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Diet-related risk factors and physical inactivity are among the leading risk factors for disability and are responsible for a large proportion of the burden of chronic non-communicable diseases. Food-based dietary guidelines (FBDGs) are useful tools for nutrition policies and public health strategies to promote healthier eating and physical activity. In this paper, we discuss the process followed in developing the dietary guidelines for the Spanish population by the Spanish Society of Community Nutrition (SENC) and further explain the collaboration with primary healthcare practitioners as presented in the context of the NUTRIMAD 2018 international congress of SENC. From a health in all policies approach, SENC convened a group of experts in nutrition and public health to review the evidence on diet-health, nutrient intake and food consumption in the Spanish population, as well as food preparation, determinants and impact of diet on environmental sustainability. The collaborative group drafted the document and designed the graphic icon, which was then subject to a consultation process, discussion, and qualitative evaluation. Next, a collaborative group was established to plan a dissemination strategy, involving delegates from all the primary healthcare scientific societies in Spain. A product of this collaboration was the release of an attractive, easy-to-understand publication.

Objective: The objective of this study was to analyze the dietary intake of the Spanish population according to ponderal status and body fat distribution., Methods: Data were obtained from ANIBES (Anthropometry, Intake, and Energy Balance in Spain), a cross-sectional study of a nationally representative sample (1013 men, 996 women) of the Spanish population (18-64 years). The final fieldwork was carried out from mid-September to November (three months) 2013. A 3-day dietary record provided information about food and beverage consumption. Height, weight, and waist circumference were assessed, and body mass index (BMI) and waist-height ratio (WHtR) calculated., Results: The Spanish population had a low consumption of fruits and vegetables, cereals, whole cereals, and dairy and high consumption of meat products. Individuals with overweight/obesity (BMI ≥ 25 kg/m 2 ) and abdominal adiposity (WHtR ≥ 0.5) showed lower compliance with dietary guidelines. In the male group, adjusting by age, inadequate consumption of cereals (<4 servings/day) and vegetables and fruit (<5 servings/day) was associated with higher risk of overweight (odds ratio [OR] = 1.704, 95% confidence interval [CI], 1.187-2.447, p = 0.001, for cereals and OR = 3.816, 95% CI, 1.947-7.480, p = 0.001, for vegetables and fruits) and abdominal adiposity (OR = 2.081, 95% CI, 1.419-3.053, p = 0.000 and OR = 4.289, 95% CI, 2.108-8.726, p = 0.001, respectively)., Conclusion: Nutritional campaigns should be conducted to improve the dietary habits of the Spanish population in general, especially men, who have poorer ponderal status and abdominal adiposity, due to their lower adherence to dietary guidelines.

Some studies have indicated that promoting the Mediterranean diet pattern as a model of healthy eating may help to prevent weight gain and the development of overweight/obesity. Bread consumption, which has been part of the traditional Mediterranean diet, has continued to decline in Spain and in the rest of the world, because the opinion of the general public is that bread fattens. The present study was conducted to assess whether or not eating patterns that include bread are associated with obesity and excess abdominal adiposity, both in the population at large or in subjects undergoing obesity management. The results of the present review indicate that reducing white bread, but not whole-grain bread, consumption within a Mediterranean-style food pattern setting is associated with lower gains in weight and abdominal fat. It appears that the different composition between whole-grain bread and white bread varies in its effect on body weight and abdominal fat. However, the term 'whole-grain bread' needs to be defined for use in epidemiological studies. Finally, additional studies employing traditional ways of bread production should analyse this effect on body-weight and metabolic regulation.

The dietary inflammatory index (DII) is a new tool to assess the inflammatory potential of the diet. In the present study, we aimed to determine the association between the DII and BMI, waist circumference and waist:height ratio (WHtR). We conducted a cross-sectional study of 7236 participants recruited into the PREvención con DIeta MEDiterránea trial. Information from a validated 137-item FFQ was used to calculate energy, food and nutrient intakes. A fourteen-item dietary screener was used to assess adherence to the Mediterranean diet (MeDiet). Sex-specific multivariable linear regression models were fitted to estimate differences (and 95 % CI) in BMI, waist circumference and WHtR across the quintiles of the DII. All nutrient intakes, healthy foods and adherence to the MeDiet were higher in the quintile with the lowest DII score (more anti-inflammatory values) except for intakes of animal protein, saturated fat and monounsaturated fat. Although an inverse association between the DII and total energy was apparent, the DII was associated with higher average BMI, waist circumference and WHtR after adjusting for known risk factors. The adjusted difference in the WHtR for women and men between the highest and lowest quintiles of the DII was 1·60 % (95 % CI 0·87, 2·33) and 1·04 % (95 % CI 0·35, 1·74), respectively. Pro-inflammatory scores remained associated with obesity after controlling for the effect that adherence to a MeDiet had on inflammation. In conclusion, the present study shows a direct association between the DII and indices of obesity, and supports the hypothesis that diet may have a role in the development of obesity through inflammatory modulation mechanisms.

Background: Excess sodium intake is associated with high blood pressure, a major risk factor for cardiovascular disease (CVD). It is unknown whether decreasing sodium intake to <2300 mg/d has an effect on CVD or all-cause mortality., Objective: The objective was to assess whether reductions in sodium intake to <2300 mg/d were associated with either an increased or a decreased risk of fatal and nonfatal CVD and all-cause mortality., Design: This observational prospective study of the PREvención con DIeta MEDiterránea (PREDIMED) trial included 3982 participants at high CVD risk. Sodium intake was evaluated with a validated food-frequency questionnaire and categorized as low (<1500 mg/d), intermediate (≥1500 to ≤2300 mg/d), high (>2300 to ≤3400 mg/d), or very high (>3400 mg/d). Subsequently, 1-y and 3-y changes in sodium intake were calculated. Multivariate relative risks were assessed by using Cox proportional hazards ratios. Marginal structural models with inverse probability weighting were used to test the effect of changes in sodium intake and the Mediterranean diet (MedDiet)., Results: We documented 125 CVD events and 131 deaths after a 4.8-y median follow-up. Sodium intake <2300 mg/d was associated with a lower risk of all-cause mortality: 48% (HR: 0.52; 95% CI: 0.30, 0.91; P = 0.02) and 49% (HR: 0.51; 95% CI: 0.26, 0.98; P = 0.04) after 1 and 3 y, respectively. Increasing sodium intake after 1 y was associated with a 72% (HR: 1.72; 95% CI: 1.01, 2.91; P = 0.04) higher risk of CVD events. The incidence rate of CVD was reduced for those who reduced their sodium intake and were randomly assigned to MedDiet interventions [4.1/10,000 (95% CI: 3.1, 8.0) compared with 4.4/10,000 (95% CI: 2.7, 12.4) person-years; P = 0.002]., Conclusions: Decreasing sodium intake to <2300 mg/d was associated with a reduced risk of all-cause mortality, whereas increasing the intake to >2300 mg/d was associated with a higher risk of CVD. Our observational data suggest that sodium intake <2300 mg/d was associated with an enhanced beneficial effect of the MedDiet on CVD. These results should be interpreted with caution, and other confirmatory studies are necessary., (© 2015 American Society for Nutrition.)

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence explored the process of setting micronutrient recommendations to address the variance in recommendations across Europe. Work centered upon the transparent assessment of nutritional requirements via a series of systematic literature reviews and meta-analyses. In addition, the necessity of assessing nutritional requirements and the policy context of setting micronutrient recommendations was investigated. Findings have been presented in a framework that covers nine activities clustered into four stages: stage one "Defining the problem" describes Activities 1 and 2: "Identifying the nutrition-related health problem" and "Defining the process"; stage two "Monitoring and evaluating" describes Activities 3 and 7: "Establishing appropriate methods," and "Nutrient intake and status of population groups"; stage three "Deriving dietary reference values" describes Activities 4, 5, and 6: "Collating sources of evidence," "Appraisal of the evidence," and "Integrating the evidence"; stage four "Using dietary reference values in policy making" describes Activities 8 and 9: "Identifying policy options," and "Evaluating policy implementation." These activities provide guidance on how to resolve various issues when deriving micronutrient requirements and address the methodological and policy decisions, which may explain the current variation in recommendations across Europe. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.].

Unlabelled: INTRODUCCIÓN: As part of the work carried out within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence in Spain, we conducted a series of semi-structured interviews with decision makers and relevant scientific institutions in the field of nutrition and public health. The information gathered was collated with national relevant official and unofficial documents and subsequently analysed., Aim: To describe the current situation about nutrition policy in Spain, with special focus on the process of setting micronutrient recommendations and the development of subsequent policies. 3 cases will be detailed: iodine, folic acid and vitamin D., Methods: Information from 9 interviews was contrasted with the available official and unofficial documents on micronutrients recommendations setting and subsequent policy applications to help the population to achieve their requirements., Results and Discussion: Common topics and themes were identified in the interviews and desk research. They describe a heterogenic picture of isolated initiatives and timid measures regarding micronutrients recommendations and subsequent policy instruments. Several recommendations coexist but none of them is the result of an official request by the government or competent authority. Iodine, folic acid and vitamin D represent the past, the present and the future of public health policy measures on micronutrients in Spain. Despite of some examples, there exist a need for action., Conclusions: Current nutrition strategies are focused on obesity, with little room for micronutrients national measures despite of the opinion of many experts. Regardless of the several nutrients recommendations coexisting nowadays in Spain, there exist the need for a coordinated action in the field of micronutrients recommendations, fostered by the health and nutrition official authorities with financial support and clear terms of reference.

Objective: To present the Mediterranean diet (MD) pyramid: a lifestyle for today., Design: A new graphic representation has been conceived as a simplified main frame to be adapted to the different nutritional and socio-economic contexts of the Mediterranean region. This review gathers updated recommendations considering the lifestyle, dietary, sociocultural, environmental and health challenges that the current Mediterranean populations are facing., Setting and Subjects: Mediterranean region and its populations., Results: Many innovations have arisen since previous graphical representations of the MD. First, the concept of composition of the 'main meals' is introduced to reinforce the plant-based core of the dietary pattern. Second, frugality and moderation is emphasised because of the major public health challenge of obesity. Third, qualitative cultural and lifestyle elements are taken into account, such as conviviality, culinary activities, physical activity and adequate rest, along with proportion and frequency recommendations of food consumption. These innovations are made without omitting other items associated with the production, selection, processing and consumption of foods, such as seasonality, biodiversity, and traditional, local and eco-friendly products., Conclusions: Adopting a healthy lifestyle and preserving cultural elements should be considered in order to acquire all the benefits from the MD and preserve this cultural heritage. Considering the acknowledgment of the MD as an Intangible Cultural Heritage of Humanity by UNESCO (2010), and taking into account its contribution to health and general well-being, we hope to contribute to a much better adherence to this healthy dietary pattern and its way of life with this new graphic representation.

This paper provides an overview of the current knowledge relating to the nutritional requirements and corresponding recommended nutrient intake values of children and adolescents for micronutrients and specificities related to these requirements in the course of childhood and adolescence in Europe. Aspects that can influence micronutrient requirements, such as physiological requirements and bioavailability of the nutrients in the organism, are discussed. The methodology used to obtain the data and also the main knowledge gaps regarding these concepts are emphasized. Methodological critical points in achieving the data and physiological aspects of children and adolescents are important in order to standardize the reference values for micronutrients among Europe for these stages of life., (© 2010 Blackwell Publishing Ltd.)

The European Micronutrient Recommendations Aligned (EURRECA) Network aims to provide standardized approaches to reveal and beneficially influence variability within the European Union in micronutrient recommendations for vulnerable population groups. Characterization of the 'vulnerability' together with the 'variability' of micronutrient needs represents the first step to creating guidelines for setting micronutrient recommendations within target populations. This paper describes some of the key factors and characteristics relevant to assess micronutrient requirements and formulate recommendations of micronutrients in pregnancy. Nutritional requirements during pregnancy increase to support fetal growth and development as well as maternal metabolism and tissue accretion. Micronutrients are involved in both embryonal and fetal organ development and overall pregnancy outcomes. Several factors may affect directly or indirectly fetal nourishment and the overall pregnancy outcomes, such as the quality of diet including intakes and bioavailability of micronutrients, maternal age, and the overall environment. The bioavailability of micronutrients during pregnancy varies depending on specific metabolic mechanisms because pregnancy is an anabolic and dynamic state orchestrated via hormones acting for both redirection of nutrients to highly specialized maternal tissues and transfer of nutrients to the developing fetus. The timing of prenatal intakes or supplementations of specific micronutrients is also crucial as pregnancy is characterized by different stages that represent a continuum, up to lactation and beyond. Consequently, nutrition during pregnancy might have long-lasting effects on the well-being of the mother and the fetus, and may further influence the health of the baby at a later age., (© 2010 Blackwell Publishing Ltd.)

This paper presents a review of the current knowledge regarding the macro- and micronutrient requirements of infants and discusses issues related to these requirements during the first year of life. The paper also reviews the current reference values used in European countries and the methodological approaches used to derive them by a sample of seven European and international authoritative committees from which background scientific reports are available. Throughout the paper, the main issues contributing to disparities in micronutrient reference values for infants are highlighted. The identification of these issues in relation to the specific physiological aspects of infants is important for informing future initiatives aimed at providing standardized approaches to overcome variability of micronutrient reference values across Europe for this age group., (© 2010 Blackwell Publishing Ltd.)

In last decades modern societies are undergoing a rapid nutrition transition process that reinforces, at international level, the emergence of nutritional problems of contradictory nature, such as malnutrition and obesity. This represents a considerable challenge for contemporary Public Health leaders, who have been gradually developing a set of strategies which overwhelmingly adopt a population perspective. Nevertheless, the collective nature of these strategies could neglect the particular individual and family needs. We consider social participation as an approach to simultaneously reinforce both individual and population perspectives during the divers phases of development of Community Nutrition programs which tackle the paradoxical nature of this problematic. However in relation to some contextual factors, we find a growing trend to develop a more technocratic dimension of participatory practices, which distorts the emancipator and transformative potential of social participation. In order to avoid this tendency, we propose the use of the five intervention axes of the Ottawa Chart for Health Promotion as a guide for a systemic integration of social participation in planning, implementation and evaluation processes of Community Nutrition programs. We therefore take into account the integration of social participation in the efforts made in developing individual capacity-building, reinforcing collective action, creating enabling environments, health care reorganization, and finally, implementing nutritional and public health policies.

Background: There is considerable variation in the recommended micronutrient intakes used by countries within Europe, partly due to different methodologies and concepts used to determine requirements and different approaches used to express the recommendations. As populations become more mobile and multi-national, and more traditional foods become available internationally, harmonised recommendations based on up to date science are needed. This was recognised by the European Commission's (EC) Directorate-General (DG) Research in their 2005 call for proposals for a Network of Excellence (NoE) on 'nutrient status and requirements of specific vulnerable population groups'. EURopean micronutrient RECommendations Aligned (EURRECA), which has 34 partners representing 17 European countries, started on its 5-year EC-funded programme in January 2007. The programme of work was developed over 2 years prior to submitting an application to the EC. The Network's first Integrating Meeting (IM) held in Lisbon in April 2007, and subsequent consultations, has allowed further refinement of the programme., Aim: This paper presents the rationale for the EURRECA Network's roadmap, which starts by establishing the status quo for devising micronutrient recommendations. The Network has the opportunity to identify previous barriers and then explore 'evidence-based' solutions that have not been available before to the traditional panels of experts. The network aims to produce the EURRECA 'toolkit' to help address and, in some cases, overcome these barriers so that it can be used by those developing recommendations., Results: The status quo has been largely determined by two recent initiatives; the Dietary Reference Intake (DRI) reports from the USA and Canada and suggestions for approaches to international harmonisation of nutrient-based dietary standards from the United Nations University (UNU). In Europe, the European Food Safety Authority (EFSA) has been asked by the EC's Directorate-General for Health and Consumer Protection to produce values for micronutrient recommendations. Therefore, EURRECA will draw on the uniqueness of its consortium to produce the sustainable EURRECA toolkit, which will help make such a task more effective and efficient. Part of this uniqueness is the involvement in EURRECA of small and medium-sized enterprises (SMEs), consumer organisations, nutrition societies and other stakeholders as well as many scientific experts. The EURRECA toolkit will contain harmonised best practice guidance for a more robust science base for setting micronutrient recommendations. Hence, in the future, the evidence base for deriving nutrient recommendations will have greater breadth and depth and will be more transparent., Conclusions: The EURRECA Network will contribute to the broader field of food and nutrition policy by encouraging and enabling the alignment of nutrient recommendations. It will do this through the development of a scientific toolkit by its partners and other stakeholders across Europe. This will facilitate and improve the formulation of micronutrient recommendations, based on transparently evaluated and quantified scientific evidence. The Network aims to be sustainable beyond its EC funding period.

Objective: To analyze compliance with the current European and Spanish nutritional objectives in a representative sample from Catalonia, a Spanish Mediterranean region; and to examine relationships between diet and plasma fatty acid composition., Design: Cross-sectional nutritional survey., Setting: Population based random sample derived from the Catalan Nutrition Survey., Subjects: A total of 516 healthy adult men (n=203) and women (n=313)., Methods: Dietary habits were assessed by means of a quantitative food frequency questionnaire. A physical exam included height, weight, waist and hip circumferences, and a fasting blood draw., Results: Gender differences were observed in nutrient and energy intakes. Women showed a better compliance with the nutritional recommendations for monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) than did men. Men showed a better compliance for saturated fatty acid (SFA) and carbohydrate than did women. However, the SFA:MUFA:PUFA ratio was similar in both gender (1.6:2.3:1.0 for men; 1.7:2.5:1.0 for women). The highest compliance was observed for nutritional goals of sodium, calcium and fruit and vegetable intakes for both genders. In addition, the present study showed that levels of certain fatty acids in plasma are clearly associated with dietary intake of foods rich in these components. The highest correlations were found for n-3 long chain polyunsaturated fatty acids with blue fish intake in both men and women (r (men)=0.36 and r (women)=0.42; P<0.001)., Conclusions: The diet followed in Catalonia seems to ensure compliance with most of the intermediate nutritional objectives for the Spanish population. However, a reduction in the SFA intake and an increase in the carbohydrate intake could be recommended in order to reduce the current prevalence of overweight and obesity in this Mediterranean region., Sponsorship: This study was supported by the Catalan Department of Health, the Nutrition Catalan Centre of the Institute of Catalan Studies, and Mercadona SA.

Objective: To analyse the degree of compliance with the nutrition objectives and population-based food guides and to indicate possible recommendations for their development within the framework of a Nutrition and Health Policy in Catalonia., Design: Using data derived from the latest Catalan Nutrition Survey (ENCAT 2002-03) conducted by the Department of Health, compliance was analysed with respect to the recommendations derived as a result of a previously conducted Survey. In addition, compliance to the recommendations elaborated by the Spanish Society of Community Nutrition (SENC) was also evaluated., Setting: Catalonian region located in the Northeast of Spain., Subjects: Analysis is based on a total of 2160 individuals (996 males and 1164 females) aged 10-80 years interviewed in 2002-03., Results: The analysis of compliance with the recommendations established in 1995 showed: (a) recommendation to maintain and increase consumption of fruits and vegetables was not achieved; (b) continued use of olive oil as the dietary fat of choice was met; (c) incomplete compliance with maintaining the Mediterranean diet traditions, especially in the younger cohorts; (d) compliance with the recommendation to decrease consumption of red meat and sausages, but non-compliance with guidance to maintain or increase fish consumption and (e) compliance with partially substituting whole milk and dairy for low-fat products. Compliance with the SENC Healthy Eating Guide revealed that those food groups with the worst results were meat and sausages (excessive), pulses (below recommendations) and fruits and vegetables (below recommendations)., Conclusions: Compliance with dietary guidelines is low in Catalonia, and reflects the need for an effective nutrition policy in the region defined by the Autonomous Government as the Plan for the Promotion of Physical Activity and Healthy Eating (PAAS).

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.

Objectives: The main purpose of this study was to evaluate the modification of knowledge, opinions and attitudes to healthy eating, weight perception and dieting practices and preventive habits over a 10-year trend in the Catalan population from 1992 to 2003., Design: Two cross-sectional surveys were carried out in Catalonia, Spain, during 1992-93 and 2002-03., Subjects: In all, 2361 individuals in the ENCAT 1992-93 nutritional survey and 2061 individuals in the ENCAT 2002-03 health survey. The subjects' ages ranged from 10 to 75 years old., Results: Lettuce and carrots, fish and olive oil were chosen as the healthiest foods in the two Catalan Nutritional Surveys. Although some improvement was reported, a high percentage of the population still thought that bread (31%), potatoes (23%) or olive oil (19%) should be moderated to prevent high blood cholesterol, especially among the youngest individuals. The perception of being overweight increased among males and decreased among females. There was an increase in the percentage of the population following a diet (from 13% to 17%). An increase in the consumption of iodine-enriched salt (from 26% to 40%) was observed as well as of diet supplements, especially among females (from 6% to 13%). The prevalence of males with diabetes increased from 3.4% to 4.5% and the number of individuals with diabetes not following any treatment decreased., Conclusion: The Catalan population has improved their knowledge of healthy food and health-related attitudes. Nutrition policy should focus on young adults as a key age group for primary prevention of future nutrition-related chronic diseases.

Background: The purpose of this study was to evaluate the changes in the nutricional habits and nutricional status of the Catalan population over 10 years interval of the two Catalan Nutricional Surveys conducted in 1992-93 and 2002-03., Methods: 2641 individuals in 1992-93 and 2060 individuals in 2002-03 aged 10 to 75 years participated in the surveys. Two 24 hour recall, a food frequency questionnaire, and a general questionnaire with information on physical activity, knowledge and opinions on nutrition and supplements use were administered. Weight (Kg), height (cm) and waist circumference (WC) (cm) were measured. A subsample of the population underwent a biochemical evaluation. Total cholesterol, HDL cholesterol, LDL cholesterol, tryglicerides and beta-carotene, alpha-tocopherol and retinol were measured., Results: A decrease in the consumption of fruit, vegetables, potatoes, meat and fish and an increase in the consumption of dairy products and fast food (in young individuals) were reported. An increase in the mean value of Body Mass Index (BMI) was observed among males, and an increase in WC mean value was observed in males and females. BMI value decreased in females (except among the younger ones). The prevalence of obesity increased among males (from 9.9% to 16.6%), but not in females. Both total cholesterol and HDL cholesterol decreased. A decrease was observed in the percentage of population with sedentary habits during leisure time., Conclusions: There is a need for an effective nutrition policy promoting healthy nutrition in accordance with the ongoing dietary guidelines.

The purpose of this article is to define the concept of Mediterranean Diet or Diets and to describe the associated health benefits recognised by the scientific community. The characteristics of the Mediterranean Diet are described as well as the effects the foods comprising it have on the most common pathologies such as cardiovascular disease and cancer. The Spanish Society of Community Nutrition's consensus based Healthy Diet Pyramid, along with Greece's pyramid for food guidelines for the adult population (from the Greek Ministry of Health), are presented and compared. They are the graphic representation of the food and physical activity guides of two typically Mediterranean countries. Nutritional and sociological trends are also discussed and their impact on the evolution of the Mediterranean Diet.

Therapeutic properties have been attributed to the diet since ancient times. Epidemiological evidence starting in the early 1960s supports the relationship between different dietary components, dietary balance and the development of risk factors for prevalent chronic diseases in Western societies. There is also evidence supporting the protective effect of other components of the diet and lifestyle, like regular physical activity. During the last two years, groups of Spanish experts in the field of food, nutrition and health sciences have been involved in the process of analysing each food group in Spanish food patterns under a standard format. For each food group, current level of consumption, trends and scientific evidence linking each particular group or its components with patterns of disease, risk factors or protective effects have been determined from a public health perspective. Conclusions and recommendations for each food group, agreed under consensus by the Spanish Society of Community Nutrition (SENC) collaborative group of experts, are summarised and reflected in the Food Guide Pyramid presented in this paper.

The objective of this paper is to present the development of the Nutritional Objectives for the Spanish Population. Preparation of draft documents contributed by different working groups was followed by a consensus meeting held in Bilbao on 5-7 October 2000, hosted by the Spanish Society of Community Nutrition and sponsored by the World Health Organisation. Establishing nutritional guidelines was conducted by: (1) analysing current food and nutritional data from nutritional surveys, for intermediate objectives; and (2) reviewing current scientific knowledge for final objectives. The objectives include intermediate and ultimate figures, and comprise percentage of energy from macronutrients and fatty acids, fruit and vegetable consumption, frequency of sweets, physical activity and body mass index, folate, calcium, sodium, fluoride and iodine intake, dietary fibre, cholesterol, alcohol and duration of breast-feeding. The nutritional objectives for the Spanish population create a rational framework for the development of dietary guidelines and nutritional policies in Spain, within a Mediterranean context.

The principal findings of the Canary Island Nutrition survey (ENCA). 1997-98 are presented. This survey was realised to obtain the following objectives: to evaluate eating habits and nutritional status utilising dietary, anthropometric and biochemical indicators in the Canary Island population along with determining lifestyle factors and the prevalence of the main cardiovascular risk factors. Additionally, a survey evaluating food-related knowledge and attitudes was also carried out. To attain this end, a cross-sectional study was realised in a representative sample of the Canary Island population aged 6 to 75 years (n = 1,747). This article summarises the key findings related to study objectives as well as study-derived recommendations to be realised within a Canary Island health and nutrition policy framework. For this purpose, the development of food based dietary guidelines addressed to meet target nutrients is needed.

The aim of the present study was to analyse the different food and nutrition profiles of the section of the Spanish population having either a low or a high intake of energy, fat, saturated fatty acids (SFA) and fibre in order to analyse the compliance with dietary guidelines. Analyses were made from the Catalan Nutrition Survey, comprising a random sample of 1600 people aged 18 to 60. Dietary information was obtained by means of two 24 h recall, and food and energy intake was categorized according to the quartiles of fat, SFA and fibre intake. The results show the food consumption patterns that distinguish low versus high fat, SFA and fibre eaters in the Spanish population, and facilitate the establishment of food-based dietary guidelines in Spain and other Mediterranean countries.

Objective: To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns.Design: A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined.Results: The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet.Conclusions: By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions. [ABSTRACT FROM AUTHOR]