish children participating in the EsNuPI (Estudio Nutricional en Población Infantil Española) study. Two 24 h dietary recalls were applied to 1448 children (1 to <10 years) divided into two sub-samples: one reference sample (RS) of the general population [n = 707] and another sample which exclusively included children consuming enriched or fortified milks, here called "adapted milks" (AMS) [n = 741]. Estimation of the usual intake shows that nutrient intake increased with age for all nutrients except vitamin D. Using as reference the Dietary Reference Values from the European Food Safety Authority (EFSA), calcium and magnesium intakes were found to be below the average requirement (AR) and adequate intake (AI), respectively, in a considerable percentage of children. Furthermore, phosphorus exceeded the AI in 100% of individuals and vitamin D was lower than the AI in almost all children studied. The results were very similar when considering only plausible reporters. When analyzing the food sources of the nutrients studied, milk and dairy products contributed the most to calcium, phosphorus, magnesium, and vitamin D. Other sources of calcium were cereals and vegetables; for phosphorus: meat, meat products, and cereals; for magnesium: cereals and fruits; and, for vitamin D: fish and eggs. These results highlight the desirability of improving the intake concerning these nutrients, which are involved in bone and metabolic health in children. The AMS group appeared to contribute better to the adequacy of those nutrients than the RS group, but both still need further improvement. Of special interest are the results of vitamin D intakes, which were significantly higher in the AMS group (although still below the AI), independent of age.

Energy Intake, Macronutrient Profile and Food Sources of Spanish Children Aged One to <10 Years-Results from the EsNuPI Study.

The present study aimed to assess energy intake, nutrient profile and food sources in Spanish children participating in the EsNuPI ("Estudio Nutricional en Población Infantil Española") study. Plausibility of energy intake and adequacy of nutrient intakes to international recommendations were analyzed in a final sample of 1448 subjects (728 boys and 720 girls) and one group representative of the 1 to <10 years old urban Spanish children (reference sample (n = 707)) who consumed milk and one of the same age who consumed adapted milk over the last year (adapted milk consumers sample (n = 741)) were compared. Both groups completed data of a face-to-face and a telephone 24-h dietary recalls. Both the reference and the adapted milk consumers samples reported an adequate daily energy intake (1503 kcal/day and 1404 kcal/day); and a high contribution to total energy from protein (16.5% and 15.6%) and fat (36.5% and 35.9%). Also, a high percentage of children from both samples were below the lower limit of the recommendations for carbohydrates (47.8% and 39.3%). As the percentage of plausible energy reporters was high for both groups (84.7% and 83.5%, respectively), data for the whole sample were analyzed. Milk and dairy, cereals, meat and derived products, fats and oils, bakery and pastry, fruits and vegetables contributed to about 80% of the total energy intake in both groups. However, the reference sample reported significantly more contribution to energy from cereals, meat and meat products, bakery and pastry and ready to cook/eat foods; meanwhile, the adapted milk consumers sample reported significantly more energy from milk and dairy products, fruits and eggs. Those results suggest that adapted milk consumers have better adherence to the food-based dietary guidelines. Further analyses are warranted to characterize food patterns and the quality of the diet in the EsNuPI study population.

Dietary and Lifestyle Patterns in the Spanish Pediatric Population (One to <10 Years Old): Design, Protocol, and Methodology of the EsNuPI Study.

The interest in a healthy diet and lifestyle during the early stages of life increased, pointing out its role in the development of noncommunicable chronic diseases throughout adult life. Dietary habits and dietary patterns begin to be established in early childhood and persist during adulthood. Therefore, the EsNuPI ("Nutritional Study in Spanish Pediatric Population") study aims to depict the dietary patterns, physical activity, and sedentary behaviors in Spanish children aged from one to <10 years old. This prospective, cross-sectional, observational study recruited a total of 1514 children from Spanish cities with >50,000 inhabitants, stratified by Nielsen areas. Participants were involved in one face-to-face survey, followed by a telephone survey after at least one week. Information about dietary intake and habits was obtained using a quantitative food frequency questionnaire and two 24-h dietary recalls. Physical activity and sedentary behaviors were registered using a specific questionnaire based on a seven-day record. Data were processed and stratified by categorical variables to be statistically analyzed in order to meet the study objectives. This study is the first of its kind in a Spanish reference population of this age range and the first to evaluate whether the consumption of adapted milk formulas and dairy products is associated with healthier dietary patterns and better diet quality and lifestyles in this group.

Normative Fecal Calprotectin Concentrations in Guatemalan Preschoolers Are High Relative to Children Reported Elsewhere.

BACKGROUND: Calprotectin is a fecal marker of intraintestinal inflammation derived from activated enteric neutrophils and macrophages. It is useful as a clinical marker in inflammatory bowel diseases; furthermore, it may have a role in public health epidemiology. OBJECTIVES: The aim of the study was to describe the distribution of fecal calprotectin in Guatemalan preschool children sharing a common institutional diet; to relate it collectively to pediatric distributions in other geographic settings, and individually to concomitant indicators of intestinal infection or colonization and other descriptive features of the child. METHODS: Fecal samples were collected in 87 subjects, ages 2 to 7 years across 3 daycare centers sharing a common institutional menu, but from different ecological settings. Stools were examined, variously by routine light microscopy, quantitative egg counts, and a Giardia antigen test, for microbiological diagnosis, and an ELISA assay for fecal calprotectin (CalproLab). RESULTS: The median fecal calprotectin value was 58 mg/kg, with a mean of 98 ±â€Š136 mg/kg and a range from 10 to 950 mg/kg; 61% of values were above the manufacturer's cut-off for elevated concentration and 51% exceeded an age-adjusted criterion. There were no associations between sex, age, growth indicators, or fecal microbiological findings by microscopy or ELISA assays, alone or in combination. The central tendency (mean or median) and distribution were generally shifted to the right in relation to comparable reports from children across the world literature. CONCLUSIONS: Although specific, low-grade intestinal infections do not define calprotectin subgroups, right-shifted fecal calprotectin status in this population may reflect a general and diffuse stress of adverse environmental sanitation.