Valoración de la ingesta dietética a nivel poblacional mediante cuestionarios individuales: sombras y luces metodológicas

José María Martin Moreno ([email protected])El desarrollo de la moderna metodología necesaria para caracterizar con rigor la ingesta de individuos y poblaciones data de hace sólo dos décadas, cuando germinó la epidemiología nutricional. La razón del carácter reciente de esta disciplina radica en el hecho de que la valoración de la ingesta dietética a nivel poblacional presenta retos complejos, que sólo van siendo superados a medida que investigamos y mejoramos los instrumentos metodológicos disponibles. En el presente artículo se revisan los métodos alternativos para estimar la ingesta de alimentos y nutrientes en los individuos. Tras una sucinta descripción de los métodos indirectos y directos de valoración del consumo alimentario, que incluye una breve referencia a los biomarcadores y a técnicas mixtas como las de estudios de "dieta total", el artículo se centra en los métodos directos de cuantificación de ingesta alimentaria mediante cuestionarios. Aquí se plantean los fundamentos, ventajas y limitaciones de las opciones alternativas. Tras ello, se pone al día de forma resumida el desarrollo de nuevos diseños de cuestionarios y de técnicas analítico-estadísticas que tienen como fin optimizar la metodología disponible. Finalmente, tras reconocer los avances realizados a la par que las cuestiones pendientes, se concluye afirmando que las aproximaciones que plantean la introducción complementaria de biomarcadores junto a la utilización optimizada de métodos combinados con cuestionarios individuales presentan potencialmente mayor fiabilidad y precisión conjunta para la estimación de la ingesta dietética a nivel poblacional, quedando patente la necesidad de impulsar la investigación que permita mejorar la metodología en este campo.The development of the modern methodology necessary to accurately characterize dietary intake in individuals and population only dates back two decades, when nutritional epidemiology first emerged. The reason for the recentness of this discipline lies in the fact that dietary assessment at the population level presents complex challenges which are only being overcome as we investigate and improve the available methodological instruments. In this paper, alternative methods to estimate food and nutritional intake are reviewed. Following a succinct description of direct and indirect methods to evaluate dietary consumption, including a brief reference to biomarkers and mixed techniques such as "total diet" studies, the article focuses on direct methods of quantifying dietary intake through questionnaires. The basis, advantages, and limitations of alternative options are considered, and subsequently the article summarizes the development of new survey designs and analytical/statistical techniques which aim to optimize the available methodology. The article finally concludes by affirming that the approximations indicated by the complementary introduction of biomarkers, together with the optimized use of combined methods with questionnaires, are potentially the most precise and trustworthy estimations of dietary intake at the population level. In light of both the advances achieved and the pending challenges, it is clear that there is a strong necessity to foster research which will lead to improvement in the methodology in this field

Riesgos para la salud causados por implantes de silicona en general, con atención especial a los implantes mamarios (Informe STOA/Parlamento Europeo)

El objetivo principal de este documento es presentar al Parlamento Europeo opciones de políticas alternativas bien documentadas en relación a los implantes de silicona (fundamentalmente implantes mamarios), basadas en un análisis exhaustivo e imparcial de la literatura científica sobre el tema y en la consulta a grupos y sectores implicados. Con el objetivo de reflejar todos los puntos de vista sobre este tema (negativos y positivos), hemos entrevistado a pacientes, contactado y recibido información de grupos de apoyo mutuo, grupos de mujeres, cirujanos plásticos y reparadores, fabricantes de implantes de mama de silicona, sociedades científicas y autoridades gubernamentales de los países miembros de la Unión Europea.Opciones, Antecedentes para las opciones relevantes europeas, Opciones para los dispositivos implantables. Posiciones del mercado y dinámica social previsibles para la difusión y control de implantes de silicona, Acción europea e internacional en este campo, Revisión de la legislación europea, Directivas relacionadas con los implantes/dispositivos médicos, Directivas relacionadas con la protección del consumidor, Otras referencias legislativas relevantes Consulta con los Estados miembros de la UE, situación actual de la distribución y uso de implantes, postura gubernamental, políticas legislativas y sanitarias adoptadas, Revisión de otras referencias relevantes relacionadas con la legislación internacional, Instrumentos de la UE relacionados con la armonización de la legislación y el control de los dispositivos médicos, Alternativas prácticas posibles, incluyendo propuestas alternativas para nuevas Directivas europeas Argumentos y pruebas, Antecedentes, incluyendo argumentos a favor y en contra de los riesgos para la salud de los implantes de silicona, Riesgos para la salud generales y específicos causados por los implantes de silicona, efectos sistémicos y efectos locales, Efectos de los implantes a corto, medio y largo plazo (cuatro,ocho y doce años), Efectos en el postoperatorio y seguimiento, Conclusiones, Visión global de la investigación primaria y de las revisiones relevantes. Período 1990-1999, Investigación llevada a cabo actualmente en la UE, Investigación actual en otros países del mundo, Conclusiones, Información primaria obtenida, Análisis de los niveles de regulación contemplados, Niveles alternativos de precaución recomendados teniendo en cuenta el conocimiento actual sobre cuestiones de salud, Implicaciones de nueva legislación, Ficha técnica, Terminología y conceptos básicos, Silicio/Sílice, Silicona y polidimetilsiloxano (PDMS), Exposición general a siliconas. El uso de silicona en dispositivos médicos, Implantes de mama. Cápsulas y materiales de relleno, Implantes alternativos según su material de relleno, Implantes rellenos de gel de silicona, Implantes rellenos de solución salina, Otros implantes, Resumen técnico sobre los implantes de silicona y sus posibles efectos, Posibles beneficios, Posibles riesgos, Riesgos y beneficios: desafíos para una decisión, REFERENCIAS BIBLIOGRÁFICAS CITADAS ANEXO: TABLAS: Tabla 1: Efectos graves sobre la salud considerados en estudios relacionados con implantes mamarios de silicona, Tabla 2: Resumen de las respuestas facilitadas por cirujanos expertos consultados, Tabla 3: Resumen de las respuestas obtenidas mediante cuestionario a mujeres con implantes de mama, Tabla 4: Resumen de las respuestas facilitadas por los fabricantes de implantes de mama, Tabla 5: Resumen de las respuestas facilitadas por los gobiernos de los países consultado

Spanish children's diet: compliance with nutrient and food intake guidelines

OBJECTIVE: To compare the diet of Spanish children against the nutrient and food intake guidelines. To calculate an index of overall diet quality and check its validity against nutrient intake. DESIGN AND SETTING: Cross-sectional study in four cities in Spain, where information on food and nutrient intake was obtained from schoolchildren through a food frequency questionnaire. PARTICIPANTS: The sample included 1112 children (overall response rate of 85%) attending public and private schools and aged 6-7 y. Children were selected through random cluster sampling in schools, and stratified by sex and socioeconomic level. MAIN OUTCOME MEASURES: Mean nutrient intake, number of food servings, and the percentage of children who meet recommended nutrient and food-serving intake levels. The overall dietary quality was assessed using the Healthy Eating Index (HEI). RESULTS: Mean micronutrient intake exceeded 100% of the recommended dietary allowances, except for vitamin B6, which registered a mean intake of 77.1%. For almost all children, intake of saturated fat was above, and that of carbohydrate below, the recommended level, in contrast to the relatively high compliance with the recommendations for poly- and monounsaturated fatty acid, salt and fiber intake (69.7, 43.7, 40.7, and 30.1%, respectively). Consumption of food servings for each of the five American pyramid food groups came close to or exceeded USDA guidelines, with the exception of cereals, with 5.4 servings per day. The mean score obtained in the HEI was 64.6. Children who complied with all the food guide pyramid recommendations registered a higher dietary variety and a healthier nutritional profile. CONCLUSIONS: Children aged 6-7 y show scant compliance with the macronutrient goals for healthy eating. Micronutrient intake is adequate in general, yet there are small groups of children with risk of deficient intake of vitamins B6 and D. While Spanish children's eating habits are reasonably in line with American food guide pyramid guidelines, consumptions of cereals and fruit should be improved.This study was partly funded by grants from the Inter-national Olive Oil Board (Consejo Oleı ́cola Internacional),Comunidad de Madrid, Fundacio ́n Pedro Barrie ́de laMaza, and Fundacio ́n Eugenio Rodrı ́guez Pascua

Consumption of bakery products, sweetened soft drinks and yogurt among children aged 6-7 years: association with nutrient intake and overall diet quality

The present study tests the hypothesis that higher consumption of bakery products, sweetened soft drinks and yogurt is associated with higher intake of energy, saturated fats, sugars and worse overall diet quality among Spanish children. This is a cross-sectional study covering 1112 children aged 6.0-7.0 years in four Spanish cities. Nutrient and food intake were obtained through a food-frequency questionnaire, and overall diet quality calculated using the healthy-eating index (HEI) developed by Kennedy et al. (1995). Standardized methods were used to measure anthropometric variables. Associations of interest were summarized as the difference in nutrient and food consumption between the value of the fifth and the first quintile of consumption (dq) of bakery products, sweetened soft drinks or yogurt, adjusted for energy intake and BMI. Bakery products, sweetened soft drinks and yogurt supplied 15.5, 1.0 and 5.6 % energy intake respectively. Higher consumption of these three foods was associated with greater energy intake (P<0.001), but not with higher BMI. Consumption of bakery products was associated with the proportion of energy derived from intake of total carbohydrates (dq 4.5 %, P<0.001) and sugars (dq 2 %, P<0.001), but did not show association with the HEI. Consumption of sweetened soft drinks was associated with a lower consumption of milk (dq -88 ml, P<0.001) and Ca (dq -175 mg/d, P<0.001), and worse HEI (dq -2, P<0.01). Consumption of yogurt, while associated with higher energy intake from saturated fats (dq 1.77 %, P<0.001) and sugars (dq 2.02 %, P<0.001), showed no association with the HEI. Differences in the intake of nutrients and foods across quintiles of consumption of bakery products, sweetened soft drinks and yogurt were usually very small. We conclude that the impact of the consumption of bakery products, sweetened soft drinks and yogurt on the quality of the diet of Spanish children is only modest, although it may contribute to aggravating certain unhealthy characteristics of their diet, particularly excess energy, saturated fats and sugars. Therefore, consumption of bakery products and sweetened soft drinks should be moderated, and priority given to consumption of low-fat, low-sugar yogurt.This study was partly funded by grants from the Inter-national Olive Oil Board (Consejo Oleı ́cola Internacional),Comunidad de Madrid, Fundacio ́n Pedro Barrie ́de laMaza, and Fundacio ́n Eugenio Rodrı ́guez PascualS

Food sources of nutrients in the diet of Spanish children: the Four Provinces Study

The aim of the present study was to assess the principal food sources of energy and nutrients among Spanish children. We used a cross-sectional study design, based on results obtained from a food-frequency questionnaire. The sample included 1112 children, aged 6-7 years, from Cadiz, Madrid, Orense and Murcia, Spain. Children were selected through random cluster-sampling in schools. We analysed the percentage contributed by each food item to total energy and nutrient intake. The most important food sources were: white bread in the case of carbohydrate (13.4 %); olive oil in the case of total lipids (18.3 %) and monounsaturated fatty acids (29.2 %); whole milk in the case of protein (10.2 %) and saturated fatty acids (14.9 %); chips (French fried potatoes) in the case of polyunsaturated fatty acids (30.4 %). The greatest proportion of Na, consumed in excess, came from salt added to meals. Ham ranked second as a source of saturated fats. Fruits and green leafy vegetables proved to have great relevance as sources of fibre and vitamins, though with regard to the latter, it was observed that fortified foods (breakfast cereals, dairy products, fruit juices, etc.) had come to play a relevant role in many cases. In conclusion, the nutritional profile of Spanish school-aged children aged 6-7 years could be improved by nutritional policies targeted at limiting their consumption of ham (cured or cooked) and of salt added to meals, replacing whole milk with semi-skimmed milk, encouraging the consumption of products rich in complex carbohydrates already present in children's diets (bread, pasta, rice) and promoting less fatty ways of cooking food.This study was partly funded by grants from the Inter-national Olive Oil Board (Consejo Oleı ́cola Internacional),Madrid Regional Authority (Comunidad de Madrid), PedroBarrie ́de la Maza Foundation and Eugenio Rodrı ́guezPascual FoundationS

Greater dietary variety is associated with better biochemical nutritional status in Spanish children: the Four Provinces Study

BACKGROUND AND AIM: Although dietary variety has been associated with a better nutritional profile, its possible role in obesity raises doubts about its overall health benefits. In this study, we examined the association between dietary variety and anthropometric variables, food intake and various food intake biomarkers in Spanish children. METHODS AND RESULTS: This was a cross-sectional study of 1112 children aged 6-7 years from Cadiz, Murcia, Orense and Madrid, who were selected by means of the random cluster-sampling of schools. Information concerning food and nutrient intake was obtained using a food frequency questionnaire, and a dietary variety index (DVI) was calculated on the basis of the number of different foods consumed more than once a month. The anthropometric variables (weight and height), and plasma lipid and vitamin levels were determined using standardised methods. Our results show that the body mass index (BMI) did not vary substantially as a function of DVI: it was 16.9 in the lowest DVI tertile and 17.2 in the highest (p=0.20). Unlike BMI, the DVI positively correlated (p<0.05) with the plasma levels of alpha and beta-carotene, lycopene, retinol, alpha-tocopherol and vitamin E, with energy intake, and with most of the foods, particularly vegetables, fruit and sausages (respective correlation coefficients of 0.43, 0.26 and 0.23). CONCLUSIONS: Dietary variety is associated with a better food and nutritional profile in Spanish children. Nevertheless, the presence of a positive association between the DVI and energy intake, and the consumption of sausages and pre-cooked products calls for the recommendation of a varied diet of healthy foods, such as cereals (especially whole grains), fruits and vegetables

Alcohol intake and risk of breast cancer: the euramic study

To evaluate the association of alcohol intake with the risk of breast cancer in post-menopausal women, we analyzed the data from an international case-control study conducted in five European countries (FRG, Switzerland, Northern Ireland, the Netherlands and Spain). Information on alcohol intake was available in 315 cases and 364 controls. Medians for the tertiles of alcohol intake among current drinkers were 1.7, 6.0, and 20.0 g/day. Adjusted relative risks (and 95% confidence intervals) of breast cancer for each tertile of intake in current drinkers, compared to never drinkers, were 1.00 (0.60-1.67), 1.01 (0.60-1.73), and 1.18 (0.69-2.03). The adjusted relative risk for ex-drinkers was 1.73 (1.07-2.79). Among both current drinkers and ex-drinkers, the relative risk was higher for those with body mass index above the median compared to those with body mass index below the median. These results do not support a dose-response effect of alcohol on breast cancer risk, although consumption levels were too low to exclude increased risk with high regular intake. Further research is necessary to evaluate the risk of developing breast cancer among ex-drinkers and the potential interaction between body mass index and alcohol drinking.Thc EURAMIC Study was supported as an European Community Concerted Action by the Commission of the European Communities (con-tracts number MR4*/265/NL and MR4*/CT91/0369[SSMA]). The natio-nal studies were financed by grants from the Dutch Ministry of Health, the Spanish "Fondo de Invcstigacioncs Sanitarias" (91E0575), the German Fe-deral Health Office, the Cancer Research Switzerland (AKT76), the Swiss National Science Foundation (32-9257-87), the Yrjö Jahnsson Foundation, the Ulster Cancer Foundation and Milk Intervention Board (co-responsibi-lity Levy Disbursement Reg EEC 110/90 Contract 77.2).S

Nutrición en Salud Pública

La salud pública es uno de los esfuerzos colectivos organizados de la sociedad para prevenir la muerte prematura, la enfermedad, las lesiones y la discapacidad, y para promover la salud de las poblaciones. La Nutrición es la ciencia que estudia el conjunto de procesos por los cuales un organismo utiliza la energía de los alimentos para mantenerse y crecer; o, expresado de forma más operativa, la ciencia que estudia los alimentos, nutrientes y otras sustancias relacionadas, su interacción y balance en relación con la salud y la enfermedad y los procesos por los cuales el organismo ingiere, digiere, absorbe, transporta, utiliza y extrae las sustancias alimenticias. A partir de estas definiciones, podemos conceptualizar la nutrición en salud pública o la salud pública nutricional (public health nutrition) como la ciencia que estudia la relación entre dieta y salud a nivel poblacional y el desarrollo de intervenciones nutricionales a nivel comunitario con el objeto de mejorar el estado de salud de las poblaciones

Ensayos de quimiosensibilidad en líneas celulares experimentales de cancer de mama : principios, métodos, resultados y posibles aplicaciones clínicas

Reducción altaUniv. de Granada, Fctd. de Medicin

Dietary variety and diversity of Spanish children: Four Provinces Study

BACKGROUND AND OBJECTIVE: Diet variety is claimed for ensuring a healthy eating. Our objective was to analyze the relationship between the variety and diversity of the diet and its nutritional quality among Spanish children. SUBJECTS AND METHOD: Cross-sectional study where information on food and nutrition was obtained through a food frequency questionnaire. The sample included 1,112 children aged 6-7 years from 4 cities. Children were selected by random cluster-sampling in schools and stratified by sex and socioeconomic level. We calculated a diet variety index (DVI)--count of food items--and a diet diversity index (DDI)--count of food groups. To measure the overall diet quality, the Healthy Eating Index (HEI-f) was used. RESULTS: The percentage of children eating less than one daily food serving varied between 0% for the grain and 11.3% for the fruit groups. Diet variety and diversity were positively associated with the intake of fiber, vitamines B6 and E and folic acid, and the percentage of caloric intake resulting from polyinsaturated fatty acids and carbohydrates. In contrast, intakes of lipis and saturated fatty acids, vitamine C, sodium and calcium were all negatively associated with diet variety and diversity. Although both DVI and DDI were possitively associated with the HEI-f, the results from a regression model showed that it was only DDI that contributed significantly to the model fitting (p < 0.001). CONCLUSIONS: These results support the goodness of a varied diet that includes ingredients from different food groups and, at the same time, maintains the energy energy within recomended levels.S