Reina García-Closas

Changes in food supply in Mediterranean countries from 1961 to 2001

OBJECTIVE To describe geographical differences and time trends in the supply of the most important food components of the traditional Mediterranean diet. DESIGN Food supply data collected from national food balance sheets for the period 1961-2001. SETTING Selected Mediterranean countries: Spain, Italy, France, Greece, Algeria, Morocco, Tunisia and Turkey. RESULTS Differences of almost 30-fold and five-fold were found in the supply of olive oil and fruits and vegetables, respectively, among the Mediterranean countries studied during the 1960s. A favourable increasing trend for the supply of fruit and vegetables was observed in most Mediterranean countries. However, an increase in the supply of meats and dairy products and a decrease in the supply of cereals and wine were observed in European Mediterranean countries from 1961 until 2001. Only in African and Asiatic Mediterranean countries were cereals the base of food supply. During the 1990s, Greeces food supply pattern was closest to the traditional Mediterranean diet, while Italy and Spain maintained a high availability of fruits, vegetables and olive oil, but were losing the other typical components. Among African and Asiatic Mediterranean countries, only Turkey presented a traditional Mediterranean dietary pattern except with respect to olive oil, the supply of which was very low. France showed a Western dietary pattern, with a high supply of animal products and a low supply of olive oil. CONCLUSIONS Dietary supplies in the Mediterranean area were quite heterogeneous in the 1960s and have experienced a process of Westernization, especially in European Mediterranean countries.

Determinants of Nutrient Intake among Children and Adolescents: Results from the enKid Study

Background: Although adequacy of nutrient intake has been studied considerably in children and adolescents across Europe, the factors associated with nutritional risk have rarely been addressed. This study was developed in order to explore the nutritional intakes of Spanish children and the factors influencing the risk of nutritional inadequacy. Objectives: To evaluate socio-economic and lifestyle variables associated with nutritional adequacy in Spanish children and adolescents. Methods: A cross-sectional study utilising face-to-face interviews. A random sample of 3,534 individuals aged 2–24 years were interviewed by a team of 43 dieticians in the subjects’ homes. Interviews included two 24-hour recalls (a second 24-hour recall in 25% of the sample) and other questions, including lifestyle. Weight and height were measured in all subjects. Under-reporters (18%) were excluded from the present analysis. An unconditional logistic regression analysis was used to identify variables associated with greater nutritional risk. Results: The participation rate was 68%. Twenty percent of males and 50% of females were classified as being at high nutritional risk. Variables associated with increased nutritional risk were: age between 14 and 24 years, being female, low social class, low educational level of the mother, having more than one sibling, smoking, watching TV during meals, sedentary habits at leisure time, infrequent meals and a poor quality breakfast. One dietary factor closely associated with nutritional risk was a failure to consume ready-to-eat cereals. Conclusions: Nutritional risk during infancy and adolescence is associated with socio-economic and educational variables of the family, and some lifestyle factors including physical activity and the quality of the breakfast meal.

Comparative analysis of nutrition data from national, household, and individual levels: results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain

Study objective: This project determined to what extent data on diet and nutrition, which were collected in a non-uniform manner, could be harmonised and pooled for international and national comparison. Design: Direct comparisons of dietary data between studies were made using food balance sheets (FBS), household budget surveys (HBS), and individual dietary data (IDS); comparisons were also made within countries. Differences in study design and methodological approaches were taken into consideration. Data from research projects from the following four World Health Organisation (WHO) Countrywide Integrated Noncommunicable Disease Intervention (CINDI) countries were included—Canada, Finland, Poland, and Spain. Main results: FBS overestimated food consumption and nutrient intake compared to IDS. Results between HBS and IDS were quite similar, except for fish, meat, pulses and vegetables, which were underestimated by HBS, and sugar and honey and cereals, which were overestimated. Percentages of energy from fat, carbohydrates and proteins were higher when estimated from FBS, HBS, and IDS respectively. Conclusions: Results suggest that estimations from these three sources of dietary data are difficult to compare because they are measuring different levels of dietary information. The understanding of their relations may be important in formulating and evaluating a nutrition policy.

Determinants of the nutritional status of vitamin E in a non-smoking Mediterranean population. Analysis of the effect of vitamin E intake, alcohol consumption and body mass index on the serum alpha-tocopherol concentration

Objectives: Study was conducted in order to investigate the association of vitamin E intake and other factors with plasma α-tocopherol concentration in a non-smoking Mediterranean population.Design: A cross-sectional study was conducted in a subsample of a representative sample of the Catalan population.Subjects: Sample size was 143 men and women, aged between 18 and 75 y, and final response rate reached 61.9% of the initial sample.Interventions: Serum alpha-tocopherol concentration standardized by serum total lipids was used as a proxy of the nutritional status of vitamin E. Vitamin E intake and alcohol consumption were estimated by a replicated 24 h recall method. Dietary data were collected in two different periods, winter and summer, in order to account for seasonal variation in nutrient intake, and were corrected for random within-person variability in order to account for day-to-day variation in nutrient intake. Multivariate linear regression models were fitted in order to estimate the determinants of serum α-tocopherol concentration.Results: In this population study, for each one mg increase in vitamin E intake, serum α-tocopherol concentration increased, on average, 0.66 micromol/L, after adjusting for age, gender, Body Mass Index (BMI), alcohol consumption and energy intake. BMI also influenced significantly serum α-tocopherol concentration, whereas alcohol intake, age and gender did not show significant associations with serum α-tocopherol.Conclusions: The study showed that vitamin E nutritional status was associated to vitamin E intake and BMI in non-smokers.Sponsorship: This study was supported by a research agreement between the Department of Health of the Autonomous Government of Catalonia and the Bosch Gimpera Foundation of the University of Barcelona (Contract 2415/95).

Which statin is most efficient for the treatment of hypercholesterolemia? a cost-effectiveness analysis

A review of the cost-effectiveness literature indicated that the hydroxymethylglutaryl coenzyme A-reductase inhibitor fluvastatin is more cost-effective for achieving minor-to-moderate reductions in low-density lipoprotein cholesterol (LDL-C) levels than 3 other statins: lovastatin, pravastatin, and simvastatin. The main goal of this study was to verify the applicability of these conclusions to Spanish health care costs and patterns of resource consumption related to the treatment of hypercholesterolemia. A stochastic simulation model was used to predict both the costs and effects of treating high-risk hypercholesterolemic patients with fluvastatin, lovastatin, pravastatin, or simvastatin. Epidemiologic data were used to find a suitable theoretic probability distribution model for baseline LDL-C values in high-risk hypercholesterolemic patients. The model was then used to generate 10,000 random observations of baseline LDL-C values; the corresponding LDL-C values after a 2-year treatment period were predicted as a function of the baseline value and the percentage reduction expected with a particular statin and dose, according to the results obtained in 2 meta-analyses. The probability of treatment discontinuation was also taken into account using estimates obtained in usual practice. The effects of treatment were expressed as the rate of success in achieving the goal level of LDL-C, as defined in the current Spanish recommendations for the treatment of hypercholesterolemia. The average costs of treatment were computed from both the social and public-financing perspectives, including the cost of lipid-lowering drugs, physician visits, laboratory tests, and days off work, as appropriate. The occurrence of nonscheduled visits and workdays lost because of side effects were taken into account to compute indirect costs relevant to the social perspective. The potential costs of treating side effects were ignored. A cost-effectiveness analysis was performed to compare the cost-effectiveness ratios obtained with each of the 4 statins considered in this study. Model-based predictions of the effects, total costs, and cost-effectiveness ratios were made. Cost-effectiveness ratios were interpreted as the cost per patient meeting the goal of therapy, according to current Spanish recommendations. The data showed that fluvastatin had the lowest cost-effectiveness ratios when LDL-C levels required reduction to < or =25% of baseline levels. In this situation, fluvastatin was more cost-effective than lovastatin, pravastatin, or simvastatin from public-financing and social perspectives.

Chinchón declaration; decalogue on low- and no-calorie sweeteners (LNCS)

Multidisciplinary experts in the areas of nutrition and health met in Chinchón, Madrid, on November 25-26, 2013 under the auspices of the Fundación para la Investigación Nutricional (Nutrition Research Foundation) and with the collaboration of the Madrid Regional Governments Health Ministry, the International Sweeteners Association and the Carlos III Health Institute CIBER of Physiopathology of Obesity and Nutrition. They analyzed the current status of scientific knowledge on low- and no-calorie sweeteners (LNCS) and developed a consensus Decalogue on their use; this constitutes the Chinchón Declaration. Sweeteners, including sugar, represent a subject of undeniable interest and are currently a popular topic, although areas relating to their safety and benefits remain unknown to segments of academia and the general public. The nature of LNCS makes them vulnerable to biased and even contradictory information. They are food additives that are broadly used as sugar substitutes to sweeten foods, medicines and food supplements when non-nutritional or non-caloric alternatives are needed. The Chinchón Decalogue is the outcome of a meeting for reflection and consensus by a group of experts with backgrounds in different scientific disciplines (toxicology, clinical nutrition, community nutrition, physiology, food science, public health, pediatrics, endocrinology and nutrition, nursing, pharmaceutical care and food legislation). The Decalogue includes different aspects of LNCS related to regulation, use, benefits and safety. In general, benefits of LNCS have been traditionally neglected in comparison with the tendency for emphasising unexisting or unproven possible risks. The need to strengthen research on LNCS in Spain was emphasized, as well as the need to educate both professionals and the public.

Author and Subject Index

The Author Index contains the primary entry for each item, listed under the first author’s name. The primary entry includes the coauthors’ names, the title of paper or other item, and its location, specified by the publication volume, number, and inclusive pages. The Subject Index contains entries describing the item under all appropriate subject headings, plus the first author’s name, the publication volume, number, and inclusive pages.