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Climbing is an Olympic discipline in full development and multidisciplinary in nature, where the influences of body composition and nutritional status on performance have not yet been clarified despite the quest for a low weight in anti-gravity disciplines such as climbing. The present cross-sectional study aimed to conduct nutritional (3-day dietary diaries) and body composition (ISAK profile) assessments on sport climbing athletes by gender and climbing level during the months of February and March 2024. The t -test for independent samples and the Mann-Whitney U-test, as well as an ANOVA and the Kruskal-Wallis H-test, were used to compare the distributions of two or more groups, respectively, and Pearson's and Spearman's correlation coefficients were used to estimate the correlations between the different variables. The mean age of the 46 Spanish climbers (22 men and 24 women) was 30 years (SD: 9) with 7.66 years of experience (SD: 6.63). The mean somatotype of the athletes was classified as balanced mesomorph. Negative correlations were observed between fat mass variables and climbing level ( p < 0.010), and positive correlations were observed with forearm circumference ( p < 0.050). The mean energy availability (EA) was 33.01 kcal-kg FFM -1 d -1 (SD: 9.02), with 55.6% of athletes having a suboptimal EA status and 35.6% having low energy availability (LEA). The carbohydrate and protein intakes were below the recommendations in 57.8% and 31.1% of athletes, respectively. There were deficient intakes of all micronutrients except phosphorus in males. These findings suggest that climbing athletes are at a high risk of developing low energy availability states and concomitant problems. Optimal nutritional monitoring may be advisable in this type of athlete to try to reduce the risk of LEA.

Purpose: This paper aims to examine the association between meal duration and obesity indicators among Spanish adolescents., Methods: We conducted a cross-sectional analysis using data from the Eating Healthy and Daily Life Activities (EHDLA) project involving 755 adolescents aged 12 to 17 years (54.8% girls) from three secondary schools in the Valle de Ricote Region of Murcia, Spain. To evaluate overall meal duration, participants were asked how long (on average) breakfast, morning snacks, lunch, afternoon snacks, and dinner typically last. Subsequently, global meal duration was measured, and the participants were categorized into tertiles. Obesity-related indicators, including body mass index (BMI) z score, waist circumference (WC), and skinfold thickness, were assessed. The analyses were adjusted for potential confounders such as sex, age, socioeconomic status, physical activity, sedentary behavior, diet quality, and energy intake., Results: Concerning meal duration status, adolescents with long meal durations had the lowest estimated marginal means of BMI z score, WC, and body fat percentage (using the sum of triceps and calf skinfolds). However, significant differences between adolescents with a long meal duration and those with a short meal duration were observed only for BMI z score ( p = 0.008), and WC ( p = 0.020). Furthermore, significant differences in BMI z score ( p = 0.017) between adolescents with a long meal duration and those with a moderate meal duration were identified., Conclusions: These findings underscore the importance of promoting slower eating habits as part of obesity prevention strategies. Future studies should explore the causality of this association and its potential for behavioral interventions.

Promoting optimal nutrition in pregnant and lactating women is crucial for maternal and infant health. This study evaluated their nutritional status and dietary habits, assessing macro and micronutrient intake based on recommendations. A descriptive study with Spanish participants examined social, obstetric, dietary, and anthropometric data using quantitative and qualitative methods. The analysis of fatty acids by gas chromatography revealed significant variability, with notable deviations in specific fatty acids like C:10:0 and C:12:0. Despite some differences, the overall composition aligns with standards. During pregnancy, 53.8% consumed five meals/day. Grilling (92.3%) and baking (76.9%) were common. Food consumption frequency differed from recommendations. Lactating mothers' mean energy intake was 2575.88 kcal/day ± 730.59 standard deviation (SD), with 45% from carbohydrates and 40% from lipids, including 37.16 g ± 10.43 of saturated fatty acids. Diets during pregnancy lacked fruits, vegetables, legumes, nuts, and cereals. Lactating mothers partially met nutritional objectives, with an energy distribution skewed towards lipids and deficiencies in calcium, iodine, vitamin D, E, and folic acid. Promoting proper nutrition during pregnancy and lactation is essential to safeguard health and prevent chronic diseases.

The aims of this research were to evaluate the current nutritional status, dietary intake, and level of physical activity and assess the need for intervention. This was a cross-sectional study with 2724 participating children aged 6-9 years old. Nutritional status was assessed using nutrimetry, dietary intake with a 3-day food-recall questionnaire and physical activity with an ad hoc questionnaire. The nutricode with the highest prevalence was healthy weight/normal stature, with 51.3% of the sample. For the BMI for age Z-score, those in the overweight/obesity category represented 37.5% of the sample, while the thinness category included 7.6%. Intake of calories, proteins, sugar, lipids, SFA, MUFA, and cholesterol were significantly higher than recommended. The thinness groups consumed a significantly higher amount of excess calories while the overweight/obesity groups had the lowest mean excess calorie intake. Children in the thinness category presented the highest rates at both ends of the spectrum for sedentary activities. This study showed the high prevalence of malnutrition in schoolchildren. The results for the risk of thinness and overweight/obesity according to individual nutrient intake should be carefully interpreted. Lifestyle is a fundamental aspect to consider when combating malnutrition, especially at the level of dietary and physical activity habits, to combine various methods of intervention to improve nutritional status.

Background Although overweight and obesity are assumed to arise from an energy imbalance, evidence has shown that the frequency and timing of meals are also potential risk factors for obesity. However, the lack of a consistent approach to define eating patterns relative to internal circadian rhythms limits the extent of these findings. Objectives The objective of this study was to investigate the association of the circadian pattern of energy intake with adiposity and with internal circadian rhythms. Methods A total of 260 Spanish adults (aged 20–30 y; 78.1% women) were included in a 6-d cross-sectional study. Participants documented sleep and dietary intake within the study period. From these data, we evaluated the chronotype, eating patterns (meal timing, eating duration, and eating frequency), and we obtained the daily profile of energy intake. In addition, we evaluated the circadian pattern of wrist temperature (internal circadian rhythm marker). Circadian patterns of energy intake and wrist temperature were analyzed, and their association among them and with anthropometric variables and diet quality was studied. Results The greater fragmentation of the circadian pattern of energy intake was associated with lower BMI (in kg/m2; −10.55; 95% CI: −16.96, −4.13; P  = 0.001). In addition, a greater eating frequency (≥5 eating occasions/d) was significantly associated with lower BMI (−1.88; 95% CI: −3.27, −0.48) and higher energy intake after 20:00 (4.14% of kcal; 95% CI: 1.67, 7.16). Furthermore, a greater eating frequency was associated with lower fragmentation (P  = 0.042) and greater stability of the circadian pattern of wrist temperature (P  = 0.016). Conclusions The daily pattern of energy intake is associated with adiposity and robust circadian rhythms. Our results shed light on the relevance of eating frequency as a potential zeitgeber for the circadian system. Although more evidence is needed, eating frequency could be considered for future chrono-nutritional recommendations for the prevention of circadian misalignment and obesity. [ABSTRACT FROM AUTHOR]

According to the latest data, Spain (19.4%) and Portugal (21.8%) are the two European countries with the highest percentage of older adults. Concerns about diet quality are increasing, especially among institutionalized older people, who are at the greatest risk of malnutrition. To assess the adequacy of dietary intake of 186 older adults (>65 y) institutionalized in public nursing homes (NH) in Galicia (Northwest Spain) and the Porto district (Northern Portugal), a cross-sectional study has been carried out. The double-weighing method and a country-specific food composition database were employed for nutritional assessment. Nutritional adequacy was assessed based on the recommendations of the EFSA and WHO. Caloric intake in Spanish NHs was higher than in Portuguese facilities; 20.3% and 35.8% of Spanish and Portuguese residents, respectively, had a protein intake below the EFSA recommendation, and 46.2% and 44.9% of residents in Portugal and Spain, respectively, had lipid intakes below the reference intake range. Further, 45.5% of the residents in Portugal and 66.9% in Spain had a carbohydrate intake within the recommended range. Salt intake was higher than the recommendation for 67.0% and 32.3% of the residents in Spain and Portugal, respectively. This study supports the notion that institutionalized older adults are prone to significant nutritional inadequacies.

Objectives: Mammographic density (MD) is a strong risk factor for breast cancer. The present study evaluates the association between relative caloric intake and MD in Spanish women.Study Design: We conducted a cross-sectional study in which 3517 women were recruited from seven breast cancer screening centers. MD was measured by an experienced radiologist using craniocaudal mammography and Boyd's semi-quantitative scale. Information was collected through an epidemiological survey. Predicted calories were calculated using linear regression models, including the basal metabolic rate and physical activity as explanatory variables. Overeating and caloric restriction were defined taking into account the 99% confidence interval of the predicted value. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using center-specific mixed ordinal logistic regression models, adjusted for age, menopausal status, body mass index, parity, tobacco use, family history of breast cancer, previous biopsies, age at menarche and adherence to a Western diet.Main Outcome Measure: Mammographic density.Results: Those women with an excessive caloric intake (>40% above predicted) presented higher MD (OR = 1.41, 95%CI = 0.97-2.03; p = 0.070). For every 20% increase in relative caloric consumption the probability of having higher MD increased by 5% (OR = 1.05, 95%CI = 0.98-1.14; p = 0.178), not observing differences between the categories of explanatory variables. Caloric restriction was not associated with MD in our study.Conclusions: This is the first study exploring the association between MD and the effect of caloric deficit or excessive caloric consumption according to the energy requirements of each woman. Although caloric restriction does not seem to affect breast density, a caloric intake above predicted levels seems to increase this phenotype. [ABSTRACT FROM AUTHOR]

Background: Sugar-sweetened beverages and added sugars (monosaccharides and disaccharides) in the diet are associated with obesity, diabetes, and cardiovascular disease, which are all risk factors for decline in physical function among older adults. Objective: The aim of this study was to examine the association between added sugars in the diet and incidence of frailty in older people. Methods: Data were taken from 1973 Spanish adults ≥60 y old from the Seniors-ENRICA cohort. In 2008-2010 (baseline), consumption of added sugars (including those in fruit juices) was obtained using a validated diet history. Study participants were followed up until 2012-2013 to assess frailty based on Fried's criteria. Statistical analyses were performed with logistic regression adjusted for age, sex, education, smoking status, body mass index, energy intake, self-reported comorbidities, Mediterranean Diet Adherence Score (excluding sweetened drinks and pastries), TV watching time, and leisure-time physical activity. Results: Compared with participants consuming <15 g/d added sugars (lowest tertile), those consuming ≥36 g/d (highest tertile) were more likely to develop frailty (OR: 2.27; 95% CI: 1.34, 3.90; P-trend = 0.003). The frailty components "low physical activity" and "unintentional weight loss" increased dose dependently with added sugars. Association with frailty was strongest for sugars added during food production. Intake of sugars naturally appearing in foods was not associated with frailty. Conclusions: The consumption of added sugars in the diet of older people was associated with frailty, mainly when present in processed foods. The frailty components that were most closely associated with added sugars were low level of physical activity and unintentional weight loss. Future research should determine whether there is a causal relation between added sugars and frailty. [ABSTRACT FROM AUTHOR]

Adequate dietary strategies are essential for the successful participation in ultra-endurance races. The aim of this study was to evaluate and compare the energy and water intakes of participants during three different mountain ultra-endurance runs. The study took place at the “Ultra Mallorca Serra de Tramuntana” (Mallorca, Spain), an ultra-endurance mountain event with runners participating either in a 44-km (Marathon,n = 51), a 67-km (Trail,n = 109) or a 112-km (Ultra,n = 53) run competition. Participants in the study answered a questionnaire focused on the nutritional intake within an hour after finishing the competition. Mean energy intake during the competitions was 183 kcal · h¯1, with an average carbohydrate intake of 31 g · h¯1(52.1% of participants consumed less than 30 g · h¯1). No significant differences between competitions were found in these parameters. However, a higher percentage of energy from lipids in participants in the Trail and the Ultra was found (P = 0.034). Furthermore, significant differences were observed in water intake per hour of competition (P = 0.039), with the lowest value for the intake during the Ultra competition. In conclusion, the majority of the participants in the study present low carbohydrate intakes. However, fluid intake seems to be adequate. Different distances did not significantly influence the participants’ nutritional strategies. [ABSTRACT FROM PUBLISHER]

Prenatal nutrition plays a crucial role in maternal and child health. This study aims to compare nutrient intake and its adequacy to recommendations among pregnant women in Spain and Poland. The ECLIPSES study in Spain utilized a self-administered food frequency questionnaire, while the PREDISH study in Poland employed a 3-day interview method. We assessed energy and nutrient intake against recommended dietary allowances. The analysis included 583 participants in the first trimester and 465 participants in the third trimester from both countries. Our findings revealed insufficient intake of iron, vitamin D, and vitamin B9 among pregnant women in both Spain and Poland. Significant differences were observed in the intake of energy, carbohydrates, fiber, calcium, iron, and vitamins D, E, C, B6, B9, and B12. Notably, 81.6% and 21.5% of participants did not meet the recommended minimum carbohydrate intake, while 99.8% and 43.8% exceeded the limit for total fat, particularly monounsaturated fatty acids (MUFAs). Tailored dietary guidance based on regional differences is crucial for pregnant women. Although variations in dietary intake were observed, both Spain and Poland faced similar risks of nutritional deficiencies, particularly for iron, vitamin D, and vitamin B9. These findings emphasize the need for enhanced efforts in preventing these deficiencies and promoting optimal prenatal nutrition.

The biological response to ultra-endurance mountain race events is not yet well understood. The aim of this study was to determine the biochemical and physiological changes after performing an ultra-endurance mountain race in runners. We recruited 11 amateur runners (age: 29.7 ± 10.2 years; height: 179.7 ± 5.4 cm; body mass: 76.7 ± 10.3 kg). Muscle damage, lactate concentration, energy balance, rating of perceived exertion (RPE), heart rate (HR), heart rate variability (HRV), body composition changes, and jump performance were analyzed before, during (only lactate, HR, and HRV), and after the race. Athletes completed 54 km in 6 h, 44 min (±28 min). After the race, myoglobin and creatine kinase concentration increased from 14.9 ± 5.2 to 1419.9 ± 1292.1 μg/L and from 820.0 ± 2087.3 to 2421.1 ± 2336.2 UI/L, respectively ( p < 0.01). In addition, lactate dehydrogenase and troponin I significantly increased after the race ( p < 0.01). Leukocyte and platelet count increased by 180.6% ± 68.9% and 23.7% ± 11.2%, respectively ( p < 0.001). Moreover, after the competition, athletes presented a 3704 kcal negative energy balance; a significant increase in RPE values; a decrease in countermovement and squat jump height; and a decrease in body mass and lower limb girths. During the event, lactate concentration did not change and subjects presented a mean HR of 158.8 ± 17.7 beats/min, a significant decrement in vagal modulation, and a significant increase in sympathetic modulation. Despite the relative 'low' intensity achieved, ultra-endurance mountain race is a stressful stimulus that produces a high level of muscle damage in the athletes. These findings may help coaches to design specific training programs that may improve nutritional intake strategies and prevent muscle damage. [ABSTRACT FROM AUTHOR]

Introduction: Recommendations of adequate total water intake (aTWI) have been proposed by the European Food Safety Agency (EFSA) and the Institute of Medicine (IOM)of the United States of America. However, there are differences in the approach used to support them: IOM recommendation is based on average intakes observed in NHANES III (Third National Health and Nutrition Examination Survey) and EFSA recommendation on a combination of observed intakes from 13 different European countries. Despite these recommendations of aTWI, the currently available scientifi c evidence is not sufficient to establish a cut-off value that would prevent disease, reduce the risk for chronic diseases or improve health status.Objective: To compare the average daily consumption of fluids (water and other beverages) in selective samples of population from Mexico, US and Spain, evaluating the quantity of fluid intake and understanding the contribution of each fluid type to the total fl uid intake. We also aim to determine if they reached adequate intake (AI) values, as defi ned by three different criteria: IOM, EFSA and water density.Methods: Three studies were compared: from Mexico, the National Health and Nutrition Survey conducted in 2012 (NHNS 2012); from US, the NHANES III 2005-2010 and from Spain the ANIBES study leaded in 2013. Different categories of beverages were used to establish the pattern of energy intake for each country. Only adult population was selected. TWI of each study was compared with EFSA and IOM AI recommendations, as well as applying the criterion of water density (mL/kcal).Results: The American study obtained the higher value of total kcal/day from food and beverages (2,437 ± 13). Furthermore, the percentage of daily energy intake coming from beverages was, for American adults, 21%. Mexico was slightly behind with 19% and Spain ANIBES study registered only 12%. ANIBES showed signifi cantly low AI values for the overall population, but even more alarming in the case of males. Only 12% of men, in contrast with 21% of women, do satisfy the EFSA criterion. The IOM criterion reaches even less with higher recommended values for daily intake. In contrast, 60% of the American population reached the recommended intake of the IOM criterion. However, available data did not allow calculating the percentage reached by the EFSA criterion. Data from the Mexican study did not permit conducting comparisons with IOM or with EFSA. However, the water density criteria (mL/kcal) was higher than 1.Conclusion: There is a notable difference between all three populations in terms of TWI. Furthermore, within the same population, values of adequacy of TWI changed signifi cantly when they were assessed using different criteria. More scientifi c evidence is required for the production of better defined water intake recommendations in the future as well as more studies focusing on beverage consumption patterns in different settings. [ABSTRACT FROM AUTHOR]

Experimental research suggests that food timing is associated with weight regulation. However, the association between the distribution of energy intake (EI) throughout the day and weight gain in the population is uncertain. A cohort of 4243 individuals (49·9 % men, 50·1 % women) aged ≥18 years was selected in 2008–2010 and followed-up through 2012. At baseline, food consumption for a typical week in the previous year was collected with a validated dietary history, and EI was assessed at six eating occasions: breakfast, mid-morning meal, lunch, mid-afternoon meal, dinner and snacking (at any other moment). Individuals were classified into sex-specific quartiles of %EI for each eating occasion. The cut-off points for increasing quartiles of %EI at lunch were 34·4, 40·8 and 47·7 % in men and 33·2, 39·4 and 46·1 % in women. Weight was self-reported at baseline and at the end of follow-up. During a 3·5-year follow-up, 16·3 % of study participants gained >3 kg. Compared with those in the lowest quartile of %EI at lunch, the multivariate OR of gaining >3 kg was 0·79 (95 % CI 0·63, 0·99) in the second quartile, 0·82 (95 % CI 0·64, 1·04) in the third quartile and 0·62 (95 % CI 0·47, 0·80) in the highest quartile (Ptrend: 0·001). The association was stronger among women and those with overweight or obesity. No association was found between the %EI at the rest of the eating occasions and weight gain. In conclusion, a higher %EI at lunch was associated with a lower risk of weight gain; this may help weight control through the appropriate distribution of daily EI. [ABSTRACT FROM PUBLISHER]

Introduction: the relationship between changes in energy intake (EI) over the last few decades and the trends towards of excess weight in children is still debated.Objective: to examine the relationship between energy and macronutrient intakes with adipostity in children, controlling for cardiorespiratory fitness (CRF) as a surrogate measure of physical activity.Method: we conducted a cross-sectional study of 320 schoolchildren aged 9-11 years (54.5% girls). We collected data on socio-demographic variables, and measured weight, height, waist circumference (WC), and fat mass percentage by bioimpedance analysis. Fat mass index (FMI) was calculated as fat mass (kg) divided by height (m) squared, to adjust for body size. Energy (kcal) and macronutrient intake (percentages) were measured by two non-consecutive 24-h recalls (weekday and weekend day), using the Young Adolescents' Nutrition Assessment on Computer (YANA-C) software program; CRF was measured by the 20-m shuttle run test.Results: boys in the 4th quartile of the WC distribution had lower fat intake (34.9%) than boys in the 1st (42.4%; p = 0.019) and 2nd quartiles (41.6%; p = 0.022). Children in the 1st quartile of the FMI distribution had higher daily EIs than children in the 4th quartile (1762.3 kcal vs. 1496.8 kcal; p = 0.023). All macronutrient intakes relative to weight were lower in children in the more adipose categories for weight status, WC and FMI (p < 0.001).Conclusion: adiposity was inversely related to energy and fat intakes. Excessive EI and high EI from fats not appears to be directly associated with the current obesity epidemic among schoolchildren living in Cuenca (Spain). [ABSTRACT FROM AUTHOR]

Low- and no-calorie sweeteners (LNCS) as a category are one of the most thoroughly evaluated additives, and thus their safety has been largely recognised. However, their potential risks and benefits generate great controversy and discussion within countries' food policies and public debate. The goal of this study was to evaluate the degree of knowledge and the perception of key Spanish stakeholders about the role of LNCS in diet, their safety, regulatory issues and their impact on health and wellness, as well as to complete a SWOT analysis of the Strengths, Weaknesses, Opportunities and Threats regarding this topic from their perspective. Participants (n = 45 stakeholders) completed an anonymous survey about their knowledge and perception of LNCS, their role in the diet, safety and legislation, as well as health issues and completed a SWOT analysis. Most of them agreed with aspects related to safety guarantees and authorisation procedure of LNCS; however, certain disparity in their opinion in relation to several of the topics was observed, especially regarding the possible role of LNCS in diet quality and health. Effective communication strategies to inform professionals and the general population, as well as new research that deepens our knowledge of the role of LNCS in weight management and other health outcomes seem to be urgently needed., (© 2022 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation.)

We aimed to analyse the impact of COVID-19 during 2020 and 2021 on the prescription of enteral nutritional support and its expenditure in the Community of Madrid, Spain, compared to pre-pandemic data from 2016 in the general population vs. elderly. We analysed official electronic prescriptions of all public hospitals of the Community of Madrid. The population over 75 years of age have the higher prescription of nutritional supplements (p < 0.001 vs. other age groups), with no differences between the 45−64 age group compared to the 65−74 age group (χ2 = 3.259, p = 0.196). The first wave of COVID-19 or the first time there was a real awareness of the virus in Spain is similar in a way to the first peak of prescription of enteral nutrition in March 2020. The second peak of prescription was observed in the over 75 age group in July 2020, being more pronounced in December 2020 and March−April of the following year (F = 7.863, p = 0.041). The last peaks correspond to summer 2021 and autumn of the same year (p = 0.031—year 2021 vs. 2020, p = 0.011—year 2021 vs. 2019), where a relationship between increased prescription of enteral nutrition and COVID-19 cases is observed. High-protein and high-calorie dietary therapies were the most prescribed in patients with or without diabetes. All of this entailed higher cost for the Community of Madrid. In conclusion, COVID-19 significantly affected the prescription of nutritional support, especially in the population over 75 years of age.

Background: University students are a part of the population potentially vulnerable in relation to their nutritional status. Objectives: To evaluate energy intake, energy profile of the diet and prevalence of underweight, overweight and obesity in university students. Methods: The study was conducted in 223 students (53% female) from the University of Murcia (Spain), mean age 21.4 ± 2.7 years. Dietary intake was estimated by a continuous 7 days dietary record, previously validated. Afterwards, total energy intake and macronutrients distribution were obtained using the software "GRUNUMUR 2.0". Physical activity was assessed by a questionnaire. Weight and height were measured and body mass index was calculated as [weight (kg)/height (m)²]. Results and discussion: Average energy intake was lower than the recommendations. In relation with the energy profile of the diet, it was higher in protein and fat, and lower in carbohydrates compared with the recommendations in the balanced diet. The prevalence of overweight was of 9.3% in female and of 24.2% in males. However, 10.2% females and 1.1% males were underweight. Only a 35,4% of the studied collective usually practiced physical activity (3-4 hours/week). Significant correlations were found between age and percentage of energy from carbohydrate (negative) and lipids (positive), indicating that older students (young adults) had significantly higher dietary unbalances than younger (adolescents). Conclusion: Students from the University of Murcia have characteristics very similar to those described in other university populations of Spain and other Western countries: low energy intake, unbalances in the energy profile of the diet, and high percentages of overweight and also of underweight. Both physical inactivity and energy unbalance of the diet could be determinants of the overweight observed. Age is a factor in worsening the energy profile of the diet, which presumably will have undesirable consequences on the health of this young population group. [ABSTRACT FROM AUTHOR]

The use of low- and no-calorie sweeteners (LNCS) in foods has increased in recent years in response to the negative effects of free sugar on health. However, the health impact of LNCS is still unclear. Studies of the prevalence of LNCS in foods have been published previously, including in Spain. However, the use of health (HCs) and nutrition claims (NCs) to promote these foods and a full nutritional characterization are largely lacking. For this purpose, we used the BADALI database with 4218 foods present in the Spanish market. Our results show that 9.3% of foods have LNCS (including both intense and polyols). Sucralose and acesulfame K were the intense sweeteners most frequently used (52.4% and 48.2%, respectively), whereas maltitol was the preferred polyol (20.3%). Of all foods with LNCS, 30% also had added sugar. Many more foods with LNCS presented HCs and NCs than those without. Sugar was the nutrient most frequently claimed in NCs for LNCS-containing foods, whereas vitamins were for those without these sweeteners. NCs compliance with regulation was similar in both conditions (60.1% for foods without and 63.9% for foods with LNCS). As expected, foods with LNCS had less total sugar content and energy. Surprisingly, the nutrient profile of yogurts with LNCS changed completely: less total and saturated fat, whereas more proteins and sodium. Biscuits with LNCS contained more fibre. The results of our study reveal that the prevalence of LNCS is becoming high in some food types in Spain and that foods containing LNCS are more frequently promoted with HCs/NCs. In addition, it confirms the general reduction in energy and sugar content expected in foods with LNCS. Furthermore, it suggests a reformulation of products beyond sugar content.

Background: The elderly, and especially those attending nursing homes, are at great risk from certain nutritional deficiencies. Objective: The aim of this study was to determine which food groups present the highest rates of consumption among the institutionalized elderly and study the energy density of each food group and the number of calories and amount of protein in the total diet of each resident. Design: This was a multicentre observational study of a sample of the institutionalized population over the age of 65. The sample of patients was drawn from four Spanish nursing homes (Santa Coloma Gramanet, Barcelona, Madrid and Bilbao). Our final sample comprised a total of 62 individuals, of whom 22 were men and 40 women, aged between 68 and 96 years. Methods: Dietary data were collected using the double weight method for each main meal (breakfast, lunch, afternoon snack and dinner), including food type, the quantity of food served and the amount of plate waste for each of the main meals served during 21 days. Statistical analyses: The characteristics of the study population were compared by Student's t-test and χ2 test. The results are expressed in terms of their median values and the interquartile range. To analyse the overall differences between sites, gender and food groups we used Kruskall-Wallis test combined with the Mann-Whitney U-test with Bonferroni correction for multiple comparisons. Results: The food group that was served most was milk products (376.25 g/day). A large amount of potatoes were also served (109.64 g/day) as were sweets and pastries (62.14 g/day). The daily serving of fruit (138.34 g/day) and vegetables (239.47 g/day) was equivalent to no more than that of a daily ration in each case. Milk was the food group with the highest consumption (311 g/day). Most of the energy was provided by groups with a higher energy density like as fats and sauces, sweets and pastries and bread. The mean protein consumption was 82,6 g/day (Table 5) and no significant differences were recorded in this consumption between men and women. Conclusions: We conclude that there is a need to improve the residents' energy intake and to redistribute their energy and protein intake among the various food groups. An alternative to increasing food portions so as to improve energy intake might involve enriching certain food types. [ABSTRACT FROM AUTHOR]

Misreporting characterized by the reporting of implausible energy intakes may undermine the valid estimation of diet-disease relations, but the methods to best identify and account for misreporting are unknown. The present study compared how alternate approaches affected associations between selected dietary factors and body mass index (BMI) by using data from the European Prospective Investigation Into Cancer and Nutrition-Spain. A total of 24,332 women and 15,061 men 29–65 years of age recruited from 1992 to 1996 for whom measured height and weight and validated diet history data were available were included. Misreporters were identified on the basis of disparities between reported energy intakes and estimated requirements calculated using the original Goldberg method and 2 alternatives: one that substituted basal metabolic rate equations that are more valid at higher BMIs and another that used doubly labeled water-predicted total energy expenditure equations. Compared with results obtained using the original method, underreporting was considerably lower and overreporting higher with alternative methods, which were highly concordant. Accounting for misreporters with all methods yielded diet-BMI relations that were more consistent with expectations; alternative methods often strengthened associations. For example, among women, multivariable-adjusted differences in BMI for the highest versus lowest vegetable intake tertile (β = 0.37 (standard error, 0.07)) were neutral after adjusting with the original method (β = 0.01 (standard error, 07)) and negative using the predicted total energy expenditure method with stringent cutoffs (β = −0.15 (standard error, 0.07)). Alternative methods may yield more valid associations between diet and obesity-related outcomes. [ABSTRACT FROM PUBLISHER]

Background/Aims: Assessing secular trends of diet quality at the population scale is an important tool for health policymakers. The aim of this study was to describe secular trends in energy intake and diet quality in a representative Mediterranean population, accounting for energy underreporting. Methods: We analyzed the dietary data from 4,061 men and 4,409 women who were included in 2 population-based cross-sectional studies conducted in northeast Spain in 2000 and 2005. The surveys included randomly selected free-living men and women between 35 to 74 years of age. Results: No significant differences in reported energy intake between 2000 and 2005 were observed. Protein (p = 0.014) and carbohydrate (p = 0.02) consumption (expressed as percent of total energy intake) decreased in men and women, respectively. Energy density and intake of total, saturated and monounsaturated fat were significantly higher (p < 0.001) in 2005 than in 2000 in both genders. In contrast, lower consumption of fibre, fruit and meat (p < 0.001) was observed for both genders in 2005 compared to 2000. A significantly lower proportion of men and women met the recommended intake for carbohydrates, total fat, saturated fat, cholesterol and fruits in 2005 when compared to 2000. When energy underreporters were excluded from the analysis, a decline in energy intake (p < 0.001) and an increase in fish consumption (p < 0.001) between 2000 and 2005 was observed in men; no other significant differences were found in diet quality and food consumption trends among non-underreporters. Conclusions: Whereas energy intake remained stable from 2000 to 2005, overall diet quality showed an unfavourable trend during this timeframe. Secular dietary trends did not change their magnitude or direction, with the exception of energy and fish consumption in men, after excluding energy underreporters from the analysis. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to analyze whether the mother's age at the offspring's birth may condition food consumption and energy and nutrients intake as well as the appropriateness of the diet of their offspring at pre-school age. Materials and methods: socio-economic, anthropometrical, and dietary data were collected from a group of 103 pre-school children from Madrid, and the population was divided according to the mother's age (= 26 years (percentile 25) or < 26 years) at birth. Results: Twenty-two point five of the mothers of the preschool children studied had their offspring before 26 years of age and 6.8% before 18. Children from younger mothers consumed less sugars (p < 0.01) and alcohol-free beverages (p < 0.05), but also less fruits (p < 0.01) and others (p < 0.05). The energy from fats was lower (p < 0.05) and that from carbohydrates higher (p < 0.05) among children with older mothers. Besides, the lipid profile was also better in this children, with less caloric intake from polyunsaturated fats (p < 0.05). Besides, fiber (p < 0.05) and vitamin C (p < 0.001) intake was higher in children from older mothers. Conclusions: It seems that mother's age may have an influence on dietary habits of their children and be a protection factor against dietary inappropriateness of the offspring, so that younger mothers might need special counseling in this respect. [ABSTRACT FROM AUTHOR]

Objective:Dietary intake is strongly influenced by the energy density of the diet. The purpose of this study was to determine the association of energy density with diet quality, dietary reference intake (DRI) for energy and lifestyle characteristics in free-living people.Subjects:The subjects were Spanish men (n=1491) and women (n=1563) selected in between 1999 and 2000 among the general population according to the 1996 census.Results:A low-energy density diet was significantly associated (P<0.001) with a higher consumption of vegetables, fruits, legumes, fish and white meat as compared to high-energy density diets. More subjects (P<0.001) with a high adherence to low-energy density diets meet DRI for energy intake and tended to be closer (P<0.05) to the recommendations of dietary intakes, established by the Spanish Society of Community Nutrition than those following a high-energy density diet. Alcohol consumption, the prevalence of a sedentary lifestyle and smoking significantly increased (P<0.01) across quartile distribution of energy density.Conclusion:Low-energy density diets of the present population were associated with a healthier lifestyle. Furthermore, our data suggest that adherence to low-energy density diets, with similar characteristics to those found in the present population, promote adequate energy intakes and increase overall diet quality.European Journal of Clinical Nutrition (2008) 62, 1194–1200; doi:10.1038/sj.ejcn.1602843; published online 11 July 2007 [ABSTRACT FROM AUTHOR]

Background: The composition of the average diet for the Canary Islands' population has been the subject of concern for the region's authorities and nutrition specialists. In this study, the composition of the average diet in the Canary Islands is estimated., Method: The approach is based on secondary data on local production and external trade. The breakdown of the total volume of apparent food consumption into specific product categories marketed to the consumers is achieved by applying hypotheses about losses in the distribution process. The estimation of food intake is obtained by making assumptions about the rates of food wastage in the final stage of consumption. This consumption is expressed not only in terms of edible weight and the market value associated with different food groups according to their local or imported origin, but also in terms of their energy and nutrient content., Results: The results obtained suggest a high-calorie diet, close to three thousand kilocalories per person per day, with an average cost of around eight euros per person per day. Imported products, with a lower average cost per unit of energy, provide most of the carbohydrates and fats., Conclusion: This study provides a complementary approach to survey-based evidence and also offers the possibility of evaluating the contributions of local or imported food to the diet., (© 2022. The Author(s).)

Obesity is declared as a chronic multifaceted health problem, and young adults may be particularly vulnerable to weight gain. This study aims to identify the role of dietary calcium intake and the muscle strength index in handling excess of fat mass in young adults and to examine if the relationship between dietary calcium intake and fat mass percentage is mediated by muscle strength. A cross-sectional study including 355 Spanish college students (aged 21.05 ± 3.11) was performed during the 2017-2018 academic year. Pearson correlation coefficients were estimated to determine the relationship between dietary calcium intake, fat mass percentage, body mass index, muscle strength components, and total energy intake. ANCOVA models were used to analyze the differences in the muscle strength index by total dietary calcium intake categories, as well as the differences in % fat mass by total dietary calcium intake and muscle strength index categories, controlling for different sets of confounders. A mediator analysis was conducted to test if the relationship between dietary calcium intake and fat mass percentage was explained by muscle strength. Data on the fat mass percentage, dietary calcium intake, and muscle strength index as the sum of the standardized z-score of the standing long jump and z-score of handgrip/weight were collected. The muscle strength index was significantly better in young adults with higher dietary calcium intake. Moreover, the fat mass percentage was significantly lower in those with a higher dietary calcium intake and a better muscle strength index. Finally, the relationship between dietary calcium intake and fat mass percentage was fully mediated by muscle strength (z = -1.90; p < 0.05), explaining 33.33% of this relationship. This study suggests that both a major dietary calcium intake and muscle strength are associated with fat mass percentage. Moreover, muscle strength mediates the link between dietary calcium intake and fat mass percentage. Therefore, both high dietary calcium intake and exercise activities aimed at improving muscle strength levels may help to prevent the cardiometabolic risk associated with an excess of fat mass in young people.

The present industrial food-production system is not suitably ecological for the environment. Mindful nutrition in sport is a relevant emergent sub-discipline that could help reduce environmental degradation. This case study describes a sustainable support diet during an ultra-endurance running (UR) event called the "Indoor Everest Challenge". This UR challenge involved attaining the altitude of Mount Everest (8849 m) in a simulated way, in less than 24 h, without using ultra-processed food and without wasting plastics. During this challenge, a male athlete (34 years, weight: 78 kg, and height: 173 cm) wore a SenseWear Armband ® (BodyMedia Inc., Pittsburg, PA, USA) accelerometer on his right arm to estimate energy expenditure. To supply his nutritional requirements, the athlete consumed only specially prepared homemade and organic food. All consumption was weighed and recorded in real-time; we determined nutrients using two databases: a food composition software, Dial Alce Ingenieria ® (Madrid, Spain), to measure energy and macro- and micro-nutrients, and Phenol Explorer Database ® (INRA Institut National de Recherche pour l'Alimentation, Paris, France) precisely to determine polyphenolic content. Most energy intake (up to 96%) came from plant foods. We found that subject consumed 15.8 g/kg -1 /d -1 or 1242 g of carbohydrates (CHO), (2.4 g/kg -1 /d -1 ) or 190 g of proteins (P), and 10,692 mL of fluid. The total energy intake (7580 kcal) showed a distribution of 65% CHO, 10% P, and 25% lipids (L). Furthermore, this sustainable diet lead to a high antioxidant intake, specifically vitamin C (1079 mg), vitamin E (57 mg), and total polyphenols (1910 mg). This sustainable approach was suitable for meeting energy, CHO, and P recommendations for UR. Physical and mental training (mindfulness) were integrated from the specific preliminary phase to the day of the challenge. The athlete completed this challenge in 18 h with a low environmental impact. This sports event had an educational component, as it awakened curiosity towards food sustainability.

Introduction: Introduction: the COVID-19 pandemic has had direct implications for clinical nutrition teams (NT), both at an organizational and healthcare level. Since March 2020, expert recommendations on nutritional intervention for patients with COVID-19 have been available. Objectives: to describe the nutritional intervention that has been carried out in patients with COVID-19, to estimate the presence of clinical dietitians-nutritionists (DN) in hospitals in Catalonia, and to know the organization of NTs. Methods: a cross-sectional study through an online survey directed to clinical DNs at hospitals in Catalonia (March 2021) was made. Results: the surveys of 36 NTs, made up of 104 DNs, have been analysed. A total of 44.44 % of NTs had to interrupt or reduce some of their usual activities during the pandemic. When nutritional screening was used, it was carried out early (24-48 h) in 56.25 % of cases, and the most common tool was the NRS-2002 (66.67 %). In 41.67 % of NTs a specific hospital diet was established, this being generally hyperproteic (89.66 %). Oral nutritional supplementation was systematically prescribed by 41.67 % of NTs, prioritizing hyperproteic (97.14 %) and hypercaloric (74.29 %) formulas. It is estimated that clinical DNs are present in approximately 61.54 % of public acute hospitals in Catalonia. Conclusions: the results reflect the adaptive capacity of NTs, reorganizing and redistributing their usual tasks and establishing infrequent measures to ensure nutritional support.

The aim of this study was to analyze dietary intake and body composition in a group of elite-level competitive rhythmic gymnasts from Spain. We undertook body composition and nutritional analysis of 30 elite gymnasts, divided into two groups by age: pre-teen (9-12 years) ( n = 17) and teen (13-18 years) ( n = 13). Measures of height, weight, and bioimpedance were used to calculate body mass index and percent body fat. Energy and nutrient intakes were assessed based on 7-day food records. The two groups had similar percentages of total body fat (pre-teen: 13.99 ± 3.83% vs. teen: 14.33 ± 5.57%; p > 0.05). The energy availability values for pre-teens were above the recommended values (>40 kcal/FFM/day) 69.38 ± 14.47 kcal/FFM/day, while those for the teens were much lower (34.7 ± 7.5 kcal/FFM/day). The distribution of the daily energy intake across the macronutrients indicates that both groups ingested less than the recommended level of carbohydrates and more than the recommended level of fat. Very low intakes of calcium and vitamin D among other micronutrients were also noted. The main finding is that teenage gymnasts do not consume as much energy as they need each day, which explains their weight and development. Moreover, they are at a high risk of developing low energy availability that could negatively impact their performance and future health.

The first month of lactation is a vulnerable nutritional period for the mother. Our aims were (1) to evaluate the nutritional status of breastfeeding women in the first month of lactation, and (2) to explore different aspects of nutrition and lifestyle through a multidimensional approach. A total of 30 healthy breastfeeding women were enrolled in this study. Dietary pattern was assessed through a 72-hour dietary recall questionnaire (days 7 and 28 postpartum) and data were compared with Dietary Recommendation Values (DRV), and through the Adherence to Healthy Food Pyramid (HFP) questionnaire (day 28). Anthropometric parameters were evaluated by bioimpedance. Using factor analysis, nutritional dimensions were extracted, and linear regression models were used to analyze the association between anthropometric parameters and dimensions. Compared to the DRV, women showed insufficient energy, water, vitamin D, and potassium intake and excessive proteins, vitamins B1, B2, B3, B6, B12, and iron intake. We observed a moderate adherence to the HFP, with women being high in the fruits, vegetables, and oil categories, and low adherence to the physical activity, dairy products, and hydration categories. The nutritional dimension, including the HFP categories of physical activity, hydration, and animal protein intake together, was negatively associated with body weight (β = -3.7 ± 1.7; p -value = 0.047). In conclusion, during the first month postpartum, breastfeeding women exhibited several nutritional imbalances and poor physical activity negatively influencing anthropometric parameters. We propose a multidimensional approach to assess the nutritional status of breastfeeding women as a tool to detect specific deficiencies, allowing for personalized counseling.

Clinical data on the direct health effects of energy deficit or surplus beyond its impact on body weight are scarce. We aimed to assess the association with all-cause, cardiovascular and cancer mortality of (1) sustained energy deficit or surplus, calculated according to each individual's en-ergy intake (EI) and theoretical energy expenditure (TEE), and (2) mid-term change in total EI in a prospective study. In 7119 participants in the PREDIMED Study ( PREvención con DIeta MEDi-terránea ) with a mean age of 67 years, energy intake was derived from a 137-item food frequency questionnaire. TEE was calculated as a function of age, sex, height, body weight and physical ac-tivity. The main exposure was the proportion of energy requirement covered by energy intake, cumulative throughout the follow-up. The secondary exposure was the change in energy intake from baseline. Cox proportional hazard models were used to estimate hazard ratios and 95% con-fidence intervals for all-cause, cardiovascular and cancer mortality. Over a median follow-up of 4.8 years, there were 239 deaths (excluding the first 2 years). An energy intake exceeding energy needs was associated with an increase in mortality risk (continuous HR 10% over energy needs = 1.10; 95% CI 1.02, 1.18), driven by cardiovascular death (HR = 1.26; 95% CI 1.11, 1.43). However, consum-ing energy below estimated needs was not associated with a lower risk. Increments over time in energy intake were associated with greater all-cause mortality (HR 10% increase = 1.09; 95% CI 1.02, 1.17). However, there was no evidence that a substantial negative change in energy intake would reduce mortality risk. To conclude, in an older Mediterranean cohort, energy surplus or increase over a 5-year period was associated with greater risk of mortality, particularly cardiovascular mortality. Energy deficit, or reduction in energy intake over time were not associated with mortal-ity risk.

In Spain, the health crisis caused by the COVID-19 pandemic led to the declaration of a state of alarm in the whole country in 2020; in this context, a nationwide lockdown was implemented, potentially altering the dietary habits of the population. The aims of this study were to describe the diet and its nutritional quality in Spanish households during the first COVID-19 epidemic wave and to compare them with the same period in 2019. Data on monthly foods and beverages household purchases in 2019 and 2020 were obtained from the nationwide Food Consumption Surveys. In April, there was an average increase, compared with 2019, of more than 40% for all food groups, with significant peaks in: alcoholic beverages (75%), appetizers (60%), eggs (59%), sugar and sweets (52%), and vegetables (50%). In March, the greatest peak was for pulses, with a 63% increment. The mean energy value of purchased foods in April was 2801 kcal/person/day, corresponding to an increase of 771 kcal/person/day (+38%), compared to the same month of 2019 (March and May: +520 kcal (+26%), June: +343 kcal (+18%)). Regarding nutrient density, there was a reduction in calcium, iodine, zinc, selenium, riboflavin, vitamins B 12 , D, A, especially retinol, and an increase in fibre, sodium, folic acid, carotenes and vitamin E. Alcohol content per 1000 kcal increased by more than 20% from April to July. Food purchase patterns in Spanish households changed during lockdown and after it, with no appreciable improvement in the quality of the diet.

Introduction: Introduction: there has been an increase in the number of endurance sports events during the last 20 years, as well as in the number of their participants. An adequate nutritional plan is essential for a satisfactory performance in this type of events, both in professional and amateur athletes. Objectives: the objective was to determine, evaluate, and compare with the current scientific recommendations the consumption of carbohydrates, water, and sodium by participants in a trail-running event. Methods: the competition completed by the athletes was the "Medio Trail de Alcoy 2019" (Alcoy, Spain), with a distance of 30 km. After completing the race, participants filled out a questionnaire about their food and drink consumption during the event, in addition to other questions about their nutritional habits in general. Eleven participants who met the inclusion criteria were included in the study. Results: the result obtained for average carbohydrate intake was 14.93 g/h, for sodium intake was 146.42 mg/h, and for water intake was 399.73 mL/h. In all, 27 % of participants visited a dietitian-nutritionist on a regular basis, and none reported gastrointestinal tract issues during the race. Conclusions: the carbohydrate and sodium consumption of participants was low as compared to current scientific recommendations; however, water consumption was adequate according to them. Our advice for endurance athletes is visit a specialized dietitian-nutritionist to achieve optimal performance in competitions.

Introduction: Introduction and objective: pregnancy is a stage of life with high nutritional vulnerability and increased levels of maternal oxidative stress. Total antioxidant capacity (CAT) identifies the protective effect of a balanced diet rich in foods of plant origin with antioxidant activity. The aim of this study was to relate CAT with dietary intake and body mass index (BMI) in pregnant women in the Community of Madrid. Methods: a cross-sectional, comparative study was conducted in 89 pregnant women and 61 healthy women of reproductive age. Age, place of origin, weight, height, BMI, macronutrient and micronutrient intake, and dietary CAT by food frequency were recorded; CAT was classified as desirable (≥ 19,301.0 µm/g) or undesirable (< 19,301.0 µm/g); the statistical analysis, including χ², Student's t-test or Mann Whitney U-test, was made using the SPSS program v.23. Results: differences were found in caloric profile, intake of antioxidant micronutrients, and dietary CAT (p < 0.05). Mean CAT in pregnant women was 23,163.0 ± 10,829.0 µm/g, whereas in non-pregnant women it was 25,916.0 ± 9,703.0 µm/g (p = 0.035). Pregnant women with a desirable CAT (56.2 %) preferred to consume fruits and vegetables, and 65.6 % of non-pregnant women preferred bread, pasta and cereals (p = 0.02). Hand fruit, citrus fruits, green leafy vegetables, and tomato were preferentially consumed by both groups. In pregnant women, poor nutritional status, overweight, and obesity rates of 36.0 % were found versus 28.0 % in non-pregnant women (p < 0.001). Conclusion: the BMI of pregnant women is not related to dietary CAT or the relatively low consumption of antioxidant components.

Objectives: Critically ill children are often malnourished and require nutrition support (NS). Early enteral nutrition (EEN) seems to be safe in critically ill patients. However, there is a scarcity of data about the management of EEN in sick pediatric patients. The aim of this study was to analyze the nutritional status, NS characteristics, macronutrient supply, and associations between NS and outcomes in critically ill children in Spain., Methods: This was a multicentric, prospective, cross-sectional study involving critically ill children who received NS and with an expected length of stay (LOS) in the pediatric intensive care unit of ≥3 d. Anthropometric variables, characteristics of NS, EEN, nutrient supply, and complications were recorded., Results: We enrolled 86 children. Undernutrition and overweight were more prevalent in children ≤2 y of age than in older children (undernutrition: 40 versus 19%, respectively; overweight: 22.2 versus 14.3%, respectively). Being overweight was associated with a shorter PICU LOS (5.8 ± 2 versus 9.8 ± 6.5; P = 0.005). EN was the preferred method for nutrient delivery. EEN was administered to 58.1% of patients and was more common in children >2 y of age than in younger patients (73.1 versus 44.4%; P = 0.015). EEN was safe and was associated with a higher caloric intake (81.6 ± 35.3 versus 59.6 ± 36.6; P = 0.019). There was a negative correlation between mean time to EN initiation and maximum energy supply (r = -0.32; P = 0.07)., Conclusions: Malnutrition was prevalent among critically ill children in Spain. Being overweight was associated with a shorter PICU LOS. EEN was safe and was associated with a higher caloric intake; however, it is rarely used in PICUs in Spain., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to <10 years old ( n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler's milk, and enriched and fortified milks) ( n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to <10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.

During menopause, women undergo a series of physiological changes that include a redistribution of fat tissue. This study was designed to investigate the effect of adding 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women daily on body composition. We conducted a 6-month, two-arm randomised, controlled trial. Postmenopausal women (57·2 (sd 3·6) years, n 132) were recruited in primary care clinics. Participants in the control group (CG) did not receive any intervention. Those of the intervention group (IG) received 10 g daily of 99 % cocoa chocolate in addition to their habitual diet for 6 months. This quantity comprises 247 kJ (59 kcal) and 65·4 mg of polyphenols. The primary outcomes were the between-group differences in body composition variables, measured by impendancemetry at the end of the study. The main effect of the intervention showed a favourable reduction in the IG with respect to the CG in body fat mass (-0·63 kg (95 % CI -1·15, -0·11), P = 0·019; Cohen's d = -0·450) and body fat percentage (-0·79 % (95 % CI -1·31, -0·26), P = 0·004; Cohen's d = -0·539). A non-significant decrease was also observed in BMI (-0·20 kg/m2 (95 % CI -0·44, 0·03), P = 0·092; Cohen's d = -0·345). Both the body fat mass and the body fat percentage showed a decrease in the IG for the three body segments analysed (trunk, arms and legs). Daily addition of 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women reduces their body fat mass and body fat percentage without modifying their weight.

Objective: To adapt a short FFQ (SFFQ) and evaluate its relative validity and reproducibility to assess food group intake in a population resident in the Basque Country. Moreover, the possible influence of associated variables (such as education level) on its validity and reproducibility was determined., Design: Nine-day 24-h recalls (24HR) were used as a reference to explore validity over the course of 1 year. The degree of misclassification in the SFFQ was evaluated by a contingency table of quartiles and by Bland-Altman plots comparing SFFQ2 and 24HR. SFFQ was administered twice to explore reproducibility at 1 year., Setting: Basque Autonomous Community., Participants: Adults aged ≥21 years (n 99). The sample was randomly selected and representative of the target population., Results: For validity, statistically significant correlations were observed for more than half of the food groups, with the lowest correlations (r or ρ) for fat (-0·008) and the highest for other foods (0·963). The mean percentage of the subjects' food intake that was classified into the same or adjacent quartile in both methods was 75·2 %. Reproducibility was explored by the correlation coefficient and ranged from 0·201 to 0·809, and 82·6 % of participants were in the same or adjacent quartile in both SFFQ. The associated variables did not seem to influence the validity and reproducibility of the SFFQ., Conclusions: An adapted SFFQ presented good reproducibility and validity for measuring most food groups in the target population, and these results did not seem to be influenced by the associated variables.

The first 1000 days of life seem to represent the temporal window of opportunity for modulating some of the risk factors associated with the later development of pathologies. Nonetheless, the dietary pattern and nutritional status of children receiving complementary feeding is still understudied. We aimed to assess the food intake in children from the LAyDI cohort (Spain) at 18 and 24 months of age and evaluate this in relation to nutrient requirements and bioactive compound consumption. This was a prospective and multicenter study analyzing information from administered questionnaires about general characteristics and food frequency consumption in 426 children of 18 months and 336 of 24 months. The observed intake of vegetables, fruits, dairy, and eggs was lower than the recommendations in both periods, contrary to the consumption of meat, fish, and pulses. The consumption of energy and macronutrients was similar for all ages studied, with protein intake being slightly higher than the recommended values. Regarding micronutrients, practically the whole sample fell below the vitamin D requirements. In addition, the estimated daily intakes of vitamin E and iron, at 24 months, were below the recommended values for this population group. The mean intake of phenols was around 650 mg/day. Flavanol intake as well as both types of fiber decreased from 18 to 24 months. In conclusion, although these results have to be confirmed in other populations, it seems pertinent to propose the design of nutritional strategies aimed at increasing the intake of vitamins D and E as well as iron in Spanish children up to 2 years.

Introduction: If we want to carry out sugar-free alternative beverages and reformulations of the beverages with full sugar in which they are reduced, at the same time we need to give a good palatability and reduce sweetness taste. An appropriate strategy is the use of different low and non-calorie sweeteners that can also be used as a tool to reduce the sugar and calorie content of food and beverages using low and non-caloric sweeteners adequately. Consumers may control the consumption of foods and beverages for decreasing compensatory effects and indulgence that avoids not reducing effectively the total intake of sugar and calories in the diet. Reformulation approaches have begun to be made for existing soft drinks to reduce the sugar content since the beginning of the 21st century, together with the market increase of alternatives without sugar or without added sugars. This sugar reduction has been possible and the percentage of beverages low calorie soft drinks have increased significantly since 2016.

Introduction: Introduction: promoting healthy lifestyles already from the pediatric age for prevention of diseases at a short, mid and long-term is compulsory worldwide. Objectives: to know eating patterns and dietary habits, physical activity and sedentary behaviours in urban Spanish children aged one to nine years old, no vegan, by evaluating the differences between standard milk consumers (RS) and milk formula (AMS). Methods: prospective, observational, cross-sectional study with 1,514 children. A food frequency questionnaire, a physical activity and sedentary behaviour questionnaire, and two 24-hour dietary recalls (one face-to-face and one by phone) were used. Results: the daily energy intake was significantly higher in the RS group (1,503 Kcal vs 1,404 Kcal). The contribution of protein and fat to the total caloric value of the diet is high, being for the first one significantly higher in RS (16.5 % vs 15.6 %). However, for carbohydrate is low and significantly higher in AMS (46.7 % vs 45.5 %). The contribution of the food groups to the energy intake present significant differences between the groups. Conclusions: Spanish children between 1-9 years old have an adequate, but slightly elevated energy intake than the recommendations. There is a high contribution of protein and fat, and low of carbohydrate to the total caloric value. AMS children have a higher adherence to dietary guidelines and nutritional recommendations and, therefore, a suggested higher diet quality.

The current study was designed to assess the influence of consumption of ultra-processed (UPF) on oxidative/antioxidant balance and evoked inflammatory signaling in young patients with celiac disease (CD). The study included 85 children. The celiac group ( n = 53) included children with CD with a long (>18 months, n = 17) or recent (<18 months, n = 36) adherence to a gluten-free diet (GFD). The control group ( n = 32) included healthy children with a significantly higher consumption of UPF compared to the control group, both expressed as kcal/day ( p = 0.043) and as percentage of daily energy intake ( p = 0.023). Among children with CD, the group with the lowest consumption of UPF (below the 50% of daily energy intake) had a greater Mediterranean diet (MD) adherence and higher moderate physical activity levels. In addition, CD children with the lowest consumption of UPF had healthier redox (lower soluble superoxide dismutase-1 and 15-F2t-isoprostanes) and inflammatory profiles (lower macrophage inflammatory protein-1α) compared to the group with the highest consumption of UPF (all, p < 0.05) regardless of the time on a GFD. These findings highlight the importance of a correct monitoring of the GFD. An unbalanced GFD with high consumption of UPF and an unhealthy pattern with less physical activity and worse adherence to MD results in a worse inflammatory profile, which could act as a parallel pathway that could have important consequences on the pathophysiology of the disease.

The aim of this study was to analyze the anthropometric characteristics and sport supplement (SS) consumption patterns of heavyweight and lightweight international rowers. Methods: The 13 heavyweights (11 males) and seven lightweights (five males) of the Spanish National Rowing Team were recruited for the study. Body composition was measured by bio-impedance analysis, and the questionnaire used in this investigation was previously validated to assess SS consumption. According to anthropometrics parameters, it was reported that male heavyweight rowers were heavier ( p < 0.001) and taller ( p < 0.001), but no statistical differences were reported for % body fat ( p = 0.104) or % lean body mass ( p = 0.161). All rowers reported consumption of at least one SS. Based on the Australian Institute of Sport's classification, higher medical supplement consumption was observed when comparing heavyweight rowers to lightweight rowers (2.5 ± 1.1 vs. 1.7 ± 0.5, p = 0.040). There were no differences in the totals of group A (strong scientific evidence for sports scenarios, p = 0.069), group B (emerging scientific support, deserving of further research, p = 0.776), or group C (scientific evidence not supportive of benefit and/or security amongst athletes, p = 0.484). The six most consumed SSs were iron (85%), caffeine (85%), β-alanine (85%), energy bars (85%), vitamin supplements (80%), and isotonic drinks (80%), with no statistical differences between heavyweight and lightweight rowers ( p > 0.05). These results suggest that the absence of differences in body composition (expressed as a percentage) do not represent anthropometric disadvantages for heavyweight rowers. In addition, SS consumption was similar between rowers, reporting only higher medical supplement consumption in heavyweight rowers.

The association between breakfast quality and total diet quality of children and adolescents ((1-17.9 years ( n = 1570)) from the National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) was analyzed. Dietary information was collected using two non-consecutive one-day food diaries (1-10 years old) or two 24 h dietary recalls (>10 years). Breakfast quality index (BQI) and a variant of Nutrient Rich Foods index (NRF9.3) were calculated to assess the total diet quality. Children and adolescents who had breakfast on at least one day ( n = 1561) were divided into two groups according to BQI: Worse Quality Breakfast (WQB) (BQI < 4 points (P66), n = 781) and Good Quality Breakfast (GQB) (BQI ≥ 4, n = 780). Younger children and those whose parents have university education presented higher BQI. GQB group had significantly higher intakes of micronutrients (vitamins A, D, C, B 1 , B 2 , B 6 , niacin, folate, calcium, potassium, magnesium). Fewer GQB children exceeded the Acceptable Macronutrient Distribution Range for fat and had folate and calcium intakes below their estimated average requirement. Daily NRF9.3 was 496.2 ± 54.0, being higher in GQB (503.8 ± 50.6 vs. 488.6 ± 56.2, p < 0.001). Increasing the quality of breakfast increased the possibility of having a NRF9.3 higher than P 50 (OR: 1.893, CI: 1.549-2.315, p < 0.0001). Breakfasts have room for quality improvement in a high percentage of children. A higher quality breakfast is associated with a benefit in the quality of the total diet.

Objectives: The aim of this study was to perform a nutritional assessment of the menus served in school canteens and to verify their effects on the nutrition of schoolchildren., Methods: We selected three collective catering companies that offered ~53 500 menus/d in 369 schools in Spain's Mediterranean area (Valencian Community). The study included four public schools with different management models as well as different supply patterns. Considering the weight of the servings, the caloric contribution of the menus was estimated., Results: Great diversity was seen both in the same school throughout the week and between the four schools (School 1: 298-946 kcal; School 2: 465-1185 kcal; School 3: 395-656 kcal; and School 4: 374-966 kcal). The energy intake from carbohydrates complied with the recommendations in three of the four schools, the energy provided from proteins was adequate in all of the schools, and the energy from lipids was higher than the recommended values in Schools 1 and 2, lower in School 3, and compliant in School 4. The most abundant fatty acids in the menus were oleic, linoleic, and palmitic acids. The sodium content in the rated menus was 229 ± 72 mg/100 g. The highest salt content came from menus that included a precooked dish, processed meat, or both., Conclusion: It is necessary to review school menus and adjust the size of the servings to the age of the children. Correct nutritional education is essential for both kitchen staff and school canteen monitors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Current dietary patterns are negatively affecting both the environment and people's health. Healthy diets are generally more environmentally friendly. However, few studies have focused on the health consequences of diets with low environmental impact. We analyzed differences in the dietary composition (types of food, macro- and micro-nutrients) of those diets with high and low environmental impact, according to greenhouse gas emission and resources use (water, land and energy) using data from a Spanish cohort (17,387 participants), collected by means of a validated food frequency questionnaire. Cox analyses were used to assess the association of dietary environmental impact with total mortality risk. At a given level of energy intake, diets with lower environmental impact contained higher amounts of plant-based foods and lower levels of animal-derived products. Less polluting diets involved higher amounts of polyunsaturated fats and dietary fiber and lower amounts of saturated fats and sodium. However, diets associated with less environmental damage also contained more added sugars, but lower levels of vitamin B12, zinc and calcium. We did not detect any association between dietary environmental impact and risk of mortality. Diets should not only produce minimal environmental impact, but the maximum overall benefits for all key dimensions encompassed in sustainable diets.

High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5-16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well.

The present study aimed to assess energy intake, nutrient profile and food sources in Spanish children participating in the EsNuPI ("Estudio Nutricional en Población Infantil Española") study. Plausibility of energy intake and adequacy of nutrient intakes to international recommendations were analyzed in a final sample of 1448 subjects (728 boys and 720 girls) and one group representative of the 1 to <10 years old urban Spanish children (reference sample ( n = 707)) who consumed milk and one of the same age who consumed adapted milk over the last year (adapted milk consumers sample ( n = 741)) were compared. Both groups completed data of a face-to-face and a telephone 24-h dietary recalls. Both the reference and the adapted milk consumers samples reported an adequate daily energy intake (1503 kcal/day and 1404 kcal/day); and a high contribution to total energy from protein (16.5% and 15.6%) and fat (36.5% and 35.9%). Also, a high percentage of children from both samples were below the lower limit of the recommendations for carbohydrates (47.8% and 39.3%). As the percentage of plausible energy reporters was high for both groups (84.7% and 83.5%, respectively), data for the whole sample were analyzed. Milk and dairy, cereals, meat and derived products, fats and oils, bakery and pastry, fruits and vegetables contributed to about 80% of the total energy intake in both groups. However, the reference sample reported significantly more contribution to energy from cereals, meat and meat products, bakery and pastry and ready to cook/eat foods; meanwhile, the adapted milk consumers sample reported significantly more energy from milk and dairy products, fruits and eggs. Those results suggest that adapted milk consumers have better adherence to the food-based dietary guidelines. Further analyses are warranted to characterize food patterns and the quality of the diet in the EsNuPI study population., Competing Interests: The funding sponsor had no role in the design of the study, in the collection, analyses or interpretation of the data; in the writing of the manuscript and in the decision to publish the results. The authors declare no conflict of interest, with the exception of Federico Lara, who is a member of the IPN.

Introduction: Introduction: validated food frequency questionnaires in children are scarce, mostly long, and only provide data about food consumption. Objectives: the aim of this study was to evaluate the reproducibility and validity of a short food frequency questionnaire that estimates energy, nutritional intake, and the frequency of food consumption in children aged between 3 and 6 years. Material and methods: in 49 children (57% boys), the reproducibility and validity of a frequency questionnaire with 41 items was assessed using Spearman's and intraclass correlations, both adjusted and not adjusted for energy. A 6-day record was used as a reference method. Results: reproducibility was high in food groups with correlations > 0.70 for most of them and between 0.5 and 0.7 for meat, fish, potatoes, sweets/soft drinks, and oil. For energy and nutrients correlations were > 0.9 and > 0.7, respectively. Validity was strong to moderate for foods with correlations > 0.7 (dairy and milk) and between 0.4 and 0.7 (sausages, eggs, yogur/cheese, vegetables and oil), and for nutrients with correlations > 0.5 (lipids, AGS, AGP, phosphorus, calcium, vitamin E and vitamin C) and between 0.3 and 0.5 (energy, starches, fiber, MUFA, cholesterol, sodium, magnesium, potassium, retinol, riboflavin, niacin, pantothenic acid, vitamin B6 and folates). All correlations were significant and increased after they had been adjusted for energy. Conclusions: the short food frequency questionnaire for children between 3 and 6 years old has high reproducibility and good validity with results that are as good as those of long food frequency questionnaires.

Background : Older people have different nutritional requirements from those of the general population; in particular, they need a lower energy intake, higher protein content to preserve muscle mass, and a greater supply of vitamins and minerals to maintain good bone health. The objective of this study is to evaluate the degree of compliance with nutritional recommendations, and its relationship with sociodemographic characteristics, clinical conditions, and lifestyles in older people residing in the Spanish Mediterranean., Methods: Cross-sectional study with 341 people over 60 years old. Participants were selected using a snowball strategy. A validated food intake frequency questionnaire for older populations was used to determine the daily food intake. This evaluation was carried out at two time points from which the average nutrient intake was obtained. Sociodemographic, clinical, and lifestyle variables were obtained from an ad hoc elaborated questionnaire., Results: Compliance with dietary intakes was low, by deficiency, such as in vitamin D, where none of the participating subjects met the requirements, and iodine, where the compliance rate did not exceed 20%, or by excess, such as with monounsaturated fatty acids, fiber, iron, B vitamins, vitamin E, and vitamin C. People with better blood pressure, cholesterol, and glucose levels observed a higher degree of compliance with the recommended intakes. Living in rural areas, being divorced, or being illiterate negatively influence meeting the recommended intakes of certain nutrients. Increased physical activity was associated with an increased compliance with Kcal recommendations, cholesterol, and vitamin B2 intake., Conclusion: this study highlights the importance of accurately knowing the dietary intakes in the older population, and what factors, such as lifestyles or sociodemographic characteristics, may predispose to better or worse compliance with the recommendations., Competing Interests: The authors declare that they have no conflict of interest.

Chronic inflammation plays a role in the development of chronic lymphocytic leukaemia (CLL), and diet might modulate chronic inflammation. This study aims to evaluate the association between the dietary inflammatory index (DII ® ) and CLL. A total of 366 CLL cases and 1643 controls of the Spanish multicase-control (MCC) Spain study were included. The inflammatory potential of the diet was assessed using the energy-adjusted dietary inflammatory index (E-DII) based on 30 items from a validated semi-quantitative food frequency questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models controlling for potential confounders. Overall, a modest, non-statistically significant, positive association was observed between CLL and E-DII scores (OR for a one-unit increase in E-DII: 1.05 (CI 95%: 0.99, 1.12), p -value = 0.09 and by tertiles: OR T2vsT1 : 1.20 (CI 95%: 0.90, 1.59); OR T3vsT1 : 1.21 (CI 95%: 0.90, 1.62), p trend = 0.21). These results were independent from disease severity ( p- het: 0.70), time from diagnosis ( p- het: 0.67) and CLL treatment received ( p- het: 0.56). No interactions were detected. In conclusion, the consumption of a diet with high pro-inflammatory components was not significantly associated with CLL. Changes towards a more pro-inflammatory dietary pattern in younger generations not included here warrant future research.