Ana M. López-Sobaler

Estimation of salt intake by 24 h urinary sodium excretion in a representative sample of Spanish adults.

The present study reports the Na intake of a representative sample of Spanish young and middle-aged adults aged 18-60 years (n 418, 53·1 % women, selected from the capitals of fifteen provinces and the surrounding semi-urban/rural area), measured with a 24 h urinary Na excretion method. To validate the paper collection of 24 h urine, the correlation between fat-free mass determined by electrical bioimpedance (50·8 (sd 11·3) kg) and that determined via urinary creatinine excretion (51·5 (sd 18·8) kg) was calculated (r 0·633, P < 0·001). Urinary Na excretion correlated with systolic and dyastolic blood pressure data (r 0·243 and 0·153, respectively). Assuming that all urinary Na (168·0 (sd 78·6) mmol/d) comes from the diet, Na excretion would correspond with a dietary salt intake of 9·8 (sd 4·6) g/d, and it would mean that 88·2 % of the subjects had salt intakes above the recommended 5 g/d. Logistic regression analysis, adjusted for sex, age and BMI, showed male sex (OR 3·678, 95 % CI 2·336, 5·791) and increasing BMI (OR 1·069, 95 % CI 1·009, 1·132) (P < 0·001) to be associated with excreting >200 mmol/d urinary Na--a consequence of the higher salt intake in men and in participants with higher BMI. The present results help us to know the baseline salt intake in the Spanish young and middle-aged adult population, and can be used as the baseline to design policies to reduce salt consumption.

The ALADINO Study: A National Study of Prevalence of Overweight and Obesity in Spanish Children in 2011

The aim of the study was to determine the prevalence of overweight and obesity in children in Spain using different sets of cut-off criteria, through a community-based cross-sectional study. The study was conducted in a representative sample of Spanish children between 6 and 9 years, recruited in Spanish schools, between October 2010 and May 2011. 7,569 boys and girls were selected. All were weighed and measured, and their parents were asked about their socioeconomic background, food habits and physical activity. The BMI of each was calculated, and the prevalence of overweight and obesity was determined by age and sex using Spanish reference tables (SPART), IOTF reference values, and WHO growth standards. The prevalence of overweight in boys ranged from 14.1% to 26.7%, and in girls from 13.8% to 25.7%, depending on the cut-off criteria. The prevalence of obesity in boys ranged from 11.0% to 20.9%, and in girls from 11.2% to 15.5%. The prevalence of obesity was the highest among those same children when using the SPART or WHO criteria. Overweight and obesity remain widespreading among Spanish children; a consensus on the definition of overweight and obesity cut-off criteria is necessary.

Vitamin D in Overweight/Obese Women and Its Relationship With Dietetic and Anthropometric Variables

Overweight/obese persons usually have an inadequate vitamin D status, a situation commonly made worse by an inadequate intake of this vitamin. For this reason, the aim of this study was to analyze dietetic and anthropometric differences in a group of young, overweight/obese Spanish women with respect to their vitamin D status. The study subjects were 66 white Spanish women (aged 20–35 years) with a BMI of 24–35 kg/m2. Dietetic, anthropometric, and biochemical data were collected. Women were divided into two groups depending on their serum vitamin D concentrations: LD (women with <90 nmol/l 25(OH)D) and HD (women with ≥90 nmol/l 25(OH)D). The intakes of vitamin D, calcium, and supplements were similar in both groups. The body weight, BMI, and waist circumference of the HD subjects were smaller than those recorded for the LD subjects (68.6 ± 4.2 kg, 26.0 ± 1.3 kg/m2, and 79.4 ± 3.4 cm compared to 76.2 ± 9.8, 28.6 ± 3.2 kg/m2, and 86.2 ± 9.3 cm, respectively; P < 0.05). The hip circumference and the waist/hip ratio were similar in both groups. A BMI of <27.7 kg/m2 (P50) was associated with serum vitamin D concentrations of ≥90 nmol/l (odds ratio = 0.1313; confidence interval: 0.0149–1.1599; P < 0.05). Overweight/obese women are at higher risk of vitamin D deficiency, largely due to excess adiposity rather than inadequate intake.

Associations between abdominal fat and body mass index on vitamin D status in a group of Spanish schoolchildren

Background/Objectives:To analyze the association between different anthropometric variables and vitamin D status in a group of Spanish schoolchildren.Subjects/Methods:Study subjects were 102 children aged 9–13 years. Records were made of their height, body weight, body mass index (BMI), waist and hip measurements (to determine the quantity of visceral or abdominal fat), and the thickness of the tricipital and bicipital skinfold (to determine the quantity of subcutaneous fat). Diets were analyzed using a 3-day weighed food record and vitamin D intakes compared with those recommended. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured using chemiluminescent assay.Results:The mean serum 25(OH)D concentration was 49.6±15.9 nmol/l. The mean serum 25(OH)D in the ID subjects (that is, those with insufficient vitamin D levels, 25(OH)D of <70 nmol/l) was 46.6±13.4 nmol/l and in the AD subjects (that is, those with adequate vitamin D levels, 25(OH)D of ⩾70 nmol/l) was 77.5±8.4 nmol/l (P<0.001). No significant difference was observed between both groups in vitamin D intake. However, the ID subjects had higher body weight, BMI, waist measurement and waist/height ratio than the AD subjects. Using a multiple linear regression analysis, only weight and BMI were found to independently influence 25(OH)D values. Children with a body weight, BMI, bicipital skinfold thickness, waist measurement and waist/height ratio above the 50th percentile for each variable were at a greater risk of having a low serum 25(OH)D concentration (<70 nmol/l).Conclusions:BMI and abdominal obesity influence the appearance of vitamin D insufficiency in children.

Influence of the desire to lose weight on food habits, and knowledge of the characteristics of a balanced diet, in a group of Madrid university students.

Objective: The aim of this study was to determine the desire to lose weight in a group of university students, and to analyse the influence of this desire on declared food habits. The degree of knowledge on what constitutes a balanced diet was also determined.Design: Cross-sectional population survey.Subjects: The study subjects were 234 university students (48 males and 186 females) aged 22.3±1.5 y. The weight and height of each were recorded. All subjects were questioned on their desire to lose weight, habitual food intake frequencies, and about what they considered to constitute a balanced diet.Results: Approximately half the population (47.9%), both male (47.8%) and female (47.9%), expressed a desire to lose weight, even though the percentage of overweight students was low (11.1% overall, although much greater among male students [39.6%] than female students [3.8]). The body mass index (BMI) of those who wanted to lose weight was greater than that of those who did not. Nonetheless, the majority of subjects (especially females) showed BMIs within the normal range (18–25 kg/m2). Among those who wished to lose weight, the consumption of sweet foods was lower — although these subjects believed they ought to consume even less. It was also thought necessary that egg consumption be reduced, although no differences were recorded in declared consumption between those who wished to lose weight and those who did not.Conclusions: The results show that there is great concern over body weight, although no great differences were seen in the food habits and nutrition knowledge of those who wished to lose weight and those who did not.

The Importance of Breakfast in Meeting Daily Recommended Calcium Intake in a Group of Schoolchildren

OBJECTIVE To evaluate the breakfast intake of calcium and milk products and to determine whether these correlate with total intake of both calcium and milk products. METHODS Food taken at breakfast and throughout the day was recorded using a 7 consecutive day food record in 200 schoolchildren aged between 9 and 13 years. RESULTS 65.3% of boys and 80.5% of girls showed intakes of calcium which were lower than recommended. Milk products were the foods most frequently included in breakfast (95.5% of subjects included them in this meal). A relationship was seen between energy provided by breakfast and the quantities of milk products (r = 0.5735) and calcium (r = 0.6908) taken at this meal. A relationship was also seen between energy provided by breakfast and daily intake of milk products (r = 0.4633) and calcium (r = 0.4954). The percentage of intakes of calcium lower than those recommended decreased when breakfast provided > or = 20% of total energy intake, and when the consumption of milk products at breakfast was greater than the 50th percentile (200 ml). Subjects with breakfast milk product intakes > or = 200 ml showed higher intakes of the same over the rest of the day (233.3 +/-140.4 g) than did those who took lesser quantities of these foods at breakfast (161.5 +/- 100.6 g). Further, those who took > or = 25% of the recommended intake of calcium at breakfast showed greater intakes of the same over the rest of the day (600.4 +/- 213.8 mg compared to 510.8 +/- 200.7 mg in subjects with lower calcium intakes). CONCLUSIONS The intake of milk products (r = 0.7587) and calcium (r = 0.7223) at breakfast correlates with the consumption of these foods in the whole diet. However, the total daily intake of milk products and calcium does not depend solely on breakfast intake. Subjects with the greatest intakes at breakfast also showed greater intakes over the rest of the day (r = 0.3953 for milk products and r = 0.4122 for calcium).

Influence of smoking on folate intake and blood folate concentrations in a group of elderly Spanish men.

OBJECTIVE To investigate the relationship between smoking habits and folate status in a group of elderly Spanish men. DESIGN We studied folate intake, serum and erythrocyte folate concentrations, hematological and biochemical data in 72 elderly males (comparing 24 smokers data with 44 nonsmokers ones). RESULTS Percentage deficiencies for folate intake, serum and erythrocyte levels were higher in smokers. Serum folate levels were significantly higher in nonsmokers. Smokers had higher mean corpuscular volume than did nonsmokers. CONCLUSIONS Smoking could be harmful to the intake and folate status. For smokers who will not give up the habit, improved dietary intake or a folate supplement is advisable.

Improvement of cholesterol levels and reduction of cardiovascular risk via the consumption of phytosterols

Hypercholesterolaemia is one of the main factors contributing to the appearance and progression of CVD, which is the main cause of death in the adult population of industrialized societies. By 2020, projections suggest that it will continue to hold first place, by then causing 37 % of all deaths. Therapeutic life-style changes to reduce cardiovascular risk include dietary modifications, such as the inclusion of phytosterols or plant sterols (known since the 1950s to reduce cholesterol levels). These help prevent the absorption of cholesterol and thus condition a reduction in total cholesterol and LDL-cholesterol levels, and ultimately in cardiovascular mortality. The fat-soluble nature of these sterols rendered margarine one of the best vehicles by which to supply them in the diet. Indeed, margarine was the first food to contain cholesterol-reducing phytosterols to be approved by the EU (in agreement with its regulations on new foods and food ingredients, 258/97/CE). Presently, phytosterols can be emulsified with lecithin and thus delivered in non-fat or low-fat foods and beverages. Margarine and dairy products (yoghurt and milk) enriched in phytosterols have proved better at lowering total cholesterol and LDL-cholesterol levels than have enriched cereals and their derivatives, although all can be of help, depending on the characteristics of each subject. The reduction in carotenoid bioavailability caused by sterols is minimized by increasing fruit and vegetable consumption. Individuals who habitually consume phytosterols should also follow traditional advice such as eating less dietary fat and increasing their physical activity. Phytosterols have been shown to be safe and effective in lowering cholesterol levels in many rigorous studies. In few areas of nutrition is there such consensus. Diet professionals should feel comfortable in prescribing phytosterols/stanols for the treatment of hypercholesterolaemia. They are safe whether taken alone or in combination with cholesterol-reducing drugs, such as statins and fibrates. Reinforcement counselling is essential, as therapy is effective only if compliance is good.

Zinc levels in maternal milk: the influence of nutritional status with respect to zinc during the third trimester of pregnancy

Objective: To study the relationship between nutritional status with respect to zinc during the third trimester of pregnancy and levels of the same mineral in transition milk (days 13 and 14 of lactation) and mature milk (day 40 of lactation).Design: Longitudinal study.Subjects: A group of 57 healthy, lactating mothers aged between 18 and 35 y (27±3.7) whose pregnancy and labour were attended by the Department of Obstetrics and Gynaecology of Cuenca INSALUD Hospital, Spain.Interventions: Zinc intake during the third trimester was determined by recording the consumption of foods over a five day period and by registering zinc provided by dietary supplements. Zinc levels in maternal serum during this stage of pregnancy, and in transition and mature milk, were determined by atomic absorption spectroscopy.Results: During pregnancy all subjects showed zinc intakes lower than those recommended. Only one pregnant subject took a supplement that provided extra zinc (1 mg/d). Subjects with an intake of lower than 50% of that recommended (L) (43.9%) showed significantly lower serum and mature milk zinc levels than did those with higher intakes (H) (56.1%) [12.0±1.5 µmol/L and 28.7±6.2 µmol/L compared to 13.3±2.6 µmol/L and 33.1±8.0 µmol/L respectively]. 56% of L subjects and 28.6% of H subjects showed serum zinc levels of less than 12.2 µmol/L. 8% of L subjects and no H subjects showed less than 11.5 µmol/L of zinc in maternal milk.Conclusions: The diet conditions maternal serum zinc levels during pregnancy and those of milk during lactation. Though all subjects showed intakes clearly below those recommended, low levels in serum or milk were much rarer. These results support the idea that there is a need to reset the limits of normality for serum and milk zinc levels. Further work in this area may confirm that the present recommended intakes of zinc be modified.Sponsporship: This work was supported by the Fondo de Investigaciones Sanitarias de la Seguridad Social (FISss).

Relationship between habitual breakfast and intellectual performance (logical reasoning) in well-nourished schoolchildren of Madrid (Spain)

Objective: To determine the relationships between habitual breakfast habits and performance in verbal aptitude, logical reasoning and mathematical tests in a group of well-nourished scholars from Madrid.Design: The study subjects were 180 children between 9 and 13 y of age. A dietetic study was undertaken using a 7-day food record. Scholastic aptitude was examined using the scholastic aptitude test (SAT-1) test.Results: Breakfast made up 19.1% of total daily intake. No differences were found between subjects in terms of personal data or total diet with respect to whether they habitually took adequate breakfasts (AB) (ie, more than 20% of daily energy being provided by this meal) or inadequate breakfasts (IB) (less than 20%). However, AB subjects achieved better reasoning scores in the SAT-1 test.Conclusions: The normal breakfast habits of schoolchildren should be taken into account when studying diet–mental function relationships, even when studying well-nourished populations.Sponsorship: This study was performed with help from Danone España S.A.