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Introduction: The aim of this article is to objectively summarize the report of the European Scientific Committee in charge of updating the algorithm underlying the front-of-pack nutritional label Nutri-Score. It described the methodology used and the priorities established, the scientific rational and the different scenarios tested, the proposed modifications and their impact on the different food groups concerned. The Scientific Committee considered that its current algorithm works globally well, but has introduced some improvements. Modifications recommended allow to correct some of its identified limits: classification of oils, fatty fish, whole grain products, nuts, cheeses, higher penalization of very sugary or very salty foods, sweet dairy products, composite products, red meat… while maintaining the overall consistency of the system and the classification of the products. The update of the Nutri-Score algorithm permits a better alignment between the Nutri-Score classifications and nutritional recommendations disseminated in the different European countries that have adopted it.

Introduction: Background: to date, gluten-free (GF) diet is the only treatment available for individuals with celiac disease. Both individual and collective food intake assessments are a challenge because a food composition database of GF products (GFPs) is lacking. Objectives: to describe the process of developing a food composition database of GFPs, and to compare the nutritional profile and price of some GFPs and non-GFPs. Methods: initially, a total of 216 brands of GFPs marketed in Spain were recorded. Nutritional information was collected from nutritional labels and product fact sheets that had been provided by food companies or collected first-hand by researchers. Then, the nutritional profile and price of the cereal and cereal byproducts foodstuff groups, including 19 types of products, were compared. Statistical analyses were performed using the SPSS statistical program (22.0 edition; SPSS, Chicago, IL, USA). Results: a total of 2,247 GFPs from 126 different foodstuff brands were included in the food composition database of GFPs (CELIAC-BASE). We classified these products into 14 foodstuff groups. The protein content of the GFPs studied was significantly lower, and the price was higher, than that of their non-GFP counterparts. Some, but not all, GFPs had a higher content of fat and sugar, and a lower content of dietary fiber as compared to their non-GFP counterparts. Some GFPs were up to 6 times more expensive than the corresponding non-GFPs. Conclusions: CELIAC-BASE is a pioneering tool for dietitians. Many GFPs have poor nutritional profiles and should be consumed only occasionally in a balanced GF diet.

Introduction: Chronic diseases and aging are placing an ever increasing burden on healthcare services worldwide. Nutritional counselling is a priority for primary care because it has shown substantial cost savings. This review aims to evaluate the evidence of the cost-effectiveness of nutritional care in primary care provided by health professionals. A literature search was conducted using PubMed/MEDLINE between January 2000 and February 2019. The review included thirty-six randomized controlled trials (RCTs) and systematic reviews conducted in healthy people and people with obesity, type-2 diabetes mellitus, cardiovascular risk or malnutrition. All the RCTs and reviews showed that nutritional intervention led by dietitians-nutritionists in people with obesity or cardiovascular risk factors was cost-effective. Dietary interventions led by nurses were cost-effective in people who needed to lose weight but not in people at high cardiovascular risk. Some dietary changes led by a primary care team in people with diabetes were cost-effective. Incorporating dietitians-nutritionists into primary care settings, or increasing their presence, would give people access to the healthcare professionals who are best qualified to carry out nutritional treatment, and may be the most cost-effective intervention in terms of health expenditure. Notwithstanding the limitations described, this review suggests that incorporating dietitians-nutritionists into primary health care as part of the multidisciplinary team could be regarded as an investment in health. Even so, more research is required to confirm the conclusions.

Introduction: The Spanish Ministry of Health, in November 2018, notified the officially adoption of the front-of-pack nutrition label Nutri-Score which will allow consumers to easily judge the nutritional quality of food at the time of purchase and to encourage industrialists to improve the nutritional composition of food. This article synthesizes the scientific work pertaining to the validation of the nutritional profile that underlies the computation of Nutri-Score and works that demonstrate its effectiveness and superiority in comparison to other existing logos or proposed by food companies. Likewise, it highlights its development in Spain and within the European Union and responds to the fake-news raised by its detractors. It also introduces the European Citizens' Initiative to make it compulsory in Europe.

The nutritional guidelines incorporate dairy products as part of a balanced and healthy diet. In almost all guidelines it is announced that dairy products have to preferably be consumed as non or low-fat version. The reason behind this recommendation is the intake of saturated fatty acids (SFA). Recently, it has been suggested that building nutritional recommendations according to the nutrient food content, leads to a limiting interpretation of the functions and properties of the consumed food. Lately, the research focus has been shifted towards the study of the food matrix, which allows assessing health effects considering all the components contained in the foods, and their impact in human health. Dairy products are the perfect example to highlight the importance of the food matrix as a determinant of the effects of nutrients on health. The potentially harmful effects of SFA on cardiometabolic health seem to be different when they are consumed within nutrient-rich foods such as yogurt, cheese or other dairy products. Epidemiological studies with large population cohorts and long term follow-up show that consumption of dairy products, especially yogurt, is not associated with an increased cardiovascular risk. Therefore, there is not enough scientific evidence to preferentially recommend the consumption of non-fat or low-fat dairy products to the general population, instead of its whole-fat version.

Introduction: metabolic syndrome (MS) components are independent risk factors for the development of cardiovascular disease and type 2 diabetes, major causes of mortality in the world., Objective: to evaluate the frequency of MS components and its association with sociodemographic variables and physical activity among young health professionals at the University of Guadalajara., Methods: a cross-sectional study entitled LATIN America METabolic Syndrome Mexico (LATINMETS-Mex) was conducted. Weight, height, waist circumference, blood pressure, triglycerides, glucose and HDL cholesterol were measured. Socio-demographic and physical activity data were surveyed. MS components were diagnosed based on the revised criteria of Alberti et al. (2009). Associations were assessed using logistic regression adjusted for age and sex., Results: a total of 316 volunteer subjects were analyzed (70.9% women, 83.8% ≤ 29 years). The frequency of MS was 7.0% and 55.5% of subjects presented one or more MS components (27.2% abdominal obesity, 26.6% low HDL cholesterol). After adjustment, abdominal obesity, high blood pressure and hypertriglyceridemia were positively associated with BMI ≥ 25 kg/m2. High blood pressure and hypertriglyceridemia were negatively associated with being female while low HDL cholesterol was positively associated with this gender after adjustment. Abdominal obesity was the only component negatively associated with physical activity (300 to 600 minutes per week) after adjusting for age and sex. No association between MS and sociodemographic variables or physical activity was found., Conclusions: half of the participants presented one or more metabolic syndrome components. Actions are required to reduce cardiometabolic risk in the study population considering the sociodemographic and lifestyle variables associated.

Yogurt is a nutrient-dense probiotic food with unique properties. It has been associated with healthy dietary patterns and postulated as a marker of diet quality. In this report we describe the nutritional composition of yogurt as a good source of several micronutrients, which may help to improve diet quality and maintain metabolic well-being as part of a healthy dietary pattern. The results of this report indicate that yogurt consumers have overall higher diet quality. Increasing yogurt consumption may help to improve the intake of some shortfall vitamins and minerals, as part of a well energy-balanced diet. Further studies such as long-term intervention one, would be useful to explore the effect of yogurt consumption, on nutritional status and health.

The quality of dietary fat critically influences health. In this consensus document the scientific evidence relating effects of dietary fat quantity and quality on cardiovascular risk is reviewed and recommendations for the Spanish adult population are issued. As a novelty in nutrition guidelines, emphasis is made more on parent foods than on fatty acids per se. In summary, replacing saturated fatty acids (SFA) for monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) reduces cardiovascular risk. Recent data suggest that SFA proper may be harmful or not depending on the parent food, a reason why an intake threshold is not established, but consumption of foods containing excess SFA, such as butter, some processed meats, and commercial confectionery and fried foods is discouraged. The established threshold of <1 % of energy intake as trans FA, well known to be harmful for cardiovascular risk, is fulfilled in Spain due in part to its present low levels in margarines. MUFA are beneficial or neutral for cardiovascular risk depending on their dietary sources (virgin olive oil versus other fats), and no intake limitations are established.n-6 PUFA are cardioprotective and recommended intakes (5-10 % of energy) are not always fulfilled in the Spanish population, thus increased consumption of their vegetable food sources (seeds, derived oils, and margarines)is encouraged. Marine n-3 PUFA are also cardioprotective and the recommendation stands to eat fatty fish≥2 servings/weeks to reach intake levels of at least 250 mg/day. Increasing evidence suggests that alpha-linolenic acid (ALA), the vegetable n-3 PUFA, is also cardioprotective,but the parent foods (walnuts, soy products,green-leaf vegetables) may provide benefits beyond ALA itself. Finally, low-fat (high carbohydrate, particularly when having a high glycemic index) diets appear to lack cardiovascular preventive effects, while high-fat,high-vegetable fat dietary patterns such as the Mediterranean diet, are protective, a reason why no upper limit on fat intake is established for the Spanish population.This position statement targets dietitians, nutritionists and other health professionals involved in dietary counsel so they can deliver it rightly and according to the last scientific evidence., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Some studies demonstrated that dehydration process is prevalent among young populations and subsequently, a cause of concern. However, the evaluation of the fluid consumption pattern of children and adolescent populations has not been widely assessed., Objective: To evaluate the total fluid intake from different types of beverages in Spanish children and adolescents., Methods: A total of 238 children and adolescents aged 3-17 years were randomly recruited from all Spanish regions. The information about the quantity and quality of daily fluid intake from different types of beverages was collected using a 24 h fluid-specific diary over 7 consecutive days., Results: Fluid intake was < 80% of the EFSA recommendations in 87% of the study population. In our sample, water was the main contributor to fluid intake, followed by milk and derivates and sweet regular beverages. No differences in consumption patterns were found according to gender. Consumption of hot beverages as well as sweet regular and sweet light beverages increased with age, while milk and milk derivates consumption decreased., Conclusion: The large majority of our young population did not meet the EFSA recommendations for total water intake. Therefore, an increase in plain water consumption in children and adolescents should be promoted in order to fulfill the fluid needs without increasing calorie intake., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Introduction: Dietary questionnaires usually only assess the intake of drinks that provide calories, but do not accurately evaluate total fluid or water intake. The evaluation of the fluid consumption pattern of a population has been the main objective of only a very few studies., Objective: To evaluate the total fluid intake from different types of beverages in Spanish adults., Methods: A total of 1,262 adults aged 18-70 years were randomly recruited from all Spanish regions. The information about the quantity and quality of daily fluid intake from different types of beverages was collected using a 24h fluid-specific diary over 7 consecutive days., Results: 50.4% of the study population had a fluid intake < 80% of the EFSA recommendations for total water intake. The odds of meeting the recommendations of total fluid intake were higher in women [OR: 2.48; 95%CI: 1.81-3.40], and in those with higher leisure-time physical activity (3-4 times/week [OR: 1.57; 95%CI: 1.01- 2.46]; 5 times/week or more [OR: 1.97; 95% CI: 1.37-2.83]). Women consumed significantly more hot and sweet light beverages. However, men consumed significantly more sweet regular and alcoholic drinks. A significant higher percentage of young and normal/underweight subjects exceed the WHO recommendations for free sugars (> 10% total energy intake) from beverages alone., Conclusion: Half of the adults studied do not meet the EFSA fluid intake recommendations. Water is the main fluid consumed. Differences in the pattern of fluid consumption were observed between ages and genders. A quarter of the population studied consumes from beverages alone already more sugar than recommended from the total diet., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Milk products contain proteins of high biologic value and digestibility; they also contain fat, carbohydrates, vitamins and minerals, specially calcium and phosphorus. Diversification of milk products consumption allows a high consumptiom of the above mentioned products, optimizing nutrient intake. In Spain, food consumption of milk products lower than the recommended amounts was observed in 20 to 40 % of the children and 30 to 45 % of the adults. Milk products represent 44 to 70 % of calcium intake in the Spanish population. Milk products consumption is positively associated with a high bone mineral density. More than 35 % of children and adults in Spain had calcium intakes below the national recommendations. Yogur contains less lactose than regular milk and fermenting milk bacteries express functioning lactase. Yogur intake is recommended to improve lactose digestion in individuals having lactose maldigestion. It seems reasonable to recommend yogur to improve calcium absorption, at least in post-menopausal women, and also for decreasing incidence and duration of infectious gastrointestinal disorders in children. Fermented milk products consumption, before, during and after medical eradication of Helicobacter Pylori, increases 5 to 10 % the effect of the specific drug therapy. Its consumption before, during and after antibiotic treatment, could also reduce the risk of diarrhea associated with the use of the above mentioned drugs. The Spanish Federation of Nutrition, Feeding and Dietetic Societies (FESNAD) recommend the following consumption of milk and milk products: Adults, 2-3 portions/day; school-age children, 2-3 portions/day; adolescents, 3-4 portions/day; pregnant and lactating women and during menopause, 3-4 portions/day; elderly, 2-4 portions/day. Considering yogur and fermented milk consumption show some advantages when compared with other milk products, we can recommend yogur within a daily and varied consumption of milk products., (Copyright AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction: Hypertension (HTN), atherogenic dyslipidemia, an increased glycemia in a fasting state, and abdominal obesity (AO), constitute a cluster of risk factors for cardiovascular disease named metabolic syndrome (MS)., Objective: To analyze the prevalence and distribution of MS and its components in healthcare personnel from the University of Antioquia., Methodology: Cross-sectional study conducted between 2010 and 2011. The collected data included anthropometrical, biochemical, socio-demographic, and lifestyle variables. The MS was diagnosed using the harmonized IDF/AHA definition. Descriptive and analytical statistical analyses were performed, including χ2 tests, and a = 0.05., Results: 285 volunteers (29.1% men) with ages between 20 and 61 years were included. 31.6% of participants were overweight with a Body Mass Index higher than 25 kg/m2 (BMI). AO (29.8%) and HTN (29.8%) were the most frequent components of MS. Global prevalence of MS was 17.5% (95%CI: 13.1; 22). There was a lower presence of MS among women (OR 0.328; 95%CI: 0.175; 0.614; p < 0.05), and a positive gradient with age and income. Likewise, the prevalence of MS was higher among smokers and those who are overweight (p < 0.05). After adjusting for age, MS was associated with sex (OR 0.348; 95%CI: 0.178; 0.680) and being overweight (OR 14.592; 95%CI: 6.343; 33.570)., Conclusion: The most frequently observed components of MS in the studied sample were AO and HTN. BMI, sex, and socio-economic status are important independent risk factors associated with MS., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction: The aim of this study was to compare two models of nutrition labeling front-of-pack, in reference to the ability of consumers to choose a diet closer to nutritional recommendations., Methods: Randomized crossover design in 32 adults (18-65 years) of both sexes. Participants were randomly exposed to two experimental conditions using nutritional traffic light system (S-SN) or monochrome system (SM). Participants had to choose options from a closed menu for five days on the basis of the experimental front-of-pack labelling. For each meal, three food options with different nutritional compositions were given to the participants. The total energy and fat, saturated fat, sugar and salt of the chosen options were calculated., Results: No significant differences at baseline sociodemographic and anthropometric characteristics were shown between individuals regardless of the experimental condition in which they started. The subjects tended to choose a diet with a lower, but not significant energy content of 23.0 ± 67.5 (P = 0.063) and a significantly lower sugar content of 3.5 ± 9.2 g, P < 0.001 and 0.6 ± 1 g, P < 0.003 for salt., Conclusions: Compared to the to the monochrome system, the multiple traffic-light system probably can help make food choices with less sugar and salt in a situation similar to the usual purchase in which there is a time limitation., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Introduction: Little research has been conducted into the attitudes and knowledge of dietitians-nutritionists (DN) or of experts in human nutrition and dietetics (EHND) regarding functional foods (FFs)., Objectives: To evaluate the knowledge of, interest in and predisposition towards FFs in Spanish DN and EHND, and how these professionals rate the potential benefits and risks associated with consuming FFs., Methods: 2100 DN and 122 EHND were asked to participate in a self-administered questionnaire. The results were expressed using percentages and the DN responses were compared with those of the EHND by means of chi-squared test. A significant difference was regarded as having been obtained if P < 0.05., Results: 204 DN and 112 EHND responded. After eliminating 45 surveys due to anomalies, 268 surveys were analyzed (170 from the DN, 8.1% participation; 98 from the EHND, 80.3% participation). No statistically significant differences were observed between the responses of the DN and the EHND except in: 1) the view that it was "dangerous" to consume certain FFs ≥ 4 times a day; and 2) the knowledge of the population regarding in which situations certain FFs should be consumed. Most of the professionals demonstrated good knowledge of FFs, consumed FFs, showed a positive attitude towards FFs and thought that the information provided to the consumer is insufficient., Discussion and Conclusions: FFs are generally accepted by nutritional professionals. However, further study is required into the discrepancies between DN and EHND regarding the view that it is "dangerous" to consume certain FFs and regarding their evaluation of whether the public know in which situations certain FFs should be consumed.

There have been several studies on the effects of dietary fibre on the metabolism. Epidemiologic studies have consistently reported an inverse relationship between dietary fibre and type 2 diabetes mellitus or cardiovascular mortality. This review focuses on observational and experimental studies that examine the effect of different types and sources of dietary fibre on body weight, glucose metabolism and lipid profile. From the available evidence, we conclude that clinical studies consistently show that the intake of viscous dietary fibre decreases the low density lipoprotein cholesterol and postprandial glucose levels, and induces short term satiety. However, few clinical trials have demonstrated that the intake of dietary fibre has a positive effect on the control of diabetes and body weight.

Background: Overweight and eating disorder (ED) are major public health problems in adolescents., Aims: To assess the association of overweight, body composition and anthropometric characteristics with the probability being at risk of ED., Methods: A two-phase study was used. 329 girls and 96 boys (aged 12-18 years) from an initial sample of 2967 adolescents were studied. The BMI, percentage of fat mass estimated by bioimpedance (FM(BIA)), waist circumference, waist-to-height ratio, and waist-to-hip ratio (WHipr) were calculated. The Eating Attitudes Test, Youth's Inventory-4 and a questionnaire to evaluate social influences were administered., Results: A total of 34.7% of girls and 53.6% of boys at risk of ED were overweight (including obesity). For girls, overweight frequency was significantly higher in risk ED group than in control group. Increases of one point in the BMI or FM(BIA) increased the probability of being at risk of ED by 12% (3.0-19.0) and 4% (0.0-8.0), respectively. An increase in WHipr was negatively associated with ED risk. Smoking and symptoms of dysthymia and the genralized anxiety disorder also increase the probability of being at risk of ED in adolescent girls. In adolescent boys, these relations were not observed., Conclusions: The higher BMI and the percentage of FM(BIA) are associated with greater risk of ED in adolescent girls, when psychological factors are present. Increases in the WHipr, characteristic of childhood body is negatively associated with that risk.