[Validity of Pro Children Project questionnaire for assessing psychosocial factors of fruit and vegetable intake in Mexico]. / Validación del cuestionario Pro Children Project para evaluar factores psicosociales del consumo de fruta y verdura en México.

OBJECTIVE: To determine content and construct validity for the Mexican version of Pro Children Project questionnaire for assessing psychosocial factors, related to fruit and vegetable intake in samples of 10-12 year-old schoolchildren. MATERIALS AND METHODS: The questionnaire consisted of 87 items. It was administered to 2084 children in an instrumental study conducted in 2011 in Ciudad Juarez, Chihuahua, Mexico. RESULTS: Kappa statistic resulted in good agreement between experts (kappa=0.69), very good agreement in children (kappa=0.93). Seven factors were obtained that explained 37.87% of the variance in fruit and 48.18% of the variance in vegetable. Cronbach's alpha values were low to moderate (range 0.55 to 0.83). An internal structure of seven first order factors was confirmed in fruits and six linked to vegetables. CONCLUSION: The questionnaire provides sufficient validity for assessing psychosocial factors related to fruit and vegetable intake in 10-12 year old schoolchildren. Finally, implications of the findings in the test adaptation process for assessing psychosocial factors of fruit and vegetable intake and for future research in this instrument are discussed.

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.

Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review.

Dietary fat and its effects on health and disease has attracted interest for research and Public Health. Since the 1980s many bodies and organizations have published recommendations regarding fat intake. In this paper different sets of recommendations are analyzed following a systematic review process to examine dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids. A literature search was conducted in relevant literature databases along a search for suitable grey literature reports. Documents were included if they reported information on either recommended intake levels or dietary reference values or nutritional objectives or dietary guidelines regarding fat and/or fatty acids and/or cholesterol intake or if reported background information on the process followed to produce the recommendations. There is no standard approach for deriving nutrient recommendations. Recommendations vary between countries regarding the levels of intake advised, the process followed to set the recommendations. Recommendations on fat intake share similar figures regarding total fat intake, saturated fats and trans fats. Many sets do not include a recommendation about cholesterol intake. Most recent documents provide advice regarding specific n-3 fatty acids. Despite efforts to develop evidence based nutrient recommendations and dietary guidelines that may contribute to enhance health, there are still many gaps in research. It would be desirable that all bodies concerned remain transparent about the development of dietary recommendations. In order to achieve this, the type of evidence selected to base the recommendations should be specified and ranked. Regular updates of such recommendations should be planned.

[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.

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.

Physiological and public health basis for assessing micronutrient requirements in children and adolescents. The EURRECA network.

This paper provides an overview of the current knowledge relating to the nutritional requirements and corresponding recommended nutrient intake values of children and adolescents for micronutrients and specificities related to these requirements in the course of childhood and adolescence in Europe. Aspects that can influence micronutrient requirements, such as physiological requirements and bioavailability of the nutrients in the organism, are discussed. The methodology used to obtain the data and also the main knowledge gaps regarding these concepts are emphasized. Methodological critical points in achieving the data and physiological aspects of children and adolescents are important in order to standardize the reference values for micronutrients among Europe for these stages of life.

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.

[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.

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.

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.

Mothers' involvement in a school-based fruit and vegetable promotion intervention is associated with increased fruit and vegetable intakes--the Pro Children study.

BACKGROUND: Several school-based fruit and vegetable interventions include activities to involve parents, but not much is know about the effectiveness of such a family component on child and parent intake levels. The current study evaluated the effects of the multi-component school-based intervention, 'the Pro Children Study', on mothers' intake levels. Furthermore, associations between level of involvement in the project and improvement in the mothers' intake levels were assessed. METHODS: Effect was evaluated in a cluster randomized controlled trial in Spain, Norway and the Netherlands among mothers of 11-year-olds. Of the 1253 mothers with complete data at baseline, 754 and 476 had complete data at first and second follow-up respectively. Fruit and vegetable intake, level of involvement and demographic variables were assessed by a parental questionnaire. Data was analyzed using multilevel regression analyses. RESULTS: Results showed no effect of the intervention on mothers' fruit and vegetable intake after one year and two year follow-up. Participation rate for the different activities varied by activity and by country, e.g. 3.7-9.4% visited the website, while 26.4-72.6% of the mothers participated in the home work assignments. Results further showed that higher involvement levels were associated with higher intake at follow-up. CONCLUSION: The Pro Children Intervention could not increase the fruit and vegetable consumption of the mothers of participating pupils, which might be explained by the low involvement in the project. More research is needed to increase mothers' involvement in school-based interventions.

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

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.

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.

[Inequality, health and nutrition in Spain: a regional view of the body mass index]. / Desigualdad, salud y nutrición en España: una visión regional del índice de masa corporal.

BACKGROUND AND OBJECTIVES: a number of environmental determinants influence children growth and development and influence the potential expression or its evolution over time. In this paper we analyse the influence of selected sociodemographic factors on overweight, body weight and height in the Spanish adult population. METHODS: the analysis was conducted in a subsample (25 to 64 years of age) of the ENPE study, a cross-sectional observational study on a random population sample. Information was collected on age, gender, educational level, occupation and place of residence. Social class was coded according to occupation. Individual body weight and height were measured. RESULTS: the prevalence of obesity is higher in men, increases with age and there is an inverse relationship with the level of education and social class. Higher prevalence rates were observed in Asturias, Galicia and in Andalusia. Short stature is more frequent in people with incomplete primary education and low social class, in contrast to high stature, which is also more frequent in the North-East and central regions. Low body weight is less frequent in people with very poor education and low social class. CONCLUSIONS: based on the unequal distribution of overweight and obesity, preventive strategies in Community Nutrition should consider improving the level of nutrition education and literacy of the population, with special emphasis on the most disadvantaged people.

Introducción y objetivos: numerosos determinantes ambientales influyen en el crecimiento y en el desarrollo y condicionan la expresión potencial o su evolución en el tiempo. Se analiza la influencia de algunos condicionantes sociodemográficos en la sobrecarga ponderal, en el peso y en la talla en la población adulta española.Métodos: el análisis se ha realizado en una submuestra (25 a 64 años) del estudio ENPE, estudio observacional transversal sobre una muestra poblacional aleatoria de población. Se recogió información sobre edad, género, nivel de estudios, ocupación y lugar de residencia. La clase social se codificó en función de la ocupación. Se tomaron mediciones individuales de peso y talla.Resultados: la prevalencia de obesidad es mayor en hombres, aumenta con la edad y se observa una relación inversa con el nivel de estudios y la clase social. Es mayor en Asturias, Galicia y Andalucía. La talla baja es más frecuente en personas con estudios primarios incompletos y clase social baja, al contrario que la talla alta, más frecuente también en las regiones norte-este y centro. El bajo peso corporal es menos frecuente en personas sin estudios y de clase social baja.Conclusiones: en base a la desigual distribución del sobrepeso y de la obesidad, las estrategias preventivas en nutrición comunitaria deben contemplar la mejora del nivel de educación nutricional y del grado de alfabetización de la población, con especial énfasis en las personas de entornos más desfavorecidos.

Ibero⁻American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages.

International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2⁻4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable.

The application of a social cognition model in explaining fruit intake in Austrian, Norwegian and Spanish schoolchildren using structural equation modelling.

BACKGROUND: The aim of this paper was to test the goodness of fit of the Attitude - Social influence - self-Efficacy (ASE) model in explaining schoolchildren's intentions to eat fruit and their actual fruit intake in Austria, Norway and Spain; to assess how well the model could explain the observed variance in intention to eat fruit and in reported fruit intake and to investigate whether the same model would fit data from all three countries. METHODS: Samples consisted of schoolchildren from three of the countries participating in the cross-sectional part of the Pro Children project. Sample size varied from 991 in Austria to 1297 in Spain. Mean age ranged from 11.3 to 11.4 years. The initial model was designed using items and constructs from the Pro Children study. Factor analysis was conducted to test the structure of the measures in the model. The Norwegian sample was used to test the latent variable structure, to make a preliminary assessment of model fit, and to modify the model to increase goodness of fit with the data. The original and modified models were then applied to the Austrian and Spanish samples. All model analyses were carried out using structural equation modelling techniques. RESULTS: The ASE-model fitted the Norwegian and Spanish data well. For Austria, a slightly more complex model was needed. For this reason multi-sample analysis to test equality in factor structure and loadings across countries could not be used. The models explained between 51% and 69% of the variance in intention to eat fruit, and 27% to 38% of the variance in reported fruit intake. CONCLUSION: Structural equation modelling showed that a rather parsimonious model was useful in explaining the variation in fruit intake of 11-year-old schoolchildren in Norway and Spain. For Austria, more modifications were needed to fit the data.