Javier Aranceta

Inflammation, obesity and comorbidities : the role of diet

The adipocyte metabolism has been shown to change during the fat enlargement process associated to obesity. Several procoagulant proteins such as plasminogen activator inhibitor type 1, tissue factor or factor VII and also inducible nitric oxide synthase show higher expression in adipose tissue of obese people in comparison to lean. This overexpression could explain at least a part of the atherogenic and cardiovascular risk associated with obesity. In addition to cytokine secretion, many other features have been observed to be common to adipocyte and monocyte/macrophage lines: for example, phagocytic and microbicidal activities, and possibly a cellular plasticity of adipose precursors. Overweight and obesity are associated with an increased risk of such metabolic abnormalities as dyslipidemia, hypertension or type 2 diabetes mellitus and cardiovascular diseases, common features of the metabolic syndrome. Initially, insulin resistance or hyperinsulinemia was suggested as the origin of these abnormalities. More recent studies indicate that adipokynes have an important role in obesity-associated metabolic complications, and suggest that chronically elevated local or systemic concentrations of adipokynes contribute to the development of complications associated with obesity and metabolic syndrome. Considering all the evidence relating to diet and inflammation, the best diet for protecting against the metabolic derangements associated with obesity and metabolic syndrome would be high in fibre-rich cereals, fruit, vegetables, fish, virgin olive oil and nuts; moderate in wine; and low in meat, processed meat foods and trans-fatty acids.

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.

Influence of sociodemographic factors in the prevalence of obesity in Spain. The SEEDO'97 Study.

Objective: To analyse the influence of social and cultural factors in the prevalence of obesity in the Spanish adult population aged 25–60 y based on available population data.Design: Pooled analysis of four cross-sectional nutrition surveys.Subjects: A total of 5388 free-living subjects aged 25–60 y, respondents of the Nutritional Surveys carried out in four Spanish regions (Catalunya, Basque Country, Madrid and Valencia) from 1990 to 1994. The samples were pooled together and weighted to build a national random sample.Measurements: Weight and height were measured on each individual by trained observers. Age, gender, educational level, occupation, habitat (rural/urban) and region were considered. Obesity was defined as body mass index ≥30 kg/m2. The protocol used in each survey was in accordance with the recommendations of the Spanish Society for the Study of Obesity (SEEDO). Logisitic regression models were designed to analyse the influence of sociodemographic factors in the prevalence of obesity in men and women.Results: The prevalence of obesity was higher in older age groups in men and women, odds ratio (OR) for every 10 y OR=1.40 (95% CI 1.39–1.41) for men and OR=1.86 (95% CI 1.85–1.87) for women. Logisitic regression analysis adjusted for age showed higher obesity rates among low educated people, OR=1.80 (95% CI 1.78–1.81) in men and OR=2.36 (95% CI 2.29–2.42) in women (P<0.001). Among men the odds ratio for the prevalence of obesity in rural areas was OR=1.87 (95% CI 1.86–1.89), compared to cities. The geographical distribution showed higher obesity rates in the southeast.Conclusion: This study supports that obesity is a multifactorial problem. Older women with low educational level and low income seem to be the most susceptible group to weight gain. Therefore, Public Health Programs should consider this type of environmental factor when planning strategies aimed at preventing or reducing the problem of obesity in western societies.European Journal of Clinical Nutrition (2001) 55, 430–435

Prevention of overweight and obesity from a public health perspective

International organizations have raised awareness of the increasing prevalence of overweight and obesity worldwide and the impact on morbidity, mortality, quality of life, and cost of healthcare. The development and implementation of obesity prevention strategies requires the identification and understanding of determinant factors that can be influenced by effective large-scale action plans over time. Strategies aimed at the primary prevention of obesity in a population should be multifaceted and designed to actively involve stakeholders and other major parties concerned; in addition, multiple settings for implementation should be considered. In this paper, an overview is presented of the strategies currently in place for obesity prevention, particularly in Spain.

Food Frequency Questionnaires

Food Frequency Questionnaires are dietary assessment tools widely used in epidemiological studies investigating the relationship between dietary intake and disease or risk factors since the early 90s. The three main components of these questionnaires are the list of foods, frequency of consumption and the portion size consumed. The food list should reflect the food habits of the study population at the time the data is collected. The frequency of consumption may be asked by open ended questions or by presenting frequency categories. Qualitative Food Frequency Questionnaires do not ask about the consumed portions; semi-quantitative include standard portions and quantitative questionnaires ask respondents to estimate the portion size consumed either in household measures or grams. The latter implies a greater participant burden. Some versions include only close-ended questions in a standardized format, while others add an open section with questions about some specific food habits and practices and admit additions to the food list for foods and beverages consumed which are not included. The method can be self-administered, on paper or web-based, or interview administered either face-to-face or by telephone. Due to the standard format, especially closed-ended versions, and method of administration, FFQs are highly cost-effective thus encouraging its widespread use in large scale epidemiological cohort studies and also in other study designs. Coding and processing data collected is also less costly and requires less nutrition expertise compared to other dietary intake assessment methods. However, the main limitations are systematic errors and biases in estimates. Important efforts are being developed to improve the quality of the information. It has been recommended the use of FFQs with other methods thus enabling the adjustments required.

Energy density, diet quality, and central body fat in a nationwide survey of young Spaniards

OBJECTIVESnTo determine the impact of energy density on diet quality and anthropometric proxy measures for central body fat in young Spaniards.nnnMETHODSnData were obtained from a representative national sample of 2513 young Spaniards aged 10 to 24 y. Dietary assessment was performed with a 24-h recall. Adherence to the Mediterranean diet was measured by the KIDMED index. Reduced rank regression analysis was used to identify energy-density dietary patterns. Waist circumferences and height were measured.nnnRESULTSnPastries and sausages showed the strongest loading for the dietary energy density factor score (DED-FS), with fruits and vegetables at the opposite end of the scale. Multiple linear regression analysis showed a positive association (P < 0.01) of dietary energy density (DED) and the DED-FS with waist circumferences regressed on height and age (WCheight+age) and waist-to-height ratio (WHtR). The adjusted odds ratio for elevated WCheight+age and WHtR increased across quartile distribution of DED (P < 0.001) and DED-FS (P < 0.05). Diet quality characterized by the KIDMED index was negatively associated (P < 0.001) with DED and the DED-FS.nnnCONCLUSIONSnHigher DED is a risk for increased central fat distribution and is associated with low adherence to the Mediterranean diet.

Caloric beverage drinking patterns are differentially associated with diet quality and adiposity among Spanish girls and boys

The present study assesses the impact of beverage consumption pattern on diet quality and anthropometric proxy measures for abdominal adiposity in Spanish adolescents. Data were obtained from a representative national sample of 1,149 Spanish adolescents aged 10–18xa0years. Height, weight, and waist circumferences were measured. Dietary assessment was performed with a 24-h recall. Beverage patterns were identified by cluster analysis. Adherence to the Mediterranean diet was measured by the KIDMED index. Three beverage clusters were identified for boys—“whole milk” (62.5xa0%), “low-fat milk” (17.5xa0%) and “soft drinks” (20.1xa0%)—and for girls—“whole milk” (57.8xa0%), “low-fat milk” (20.8xa0%) and juice (21.4xa0%), accounting for 8.3, 9.6, 13.9, 8.6, 11.5 and 12.9xa0% of total energy intake, respectively. Each unit of increase in the KIDMED index was associated with a 14.0xa0% higher (pu2009=u20090.004) and 11.0xa0% lower (pu2009=u20090.048) probability of membership in the “low-fat milk” and “soft drinks” cluster in girls and boys, respectively, compared with the “whole milk” cluster. Boys in the “soft drinks” cluster had a higher risk of 1-unit increase in BMI z score (29.0xa0%, pu2009=u20090.040), 1-cm increase in waist circumference regressed on height and age (3.0xa0%, pu2009=u20090.027) and 0.1-unit increase in waist/height ratio (21.4xa0%, pu2009=u20090.031) compared with the “whole milk” cluster. Conclusion: A caloric beverage pattern dominated by intake of “soft drinks” is related to general and abdominal adiposity and diet quality in Spanish male adolescents.

Community nutrition in Spain: advances and drawbacks

Scientific evidence has placed community nutrition among the front-line strategies in health promotion. Community nutrition in different regions of Spain has developed at an unequal pace. Early initiatives in the mid 1980s provided good-quality population data and established a basis for nutrition surveillance including individual body measurements, dietary intake data, information on physical activity, and biomarkers. The Nutrition and Physical Activity for Obesity Prevention Strategy (NAOS) reinforces community nutrition action in Spain. Presented here is an overview of developments in community nutrition in Spain in recent years as well as potential trends under the scope of the NAOS.

Dietary intake and anthropometric reference values in population studies

In nutritional epidemiology it is essential to have reference values for nutrition and anthropometry in order to compare individual and population data. With respect to reference nutritional intake, the new concept of Dietary Reference Intakes is generated based more on the prevention of chronic diseases than on covering nutritional deficiencies, as would occur in the early Recommendations. As such, the more relevant international organizations incorporated new concepts in their tables, such as the Adequate Intake levels or the Tolerable Upper Intake levels. Currently, the EURRECA recommendations (EURopean micronutrient RECommendations Aligned) are generating reference values for Europe in a transparent, systematic and scientific manner. Using the DRI, health-care authorities formulated nutritional objectives for countries or territories and Dietary Guides to disseminate the dietary advice to the population. Anthropometric assessment continues to be one of the most-used methods for evaluating and monitoring health status, nutritional state and growth in children, not only individuals but also communities. Different organizations have established anthropometric reference patterns of body mass index (BMI) with cut-off points to define overweight and obesity. In children, growth curves have been revised and adapted to the characteristics of healthy children in order to obtain anthropometric reference standards that better reflect optimum growth in children. The Growth Standards for children below 5 years of age of the WHO are a response to these principles, and are widely accepted and used worldwide.