High consumption of ultra-processed foods is associated with increased risk of micronutrient inadequacy in children: The SENDO project

Due to its rising prevalence, which parallels that of ultraprocessed food (UPF) consumption, inadequate micronutrient intake in childhood is a public health concern. This study aimed to evaluate the association between UPF consumption and inadequate intake of 20 micronutrients in a sample of children from the Mediterranean area. Cross-sectional information from participants in the “Seguimiento del Niño para un Desarrollo Óptimo” (SENDO) project 2015–2021 was used. Dietary information was gathered with a previously validated 147-item semi-quantitative food frequency questionnaire and the NOVA system was used to classify food items. Children were classifed by tertiles of energy intake from UPF. Twenty micronutrients were evaluated, and inadequate intake was defned using the estimated average requirement as a cutof. Crude and multivariable adjusted OR (95% CI) for the inadequacy of≥3 micronutrients associated with UPF consumption were calculated ftting hierarchical models to take into account intra-cluster correlation between siblings. Analyses were adjusted for individual and family confounders. This study included 806 participants (51% boys) with a mean age of 5 years old (SD: 0.90) and an average energy intake from UPF of 37.64% (SD: 9.59). An inverse association between UPF consumption and the intake of 15 out of the 20 micronutrients evaluated was found (p<0.01). After the adjustment for individual and family confounders, compared with children in the frst tertile of UPF consumption, those in the third tertile showed higher odds of inadequate intake of≥3 micronutrients (OR 2.57; 95%CI [1.51–4.40]). Conclusion: High UPF consumption is associated with increased odds of inadequate intake of micronutrients in childhood

Longer breastfeeding duration is associated with lower consumption of ultraprocessed foods in a sample of spanish preschoolers: The SENDO project

Background: Breastfeeding has been linked to a higher consumption of fruit and vegetables at ages 4 to 5 years. More recently, it has been suggested that it may also be associated with lower ultraprocessed food (UPF) consumption in childhood. Objective: The aim of this study was to assess whether breastfeeding duration was associated with consumption of UPF in a sample of Mediterranean preschoolers. Design: This study involved a cross-sectional analysis of baseline information of children in the Child Follow-Up for Optimal Development cohort. Children were enrolled at ages 4 to 5 years and information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative food frequency questionnaire and foods were classified based on the degree of processing according to the NOVA classification. Participants/setting: This study used baseline information for 806 participants enrolled in the Child Follow-Up for Optimal Development cohort between January 2015 and June 2021 in Spain. Main outcomes measures: Main study outcome measures were difference in grams per day and in the percentage of total energy intake from UPF consumption related to breastfeeding duration, and odds ratio that UPF represents a high percentage of total energy intake. Statistical analyses: Crude and multivariable adjusted estimates were calculated with generalized estimating equations to account for intracluster correlation between siblings. Results: The prevalence of breastfeeding in the sample was 84%. After adjusting for potential confounders, children who were breastfed for some time reported significantly lower consumption of UPF than children who were not breastfed at all. The mean differences were -19.2 g (95% CI -44.2 to 10.8) for children who were breastfed for <6 months, -42.5 g (95% CI -77.2 to -7.80) for those who were breastfed for 6 to 12 months, and -43.6 g (95% CI -79.8 to -7.48) for those who were breastfed for 12 months or more (P value for trend = 0.01). After adjusting for potential confounders, compared with children who were not breastfed, those who were breastfed for ≥12 months had consistently lower odds of UPF representing more than 25%, 30%, 35%, and 40% of total energy intake. Conclusions: Breastfeeding is associated with lower consumption of UPF in Spanish preschoolers

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

Joint association of the Mediterranean diet and smoking with all-cause mortality in the Seguimiento Universidad de Navarra (SUN) cohort

Objectives: Although low-quality diets and smoking are independently associated with higher mortality risk, a joint analysis of both risk factors in relation to mortality has not been sufficiently studied. The aim of this study was to explore the effect modification between level of adherence to a Mediterranean dietary pattern (MedDiet) and smoking status on all-cause, cancer, and cardiovascular mortality.Methods: We conducted a prospective analysis to assess the association between diet and smoking status in the SUN (Seguimiento Universidad de Navarra) cohort study. Deaths were confirmed by review of the National Death Index. Participants were classified into six categories according to the MedDiet (adherence/non-adherence) and their exposure to smoking (never/former/current smoker). Multivariate-adjusted Cox regression models were fitted to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for mortality. During a mean follow-up of 11.5 y (SD 4.5), we observed 18 948 participants (mean age 38.4 y; SD 12.4) and 431 deaths (51.3% cancer deaths). Results: A higher risk for death was found among smokers with a low adherence to the MedDiet (HR, 2.20; 95% CI, 1.45-3.34) compared with never smokers with high adherence to the MedDiet. The P value for supra-multiplicative effect modification was not statistically significant, meaning that the effect of both factors is multiplicative. A higher risk for premature death from cancer was found in smokers and in those nonadherent with the MedDiet.Conclusion: Smoking and poor adherence to the MedDiet exerted a multiplicative effect in increasing allcause mortality and cancer-related mortality in a Spanish population of university graduates.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/

Breastfeeding is associated with higher adherence to the Mediterranean diet in a Spanish population of preschoolers: the SENDO project

Objective: To assess whether breastfeeding during the first months of life is associated with adherence to the Mediterranean dietary (MedDiet) pattern in preschool children. Design: The Seguimiento del Nino para un Desarrollo & Oacute; ptimo (SENDO) project is an ongoing pediatric cohort with open recruitment, started in 2015 in Spain. Participants, recruited when they are 4 to 5 years old at their primary local health center or school, are followed annually through online questionnaires. For this study, 941 SENDO participants with full data on study variables were included. Breastfeeding history was collected retrospectively at baseline. Adherence to the Mediterranean diet was assessed with the KIDMED index (range -3 to 12). Results: After accounting for multiple sociodemographic and lifestyle confounders, including parental attitudes and knowledge about dietary recommendations for children, breastfeeding was independently associated with a higher adherence to the MedDiet. Compared with children who were never breastfed, children breastfed for >= 6 months had a one-point increase on their mean KIDMED score (Mean difference +0.93, 95%confidence interval [CI]. 0.52-1.34, p for trend = 8) was 2.94 (95%CI 1.50-5.36) in children who were breastfed for at least 6 months, as compared to their peers who were never breastfeed. Children who were breastfed for less than 6 months exhibited intermediate levels of adherence (p for trend <0.01). Conclusion: Breastfeeding for 6 months or longer is associated with a higher adherence to the Mediterranean diet during the preschool years

Análisis del papel del patrón de la dieta Paleolítica, proteínas dietéticas de alta calidad y aminoácidos dietéticos sobre el riesgo de enfermedad cardiovascular y obesidad en una cohorte prospectiva Mediterránea

Las enfermedades no transmisibles (ENT), también conocidas como enfermedades crónicas, tienden a ser enfermedades multifactoriales que engloban un amplio espectro de factores relacionados con la edad, los antecedentes familiares, la predisposición genética, factores metabólicos, la actividad física, el tabaquismo, el alcohol y la dieta (2,3). Tales cambios en el estilo de vida pueden disminuir los riesgos de dichas enfermedades cardiometabólicas, como enfermedades que afectan al sistema circulatorio, diabetes mellitus tipo 2, enfermedades del sistema respiratorio, cáncer, y la obesidad como factor de riesgo de estas enfermedades, entre otras (4). Las ENT están en el punto de mira de la salud pública porque producen aproximadamente un total de 31,4 millones de muertes mundiales (5). Los factores de riesgo metabólicos contribuyen a cuatro cambios metabólicos fundamentales que aumentan el riesgo de enfermedades cardiovasculares (ECV): el aumento de la tensión arterial, el sobrepeso y la obesidad, la hiperglucemia, y la hiperlipidemia. En términos de muertes atribuibles, el principal factor de riesgo metabólico es el aumento de la presión arterial (al que se atribuyen el 19% de las muertes a nivel mundial), seguido por el sobrepeso y la obesidad (6). La principal hipótesis de este trabajo es que un mayor consumo de alimentos proteicos de alta calidad protege frente a la ECV y la obesidad en una población adulta que sigue unas recomendaciones dietéticas de estilo Mediterráne

Análisis del papel del patrón de la dieta Paleolítica, proteínas dietéticas de alta calidad y aminoácidos dietéticos sobre el riesgo de enfermedad cardiovascular y obesidad en una cohorte prospectiva Mediterránea

Las enfermedades no transmisibles (ENT), también conocidas como enfermedades crónicas, tienden a ser enfermedades multifactoriales que engloban un amplio espectro de factores relacionados con la edad, los antecedentes familiares, la predisposición genética, factores metabólicos, la actividad física, el tabaquismo, el alcohol y la dieta (2,3). Tales cambios en el estilo de vida pueden disminuir los riesgos de dichas enfermedades cardiometabólicas, como enfermedades que afectan al sistema circulatorio, diabetes mellitus tipo 2, enfermedades del sistema respiratorio, cáncer, y la obesidad como factor de riesgo de estas enfermedades, entre otras (4). Las ENT están en el punto de mira de la salud pública porque producen aproximadamente un total de 31,4 millones de muertes mundiales (5). Los factores de riesgo metabólicos contribuyen a cuatro cambios metabólicos fundamentales que aumentan el riesgo de enfermedades cardiovasculares (ECV): el aumento de la tensión arterial, el sobrepeso y la obesidad, la hiperglucemia, y la hiperlipidemia. En términos de muertes atribuibles, el principal factor de riesgo metabólico es el aumento de la presión arterial (al que se atribuyen el 19% de las muertes a nivel mundial), seguido por el sobrepeso y la obesidad (6). La principal hipótesis de este trabajo es que un mayor consumo de alimentos proteicos de alta calidad protege frente a la ECV y la obesidad en una población adulta que sigue unas recomendaciones dietéticas de estilo Mediterráne

Association between a new dietary protein quality index and micronutrient intake adequacy: a cross-sectional study in a young adult Spanish Mediterranean cohort

PURPOSE: There is no evidence of a dietary index that measures not only the quantity but also the quality of protein. The aim is to investigate the association between a new dietary protein quality index (PQI) and micronutrient intake adequacy in a Mediterranean cohort. DESIGN: We assessed 17,535 participants’ diet at baseline using a semi-quantitative FFQ. The PQI was calculated according to the ratio of protein (g/d) sources: [fish, seafood, lean meat, pulses, eggs, nuts, low-fat dairy, and whole grains]/[red and ultra-processed meats, whole-fat or semi-skimmed dairy, potatoes and refined grains]. Participants were classified into quintiles of PQI. We evaluated the intakes of Fe, Cr, I, K, Mg, Ca, P, Na, Se, Zn and vitamins A, B1, B2, B3, B6, B12, C, E and folic acid. Micronutrient adequacy was evaluated using DRIs. Logistic regression analysis was used to assess the micronutrient adequacy according to quintiles of PQI. RESULTS: In this cross-sectional analysis, a total of 24.2% and 4.3% participants did not to meet DRIs in ≥ 4 and ≥ 8 micronutrients, respectively. The odds of failing to meet ≥ 4 and ≥ 8 DRI were lower in participants in the highest quintile of protein quality (OR = 0.22; IC 95% = 0.18, 0.26; P-trend < 0.001; and OR = 0.08; IC 95% = 0.05, 0.14; P-trend < 0.001, respectively) as compared to participants in the lowest quintile. CONCLUSION: Higher PQI was found to be strongly associated with better micronutrient intake adequacy in this Mediterranean cohort. The promotion of high-quality protein intake may be helpful for a more adequate intake of micronutrients. The odds of failing to meet certain numbers of DRIs were lower rather than saying lower risk. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00394-022-02991-z

High consumption of ultra-processed foods is associated with increased risk of micronutrient inadequacy in children: The SENDO project

Due to its rising prevalence, which parallels that of ultraprocessed food (UPF) consumption, inadequate micronutrient intake in childhood is a public health concern. This study aimed to evaluate the association between UPF consumption and inadequate intake of 20 micronutrients in a sample of children from the Mediterranean area. Cross-sectional information from participants in the “Seguimiento del Niño para un Desarrollo Óptimo” (SENDO) project 2015–2021 was used. Dietary information was gathered with a previously validated 147-item semi-quantitative food frequency questionnaire and the NOVA system was used to classify food items. Children were classifed by tertiles of energy intake from UPF. Twenty micronutrients were evaluated, and inadequate intake was defned using the estimated average requirement as a cutof. Crude and multivariable adjusted OR (95% CI) for the inadequacy of≥3 micronutrients associated with UPF consumption were calculated ftting hierarchical models to take into account intra-cluster correlation between siblings. Analyses were adjusted for individual and family confounders. This study included 806 participants (51% boys) with a mean age of 5 years old (SD: 0.90) and an average energy intake from UPF of 37.64% (SD: 9.59). An inverse association between UPF consumption and the intake of 15 out of the 20 micronutrients evaluated was found (p<0.01). After the adjustment for individual and family confounders, compared with children in the frst tertile of UPF consumption, those in the third tertile showed higher odds of inadequate intake of≥3 micronutrients (OR 2.57; 95%CI [1.51–4.40]). Conclusion: High UPF consumption is associated with increased odds of inadequate intake of micronutrients in childhood

Individual and family predictors of ultra-processed food consumption in Spanish children: The SENDO project

Brackground: Ultra-processed food (UPF) consumption is increasing exponentially, becoming a matter of concern for Public Health, given its adverse health effects. Objective: To identify individual and family factors predicting UPF consumption in childhood. Design: The SENDO project is an ongoing prospective dynamic cohort of Spanish children. In this study, we used baseline information of participants recruited between January 2015 and June 2021. Dietary information was collected with a validated semi-quantitative FFQ, and food items were classified using the NOVA classification. Individual and family factors associated with UPF consumption (p< 0.20) in univariate analyses were introduced in a model of generalized estimating equations (GEE) which accounted for intra-cluster correlations between siblings. Setting: The SENDO proyect (Spain), 2015-2021. Participants: Spanish children are recruited at the age of 4-5 years and followed yearly through online questionnaires completed by parents. Results: In this sample of 806 participants (49% girls; mean age 5 years [SD: 0.90]), the mean UPF consumption was 37.64 % of total energy intake (sd: 9.59). Large family size and longer exposure to screens predicted higher consumption of UPF. On the other hand, better knowledge of children's dietary recommendations, healthy dietary attitudes towards child's eating habits and longer breastfeeding were associated with lower consumption of UPF. All these factors accounted for approximately 16% of the variability on the consumption of UPF in childhood. Conclusion: Since most of the factors identified in this study are modifiable, they should be considered in public health strategies aimed at promoting heathy dietary habits in early life