Blanca Román-Viñas

Dietary patterns and nutritional adequacy in a Mediterranean country

Dietary patterns have been related to health outcomes and morbi-mortality. Mediterranean diet indexes are correlated with adequate nutrient intake. The objective of the present study was to analyse the adequacy of nutrient intake of a posteriori defined Mediterranean (MDP) and Western (WDP) diet patterns in the Seguimiento Universidad de Navarra (SUN) cohort. A sample of 17 197 subjects participated in the study. Participants completed a 136-item validated semi-quantitative FFQ. Principal component analysis was used to define dietary patterns. Individuals were classified according to quintiles of adherence based on dietary pattern scores. Non-dietary variables, such as smoking and physical activity habits, were also taken into account. The probability approach was used to assess nutrient intake adequacy of certain vitamins (vitamins B12, B6, B3, B2, B1, A, C, D and E) and minerals (Na, Zn, iodine, Se, folic acid, P, Mg, K, Fe and Ca). Logistic regression analysis was used to assess the adequacy of nutrient intake according to adherence to dietary patterns. WDP and MDP were defined. A higher quintile of adherence to an MDP was associated to a lower prevalence of inadequacy for the intake of Zn, iodine, vitamin E, Mg, Fe, vitamin B1, vitamin A, Se, vitamin C and folic acid. The adjusted OR for not reaching at least six (or at least ten) nutrient recommendations were 0.09 (95 % CI: 0.07, 0.11) (and 0.02 (95 % CI: 0.00, 0.16)) for the upper quintile of MDP and 4.4 (95 % CI: 3.6, 5.5) and 2.5 (95 % CI: 1.1, 5.4) for the WDP. The MDP was associated to a better profile of nutrient intake.

The Mediterranean Diet and Nutritional Adequacy: A Review

The Mediterranean dietary pattern, through a healthy profile of fat intake, low proportion of carbohydrate, low glycemic index, high content of dietary fiber, antioxidant compounds, and anti-inflammatory effects, reduces the risk of certain pathologies, such as cancer or Cardiovascular Disease (CVD). Nutritional adequacy is the comparison between the nutrient requirement and the intake of a certain individual or population. In population groups, the prevalence of nutrient inadequacy can be assessed by the probability approach or using the Estimated Average Requirement (EAR) cut-point method. However, dietary patterns can also be used as they have moderate to good validity to assess adequate intakes of some nutrients. The objective of this study was to review the available evidence on the Nutritional Adequacy of the Mediterranean Diet. The inclusion of foods typical of the Mediterranean diet and greater adherence to this healthy pattern was related to a better nutrient profile, both in children and adults, with a lower prevalence of individuals showing inadequate intakes of micronutrients. Therefore, the Mediterranean diet could be used in public health nutrition policies in order to prevent micronutrient deficiencies in the most vulnerable population groups.

Dairy products and health: a review of the epidemiological evidence

Evidence-based nutrition is essential to move forward in the science of community nutrition. The present study is a review of the epidemiological evidence of dairy products and health. There is an inverse association between the intake of dairy products and hypertension, stroke and colorectal cancer. There is no evidence of an association between the consumption of dairy products and breast cancer. There is some evidence linking high-fat dairy products and an incremental risk of prostate cancer and weak evidence of the protective capacity of dairy products on bone health. More prospective studies should be developed in order to establish better evidence of the relationship between dairy products and health. Due to the importance of dairy products in public health nutrition, quantitative recommendations should be established in the light of the scientific evidence.

International Physical Activity Questionnaire: Reliability and validity in a Spanish population

Abstract Although questionnaires are useful for evaluating patterns of physical activity in populations, they need to be validated. The objective of this study was to determine the validity and reliability of the long version of the International Physical Activity Questionnaire (IPAQ) in a Spanish population. The participants wore a uniaxial MTI Actigraph (Computer Science and Application, Inc.) accelerometer for 7 days and self-completed the IPAQ questionnaire twice, to assess its reliability. Criterion validity was assessed by comparing data from the IPAQ and data from the MTI. The final sample included 54 adults for the validity analysis and 66 adults for the reliability analysis. The correlations (r) between the IPAQ and the accelerometer were 0.29 (P<0.05) for total physical activity (MET · min−1 · day−1) versus total counts per minute, 0.30 (P<0.05) for time spent in vigorous activity, and 0.34 (P<0.05) for time spent sitting. The IPAQ showed a good reliability coefficient for total physical activity (r=0.82, P<0.05), vigorous activity (r=0.79, P<0.05), moderate activity (r=0.83, P<0.05), and time spent walking (r=0.73, P<0.05). Total time spent on work-related physical activities (r=0.92, P<0.05), on household-related activities (r=0.86, P<0.05), and leisure-time physical activities (excluding walking) (r=0.82, P<0.05) showed good reliability coefficients. Bland Altman analysis showed that discrepancies between the two methods increased with the amount of moderate and vigorous physical activity undertaken. In conclusion, the long version of the IPAQ has acceptable validity for the measurement of total and vigorous physical activity, and good reliability coefficients for application in the Spanish population studied here. The questionnaire showed poor validity for reporting moderate-intensity activity in this Spanish population.

Validity of dietary patterns to assess nutrient intake adequacy.

The purpose of the present study was to conduct a systematic review of the literature on the value of the methods used to assess dietary patterns for measuring nutrient intake adequacy in the population. Systematic review on Pubmed database up to April 2008. The search included specific key words and MeSH terms. No language limit was set. Only studies that compared food patterns with nutrient intake adequacy or nutrient biomarkers were included in the analysis. The search resulted in 1504 articles. The inclusion and exclusion criteria limited the selection to thirty articles. Nineteen studies evaluated the usefulness of the dietary patterns, either a priori defined (thirteen studies), or defined by factor analysis (four studies) or by cluster analysis (two studies), but only nine of them tested their validity (four a priori defined and four a posteriori defined). Diet indices showed moderate to good validity results for measuring the adequacy of intakes for alpha-carotene, beta-carotene, vitamin C, vitamin B6, Ca, folic acid, Fe and Mg. The factor analysis approach showed moderate to good validity correlations with the adequacy of intake of alpha-carotene, beta-carotene, lutein, lycopene, vitamin C, vitamin B6 and folic acid. Vitamin B12 and vitamin E are the micronutrients with less probability of being adequately assessed with dietary patterns a priori or a posteriori defined. Diet indices are tools with fair to moderate validity to assess micronutrient intake adequacy.

How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review

EURopean micronutrient RECommendations Aligned is a network of excellence funded by the European commission, and established to address the problem of differences between countries in micronutrient recommendations as well as to understand how nutritional information including requirements and adequacy of intake is processed among different population groups. The aims of the present paper were to review the methods used for the adequacy assessment of the intake of six micronutrients of public health concern (vitamin A, folate, vitamin B12, Fe, Zn and iodine) in non-European and European nutrition surveys carried out on the apparently healthy population and to compare in particular the adequacy across surveys for folate intake. A systematic literature review was conducted to identify nutrition surveys that assessed micronutrient intake adequacy. The search yielded 9049 records, out of which 337 were eligible for the selected micronutrients. The majority (83.9 %) of the European surveys compared the adequacy of the nutrient intake against the Recommended Dietary Allowances (RDA); only a few surveys (8.0 %) used the estimated average requirement cut-point method, while none of them used the probability approach. The comparison of folate inadequacy across eight countries revealed that about 25 % of the adult female population had inadequate intakes when judged against the different recommendations used by the respective investigators, but nearly 75 % had inadequate intakes when compared against the estimated average requirement cut-point value of 320 microg/d. The present review showed that different methods were applied across Europe to estimate the adequacy of micronutrient intake, which led to different prevalence estimates of micronutrient inadequacy.

Trends in physical activity status in Catalonia, Spain (1992-2003)

AIMnThe promotion of a healthy and active lifestyle among the population is essential for the prevention of numerous chronic diseases. Physical activity measurement and surveillance is crucial for understanding and evaluating campaigns to promote its practice.nnnOBJECTIVEnTo evaluate the 10-year trends in physical activity habits in the Catalan population.nnnDESIGNnTwo cross-sectional nutritional surveys were carried out within a 10-year interval in the population of Catalonia. Data on physical activity include leisure-time physical activity, occupational physical activity and walking activity and regular stair climbing. SubjectIn all, 2344 individuals participated in the ENCAT 1992-93 study and 2055 individuals in the ENCAT 2002-03 survey, aged 10 to 75 years.nnnRESULTSnInactivity related to occupation increased (from 53% in 1992-93 to 56% in 2002-03 of the Catalan population having sedentary work-related activities). In both genders, the percentage of people who walked to work at least 30 min decreased (from 19% to 16% in men and from 25% to 19% in women). There was a decrease in the percentage of people who were completely sedentary during leisure time (from 59% to 56%), and an increase in the percentage of people who did at least 2 days of vigorous activity (from 39% to 46% in men and from 26% to 32% in women).nnnCONCLUSIONSnThe physical activity related to work and transportation has decreased during the period observed. Although a slight improvement has been noted, the percentage of people who are sedentary during leisure time is still high among both men and women.

The Effect of the Mediterranean Diet on Hypertension: A Systematic Review and Meta-Analysis.

OBJECTIVEnThe adoption of a Mediterranean diet (MD) pattern of eating is often described as a strategy to help prevent or manage hypertension. However, this dietary regimen has not been reviewed systematically for its efficacy against hypertension. Therefore, the purpose of this study was to analyze the effect of interventions of at least 1 year duration on blood pressure (BP) values through a systematic review and meta-analysis. The focus was on interventions comparing an MD with a low-fat diet.nnnDESIGNnThe authors accessed and searched PubMed and Scopus databases up to March, 2015. Randomized control trials comparing MD vs low-fat diet were included. The researchers assessed the methodological quality, extracted the valid data, and conducted the meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.nnnRESULTSnSix trials (more than 7,000 individuals) were identified. Meta-analysis showed that interventions aiming at adopting an MD pattern for at least 1 year reduced both the systolic BP and diastolic BP levels in individuals with normal BP or mild hypertension. The effect was higher for the systolic BP (-1.44 mm Hg) but also consistent for the diastolic BP (-0.70 mm Hg). However, the results have to be interpreted with caution owing to the reduced number of studies eligible for inclusion in this meta-analysis. This situation limited the statistical power of the analyses. Furthermore, in all analyses, the pooled effect estimation showed a high evidence of heterogeneity, which compromises the validity of the pooled estimates.nnnCONCLUSIONS AND IMPLICATIONSnA positive and significant association was found between the MD and BP in adults. However, in all cases the magnitude of the effect was small. Based on this limited group of studies and their heterogeneity, the authors found insufficient convincing evidence to suggest that the MD decreased BP. Further standardized research is urgently needed to reach evidence-based conclusions to clarify the role of MD in BP management, particularly in Europe and other societies where prevalence of cardiovascular diseases is increasing.

The Effect of Iron on Cognitive Development and Function in Infants, Children and Adolescents: A Systematic Review

A systematic review was conducted to summarize the evidence currently available from randomized controlled trials (RCTs) concerning the effect of iron intake of infants, children and adolescents on measures of cognitive development and function. The Cochrane Library, MEDLINE and Embase were searched up to and including February 2010. Studies were also identified by checking the bibliographies of the articles retrieved. All RCTs with an adequate control group in which iron supply was provided by natural food sources, fortified foods, formula or supplements to infants, children or adolescents until the age of 18 years were considered for inclusion. No language restrictions were applied. Fourteen studies met the selection criteria. Twelve out of these 14 studies had a high or moderate risk of bias. A large degree of heterogeneity of study populations, iron dosages and outcome measures precluded performing a quantitative meta-analysis. Overall, the studies suggest a modest positive effect of iron supplementation on cognition and psychomotor outcomes in anemic infants and children after supplementation periods of at least 2 months of duration.

Effects of dietary assessment methods on assessing risk of nutrient intake adequacy at the population level: from theory to practice

The present study evaluated how applying different dietary methods affects risk assessment of inadequate intakes at the population level. A pooled analysis was conducted using data from two Spanish regional representative surveys both applying similar methodology with a total sample of 2615 individuals aged 12-80. Diet was assessed in the entire sample applying data from one 24 h recall (24HR), a mean of two non-consecutive 24HR, both crude and adjusted for intraindividual variability, and a FFQ. Intakes of vitamins A, C, E, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, Fe, Mg, P and Zn were compared to the average nutrient requirement (ANR or estimated average requirement) in the entire sample and also excluding under-reporters applying the ANR cut-point method (and the probability approach for Fe). Higher percentages of intakes below the ANR were seen for 1-24HR and the mean of 2-24HR, except for nutrients with the highest rates of inadequacy (vitamins A, E, folate and Mg). For these micronutrients, higher percentages of inadequacy were obtained by adjusted 24HR data and the lowest with FFQ. For the remaining nutrients, adjusted data gave the lowest inadequacy percentages. The best concordance was seen between 2-24HR and 1-24HR as well as for adjusted 24HR, with the least observed between FFQ and the other methods. Exclusion of under-reporters considerably reduced inadequacy in both daily methods and FFQ. Crude daily data gave higher estimates of inadequate intakes than adjusted data or FFQ. Reproducibility of daily methods was also reasonably good. Results may differ depending on the micronutrient thus impeding reaching conclusions/recommendations common for all micronutrients.