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The aims of this study were to assess cognitions relating to hypoglycaemia in adults with type 1 diabetes and impaired awareness of hypoglycaemia before and after the multimodal HypoCOMPaSS intervention, and to determine cognitive predictors of incomplete response (one or more severe hypoglycaemic episodes over 24 months).This analysis included 91 adults with type 1 diabetes and impaired awareness of hypoglycaemia who completed the Attitudes to Awareness of Hypoglycaemia (A2A) questionnaire before, 24 weeks and 24 months after the intervention, which comprised a short psycho-educational programme with optimisation of insulin therapy and glucose monitoring.The age and diabetes duration of the participants were 48±12 and 29±12 years, respectively (mean±SD). At baseline, 91% reported one or more severe hypoglycaemic episodes over the preceding 12 months; this decreased to20% at 24 weeks and after 24 months (p=0.001). The attitudinal barrier 'hyperglycaemia avoidance prioritised' (ηParticipation in the HypoCOMPaSS RCT was associated with improvements in hypoglycaemia-associated cognitions, with 'hyperglycaemia avoidance prioritised' most prevalent. Incomplete prevention of subsequent severe hypoglycaemia episodes was associated with persistence of the cognition 'asymptomatic hypoglycaemia normalised'. Understanding and addressing cognitive barriers to hypoglycaemia avoidance is important in individuals prone to severe hypoglycaemia episodes.www.isrctn.org : ISRCTN52164803 and https://eudract.ema.europa.eu : EudraCT2009-015396-27.

PurposeRandomised controlled trials identify causal links between variables but not why an outcome has occurred. This analysis sought to determine how psychological factors assessed at baseline influenced response to personalised nutrition.Design/methodology/approachWeb-based, randomised, controlled trial (RCT) was conducted across seven European countries. Volunteers, both male and female, aged over 18 years were randomised to either a non-personalised (control) or a personalised (treatment) dietary advice condition. Linear mixed model analysis with fixed effects was used to compare associations between internal and external health locus of control (HLoC), nutrition self-efficacy (NS-E) and self-report habit index (S-RHI) at baseline (N = 1444), with healthy eating index (HEI) and Mediterranean diet index (MDI) scores between conditions post-intervention (N = 763).FindingsAn increase in MDI scores was observed between baseline and six months in the treatment group which was associated with higher NS-E (p p p p p = 0.009). Interaction between time and condition indicated increased HEI scores (p p = 0.032). Internal HLoC had no effect on MDI or HEI.Originality/valuePsychological factors associated with behaviour change need consideration when tailoring dietary advice. Those with weaker habit strength will require communication focussed upon establishing dietary habits and support in integrating advised changes into daily routine. Information on habit strength can also be used to inform how progress towards dietary goals is monitored and fed back to the individual. Those with stronger habit strength are more likely to benefit from personalised nutrition.

Background: Apart from ATTR amyloidosis, the epidemiology and outcomes of the most common subtypes of systemic amyloidosis in Portugal remain primarily unknown. Methods: This retrospective cohort study evaluated patients with renal biopsy-proven amyloidosis, diagnosed from January 1978 to December 2019. Follow-up started at kidney disease presentation and ended at death or August 2020. Clinical presentation, survival, and prognostic factors were analysed. Results: Of 123 patients with amyloid nephropathy, 111 had definite amyloid typing and were analysed. AA amyloidosis was the most frequent type (56.1%) and was related mainly to chronic infection (47.8%) and chronic inflammatory arthritis (29.0%). AL amyloidosis was present in 25.2% of patients and hereditary forms in 6.5% (4.1% AFibE526V, 2.4% ATTRV30M). During follow-up, 73.9% of AA and 54.8% of AL patients progressed to end-stage renal disease, and 79.7% of AA and 77.4% of AL died; median overall survival was 66.0 (95% CI, 33.0–99.0) and 18.0 (95% CI, 9.3–26.7) months (p = 0.025), respectively. There were no significant differences in renal outcome and survival on dialysis between these two types. In multivariate analysis, cardiac involvement at presentation (HR 6.26 [95% CI, 2.89–13.56]) and estimated glomerular filtration rate 2 (HR 2.05 [95% CI, 1.06–3.99]) independently influenced AA and AL amyloidosis survival. Cardiac involvement at presentation was an independent predictor of death (HR 9.65 [95% CI, 2.91–31.95]) and early mortality in AL amyloidosis. Conclusions: In Portugal, AA amyloidosis and related chronic infections are still relevant. Regarding AL amyloidosis, the low incidence and advanced disease at presentation result from missed and erroneous diagnoses, leading to delayed referrals and poor outcomes in these patients.

Background & aims: The aging process has physiological, psychological and social implications that interfere with food choice. This work aims to identify factors influencing food choice among community-living older adults and their relationship with social characteristics, health status and nutritional risk. Methods: Four hundred fifty-nine older adults (65 years old) living in Vila Nova de Gaia (Portugal) were interviewed by trained interviewers in a face-to-face situation. Results: Participants had a mean age of 73 years (SD = 6). The majority were women (64.0%), married (67.8%) and lived in their own home (80.2%). Several associations were found between factors that influence food choice and sex, problems with sense organs and pathologies/problems. Older adults at malnourished or at risk of malnutrition or with high cardiovascular risk attribute less importance to the food's content in additives, colorants and preservatives. We also found a positive association between weight status and the importance attributed to food availability and a negative association between weight status and the ease of chewing were found. Conclusion: Knowledge on the factors influencing food choice among older adults may provide essential information for more effective clinical and community interventions, and for the development of new products to facilitate healthy choices among community-living older adults. (c) 2022 European Society for Clinical Nutrition and Metabolism

BACKGROUND & AIMS The Mini Nutritional Assessment (MNA) is the most used tool to assess malnutrition and/or its risk among older adults. Its Screening section was proposed as a short form (MNA-SF) but studies comparing the two forms present controversial results. Our main aims were to study the agreement between MNA-SF and its full form (MNA-FF) among Portuguese older adults living in the community and to develop a more sensible version of the MNA-SF. MATERIAL AND METHODS This cross-sectional study used a convenience sample of 456 older adults (54.2% females) aged 65-92 years (mean = 73; SD = 6). Data analyzed included: nutritional status (MNA), social support (Fillenbaum's Social Network Index), level of independency in daily activities (Lawton e Brody's scale) and eating-related quality of life. Both MNA-FF and MNA-SF classify participants as malnourished, at risk of malnutrition or with normal nutrition status. Anthropometric assessments (weight, height, arm and calf perimeters) were carried out and BMI was computed. RESULTS The agreement between the two classifications is 82.7%, but Cohen's k shows a weak agreement (weighted Cohen's k = 0.497; p

Background & aims: Food-related quality of life (FRQoL) assesses the specific impact of diet, eating behaviors, and food-related anxiety on a person's Health-related quality of life. The food serves a set of purposes that go beyond supplying the basic physiological needs, it also has a hedonic and social dimension. In addition, the relationship between food and health and well-being nowadays is unquestionable. This study aims to investigate the multidimensional aspects of FRQoL by identification the underlying factors associated to it. Methods: This cross-sectional study is part of the Pronutrisenior project and included 602 older adults (>65 years old) from Vila Nova da Gaia, Portugal. Data were collected by a questionnaire of indirect application by trained nutritionists in a face-to-face situation. FRQoL was assessed by The Satisfaction with Food-Related Life Scale. Results: Women, younger individuals and those with inadequate social support network had lower FRQoL. Insomnia and nutritional risk were also related to lower FRQoL. Conclusions: Our findings should be taken into account in clinical practice in order to optimize the intervention of health professionals, and the groups identified as having lower FRQoL should be given special attention. (c) 2021 European Society for Clinical Nutrition and Metabolism

Aim There has been an increase in the development of technologies that can deliver personalised dietary advice. Devising healthy, sustainable dietary plans will mean taking into consideration extrinsic factors such as individual social circumstances. The aim of this study was to identify societal groups more or less receptive to and likely to engage with personalised nutrition initiatives. Sample and methods Volunteers were recruited via a social research agency from within the UK. The resultant sample (N = 1061) was 49% female, aged 18-65 years. Results MANOVA (Tukey HSD applied) indicated that females and younger people (aged 18-29 years) had more favourable attitudes and were more likely to intend to adopt personalised nutrition. There were no differences in attitude toward or intention to adopt personalised nutrition between different education levels, income brackets or occupational groups. Conclusion These results imply that females and younger people may be most likely to adopt personalised nutrition in the future. Initiatives to promote healthy eating should target males and older people.

RESUMO INTRODUÇÃO: O local de trabalho é uma importante área de ação para a promoção de estilos de vida saudáveis. OBJETIVOS: Avaliar fontes de informação e temáticas que suscitam maior interesse sobre alimentação/nutrição, estado de saúde e conhecimentos sobre alimentação dos colaboradores de uma câmara municipal. METODOLOGIA: Participaram no estudo 118 colaboradores de uma câmara municipal. Foram recolhidos dados sociodemográficos, autoperceção do estado de saúde, peso e altura, fontes de informação e temas preferenciais sobre alimentação/nutrição e conhecimentos nesta área (recomendações dietéticas; fonte alimentar de nutrientes; relação dieta-doença) através do Questionário de Conhecimentos Nutricionais (QCN). RESULTADOS: As mulheres apresentaram nível superior de conhecimentos, quer no total (p = 0,001), quer nas secções relativa à fonte alimentar de nutrientes (p = 0,001) e à relação dieta-doença (p = 0,030). Também os participantes mais novos (R = -0,205; p = 0,030), com menor índice de massa corporal (R = -0,188; p = 0,049), maiores habilitações literárias (R = 0,506; p < 0,001) e que se autopercecionam mais saudáveis (R = 0,123) apresentaram nível superior de conhecimentos. A secção relativa à relação dieta- doença foi aquela em que se verificou menor nível de conhecimentos. Relativamente às fontes de informação, 67,8% relataram ter por hábito fazê-lo, principalmente na Internet (58,5%) ou através de um médico (30,5%). Os participantes que realizam pesquisa apresentaram um maior nível de conhecimentos (mediana = 67,2% vs. 57,8%; p = 0,004). Estudaram-se também as diferenças nos conhecimentos entre quem utilizava ou não cada fonte de informação. CONCLUSÕES: Estes resultados evidenciam que o nível de conhecimentos sobre alimentação neste grupo não é elevado, justificando a necessidade de implementar intervenções a nível da promoção da literacia alimentar/nutricional. Pelas suas características, a vertente da educação alimentar deve ser prioritária, bem como intervenções ao nível do ambiente alimentar no local de trabalho.

Information about nutrition and health are important to empower older adults on what their food choice is concerned. The present research aims to study the perceived need and preferences regarding sources of information about healthy eating among older adults and to relate them with sociodemographic characteristics. A sample of 602 older adults (≥65 years old) living in the community (Vila Nova de Gaia, Portugal) was assessed by trained nutritionists using a structured questionnaire developed within the Pronutrisenior project. Most participants (87.5%) are concerned about healthy eating, and 69.3% would like to receive more information about the subject, mainly as audiovisual material (49.8%). Women prefer to receive information through practical cooking sessions and audiovisual material. Highly educated individuals prefer leaflets with text as well as audiovisual material, while more independent individuals prefer a wide range of media, such as booklets with pictures, informational posters, and food education and practical cooking sessions. Those with an adequate social support network prefer booklets with text. Age was not related to these preferences. These results can inform stakeholders about the most effective means of transmitting information on food and nutrition to older adults and are therefore useful in tailoring community and clinical interventions.

Malnutrition is associated to a progressive decline in health, reduced physical and cognitive functional status and mortality. However, the malnutrition prevalence differs across countries. Previous studies reported 19% of malnourished elderly in Turkey and 1.3% in Portugal.We aimed to compare the nutritional status between between Portuguese and Turkish older adults using the Mini-Nutritional Assessment.This is a cross-sectional study using data from the Pronutrisenior project, collected in Vila Nova de Gaia, Portugal (n = 430), and a study in Ankara, Turkey (n = 162). The sample consisted of older adults living at their homes. Socio-demographic data, clinical data from the medical records, the full form of Mini-Nutrititional Assessment, MNA-FF and anthropometry (weight, height, BMI, mid-arm circumference and calf circumference) were collected.Turkish older adults lived more frequently with children, are more likely to be widow/widower, and have a higher probability of being housewife/househusband. A larger proportion of the Portuguese have tooth loss, diabetes, hypertension, oncologic diseases, kidney diseases, osteoarticular problems, or eye problems and a larger proportion of the Turkish have anemia. The BMI average is smaller in the Turkish sample, while the calf circumference average is larger. Turkish have a larger proportion of malnourished or at risk of malnutrition (4.9% and 31.5% vs. 1.2% and 24.0%, respectively). The average MNA-FF score is higher among the Portuguese, males and on people using denture, and without: toothloss, hypertension, CVD, anemia and oncological diseases. Moreover, higher MNA-FF scores were associated with younger ages, higher BMI and higher calf circumference.The effect size was larger for CVD and sex.The prevalence of malnutrition in European and American populations ranges from 1% to 15% in ambulatory living elders, more common among females as in this work. Other studies showed that higher BMI is related with lower malnutrition prevalence and higher prevalence of obesity-related chronic diseases. Tooth loss was more frequent in the Portuguese, which may be due to a higher intake of sweets or packaged food. Portuguese elders had lower calf circumferences but higher BMI, which may be related to lower muscle mass and/or higher fat mass. The differences between the Portuguese and the Turkish may be related to the different per capita gross national product, positively correlated with BMI and the consumption of processed foods. Anemia in Turkish elders may be related with BMI and their lower consumption of meat and the higher tea intake that may reduce iron absorption, as reported by other studies.

Malnutrition is a serious health problem among older adults. The Mini Nutritional Assessment (MNA) is the most used tool to assess malnutrition among older adults. It was proposed that the Screening section could be used as a short form of the MNA (MNA-SF), but the study of the two forms show a wide range of agreement (71.8 to 93.3% and Cohen's kappa from 0.52 to 0.78). Nevertheless, most of the studies recommend the use of the MNA-SF, but in some this conclusion is not completely congruent with the results. The aims of this work were to study the agreement between the nutritional status classification using the MNA-SF and the MNA-FF among Portuguese older adults living in the community, to compare the scores in each question of the MNA-FF between participants correctly or incorrectly classified using the MNA-SF, and to develop a more sensible version of the MNA-SF. The current study is part of the PRONUTRISENIOR project. Data from 456 older adults (54.2% females) aged 65 to 92 years (mean = 73; SD = 6) living in the community (Vila Nova de Gaia, Portugal) were analyzed. The agreement between the two classifications is 82.7%, but Cohen's k shows a weak agreement (weighted k = 0.497; p < 0,001). MNA-SF showed a very low sensitivity (42.6%) detecting participants malnourished or at risk of malnutrition. Participants classified as normal using the MNA-SF despite at risk using the MNA-SF presented lower scores in two items from the Assessment section: number of full meals eaten daily and amount of fluid consumed per day. These two items were included in MNA-SF to obtain an extended short-version (MNA-SF8), which presented a sensitivity of 91.8% (and a specificity of 79.9%). The areas under the ROC curves were 0.858 and 0.929, respectively for MNA-SF and MNA-SF8. The addition of two items to the MNA-SF provides a more sensible tool to detect risk of malnutrition among elderly. These findings suggest that, among the studied population, general eating-related questions regarding (full meals and fluid intake) are relevant to assess malnutrition. Similar studies should be carried out among other populations in order to verify the possibility of their generalization. [The PRONUTRISENIOR project was financed by Iceland, Liechtenstein and Norway through the EEA Grants (PT06 – Public Health Initiatives, reference 81NU5).]

Background: Developing technologies in real-time continuous glucose monitoring (CGM) are successfully reducing severe hypoglycemia (SH) in trials and clinical practice. Their impact on impaired awareness of hypoglycemia, a major risk factor for SH, is uncertain. Methods: The present study examined two scales for assessing hypoglycemia awareness status, the Gold score and the eight-item Minimally Modified Clarke Hypoglycemia Survey (MMCHS), commonly used in trials of CGM, in Portuguese-speaking adults with type 1 diabetes and conducted an exploratory factor analysis on MMCHS. Results: A bifactorial structure in MMCHS was revealed, with a clear distinction between items that measure SH experience and those that measure hypoglycemia awareness status. The latter is associated with the same risk for SH as the Gold score. Conclusions: We conclude that improvement in awareness scores by the MMCHS may reflect only a reduction in SH with no restoration of endogenous awareness, making the current literature consistent in evidence that CGM does not improve endogenous awareness and nonsensor supported protection from SH. This has implications for risk of SH when CGM is not being worn.

Eating behaviour refers to quantitative and qualitative features of the selection and decision on the foods to be consumed. Knowledge on determinants of eating behaviour increases the success of actions and interventions aiming to promote healthy eating habits and to prevent diseases. Several constructs facilitate the comprehension of health-related changes, among which the Locus of Control (LoC) and Stages of Change (SoC). Our aim was to study the relationships between several dimensions of eating behaviour with the health LoC and SoC towards healthy eating among Portuguese higher education students. Data from 267 higher education students (63.7% females) aged 18 to 27 years were assessed regarding health LoC (Health Locus of Control Scale; Ribeiro, 1994), SoC towards healthy eating (question and items from Kearney et al. (1999), adapted to refer specifically to the adoption of healthy eating) and eating behaviour. Emotional and external eating were measured using the Dutch Eating Behavior Questionnaire, flexible and rigid control of eating behaviour was measured with the Portuguese version of the subscales proposed by Westenhoefer et al. (1999), the Portuguese version of the Binge Eating Scale was used to assess binge eating severity, and eating self-efficacy was measured using the General Eating Self-Efficacy Scale. BMI was calculated using self-reported weight and height. No significant associations were found between BMI and health LoC. In the female subsample, i-LoC assessed through the factor “locus of control” was negatively associated with binge eating and positively with eating self-efficacy. However, we also found a negative association between eating self-efficacy and i-LoC assessed by the factor “other powerful”. Among men, none of the eating behaviour dimensions presented an association with health LoC. Regarding SoC, participants in the maintenance stage presented lower external eating and binge eating (both sexes), lower emotional eating and higher eating self-efficacy (women) and dietary restraint (higher rigid control among men but higher flexible control among women), when compared to those in the pre-contemplation/ contemplation stages. Our results suggest that SoC and LoC may be useful to achieve deeper knowledge on eating behaviour. Their assessement may also help designing early and sex-directed (namely regarding the different types of dietary restraint) programs and interventions focusing eating behaviour.

Objectives The aim of this study was to explore the relationships between eating behavior dimensions and psychopathological symptoms among Portuguese undergraduate students. Methods We studied 258 participants (62.4% women) regarding eating behavior dimensions (emotional, external and binge eating, flexible and rigid control of eating behavior, and eating self-efficacy), psychopathological distress (as assessed by the Brief Symptom Inventory), and body mass index. In addition to studying bivariate associations between eating behavior dimensions and psychopathological subscales and indexes, what we believe to be a novel analytical approach, considering simultaneously the effects of the overall level of psychopathological distress and the relevance of specific symptoms on the eating behavior dimensions. Results Emotional, external, and binge eating had positive correlations with psychopathological symptomatology, whereas eating self-efficacy was negatively associated. Conclusions Multivariate analysis showed that the overall level of psychopathological distress (combined with body mass index, among women) had a larger effect on eating behavior than the relevance of specific symptoms.

Eating behaviour is of particular interest for research focusing on body weight status. However, little is known about the relationships of certain factors, especially social desirability, with self-reported eating behaviour such as cognitive restraint, uncontrolled eating, and emotional eating among young adult males and females. This study aimed to evaluate the relationships between eating behaviour and age, socioeconomic status (SES), physical activity (PA), body mass index (BMI), waist-to-height ratio (WHtR), and social desirability among university students. A cross-sectional study was conducted among 353 university students (59.2% females). Eating behaviour was assessed using the 13-item Three-Factor Eating Questionnaire (TFEQ-13). SES and PA were determined using self-reporting, and the Marlowe–Crowne Social Desirability Scale assessed social desirability. BMI and WHtR were calculated based on measured parameters. Associations between self-reported eating behaviour and other variables were assessed using Pearson’s correlation coefficient and multivariate general linear models. Cognitive restraint was positively correlated with BMI and WHtR in both males (r = 0.174, P = 0.036 and r = 0.194, P = 0.020, respectively) and females (r = 0.239, P &lt, 0.001 and r = 0.165, P = 0.017, respectively), and emotional eating was positively correlated with BMI among females (r = 0.184, P = 0.008). Social desirability was negatively correlated with uncontrolled eating (r = −0.287, P &lt, 0.001) and emotional eating (r = −0.301, P &lt, 0.001) among females. There were no significant correlations between eating behaviour and age or socioeconomic status (P &gt, 0.05). Multivariate analysis showed that, among males, PA had a main effect on emotional eating (ηp2 = 0.044, F = 6.276, P = 0.013). Among females, cognitive restraint was positively associated with PA (ηp2 = 0.034, F = 7.127, P = 0.008) and BMI (ηp2 = 0.038, F = 7.959, P = 0.005), and emotional eating with BMI (ηp2 = 0.032, F = 6.638, P = 0.011). Social desirability had the highest main effect on eating behaviour among females, being negatively associated with uncontrolled eating (ηp2 = 0.077, F = 16.754, P &lt, 0.001) and emotional eating (ηp2 = 0.082, F = 18.046, P &lt, 0.001). This study showed that PA, BMI, WHtR, and social desirability were associated with self-reported eating behaviour among university students. Social desirability bias should be considered when evaluating uncontrolled eating and emotional eating among females.

Background/Aims: Personalised nutrition has potential to revolutionise dietary health promotion if accepted by the general public. We studied trust and preferences regarding personalised nutrition services, how they influence intention to adopt these services, and cultural and social differences therein. Methods: A total of 9,381 participants were quota-sampled to be representative of each of 9 EU countries (Germany, Greece, Ireland, Poland, Portugal, Spain, the Netherlands, the UK, and Norway) and surveyed by a questionnaire assessing their intention to adopt personalised nutrition, trust in service regulators and information sources, and preferences for service providers and information channels. Results: Trust and preferences significantly predicted intention to adopt personalised nutrition. Higher trust in the local department of health care was associated with lower intention to adopt personalised nutrition. General practitioners were the most trusted of service regulators, except in Portugal, where consumer organisations and universities were most trusted. In all countries, family doctors were the most trusted information providers. Trust in the National Health Service as service regulator and information source showed high variability across countries. Despite its highest variability across countries, personal meeting was the preferred communication channel, except in Spain, where an automated internet service was preferred. General practitioners were the preferred service providers, except in Poland, where dietitians and nutritionists were preferred. The preference for dietitians and nutritionists as service providers highly varied across countries. Conclusion: These results may assist in informing local initiatives to encourage acceptance and adoption of country-specific tailored personalised nutrition services, therefore benefiting individual and public health.

IntroductionIrritable Bowel Syndrome (IBS) is a functional and multifactorial gastrointestinal disorder characterized by pain, abdominal distention and motility changes, currently diagnosed based on the Rome IV criteria. The efficacy of classic pharmacological, psychological and dietary treatments for this condition are generally low. The Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) are short chain carbohydrates poorly absorbed at the intestinal level, fermentable by the microbiota and presumably involved in IBS-associated symptomatology.AimsTo evaluate the efficacy, feasibility and acceptability of a FODMAP-restricted feeding approach in the relief of symptomatology and in the improvement of the quality of life of patients with IBS, determining the reintroduction of the FODMAP food subgroup(s) involved in the symptom exacerbation.Materials and MethodsAfter assessing the existence of initial emotional disorders through the Hospital Anxiety and Depression Scale (HADS) and eating habits, through dietary history, patients diagnosed with IBS were put on a FODMAP-restricted diet for 6 weeks. During this period, the weekly evolution of symptom frequency was assessed. At the end, tests were undertaken to discover the global evolution of the symptoms through the Irritable Bowel Syndrome - Global Assessment Scale (IBS-GAI), the severity of symptomatology through the Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS) and quality of life through Irritable Bowel Syndrome - Quality of Life (IBS-QoL).Subsequently, participants tested their tolerance to various FODMAP subtypes with weekly and isolated reintroduction of these in their diet.ResultsIn the 36 participants, with a mean age of 38.8 years, there was a reduction in the total consumption of FODMAP from 22.1 g to 2.1 g (p < 0.001). A moderate or substantial improvement in the IBS-GAI was observed in 88.9%. An average reduction of 235 points in the IBS-SSS (p < 0.001) and a mean increase of 28.7 in the IBS-QoL (p < 0.001) was achieved. The initial anxiety and depression levels were not associated with IBS-SSS and presented an inverse association with the IBS-QoL. There was significant improvement in all symptomatology during the 1st week of total FODMAP restriction, except for constipation with an amelioration observed at the 6st week. There was a frequency of intolerance ranging from 30.8% for fructans to 80.8% for lactose with the reintroduction of the FODMAP subtypes.ConclusionA FODMAP-restricted diet, implemented over a period of 6 weeks, is effective in reducing the severity and frequency of GI symptoms and improving the quality of life of portuguese patients with IBS.

The accreditation systems in health care institutions are one of the most relevant current health-related topics. It is widely recognized as a major step towards the implementation and maintenance of good practices; this needs, however, that both changes and their maintenance are adequately and frequently assessed.

Introduction: Functional foods are those that promote health and well-being and/or decrease the risk of certain chronic diseases. It is known that young people' knowledge about functional foods is low. The aim of this study is to assess the psychometric proprieties of the "Attitudes towards Functional Foods Scale" in a sample of adolescents and, based on that analysis, adapting the scale for its use among this population group.Material and Methods: After a pre-test, the scale was applied to 340 students attending the 3rd cycle of basic education in Terceira island (Azores, Portugal), whose ages ranged between 11 and 19 years (mean = 14.0, standard deviation = 1.2). We analyzed the scale's internal consistency and construct validity.Results: The study of the psychometric proprieties led to the exclusion of one item. Cronbach's alpha (alpha = 0.876) showed a good internal consistency of the scale, and factor analysis revealed that, as the original (adults) version, it presents an unifactorial structure.Discussion: The scale showed to be an instrument easy and quick to apply among adolescents. We emphasize that its application should be preceded by the clarification on the concept of functional foods in order to ensure the adequacy of the answers.Conclusion: This study has demonstrated the adequacy of the Attitudes Towards Functional Foods Scale to assess Portuguese adolescents' perception regarding functional foods, highlighting the need of using its adapted version., This work was funded by the Calouste Gulbenkian Foundation and was part of the project "Health-promoting foods in schools - more knowledge, better growth" within the Literacy in Health 2014 contest - "Citizens and Health: improving information, improve decision".

In Portugal people aged 65 and above will be the populational group with the highest growth rate of the next decades. Healthy ageing constitutes a challenge as not only the number of years lived are essential, but also the quality of life becomes a priority. The aim of this study was to understand the relationship between health self-perception (HSP), food consumption and nutritional status among Portuguese older adults. Four hundred fifty-nine older adults (aged 65) were interviewed, almost half had a positive HSP. The most significant predictor of HSP was nutritional status, p = 0.005, but independence in shopping had the largest impact on how they compared to others, p < 0.001. Interventions need to focus on factors like nutritional status, independency on Activities of Daily Living, Satisfaction with Food-Related Life and utilize them to modify the negative HSP and attitudes towards ageing and health and maximize the positive aspects of old age. (c) 2019, Springer Nature Limited.

Personalized nutrition allows individual variation in dietary, lifestyle, anthropometric, phenotypic, and/or genomic information to be considered when giving dietary advice. Compared to “generic” dietary health messages, personalized dietary advice has been shown more likely to result in healthy dietary change. Personalized regimes can help clients in this endeavor by putting them in control and taking into consideration the individual’s propensity for behavior change, motives for food choice, as well as social and lifestyle factors impacting upon the eating context. Provision of personalized nutrition services across Europe should consider intercountry differences in perceived barriers to the uptake of personalized nutrition including those associated with the process from the collecting of information and taking of biological samples through to how the results are interpreted and delivered. Irrespective of European country, potential consumers appear to trust health professionals such as dietitians over commercial agents to provide personalized nutrition. Dieticians therefore are likely to play a key role in making personalized nutrition happen in the future. Organizations representing nutrition and dietetics professionals will need to be consulted for guidance on how to address the ethical and legal issues around personalized nutrition and regulate practice. A future is envisaged where commercial personalized nutrition will work with existing health providers in bringing the benefits of personalized nutrition to the wider public.

BACKGROUND: Personalised nutrition (PN) may promote public health. PN involves dietary advice based on individual characteristics of end users and can for example be based on lifestyle, blood and/or DNA profiling. Currently, PN is not refunded by most health insurance or health care plans. Improved public health is contingent on individual consumers being willing to pay for the service.METHODS: A survey with a representative sample from the general population was conducted in eight European countries (N= 8233). Participants reported their willingness to pay (WTP) for PN based on lifestyle information, lifestyle and blood information, and lifestyle and DNA information. WTP was elicited by contingent valuation with the price of a standard, non-PN advice used as reference.RESULTS: About 30% of participants reported being willing to pay more for PN than for non-PN advice. They were on average prepared to pay about 150% of the reference price of a standard, non-personalised advice, with some differences related to socio-demographic factors.CONCLUSION: There is a potential market for PN compared to non-PN advice, particularly among men on higher incomes. These findings raise questions to what extent personalized nutrition can be left to the market or should be incorporated into public health programs.

ObjectiveThe present study explored associations between food choice motives, attitudes towards and intention to adopt personalised nutrition, to inform communication strategies based on consumer priorities and concerns.Design/SettingA survey was administered online which included the Food Choice Questionnaire (FCQ) and items assessing attitudes towards and intention to adopt personalised nutrition.SubjectsNationally representative samples were recruited in nine EU countries (n 9381).ResultsStructural equation modelling indicated that the food choice motives ‘weight control’, ‘mood’, ‘health’ and ‘ethical concern’ had a positive association and ‘price’ had a negative association with attitude towards, and intention to adopt, personalised nutrition. ‘Health’ was positively associated and ‘familiarity’ negatively associated with attitude towards personalised nutrition. The effects of ‘weight control’, ‘ethical concern’, ‘mood’ and ‘price’ on intention to adopt personalised nutrition were partially mediated by attitude. The effects of ‘health’ and ‘familiarity’ were fully mediated by attitude. ‘Sensory appeal’ was negatively and directly associated with intention to adopt personalised nutrition.ConclusionsPersonalised nutrition providers may benefit from taking into consideration the importance of underlying determinants of food choice in potential users, particularly weight control, mood and price, when promoting services and in tailoring communications that are motivationally relevant.

Purpose The purpose of this paper is to assess the reliability of a Portuguese version of the cooking skills scale (CSS) and to evaluate the association between cooking skills and socio-demographic, psychological and other cooking-related variables. Design/methodology/approach The study was conducted as an online survey among 730 Portuguese university students. Translation and back-translation of the CSS were performed. Data were assessed in two stages (test and retest) and the psychometric properties of the CSS were analyzed. The effect of socio-demographic variables was assessed by binary logistic regression analysis. The odds ratios for upper tertile of the CSS score were calculated using the lower tertile as reference. Findings Cronbach’s α for the CSS was 0.90. In the analysis of test-retest reliability, Spearman’s rank correlation coefficient was 0.79 and Cohen’s κ (for tertiles) was 0.49. Cooking skills were higher in respondents cooking more often, feeling more confident, enjoying more and indicating the personal interest as the main motivation to learn how to cook. Cooking skills were significantly better in females, older students and those with more independent place of residence. Originality/value Very good psychometric properties of the Portuguese version of the CSS were found among university students, providing a proper and simple tool to measure cooking skills in future studies with similar populations. The interventions encouraging to acquire and improve cooking skills as part of promoting healthy eating should be targeted especially toward men and young adults.

Eduardo Sepúlveda,1,2 Rui Poínhos,2,3 Miguel Constante,4,5 José Pais-Ribeiro,1,2 Paula Freitas,6,7 Davide Carvalho6,71Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal; 2Associação de Prevenção e Apoio à Diabetes, Porto, Portugal; 3Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; 4Institute of Psychiatry, King’s College London, London, UK; 5Department of Psychiatry, Hospital Beatriz Ângelo, Loures, Portugal; 6Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal; 7Faculty of Medicine, University of Porto, Porto, PortugalBackground: Diabetes mellitus is a chronic metabolic disease, the prevalence of which has registered a considerable increase, mainly in adults and elderly. The purpose of this study was to assess the relationship between health-related quality of life in patients with diabetes and sex, body mass index, type of diabetes and treatment regimens (type 1 diabetes: intensive versus conventional treatment; type 2 diabetes: insulin use versus non-insulin use), and duration of diabetes.Methods: One hundred and twenty-four patients with diabetes were interviewed. Health-related quality of life was evaluated using the age-adjusted Short-Form 36 dimensions (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health), and related to demographic and clinical variables. Independent samples t-tests and One-Way Analysis of Variance were used to compare means of independent samples. The degree of association between pairs of variables was measured by Pearson’s (r) or Spearman’s (rs) correlation coefficients.Results: The mean age of the study population was 55.7±16.4 years; 54.8% were male, and 77.4% had type 2 diabetes. Females reported worse quality of life than males in all dimensions of the Short-Form 36, except for role-physical and bodily pain. Obese patients had worse physical functioning than normal weight and overweight patients, and worse vitality than their normal weight counterparts. Type 2 diabetic patients taking insulin had lower physical functioning and vitality than those without insulin therapy. Longer duration of diabetes was associated with lower physical functioning, role-physical, general health, vitality, role-emotional, and mental health.Conclusion: Being female, obese, having type 2 diabetes and taking insulin, and having a longer disease duration are characteristics associated with worse age-adjusted quality of life in patients with diabetes.Keywords: clinical variables, demographic variables, diabetes mellitus, health-related quality of life

Objectives The aim of this study was to relate social desirability with eating behavior dimensions among higher education students in Portugal, and to assess the effect of social desirability on the association between pairs of eating behavior dimensions. Methods Data from 266 higher education students (62.8% women) aged between 18 and 27 y were evaluated. Social desirability and several eating behavior dimensions (emotional and external eating, flexible and rigid restraint, binge eating, and eating self-efficacy) were assessed. Results In both women and men, social desirability showed negative associations with emotional, external, and binge eating, and positive associations with eating self-efficacy. For the majority of the correlations, the control for social desirability led to a decrease in the strength of the association: Social desirability showed a greater effect on the associations between external and binge eating, external eating and eating self-efficacy, binge eating and eating self-efficacy, and emotional and external eating. Conclusion This study demonstrated that social desirability should be considered when assessing the dimensions of eating behavior, namely eating self-efficacy and dimensions related to overeating.

Introduction The study of eating behaviour should consider the presence of potential sources of bias, including social desirability. This is particularly relevant among students of Nutrition Sciences, since they have a higher risk of eating disorders. Objective To analyse the effect of social desirability in the assessment of eating behaviour dimensions among nutrition students. Methods In this cross-sectional study, we analysed data from 149 students of Nutrition Sciences. Participants completed a questionnaire assessing social desirability and eating behaviour dimensions (emotional, external and binge eating, flexible and rigid control, and eating self-efficacy). Results Among males, social desirability had a negative association with binge eating, while among women it had a negative association with emotional, external and binge eating and a positive association with eating self-efficacy. In both subsamples, social desirability showed no significant association with any of the two types of dietary restraint (rigid and flexible control). Discussion Overall, the association between social desirability and eating behaviour dimensions among students of Nutrition Sciences occurs in the same direction as found in students from other areas. However, alongside these similarities, there is a stronger association between social desirability and binge eating among male students of Nutrition Sciences. We hypothesize that this may be related with the different knowledge of students from different areas, and the way they perceive and face the treatment of eating disorders. Conclusion Our study shows that social desirability should be considered while assessing eating behaviour among nutrition students, particularly when studying external eating, binge eating and eating self-efficacy. Moreover, when tailoring interventions to reduce the possible effects of eating behaviour on nutritionists and dieticians' practice, we should consider the influence of social desirability.

ObjectivesFluid overload (FO) is frequently present in peritoneal dialysis (PD) patients and is associated with markers of malnutrition, inflammation, and atherosclerosis/calcification (MIAC) syndrome. We examined the relationships in stable PD patients between phase angle (PhA) and the spectrum of uremic vasculopathy including vascular calcification and arterial stiffness and between PhA and changes in serum fetuin-A levels.MethodsSixty-one stable adult PD patients were evaluated in a cross-sectional study (ST1). Phase angle was measured by multifrequency bioimpedance analysis (InbodyS10, Biospace, Korea) at 50 kHz. Augmentation index (AI), a surrogate marker of arterial stiffness, was assessed by digital pulse amplitude tonometry (Endo PAT, Itamar Medical, Caesarea, Israel). Vascular calcification was assessed by simplified calcification score (SCS). Serum fetuin-A levels were measured by ELISA (Thermo scientific; Waltham, MA, USA). Serum albumin was used as a nutritional marker, and serum C-reactive protein (CRP) was used as an inflammatory marker. The same assessments were carried out longitudinally (ST2) in the first 33 patients who completed 1 year of evaluation in ST1.ResultsIn ST1, patients with PhA < 6° had higher CRP levels, AI, and SCS and lower serum albumin and fetuin-A levels, in comparison with patients with PhA ≥ 6°. In addition, PhA was a predictor of both AI ((3 = -0.351, p = 0.023) and SCS > 3 (EXP (B) = 0.243, p = 0.005). In ST2, the increase of PhA over time was associated with decreases in both AI ( r = -0.378, p = 0.042) and CRP levels ( r = -0.426, p = 0.021), as well as with the increase in serum fetuin-A levels ( r = 0.411, p = 0.030).ConclusionsPhase angle predicts both arterial stiffness and vascular calcification in stable PD patients.

Background: Fruit and vegetable intake is crucial in health promotion and disease prevention. Inadequate intake is found among adult populations worldwide. Aims: To assess fruit and vegetable intake among Portuguese mothers and to examine its association with sociodemographic determinants. Methods: A national cross-sectional survey was performed in Portugal as part of the Pro Children study. Data from self-administrated precoded 24-hour recall and food frequency questionnaires answered by 1,853 mothers of 11- to 13-year-old children were analyzed. Descriptive analysis of the data was followed by logistic regression to assess associations between daily fruit and vegetable intake and sociodemographic determinants. Results: The mean fruit and vegetable intake was 221.2 and 170.0 g/day, respectively. Only 46% of the mothers met the WHO recommendations (≥400 g fruit and vegetables/day). Daily fruit intake was significantly higher among mothers who live with a spouse/partner, and who belong to a higher social class. For vegetables, daily intake was significantly higher among mothers with a higher education and social class. Conclusions: This study shows that the mean intake of fruit and vegetables among Portuguese mothers is far below international recommendations. Effective strategies to promote fruit and vegetable intake are needed, especially for mothers belonging to lower social classes and educational levels.

Introdução: A hipovitaminose D está associada a compromisso ósseo e, na idade adulta, a um maior risco de desenvolvimento de doenças crónicas. São escassos os estudos portugueses relativos ao status de vitamina D e da massa óssea em idade pediátrica. Este trabalho teve como objetivo caracterizar o status de vitamina D e de massa óssea em crianças e adolescentes residentes na região do Porto e estudar a sua relação com o estado nutricional e a prática de atividade física. Métodos: Estudo retrospetivo que incluiu 122 crianças e adolescentes (5-18 anos), avaliadas durante os meses de inverno e primavera de 2011 e 2012. Procedeu-se à caraterização antropométrica, da composição corporal (Inbody 230®), do status de massa óssea e do padrão de atividade física e à avaliação das concentrações séricas de 25-hidroxivitamina D e dos marcadores do metabolismo fosfocálcico. Considerou-se deficiência em vitamina D valores de 25-hidroxivitamina D < 20 ng/mL e “compromisso de massa óssea para a idade” valores de Z-score da densidade mineral óssea ≤ -2,0. Resultados: Cerca de metade da amostra (n = 67; 47,8%) apresentou deficiência em vitamina D. Verificou-se uma prevalência de 4,7% de compromisso de massa óssea para a idade. Os níveis de 25-hidroxivitamina D registaram uma correlação negativa com a paratormona (r = 0,342; p = 0,013), mas não demonstraram qualquer correlação com as variáveis antropométricas, a massa gorda, a massa óssea ou a atividade física. Discussão: Observou-se uma elevada prevalência de deficiência em vitamina D em crianças e adolescentes da região do Porto, independentemente do estado de nutrição e do padrão de atividade física. De forma a obviar possíveis repercussões futuras com implicações na saúde pública, importa o conhecimento da realidade a nível nacional., Portuguese Journal of Pediatrics, Vol. 47 No. 1 (2016)