Lourdes Ribas-Barba

Prevalence and deteminants of obesity in Spanish children and young people.

Prevalence estimates of obesity in a national random sample of Spanish children and young people are presented in this paper, defined by age- and sex-specific BMI national reference standards for the 85th percentile (overweight) and 97th percentile (obesity), as well as by Cole et al. criteria. A random sample of 3534 people, aged 2-24 years, was interviewed between 1998 and 2000. The study protocol included personal data, data on education and socioeconomic status (SES) for the family, dietary assessment, anthropometric measurements and physical activity. The prevalence of obesity was 13.9 % (95 % CI 12.7, 15.1) considering Spanish reference standards as cut-offs. Obesity was significantly higher in boys (15.6 %) than in girls (12 %). The highest values were observed between 6 and 13 years of age. Using Coles cut-offs, the estimated prevalence of obesity was 6.3 % (95 % CI 5.4, 7.5) with a similar pattern to that previously described by sex. Regarding sociodemographic factors, sex, age group, region, size of locality of residence, mothers level of education and family SES level were significant predictors for obesity in children and adolescents under 14 years. Among young people, the main sociodemographic predictors for obesity were geographical region and family SES level. Odds ratio for obesity was 1.27 for those with a more frequent consumption of buns, cakes and snacks, and 1.71 for those with more frequent consumption of sugared drinks. Adequate consumption of fruit and vegetables, usually having breakfast and regular sports practice had a protective effect. The available data show that obesity in Spain is a public health issue given its magnitude and increasing trends. Among Spanish children and young people, those at prepubertal age, particularly boys, can be identified as a group at higher risk for overweight and obesity, particularly children from lower SES families.

Weight status of European preschool children and associations with family demographics and energy balance‐related behaviours: a pooled analysis of six European studies

This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4–7 years); (ii) identify energy balance‐related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in prevalence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long‐term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers.

Nutrient adequacy in Spanish children and adolescents.

The nutritional intakes of the Spanish child and adolescent population are presented, as well as the population at risk of inadequate nutrient status. A random sample of 3534 people aged 2-24 years were interviewed between 1998 and 2000. Interviews included two 24 h recalls and a general questionnaire and anthropometric evaluations for the entire sample. After excluding under-reporters (18.7 %), the final sample was 2855 individuals (1348 males and 1507 females). The average intake of energy was 9543 kJ in males and 7804 kJ in females, with important variations seen by age group. Energy intake increased with age in both sexes until 14-17 years, which also applied to almost all of the nutrients studied, with the exception of vitamin C. A decreasing trend in the percentage of energy from carbohydrates was seen in both sexes. At the low socioeconomic level, it was observed that all nutrient intakes were less favourable when compared with higher socioeconomic levels. Nutrients with associated intakes below one-third of the Spanish recommended nutrient intake (RNI) included vitamin D (42 % of the sample) and folate (10 % of females), and the percentages falling below two-thirds of the RNI corresponded to: vitamin D (97 %), vitamin A (60 %), vitamin E (54 %), folate (58 % of females), Fe (23 % of females), vitamin C (8 %), Mg (4.5 %), Ca (5 % of females) and vitamin B6 (5 % of females). Adolescents aged between 14 and 17 years was the group with the highest nutritional risk, especially among girls. Nutritional adequacy in Spanish children was, in general, adequate, although it is necessary to analyse the implications of high inadequate intakes of vitamins D, E and A, which means that the current recommended intakes should be reconsidered. It should be noted that folate levels should be doubled in the near future.

Obesity and overweight trends in Catalonia, Spain (1992-2003): gender and socio-economic determinants

OBJECTIVE To evaluate the trends of overweight and obesity prevalences in the population of Catalonia, Spain, aged 18-75 years, and the influence of socio-economic determinants on these prevalence trends. DESIGN Analysis based on data from two representative population-based cross-sectional surveys. SETTING Data from the two Evaluations of Nutritional Status in Catalonia (ENCAT 1992-93 and ENCAT 2002-03), Spain. Weights and heights were obtained by direct measurement in standardised conditions by trained interviewers. Overweight and obesity were defined using body mass index (BMI) and waist circumference (WC), categorised according to WHO criteria. SUBJECTS In total, 1015 men and 1233 women from ENCAT 1992-93, and 791 men and 924 women from ENCAT 2002-03. RESULTS Mean BMI and mean WC were higher in males in 2002-03 as compared to 1992-93, while for females mean BMI was lower except for the youngest group, and mean WC was higher. In men, overall BMI overweight prevalence remained stable (from 44.1% to 43.7%), while obesity increased (from 9.9% to 16.6%); total WC overweight remained stable (from 21.7 to 23.8%), while WC obesity increased (from 13.1% to 24.4%). In women, overall BMI overweight increased (from 29.1% to 30.1%), whereas BMI obesity remained stable (from 15.0% to 15.2%); total WC overweight decreased (from 21.8% to 17.7%), while WC obesity increased (from 24.5% to 31.1%). The socio-economic and education variables had an influence on BMI and WC overweight and obesity rates mainly on females in both surveys and on the youngest men only in the 1992-93 survey. CONCLUSIONS Ten-year trends indicate that Catalan males are getting bigger overall (BMI) and around the waistline (WC), while Catalan females only have bigger waistlines (WC). BMI male obesity prevalence has overtaken that of females. WC obesity continues to be more prevalent among females than males.

Dietary exposure assessments for children in europe (the EXPOCHI project): rationale, methods and design.

Background/purposeThe number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims [1] to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and [2] to use these data to assess the usual intake of lead, chromium, selenium and food colours.MethodsEXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used.ConclusionThe EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.

Trends in energy and nutrient intake and risk of inadequate intakes in Catalonia, Spain (1992-2003).

OBJECTIVES To analyse trends in energy and nutrient intakes and nutritional adequacy from 1992 to 2003. DESIGN Two consecutive cross-sectional studies carried out on random samples of the Catalan population ENCAT 1992-93 and ENCAT 2002-03. Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days. Spanish food consumption tables were used. Energy and nutrient data were adjusted for intraindividual variability, and the Spanish recommend nutrient intakes (RNIs) were used in the analysis. SETTING Catalonia region, North Eastern Spain. SUBJECTS Analysis is based on a total of 4701 individuals; 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS No relevant changes in energy intake trends were observed, although a decrease was observed in the daily consumption of proteins (-7 g), cholesterol (-56 mg), potassium (-245 mg), vitamin A (-283 RE microg), retinoids (-71 microg), carotenoids (-1520 microg), niacin (-29 mg), folates (-15 microg), vitamin B12 (-1.6 microg) vitamin D (-0.5 microg), fibre and iron, and an increase in the consumption of calcium (+57 mg) and a slight increase in lipids and fatty acids (% energy). In general, the most outstanding trends were those of vitamin A (as a result of the decreased consumption of offal), proteins, vitamin D and B12 (due to the decreased consumption of meat and fish) and calcium (as a consequence of the increased consumption of dairy products). CONCLUSION No changes were observed in the energy intake of males or females; therefore, the obesity changes may possibly be attributed to changes in physical activity patterns. However, an increase in energy sources of a poorer nutritional profile has been identified, especially for between meal snacks.

Trends in dietary habits and food consumption in Catalonia, Spain (1992–2003)

OBJECTIVE To analyse trends in food habits and food consumption from 1992 to 2003. DESIGN Two consecutive cross-sectional nutrition surveys were carried out on random samples of the Catalan population (Evaluation of Nutritional Status in Catalonia (ENCAT) 1992-93 and ENCAT 2002-03). Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days and a food frequency questionnaire was used to ascertain tendencies in the frequency of food consumption. SETTING Catalonia region, Northeastern Spain. SUBJECTS Analysis is based on a total of 4701 individuals: 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS The trends from 1992 to 2003 showed an increase in eating between meals and outside the home. There was also an upsurge in consumers for fast food, especially among young adults. Notable decreases in fruit consumption (from 301 to 224 g day(-1)) as well as in vegetables, potatoes, meat (red meat and chicken), fish (whitefish and seafood) and offals were observed. In contrast, there was an increase in dairy product consumption, in general (from 255 to 312 g day(-1)), as well as low fat and skim milk derivatives. Fruit juice, nuts and olive oil consumption also increased, the latter being consumed daily by 96% of the population. Little variation was observed for the rest of the food groups in the period studied. Overall, Catalonia is characterised by a model of consumption that is quite favourable, inherent to Mediterranean countries but with important differences according to age. CONCLUSION Based on the food consumption trends observed in Catalonia, an increase in the consumption of fruits and vegetables, as well as whole grain cereals and fish, should be promoted, along with a reduction in the consumption of meat and sausages.

Dietary assessment methods for intakes of iron, calcium, selenium, zinc and iodine.

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence is working towards developing aligned micronutrient recommendations across Europe. The purpose of the present study was to conduct a review of methods used in validation studies carried out in adults assessing dietary intake of EURRECA priority minerals. A search strategy and inclusion criteria were defined and a scoring system was developed to rate the quality of each validation study that produced a quality index with possible scores obtained ranging from 0.5 to 7. A MEDLINE and EMBASE literature review was conducted. Articles/validation studies meeting the inclusion criteria included: 79/88 for Fe; 95/104 for Ca; 13/15 for Se; 29/30 for Zn; 7/9 for iodine. The most frequently used method to ascertain dietary intake was the Food Frequency Questionnaire (FFQ), whereas dietary records (DR) and 24 h recalls were the most used reference methods. The correlation coefficients (CC) between study mineral intakes estimated by FFQ and the reference method were weighted according to the studys quality index and obtained acceptable to good ratings, ranging from 0.36 to 0.60 when the reference method was DR and from 0.41 to 0.58 when the reference was 24 h recalls. A minority of studies (n 9) used biomarkers for validation and among these, five included iodine obtaining a CC of 0.47. The FFQ was seen as a valid method for assessing mineral intake, particularly for Ca and, to a lower extent, for iodine and Zn. Se and Fe showed only acceptable correlations. The present review provides new insights regarding the characteristics that assessment methods for dietary mineral intakes should fulfil.

Evaluating associations between Mediterranean diet adherence indexes and biomarkers of diet and disease

OBJECTIVE We examined associations between two Mediterranean diet (MD) adherence indexes (the MD index, MDI, and the MD score, MDS) and several blood biomarkers of diet and disease. SUBJECTS We studied 328 individuals from Catalonia (Northeastern Spain), ages 18-75, who provided fasting blood samples, a subset of the 2346 individuals as part of a larger representative and random sample from the 1992-1993 Catalan Nutritional Survey. DESIGN AND METHOD Diet was measured using 24-h recalls. Biomarkers studied were plasma levels of beta-carotene, alpha-tocopherol, retinol, vitamins B12, C and folates as well as serum total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides. Multivariate linear regression was used to analyse associations of the nutrient biomarkers with the dietary pattern indexes, adjusting for potential confounders. RESULTS AND CONCLUSIONS Subjects with higher MD adherence, as measured by the two dietary indexes, had significantly higher plasma concentrations of beta-carotene, folates, vitamin C, alpha-tocopherol and HDL cholesterol. The most highly significant relationship was that between folates and the adherence to the MD Pattern, as determined by both indexes. These research findings suggest the potential usefulness of biomarkers as complementary tools for assessing adherence to a dietary pattern. This type of data not only informs the development of robust dietary adherence indexes, but it also provides specific clues about the potential physiological mechanisms that explain the beneficial effects of the MD pattern on chronic disease risk.

Usage of Plant Food Supplements across Six European Countries: Findings from the PlantLIBRA Consumer Survey

Background The popularity of botanical products is on the rise in Europe, with consumers using them to complement their diets or to maintain health, and products are taken in many different forms (e.g. teas, juices, herbal medicinal products, plant food supplements (PFS)). However there is a scarcity of data on the usage of such products at European level. Objective To provide an overview of the characteristics and usage patterns of PFS consumers in six European countries. Design Data on PFS usage were collected in a cross-sectional, retrospective survey of PFS consumers using a bespoke frequency of PFS usage questionnaire. Subjects/setting A total sample of 2359 adult PFS consumers from Finland, Germany, Italy, Romania, Spain and the United Kingdom. Data analyses Descriptive analyses were conducted, with all data stratified by gender, age, and country. Absolute frequencies, percentages and 95% confidence intervals are reported. Results Overall, an estimated 18.8% of screened survey respondents used at least one PFS. Characteristics of PFS consumers included being older, well-educated, never having smoked and self-reporting health status as “good or very good”. Across countries, 491 different botanicals were identified in the PFS products used, with Ginkgo biloba (Ginkgo), Oenothera biennis (Evening primrose) and Cynara scolymus (Artichoke) being most frequently reported; the most popular dose forms were capsules and pills/tablets. Most consumers used one product and half of all users took single-botanical products. Some results varied across countries. Conclusions The PlantLIBRA consumer survey is unique in reporting on usage patterns of PFS consumers in six European countries. The survey highlights the complexity of measuring the intake of such products, particularly at pan-European level. Incorporating measures of the intake of botanicals in national dietary surveys would provide much-needed data for comprehensive risk and benefit assessments at the European level.