Rosa M. Ortega

Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents

OBJECTIVE To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns. DESIGN Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered). SETTING Spain. SUBJECTS In total, 3850 children and youths aged 2-24 years residing in Spain. RESULTS Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age. CONCLUSIONS The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.

Importance of functional foods in the Mediterranean diet.

OBJECTIVE Analyse the importance of components of Mediterranean diet in functional feeding. DESIGN We have based the study in a bibliographic review. RESULTS Many of the characteristic components of the traditional Mediterranean diet (MD) are known to have positive effects on health, capacity and well-being, and can be used to design functional foods. Vegetables, fruits and nuts are all rich in phenols, flavonoids, isoflavonoids, phytosterols and phytic acid--essential bioactive compounds providing health benefits. The polyunsaturated fatty acids found in fish effectively regulate haemostatic factors, protect against cardiac arrhythmias, cancer and hypertension, and play a vital role in the maintenance of neural functions and the prevention of certain psychiatric disorders. Accumulating evidence suggests that olive oil, an integral component of the MD, may have health benefits, including the reduction of the risk of coronary heart disease, the prevention of several types of cancer and the modification of the immune and inflammatory responses. Olive oil is known for its high levels of monounsaturated fatty acids and is a good source of phytochemicals, such as polyphenolic compounds, squalene and alpha-tocopherol. In the context of the MD, the benefits associated with the consumption of several functional components may be intensified by certain forms of food preparation. In addition, the practice of more physical activity (once common among Mediterranean populations) and the following of other healthy lifestyle habits may have additive effects. CONCLUSIONS The identification of the active constituents of the MD is crucial in the formulation of appropriate dietary guidelines. Research into the pharmacological properties of the minor components of this diet (vitamins, sterols, polyphenols, etc.) is very active and could lead to the formulation of functional foods and nutraceuticals.

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.

Wholegrain cereals and bread: a duet of the Mediterranean diet for the prevention of chronic diseases.

OBJECTIVE The promotion of healthy lifestyles is one of the major goals of governments and international agencies all over the world. Wholegrain cereals are rich in nutrients and many phytochemical compounds, with recognised benefits for health, including dietary fibre, a number of phenolic compounds, lignans, vitamins and minerals and other bioactive components. The aim of the present work is to review the fundamental studies that support the consumption of wholegrain cereals and bread to prevent chronic diseases. DESIGN Descriptive review considering human studies. SETTING AND SUBJECTS Subjects included in randomised intervention trials and cohort studies from different countries published up to 2010. RESULTS Several studies show consistently that subjects who ingest three or more portions of foods per day based on wholegrain cereals have a 20-30 % lower risk of CVD than subjects who ingest low quantities of cereals. This level of protection is not observed with the ingestion of refined cereals, these being even higher than with the intake of fruit and vegetables. Likewise, high intake of wholegrain cereals and their products, such as whole-wheat bread, is associated with a 20-30 % reduction in the risk of type 2 diabetes. Finally, protection against the risk of colorectal cancer and polyps, other cancers of the digestive tract, cancers related to hormones and pancreatic cancer has been associated with the regular consumption of wholegrain cereals and derived products. CONCLUSIONS The regular intake of wholegrain cereals can contribute to reduction of risk factors related to non-communicable chronic diseases.

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 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.

Relationship between iron status in pregnant women and their newborn babies Investigation in a Spanish population

We studied 157 pregnant women living in Merida, Spain, during their third trimester of pregnancy and their newborns at birth, analyzing the mothers and the umbilical cords blood for hemoglobin, hematocrit, mean corpuscular hemoglobin concentration (MCHC), serum iron and serum ferritin. We observed statistically significant correlations between hemoglobin and hematocrit values of the mother with erythrocyte count, hemoglobin and hematocrit values of her child and between serum iron of mother and child. The blood levels in the umbilical cord did not decrease until the ferritin value of the mother was < 12 μg/1. Under these conditions the ferritin levels in the umbilical cord blood (80.4 μg/1) were significantly lower than in those newborn infants whose mother had adequate ferritin levels (123 μg/1). We deduce that maternal iron status seems to condition, at least partially, fetal iron status, specially when the mother has some deficiencies. We did not find a lower birth weight in children of anemic mothers. Actually, we found an inverse correlation between maternal hemoglobin values and infant birth weight (r =‐0.1731, p < 0.05). It is possible that the demands on the mother are increased in the case of a newborn infant of greater size.