Influence of parental healthy-eating attitudes and nutritional knowledge on nutritional adequacy and diet quality among preschoolers: the SENDO project

Parental nutrition knowledge and attitudes play a fundamental role in their children's food knowledge. However, little is known about their influence on their children's diet quality and micronutrient intake. Thus, we aimed to assess the association of parental nutrition knowledge and healthy-eating attitudes with their children's adherence to the Mediterranean dietary pattern and micronutrient adequacy. Parental healthy-eating attitudes and knowledge of the quality of their child's diet as well as anthropometric, lifestyle, and nutrient intake characteristics were recorded with a basal questionnaire that included a 140-item-food frequency-questionnaire. A total of 287 pre-school children were included in the analyses. Intake adequacy was defined using the Estimated Average Requirements (EAR) cut-off point method. We developed a parental nutrition knowledge and healthy-eating attitudes scores and evaluated whether they were independently associated with 1) children's inadequate intake (probability of failing to meet 3 EAR) of micronutrients, using logistic regression analyses, and 2) children's diet quality (adherence to the Mediterranean Diet according to a Mediterranean Diet Quality Index for children and adolescents, the KIDMED index), using multiple linear regression models. A higher score in the parental healthy-eating attitudes score was associated with lower risk of failing to meet 3 EAR compared with the reference category (odds ratio (OR): 0.3; 95% confidence interval (CI) 0.12-0.95; p for trend: 0.037) and a higher adherence to the Mediterranean diet in the most adjusted model ( coefficient: 0.34; 95% CI 0.01-0.67; p for trend: 0.045). Our results suggest a positive association of parental healthy-eating attitudes with nutritional adequacy and diet quality in a sample of Spanish preschoolers. Public health strategies should focus on encouraging parental healthy-eating attitudes rather than simply educating parents on what to feed their children, recognizing the important influence of parental behavior on children's practices

Heterosexual oral and anal sex in Kinshasa (D.R.Congo): Data from OKAPI prospective cohort

Background Sexually transmitted infections can be spread through oral and anal heterosexual sex. There are few data on these practices in Sub-Saharan Africa. We analyzed the prevalence of heterosexual oral and anal sex among HIV Voluntary Counseling and Testing (VCT) attendees in Kinshasa and the associated sociodemographics, perceptions and behavioral factors. Methods OKAPI (Observational Kinshasa AIDS Prevention Initiative) prospective cohort study. It evaluates the VCT impact on HIV-related knowledge and behaviors at 6 and 12-month follow-up. Since April 2016 until April 2018, 797 persons aged 15–59 years were HIV tested and replied to a baseline interview, including information about anal and oral sex. Descriptive, bi- and multivariate analyses were performed using baseline data. Results Among 718 sexually active participants reporting heterosexual sex, 59% had had oral sex, 22% anal sex and 18% both practices. Among participants reporting “not” having had sex, 6% reported oral sex, 3% anal sex and 1% both. Oral sex was associated with a daily use of the Internet/mobile phone, perceiving low community HIV risk, reporting HIV-related behaviors (multiple partners, inconsistent condom use, anal, paid and forced sex) and having been pregnant. Being married-monogamous was inversely associated with oral sex. Anal sex was directly associated with having other risk sexual behaviors. Conclusions Oral and anal sex were common among people reporting heterosexual sex in Kinshasa. Perceiving a low community HIV risk and having other sexual risk behaviors are associated with these practices, which are commonly not considered as risky despite their strong association with HIV/STIs. They need to be considered when designing preventive strategies in Kinshasa

Validity and reproducibility of a semi-quantitative food frequency questionnaire in Spanish preschoolers - The SENDO project

Introduction: nowadays, it is important to determine whether food frequency questionnaires (FFQ) are valid tools to collect information on usual diet in children. Objective: we evaluated the reproducibility and validity of the semi-quantitative FFQ used in a Spanish cohort of children aged 4-7 years. Methods: to explore its reproducibility, parents filled a 138-item FFQ at baseline (FFQ-0) and then one year later (FFQ-1). To explore its validity, the FFQ-1 was compared with four weighed 3-day dietary records (DRs) that were used as standard of reference. To estimate associations we calculated deattenuated Pearson’s correlation coefficients to correct for season-to-season variability, and the Bland-Altman index. We also calculated the weighted kappa index and assessed participant’s gross misclassification across quintiles. We analyzed data from 67 (for reproducibility) and 37 (for validity) children aged 4-7 years old, recruited by the pilot study of the SENDO project. Results: regarding reproducibility, we found mean Bland-Altman indexes of 0-10.45 % for nutrients and 1.49 %-10.45 % for foods. The adjusted r ranged between 0.29 and 0.71, and between 0.27 and 0.74 for nutrients and foods, respectively. Regarding validity, we found mean Bland-Altman indexes of 0 %-16.22 % and 0 %-10.81 % for nutrients and for food groups, respectively. The deattenuated r ranged between 0.38 and 0.81 for nutrients, and between 0.53 and 0.68 for foods. The weighted kappa index for agreement across quintiles ranged from 54.1 to 85.1 for nutrients, and from 55.4 to 78.4 for food groups. Conclusions: our results showed acceptable levels of both reproducibility and validity, and that the ad-hoc developed FFQ is a valid tool for assessing usual diet in Spanish preschoolers.Introducción: es importante determinar si los cuestionarios de frecuencia de consumo de alimentos (CFCA) son herramientas válidas para recopilar información sobre la dieta habitual en los niños. Objetivo: evaluar la reproducibilidad y validez del CFCA semi-cuantitativo de una cohorte española de niños de 4 a 7 años. Métodos: en total se estudiaron 67 (para reproducibilidad) y 37 (para validez) niños de 4 a 7 años de edad del estudio piloto del proyecto SENDO. Para explorar la reproducibilidad, los padres cumplimentaron el CFCA basalmente (CFCA-0) y al año (CFCA-1). Para explorar la validez, el CFCA-1 se comparó con cuatro registros dietéticos (DR) pesados de 3 días. Calculamos coeficientes de correlación de Pearson desatenuados para corregir la variabilidad inter-estacional, y el índice de Bland-Altman. El índice kappa ponderado permitió evaluar la clasificación errónea de los participantes entre quintiles. Resultados: respecto a la reproducibilidad, encontramos índices promedio de Bland-Altman de 0-10,45 % para los nutrientes y de 1,49-10,45 % para los alimentos. La r ajustada varió entre 0,29 y 0,71, y entre 0,27 y 0,74 para nutrientes y alimentos, respectivamente. En cuanto a la validez, encontramos índices promedio de Bland-Altman de 0-16,22 % y 0-10,81 % para nutrientes y alimentos, respectivamente. La r desatenuada osciló entre 0,38 y 0,81 para los nutrientes y entre 0,53 y 0,68 para los alimentos. El índice kappa ponderado para el acuerdo entre quintiles varió entre 54,1 y 85,1 para los nutrientes y entre 55,4 y 78,4 para los grupos de alimentos. Conclusiones: nuestros resultados mostraron niveles aceptables tanto de reproducibilidad como de validez. El FFQ desarrollado ad hoc es una herramienta válida para evaluar nutrientes y alimentos en preescolares españoles

Influence of parental healthy-eating attitudes and nutritional knowledge on nutritional adequacy and diet quality among preschoolers: the SENDO project

Parental nutrition knowledge and attitudes play a fundamental role in their children's food knowledge. However, little is known about their influence on their children's diet quality and micronutrient intake. Thus, we aimed to assess the association of parental nutrition knowledge and healthy-eating attitudes with their children's adherence to the Mediterranean dietary pattern and micronutrient adequacy. Parental healthy-eating attitudes and knowledge of the quality of their child's diet as well as anthropometric, lifestyle, and nutrient intake characteristics were recorded with a basal questionnaire that included a 140-item-food frequency-questionnaire. A total of 287 pre-school children were included in the analyses. Intake adequacy was defined using the Estimated Average Requirements (EAR) cut-off point method. We developed a parental nutrition knowledge and healthy-eating attitudes scores and evaluated whether they were independently associated with 1) children's inadequate intake (probability of failing to meet 3 EAR) of micronutrients, using logistic regression analyses, and 2) children's diet quality (adherence to the Mediterranean Diet according to a Mediterranean Diet Quality Index for children and adolescents, the KIDMED index), using multiple linear regression models. A higher score in the parental healthy-eating attitudes score was associated with lower risk of failing to meet 3 EAR compared with the reference category (odds ratio (OR): 0.3; 95% confidence interval (CI) 0.12-0.95; p for trend: 0.037) and a higher adherence to the Mediterranean diet in the most adjusted model ( coefficient: 0.34; 95% CI 0.01-0.67; p for trend: 0.045). Our results suggest a positive association of parental healthy-eating attitudes with nutritional adequacy and diet quality in a sample of Spanish preschoolers. Public health strategies should focus on encouraging parental healthy-eating attitudes rather than simply educating parents on what to feed their children, recognizing the important influence of parental behavior on children's practices

Nutrition and gastronomy in the Community of Navarra

Introducción: Navarra es una comunidad que presenta gran variedad geográfica y climática, lo que da lugar a una amplia oferta alimentaria. Objetivos: revisar la gastronomía típica de Navarra, así como la evidencia disponible sobre el patrón de consumo de alimentos, el perfil nutricional y los indicadores sanitarios de la población navarra. Resultados: Navarra cuenta con 7 denominaciones de origen protegidas y 6 indicaciones geográficas protegidas. Su identidad gastronómica se asocia fundamentalmente con las verduras y las hortalizas, el cordero, la ternera y los embutidos autóctonos, lo que se refleja en el patrón de consumo. Comparativamente, los navarros consumen más hortalizas y frutas frescas, pero también presentan una ingesta frecuente y excesiva de carnes (especialmente rojas) y embutidos. Los estudios disponibles sobre el perfil nutricional muestran ingestas elevadas de proteínas y grasas en la población adulta, e inadecuación en algunos micronutrientes en la población infantil. En el contexto nacional, Navarra presenta menores tasas tanto de sobrepeso y obesidad como de sedentarismo en población adulta y se observa una tendencia a la baja en prevalencia de obesidad infantil. Conclusiones: la oferta alimentaria y gastronómica de Navarra es variada y con un gran protagonismo de las verduras y hortalizas, aunque el patrón de consumo de alimentos es mejorable. Para lograr una alimentación saludable y sostenible, es fundamental inculcar conocimientos gastronómicos y habilidades culinarias desde edades tempranas

Lifestyle-Related Factors and Total Mortality in a Mediterranean Prospective Cohort

Introduction: Lifestyle-related habits have a strong influence on morbidity and mortality world- wide. This study investigates the association between a multidimensional healthy lifestyle score and all-cause mortality risk, including in the score some less-studied lifestyle-related factors. Methods: Participants (n=20,094) of the Seguimiento Universidad de Navarra cohort were fol- lowed up from 1999 to 2018. The analysis was conducted in 2019. A 10-point healthy lifestyle score previously associated with a lower risk of major cardiovascular events was applied, assigning 1 point to each of the following items: never smoking, moderate-to-high physical activity, moderate-to-high Mediterranean diet adherence, healthy BMI, moderate alcohol consumption, avoidance of binge drinking, low TV exposure, short afternoon nap, time spent with friends, and working ≥40 hours per week. Results: During a median follow-up of 10.8 years, 407 deaths were documented. In the multivari- able adjusted analysis, the highest category of adherence to the score (7−10 points) showed a 60% lower risk of all-cause mortality than the lowest category (0−3 points) (hazard ratio=0.40, 95% CI=0.27, 0.60, p<0.001 for trend). In analyses of the healthy lifestyle score as a continuous variable, for each additional point in the score, a 18% relatively lower risk of all-cause mortality was observed (adjusted hazard ratio=0.82, 95% CI=0.76, 0.88). Conclusions: Adherence to a healthy lifestyle score, including some less-studied lifestyle-related factors, was longitudinally associated with a substantially lower mortality rate in a Mediterranean cohort. Comprehensive health promotion should be a public health priority. Am J Prev Med 2020;59(2):e59−e67. © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved

Heterosexual oral and anal sex in Kinshasa (D.R.Congo): Data from OKAPI prospective cohort

Background Sexually transmitted infections can be spread through oral and anal heterosexual sex. There are few data on these practices in Sub-Saharan Africa. We analyzed the prevalence of heterosexual oral and anal sex among HIV Voluntary Counseling and Testing (VCT) attendees in Kinshasa and the associated sociodemographics, perceptions and behavioral factors. Methods OKAPI (Observational Kinshasa AIDS Prevention Initiative) prospective cohort study. It evaluates the VCT impact on HIV-related knowledge and behaviors at 6 and 12-month follow-up. Since April 2016 until April 2018, 797 persons aged 15–59 years were HIV tested and replied to a baseline interview, including information about anal and oral sex. Descriptive, bi- and multivariate analyses were performed using baseline data. Results Among 718 sexually active participants reporting heterosexual sex, 59% had had oral sex, 22% anal sex and 18% both practices. Among participants reporting “not” having had sex, 6% reported oral sex, 3% anal sex and 1% both. Oral sex was associated with a daily use of the Internet/mobile phone, perceiving low community HIV risk, reporting HIV-related behaviors (multiple partners, inconsistent condom use, anal, paid and forced sex) and having been pregnant. Being married-monogamous was inversely associated with oral sex. Anal sex was directly associated with having other risk sexual behaviors. Conclusions Oral and anal sex were common among people reporting heterosexual sex in Kinshasa. Perceiving a low community HIV risk and having other sexual risk behaviors are associated with these practices, which are commonly not considered as risky despite their strong association with HIV/STIs. They need to be considered when designing preventive strategies in Kinshasa

Mediterranean diet and health outcomes in the SUN cohort

The Mediterranean Dietary (MedDiet) Pattern has been linked to many beneficial health effects. This review summarizes the main findings of a prospective cohort study, the Seguimiento Universidad de Navarra (SUN) cohort, specifically focused on MedDiet and the risk of major chronic disease. It is an open cohort in which 22,786 Spanish university graduates have participated since 1999 until February 2018. Data on diet, lifestyle and clinical diagnosis are collected at baseline and every two years. After reviewing 21 publications from the SUN cohort on the effects of the MedDiet, we conclude that this cohort has provided good evidence that a high MedDiet adherence is associated with a reduced incidence of all-cause mortality, fatal and non-fatal major cardiovascular disease (CVD), type 2 diabetes, weight gain, metabolic syndrome, depression, cognitive decline, and nephrolithiasis. An inverse dose-response relationship was found for many of these associations. The MedDiet was also associated with lower average heart rate, a mitigation of the harmful effects of overweight/obesity on the risk of CVD, and an attenuation of the effects of obesity on type 2 diabetes. A suggestion that the MedDiet may enhance fertility was also found

Do healthy doctors deliver better messages of health promotion to their patients?: Data from the SUN cohort study

Background Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors. Methods We assessed 890 doctors aged ≤65 years participating in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits. Results Among doctors, 31% reported <10 min per visit; 73% counseled 60–100% of their patients on smoking cessation, 58% on physical activity, 54% on weight control, 51% on healthy nutrition, 44% on alcohol avoidance/reduction and 28% recommended alcohol moderate consumption. The percentage of doctors that counseled 100% of their patients about lifestyle was 43% for smoking cessation, 15% for exercise and 13% for weight control and nutrition. Better doctor’s adherence to the Mediterranean dietary pattern was associated with more frequent and longer nutrition counseling. Higher practice of physical activity was associated with longer time on counseling about exercise to their patients. Among doctors both current and former smoking were inversely associated with the frequency and duration of their smoking cessation/avoidance counseling practices. Conclusions Personal behavioral changes among doctors and better training of medical doctors on a personal healthy diet and lifestyle are likely to contribute to improve the behavioral counseling given to patients