Objectives: The main purpose of this study was to evaluate the modification of knowledge, opinions and attitudes to healthy eating, weight perception and dieting practices and preventive habits over a 10-year trend in the Catalan... more
Objectives: The main purpose of this study was to evaluate the modification of knowledge, opinions and attitudes to healthy eating, weight perception and dieting practices and preventive habits over a 10-year trend in the Catalan population from 1992 to 2003. Design: Two cross-sectional surveys were carried out in Catalonia, Spain, during
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Abstract “Nudge” policies are increasingly popular, seeking to modify health-related decisions by affecting response to available options. Thus, critical appraisals of the effectiveness of health-related nudging interventions could help... more
Abstract “Nudge” policies are increasingly popular, seeking to modify health-related decisions by affecting response to available options. Thus, critical appraisals of the effectiveness of health-related nudging interventions could help health policy makers in making evidence-based decisions with regards to which of these interventions should be incorporated into policy. The aim of the present effort was to systematically appraise the evidence on nudging interventions on healthy diet and physical activity (PA). A systematic review was performed using Pubmed, Web of Science Core Collection citation index and the Cochrane Controlled Register of Trials (CENTRAL). Interventional studies were included if they quantitatively assessed healthy diet and/or PA interventions that were explicitly related to a nudging context. Methodological assessment was performed using the Cochrane collaboration’s risk of bias tool and the Research Triangle Institute item bank. Sixty-four studies were included with varying degrees of bias. Sixty studies investigated healthy diet interventions, three studied PA interventions and one studied interventions pertaining to both. Overall, specific types of interventions such as proximity and presentation alterations can be effective in encouraging people towards the adoption of healthier diet choices, whereas labelling, availability, prompting, functional design and sizing “nudge” interventions provide inconclusive results so far. Nudging interventions improving convenience seem to be effective in encouraging people towards making healthier diet choices, whereas evidence on PA is limited. Further conceptual development and research is needed to optimally determine the type, intensity and circumstances that make nudge-related interventions more effective, particularly regarding PA.
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ObjectiveThe traditional Mediterranean diet includes high consumption of fruits, vegetables, olive oil, legumes, cereals and nuts, moderate to high intake of fish and dairy products, and low consumption of meat products. Intervention... more
ObjectiveThe traditional Mediterranean diet includes high consumption of fruits, vegetables, olive oil, legumes, cereals and nuts, moderate to high intake of fish and dairy products, and low consumption of meat products. Intervention effects to improve adoption of this diet may vary in terms of individuals’ motivational or volitional prerequisites. In the context of a three-country research collaboration, intervention effects on these psychological constructs for increasing adoption of the Mediterranean diet were examined.DesignAn intervention was conducted to improve Mediterranean diet consumption with a two-month follow-up. Linear multiple-level models examined which psychological constructs (outcome expectancies, planning, action control and stage of change) were associated with changes in diet scores.SettingWeb-based intervention in Italy, Spain and Greece.SubjectsAdults (n454; mean age 42·2 (sd10·4) years, range 18–65 years;n112 at follow-up).ResultsAnalyses yielded an overall ...
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The purpose of this article is to define the concept of Mediterranean Diet or Diets and to describe the associated health benefits recognised by the scientific community. The characteristics of the Mediterranean Diet are described as well... more
The purpose of this article is to define the concept of Mediterranean Diet or Diets and to describe the associated health benefits recognised by the scientific community. The characteristics of the Mediterranean Diet are described as well as the effects the foods comprising it have on the most common pathologies such as cardiovascular disease and cancer. The Spanish Society of Community Nutrition's consensus based Healthy Diet Pyramid, along with Greece's pyramid for food guidelines for the adult population (from the Greek Ministry of Health), are presented and compared. They are the graphic representation of the food and physical activity guides of two typically Mediterranean countries. Nutritional and sociological trends are also discussed and their impact on the evolution of the Mediterranean Diet.
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Abstract: A meta-analysis of the most representative Spanish nutrition studies was carried out to identify inadequate intakes of vitamins A, B1, B6, C, E, folate, iron, and calcium in children aged 4 to 18. Information on vegetable, fruit... more
Abstract: A meta-analysis of the most representative Spanish nutrition studies was carried out to identify inadequate intakes of vitamins A, B1, B6, C, E, folate, iron, and calcium in children aged 4 to 18. Information on vegetable, fruit and fruit juice/beverage intake was also solicited. Data drawn from the selected studies yielded a total of 6540 children and adolescents in eight geographical areas. The sample was stratified by age (children: 4 to 14 years old and adolescents: 13–18 years old) and sex. Inadequate intakes (below two-thirds of the recommended values) were notable in children for vitamin E, vitamin C, and vitamin A and in girls, iron. In adolescents, low intakes were especially marked for vitamin E and vitamin A, and in girls, calcium, folate, and iron. Adolescents consumed more vegetables, fruit juice, and fruit drinks whereas children had higher fruit intakes. Regional differences in consumption were also detected. Strategies for improving nutrient intake in these...
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There is a growing recognition that social support can potentially exert consistent or opposing effects in influencing health behaviours. The present paper presents a cross-sectional study, including 2,064 adults from Italy, Spain and... more
There is a growing recognition that social support can potentially exert consistent or opposing effects in influencing health behaviours. The present paper presents a cross-sectional study, including 2,064 adults from Italy, Spain and Greece, who were participants in a multi-centre randomised controlled trial (C4H study), aiming to examine whether social support is correlated with adherence to a healthy Mediterranean diet and physical activity. Social support data were available for 1,572 participants. The majority of the sample reported emotional support availability (84·5 %), financial support availability (72·6 %) and having one or more close friends (78·2 %). Mediterranean diet adherence was significantly associated with emotional support (P = 0·009) and social network support (P = 0·021). No statistically significant associations were found between participant physical activity and the social support aspects studied. In conclusion, emotional and social network support may be as...
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Background: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy,... more
Background: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact—and thus the sustainability—of diets. Objective: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. Methods: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. Conclusions: The new envir...
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We review and compare trends in coronary heart disease (CHD) and stroke mortality in Spain from 1966 to 1990 and changes in food consumption at national and regional levels. Since 1976, a decrease in cardiovascular disease (CVD) mortality... more
We review and compare trends in coronary heart disease (CHD) and stroke mortality in Spain from 1966 to 1990 and changes in food consumption at national and regional levels. Since 1976, a decrease in cardiovascular disease (CVD) mortality in males and females has been observed, and standardized CHD mortality rates have fallen. Stroke mortality decreased during the same period. Trends in food consumption show increases in intakes of meat, dairy products, fish, and fruit, but decreases in consumption of olive oil, sugar, and all foods rich in carbohydrates. Although fat and saturated fat intakes increased, these changes were not accompanied by an increase in CHD mortality rates. This paradoxical situation can be explained by expanded access to clinical care, increased consumption of fruit and fish, improved control of hypertension, and a reduction in cigarette smoking. Diet appears to have an important role in this paradox, but it may not be as critical as other factors. Nevertheless, we suggest dietary guidelines for prevention of CHD in Spain.
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An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more... more
An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment. A two-arm digital intervention with 269 men and 395 women (M = 41.2, SD = 11.45; range: 19-66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform. Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes. FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount ...
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In 1996, the World Food Summit reaffirmed the inalienable right that each person across the globe has to access safe, adequate and nutritious food. At that time a goal was established to reduce by half the number of undernourished persons... more
In 1996, the World Food Summit reaffirmed the inalienable right that each person across the globe has to access safe, adequate and nutritious food. At that time a goal was established to reduce by half the number of undernourished persons worldwide by 2015, in other words the year that we are now commencing. Different countries and organisations considered the necessity of reaching consensus and developing indicators for measuring household food insecurity. The availability of a simple but evidence-based measurement method to identify nutritionally at-risk population groups constitutes an essential instrument for implementing strategies that effectively address relevant key issues.
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The purpose of this study was to evaluate the changes in the nutricional habits and nutricional status of the Catalan population over 10 years interval of the two Catalan Nutricional Surveys conducted in 1992-93 and 2002-03. 2641... more
The purpose of this study was to evaluate the changes in the nutricional habits and nutricional status of the Catalan population over 10 years interval of the two Catalan Nutricional Surveys conducted in 1992-93 and 2002-03. 2641 individuals in 1992-93 and 2060 individuals in 2002-03 aged 10 to 75 years participated in the surveys. Two 24 hour recall, a food frequency questionnaire, and a general questionnaire with information on physical activity, knowledge and opinions on nutrition and supplements use were administered. Weight (Kg), height (cm) and waist circumference (WC) (cm) were measured. A subsample of the population underwent a biochemical evaluation. Total cholesterol, HDL cholesterol, LDL cholesterol, tryglicerides and beta-carotene, alpha-tocopherol and retinol were measured. A decrease in the consumption of fruit, vegetables, potatoes, meat and fish and an increase in the consumption of dairy products and fast food (in young individuals) were reported. An increase in the...
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The purpose of this article is to define the concept of Mediterranean Diet or Diets and to describe the associated health benefits recognised by the scientific community. The characteristics of the Mediterranean Diet are described as well... more
The purpose of this article is to define the concept of Mediterranean Diet or Diets and to describe the associated health benefits recognised by the scientific community. The characteristics of the Mediterranean Diet are described as well as the effects the foods comprising it have on the most common pathologies such as cardiovascular disease and cancer. The Spanish Society of Community Nutrition's consensus based Healthy Diet Pyramid, along with Greece's pyramid for food guidelines for the adult population (from the Greek Ministry of Health), are presented and compared. They are the graphic representation of the food and physical activity guides of two typically Mediterranean countries. Nutritional and sociological trends are also discussed and their impact on the evolution of the Mediterranean Diet.
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The food frequency questionnaires are widely used in epidemiological researches like dietary assessment method. Traditionally, they have been self-administered in paper but the use of information and communication technologies has led to... more
The food frequency questionnaires are widely used in epidemiological researches like dietary assessment method. Traditionally, they have been self-administered in paper but the use of information and communication technologies has led to develop Internet and computerized food frequency questionnaires. It is the objective of this article to offer a global perspective of the new technologies applied to FFQ. It will be presented the purpose of the food frequency questionnaire, the number of strengths of the web-based surveys versus print-surveys and finally, a description of the manuscripts that have used web-based and computerized FFQ.
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Research was conducted within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence, to find the best practice in assessing nutrient intakes. Objectives include: to search for and use data on individual... more
Research was conducted within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence, to find the best practice in assessing nutrient intakes. Objectives include: to search for and use data on individual nutrient intake adequacy (NIA) assessment collected in twenty-eight European countries and the four European Free Trade Association countries; to design and test innovative tools for data quality analysis. The information was obtained using the method described by Blanquer et al. in the present issue. The best-practice criteria were devised to select the most appropriate survey in each country. Then a survey quality scoring system was developed in consultation with experts and tested on these surveys. Weights were allocated according to a variable priority order agreed by consultation. The thirty-two countries yielded twenty-four national surveys (eight countries excluded). Data collection techniques: eleven countries/surveys used personal interviews only...
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The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from... more
The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembo...
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ObjectiveTo provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake... more
ObjectiveTo provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake.DesignMEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability.SettingEurope.SubjectsChildren, adults and elderly.ResultsData from eighteen publications originating primarily from Western Europe showed that there is a posit...
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The pre- and postgraduate academic education and training of dietetic professionals was evaluated in a European Union initiative titled the Latin American Academic Training Project (Project ALFA). The principal goal was to optimize the... more
The pre- and postgraduate academic education and training of dietetic professionals was evaluated in a European Union initiative titled the Latin American Academic Training Project (Project ALFA). The principal goal was to optimize the quality of dietetics training and evaluate the potential for adapting and harmonizing course curriculums (to comply with the European Community Directive for the General System of
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To examine if and how ready-to-eat cereals (RTEC) contribute to the quality of the diet of children, adolescents and young adults in a Mediterranean setting. A random sample of 3534 subjects aged 2 to 24 years in Spain was studied. Food... more
To examine if and how ready-to-eat cereals (RTEC) contribute to the quality of the diet of children, adolescents and young adults in a Mediterranean setting. A random sample of 3534 subjects aged 2 to 24 years in Spain was studied. Food and nutrient intakes were determined by a 24 hour recall. RTEC consumption was assessed by a quantitative food frequency questionnaire. Additional questions on socioeconomic level and nutritional knowledge were administered. Cereal consumption was classified into non-consumers and daily intakes between 1 and 20g, 21 and 40g, and more than 40g. After excluding the underreporters the final sample consisted of 2852 individuals. About half of the population (49.8%) reported eating RTEC. Macronutrient profile improved with increasing cereal consumption. Intakes of thiamine, riboflavin and vitamin B6 increased significantly with increasing consumption of RTEC in all age-sex groups, whereas niacin and folate intake improved in almost all groups and calcium, iron and vitamin D in at least half of the groups. Except for magnesium, vitamin B12 and vitamin E in males, consumption of RTEC was significantly associated with increased coverage of the daily nutrient requirements for all micronutrients studied. Higher levels of RTEC consumption was associated with a greater consumption of dairy products, and related to better breakfast quality. Level of RTEC consumption is associated with a better nutritional profile in the diets of Spanish children, adolescents and young adults and a lower risk for inadequate micronutrient intakes. RTEC consumers have better quality breakfasts, in terms of both food choices as well as energy and nutrient content.
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Research Interests: Marketing, Diet, European Union, Market Structure, Medicine, and 15 moreSpain, Herbal Medicine, Humans, Food Consumption, Dietary Supplements, Food Legislation, Wild edible plants, Questionnaires, European Community, Study design, Food Sciences, Distribution Channel, Member States, General Population, and Food Function
Research Interests: Nutrition and Dietetics, Decision Making, Evidence Based Medicine, Biology, Diet, and 15 moreMedicine, Animal Production, Micronutrients, Humans, Europe, Nutritional Status, Biological markers, Food Sciences, Risk Assessment, Reference Values, Nutrition Policy, Energy Intake, Randomized Controlled Trials as Topic, Nutrition assessment, and Recommended dietary allowances
Currently, a factorial approach is used to derive reference values for iron. Calculations include the use of a bioavailability factor to convert the physiological requirement, derived from obligatory losses and requirements for growth and... more
Currently, a factorial approach is used to derive reference values for iron. Calculations include the use of a bioavailability factor to convert the physiological requirement, derived from obligatory losses and requirements for growth and development, into a dietary intake value. A series of systematic reviews undertaken by the EURRECA Network of Excellence aimed to identify data that may increase the accuracy of factorial calculations across all population groups. The selection of robust data was guided by the use of standardized review methodology and the evidence-based selection of status biomarkers and dietary intake assessment techniques. Results corroborated the dearth of relevant factorial data, including whole-diet bioavailability data, and confirmed the need to continue extrapolating physiological requirements across population groups. Data were also unavailable that would allow reference values to be based on selected health outcomes associated with iron intake or status. Ideally, a series of observational and randomized controlled trial (RCT) studies need to be undertaken across all population groups and life stages to generate robust data for setting dietary reference values for iron. It will also be essential to include information on polymorphisms that potentially influence iron absorption and status in the derivation process.
Research Interests: Nutrition and Dietetics, Evidence Based Medicine, Diet, Iron Deficiency, Animal Production, and 14 moreMicronutrients, Humans, Dietary Supplements, Systematic review, Biological markers, Food Sciences, Critical Reviews in Food Science and Nutrition (CRIT REV FOOD SCI), Iron Requirement, Reference Values, Biological Availability, Nutrition Policy, Randomized Controlled Trials as Topic, Nutrition assessment, and Recommended dietary allowances
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The purpose of this study was to analyze the prevalence of nutrient intake inadequacy in Europe, applying the Nordic Nutritional Recommendations in the context of the EURRECA Network of Excellence. Nutrient data was obtained from the... more
The purpose of this study was to analyze the prevalence of nutrient intake inadequacy in Europe, applying the Nordic Nutritional Recommendations in the context of the EURRECA Network of Excellence. Nutrient data was obtained from the European Nutrition and Health Report II. Those nutritional surveys using a validated food frequency questionnaire or diet history and a food diary/ register with at least 7 days of registers or with an adjustment for intraindividual variability were included. The nutrients analyzed were: vitamin C, vitamin D, vitamin B(12), folic acid, calcium, iron, zinc, selenium, copper, and iodine. The estimated average requirement cut point was applied to estimate inadequacy. The Nordic and Institute of Medicine nutrient recommendations were used as references. The mean prevalence of inadequacy was below 11% for zinc, iron, and vitamin B(12) (only in the elderly), and it was 11-20% for copper in adults and the elderly and for vitamin B(12) in adults and vitamin C in the elderly. The prevalence was above 20% for vitamin D, folic acid, calcium, selenium, and iodine in adults and the elderly and for vitamin C in adults. Vitamin C, vitamin D, folic acid, calcium, selenium, and iodine were the nutrients showing a higher prevalence of inadequate intakes in Europe.
Research Interests: Nutrition and Dietetics, Vitamin D, Folic acid, Micronutrients, Malnutrition, and 23 moreHumans, Europe, Copper, vitamin C, Selenium, Iodine, Female, Male, Young Adult, Food Frequency Questionnaire, Zinc, Iron, Nutritional Status, Aged, Prevalence, Middle Aged, Questionnaires, Food habits, Adult, Institute of Environmental Medicine, Food Preferences, Energy Intake, and Nutrient Intake
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Information and communication technologies (ICT) offer innovative formats for promoting healthy lifestyles and reinforcing public health initiatives. They can be applied to large population segments without losing the functionality of... more
Information and communication technologies (ICT) offer innovative formats for promoting healthy lifestyles and reinforcing public health initiatives. They can be applied to large population segments without losing the functionality of being tailored to individual fluctuating needs. Advantages of ICT include real-time provision and adaptation of nutrition and health recommendations based on an individual's particular situation, the potential to combine assessment procedures with healthy lifestyle support and the ability to unify psychosocial and cultural dimensions to enhance adherence. Two pilot programs are presented that show the potential for applying ICT to the promotion of healthy eating and physical activity habits.