Characterization of the degree of food processing in the European Prospective Investigation into Cancer and Nutrition: Application of the Nova classification and validation using selected biomarkers of food processing

Background: Epidemiological studies have demonstrated an association between the degree of food processing in our diet and the risk of various chronic diseases. Much of this evidence is based on the international Nova classification system, which classifies food into four groups based on the type of processing: (1) Unprocessed and minimally processed foods, (2) Processed culinary ingredients, (3) Processed foods, and (4) “Ultra-processed” foods (UPF). The ability of the Nova classification to accurately characterise the degree of food processing across consumption patterns in various European populations has not been investigated so far. Therefore, we applied the Nova coding to data from the European Prospective Investigation into Cancer and Nutrition (EPIC) in order to characterize the degree of food processing in our diet across European populations with diverse cultural and socio-economic backgrounds and to validate this Nova classification through comparison with objective biomarker measurements. Methods: After grouping foods in the EPIC dataset according to the Nova classification, a total of 476,768 participants in the EPIC cohort (71.5% women; mean age 51 [standard deviation (SD) 9.93]; median age 52 [percentile (p)25– p75: 58–66] years) were included in the cross-sectional analysis that characterised consumption patterns based on the Nova classification. The consumption of food products classified as different Nova categories were compared to relevant circulating biomarkers denoting food processing, measured in various subsamples (N between 417 and 9,460) within the EPIC cohort via (partial) correlation analyses (unadjusted and adjusted by sex, age, BMI and country). These biomarkers included an industrial transfatty acid (ITFA) isomer (elaidic acid; exogenous fatty acid generated during oil hydrogenation and heating) and urinary 4-methyl syringol sulfate (an indicator for the consumption of smoked food and a component of liquid smoke used in UPF). Results: Contributions of UPF intake to the overall diet in % grams/day varied across countries from 7% (France) to 23% (Norway) and their contributions to overall % energy intake from 16% (Spain and Italy) to >45% (in the UK and Norway). Differences were also found between sociodemographic groups; participants in the highest fourth of UPF consumption tended to be younger, taller, less educated, current smokers, more physically active, have a higher reported intake of energy and lower reported intake of alcohol. The UPF pattern as defined based on the Nova classification (group 4;% kcal/day) was positively associated with blood levels of industrial elaidic acid (r = 0.54) and 4-methyl syringol sulfate (r = 0.43). Associations for the other 3 Nova groups with these food processing biomarkers were either inverse or non-significant (e.g., for unprocessed and minimally processed foods these correlations were –0.07 and –0.37 for elaidic acid and 4-methyl syringol sulfate, respectively). Conclusion: These results, based on a large pan-European cohort, demonstrate sociodemographic and geographical differences in the consumption of UPF. Furthermore, these results suggest that the Nova classification can accurately capture consumption of UPF, reflected by stronger correlations with circulating levels of industrial elaidic acid and a syringol metabolite compared to diets high in minimally processed foods.International Agency for Research on Cancer (IARC)Imperial College LondonNIHR Imperial Biomedical Research Centre (BRC)Danish Cancer Society (Denmark)Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France)German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany)Associazione Italiana per la Ricerca sul Cancro- AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy)Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (Netherlands)Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology - ICO (Spain)Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden)Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford) (United Kingdom

Aprendizaje basado en errores en materias de la nutrición: validación de una estrategia docente en un contexto interuniversitario

La detección de errores introducidos por el profesor, es decir, el aprendizaje basado en errores, puede ayudar a retener el conocimiento por parte del estudiante durante el proceso de aprendizaje. Además, la gamificación a través de plataformas como Kahoot! hace que el aprendizaje sea divertido e interactivo debido al uso de cuestionarios y premios que promueven la motivación entre los estudiantes, lo que ayuda a reforzar el aprendizaje. Planteamos la hipótesis de que los resultados académicos mejoran si el profesor incluye errores de forma deliberada en la clase, y si logra motivar a los estudiantes a identificarlos a través de estrategias de gamificación. El proyecto también planteó que la búsqueda activa de estos errores por parte de grupos de estudiantes incrementaría la dedicación a la materia, la adquisición de conocimientos y el fomento del trabajo en equipo. Así, el objetivo de esta investigación fue examinar si la detección de errores por parte de los estudiantes, tras introducirlos intencionadamente por parte del profesor durante una clase magistral, mejora el autoaprendizaje y los resultados de aprendizaje en estudiantes universitarios, tomando como ejemplo asignaturas del Grado en Nutrición Humana y Dietética, del Grado en Ciencia y Tecnología de los Alimentos y del Grado en Farmacia. Más de 60 estudiantes participaron en cada una de las asignaturas elegidas. En el estudio piloto participaron un total de 65 estudiantes (alumno/as de una asignatura troncal segundo curso). En primer lugar, se seleccionaron dos temas para introducir hasta 10 errores en cada uno de ellos (temas de intervención). Adicionalmente, se seleccionaron de la guía docente de la asignatura dos temas homólogos, de similar tamaño y dificultad; estos temas no incluían ningún error (temas de control). Cada tema fue tratado en una clase magistral. En las siguientes clases, se implementaron preguntas de los temas con errores con Kahoot!, donde cada pregunta incluía respuestas con errores y sin errores. Lo mismo se hizo para los temas sin errores. Después de cada Kahoot! (4 en total), se discutieron y debatieron los resultados de las respuestas, principalmente las que incluían los errores. El examen de evaluación incluyó preguntas de opción múltiple siguiendo un procedimiento similar, para temas con y sin errores. El número de respuestas positivas (evaluadas como porcentaje) se comparó entre ambos grupos de temas mediante la prueba t de Student. Además, analizamos el efecto de esta experiencia en la calificación final (variable independiente) mediante modelos de regresión lineal (variable dependiente: respuestas positivas en temas con errores versus sin errores). La significación estadística se fijó en un 0,05. Por otro lado, tras la evaluación, se administró un cuestionario para conocer la opinión y grado de satisfacción del alumnado con respecto a esta experiencia de innovación docente. Nuestros resultados revelaron que los estudiantes que realizaron la detección de errores y posteriormente completaron las actividades programadas (cuestionarios Kahoot! y debates posteriores) lograron mejores resultados de aprendizaje. En la evaluación final, el porcentaje de respuestas positivas (aciertos) fue del 65% y 56% en temas con y sin errores, respectivamente. Esta diferencia fue estadísticamente significativa (p-valor=0,02). No hubo diferencias por sexo en cuanto a la tasa de respuestas positivas (p-valor>0,05). Además, el análisis de correlación reveló que la detección de errores evaluada por el número de respuestas positivas se correlacionó positivamente con la calificación obtenida por los estudiantes (rho=0,36). En modelos de regresión multivariante, la nota final tendió a aumentar con la relación de respuestas positivas en temas con errores versus sin errores (p-valor=0,06). Con respecto a las respuestas de la encuesta, casi el 65% de los encuestados informaron que los errores se recordaron al estudiar los temas/temas. Además, el 87 % de los encuestados encontró Kahoot motivador y divertido y el 57 % también informó que la motivación era mayor en los temas con errores que en los temas sin errores. En conclusión, nuestros resultados sugieren que la introducción intencionada de errores en las clases magistrales por parte del profesor, y la identificación posterior por parte del alumno puede ser una herramienta con un considerable potencial en el proceso de enseñanza y aprendizaje de las asignaturas en materia de la nutrición. El estudio piloto se extendió a otras asignaturas durante el segundo semestre. Se han completado los cuestionarios Kahoot! y las sesiones de debates de errores. Los resultados se están recogiendo actualmente, ya que se requiere de la recogida de información tras la evaluación de las asignaturas. Los resultados están siendo validados externamente en la Universidad Complutense de Madrid (UCM) sobre las mimas asignaturas y grados universitarios. De confirmarse nuestros resultados, pretendemos extender esta experiencia a otras materias y grados.Detection of errors introduced by the professor, i.e., error-based learning, may help to retain knowledge by the student during the learning process. In addition, gamification through platforms such as Kahoot! makes learning fun and interactive due to the use of quizzes and rewards that promote motivation among students, thus, helping in learning reinforcement. We hypothesized that academic performance will be improved if the professor deliberately includes errors and manages to motivate students to find them through gamification strategies. Moreover, the active search for these errors by groups of students was supposed to increase the dedication to the subject, the acquisition of knowledge and the promotion of teamwork. Thus, the objective of this research was to examine whether error detection by students, after intentionally introducing them by the professor during a master class, improves self-study and learning outcomes in university students, taking as an example those of the Human Nutrition and Dietetics Degree, Food Science and Technology Degree and Pharmacy Degree. More than 60 students participated in each of the chosen subjects. A total of 65 students (students of a second-year core subject) participated in the pilot study. Firstly, we selected two themes to introduce up to 10 errors in each theme (intervention themes). Additionally, two homologous themes, similar in size and difficulty, were selected from the syllabus of the subject; these themes did not include any errors (control themes). Each theme was covered in a master class. In the following classes quiz questions from topics with errors were implemented with Kahoot!, whereby every question included responses with errors and without errors. The same was done for the topics without errors. After every Kahoot! quiz (4 in total), the results of the responses were discussed, mainly regarding those including the errors. The evaluation exam included multiple choice questions following a similar procedure, for themes with and without errors. The number of positive responses (assessed as percentage) was compared between both groups of themes by Student´s t-test. In addition, we analyzed the effect of this experience on the final evaluation grade (independent variable) using linear regression models (dependent variable: positive responses in themes with errors vs without errors), controlling for variables such as gender and attendance rate. Statistical significance was set at 0,05 threshold. On the other hand, after the evaluation, a questionnaire (Survey) was administered to find out the opinion and degree of satisfaction of the students with respect to this teaching innovation experience. Our results revealed that students who conducted error detection and subsequently completed self-regulation activities (Kahoot! quizzes and posterior discussions) achieved better performance. The percentage of positive responses was 65% and 56% in themes with and without errors, respectively. This difference was statistically significant (p-value=0.02). There were no differences by gender regarding the rate of positive responses (p-value>0.05). Furthermore, the correlation analysis revealed that error detection assessed by the number of positive responses was positively correlated with the students’ performance (rho=0.36). In multivariate regression models, the final grade tended to increase with the ratio of positive responses in themes with errors vs those without errors (p-value=0.06). Regarding the survey responses, nearly 65% of the respondents reported that the errors were remembered when studying the themes/topics. Furthermore, 87% of the respondents found Kahoot motivating and fun and 57% of the respondents also reported that motivation was higher in themes with errors than in themes without errors. In conclusion, our results suggest that intentionally introducing errors in the master classes and their subsequent identification by the student might be a tool with considerable potential in the teaching and learning process of subjects of the Nutrition degree. The pilot study was extended to other subjects during the second semester. Kahoot! quizzes have been completed along wiht discussions and debates in the classroom. The results are currently being collected, since the most relevant data will be available after the evaluation of the subjects. The results are being externally validated at the Complutense University of Madrid (UCM) on the same subjects and degrees. If our results are confirmed, we intend to extend this experience to other subjects and university degrees

A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study

The MedLey trial was funded by a National Health and Medical Research Council Grant (#APP1050949 to KJM). The InterAct project was funded by the EU FP6 programme (grant number LSHM_CT_2006_037197 to NJW). Biomarker measurements for carotenoids were funded jointly by the InterAct project, the EPIC-CVD project, and the MRC Cambridge Initiative (RG71466 and SJAH/004 to NJW, NGF, JD, AB). EPIC-CVD has been supported by the UK Medical Research Council (MR/L003120/1 to ASB and JD), the British Heart Foundation (RG/13/13/30194 and RG/18/13/33946 to ASB and JD), the European Commission Framework Programme 7 (HEALTH -F2-2012-279233 to ASB and JD), the European Research Council (268834 to ASB and JD), and the National Institute for Health Research (NIHR; Cambridge Biomedical Research Centre at the Cambridge University Hospitals NHS Foundation Trust, BRC-1215-20014 to ASB and JD). This work was also supported by Health Data Research UK (to ASB and JD), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), and Wellcome. The coordination of EPIC is financially supported by the International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Ge'ne'rale de l'Education Nationale, Institut National de la Sante' et de la Recherche Me'dicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Iblea Ricerca Epidemiologica (A.I.R.E. - ONLUS) Ragusa, Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di San Paolo, National Research Council and Sicilian Regional Government (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands~Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS) -Instituto de Salud Carlos III (ISCIII), Regional Governments of Andaluci'a, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology -ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skane and Vasterbotten (Sweden); Cancer Research UK (14136 to NJW; C8221/A29017), Medical Research Council (1000143 to NJW; MR/M012190/1) (United Kingdom). JGS was supported by the MRC PhD studentship. NJW, NGF, and FI acknowledge funding from the Medical Research Council Epidemiology Unit (MC_UU_00006/1, MC_UU_00006/3); and NJW, NGF and AK from the NIHR Cambridge Biomedical Research Centre (IS-BRC-1215-20014; NIHR203312). NGF and JD are NIHR Senior Investigators. JD holds a British Heart Foundation Professorship. MBS acknowledges funding from the Federal Ministry of Education and Research and the State of Brandenburg (DZD grant 82DZD03D03). JSZ has received funding from Westlake University (No YSYY0209) and European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 701708. PWF has received funding from Novo Nordisk, Swedish Diabetes Association, Swedish Heart-Lung Foundation, European Research Council. ER has received funding from Imperial College Biomedical Research Centre. The funders of the studies had no role in the study design, data collection, data analysis, data interpretation, or report preparation. Trial Australian.Background Self-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated using an objectively measured biomarker of the Mediterranean diet. Methods and findings We derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22,202 participants, of whom 9,453 were T2D cases, with relevant biomarkers from an original case-cohort of 27,779 participants sampled from a cohort of 340,234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms; the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding. Conclusions These findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.EU FP6 programme LSHM_CT_2006_037197European Commission Framework Programme 7 HEALTH-F2-2012-279233European Research Council (ERC)World Health OrganizationHealth Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII)Catalan Institute of Oncology - ICO (Spain)Spanish Government 701708Marie Curie Actions 701708European Union's Horizon 2020, Marie Sklodowska-Curie 70170

Dietary Intake of 91 Individual Polyphenols and 5-Year Body Weight Change in the EPIC-PANACEA Cohort

Polyphenols are bioactive compounds from plants with antioxidant properties that may have a protective role against body weight gain, with adipose tissue and systemic oxidative stress as potential targets. We aimed to investigate the dietary intake of individual polyphenols and their association with 5-year body weight change in a sub-cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). This study included 349,165 adult participants from nine European countries. Polyphenol intake was estimated through country-specific validated dietary questionnaires and the Phenol-Explorer database. Body weight was obtained at recruitment and after a mean follow-up time of 5 years. Associations were estimated using multilevel mixed linear regression models. From 91 polyphenols included, the majority (n = 67) were inversely associated with 5-year body weight change after FDR-correction (q < 0.05). The greatest inverse associations were observed for quercetin 3-O-rhamnoside (change in weight for doubling in intake: -0.071 (95% CI: -0.085; -0.056) kg/5 years). Only 13 polyphenols showed positive associations with body weight gain, mainly from the subclass hydroxycinnamic acids (HCAs) with coffee as the main dietary source, such as 4-caffeoylquinic acid (0.029 (95% CI: 0.021; 0.038) kg/5 years). Individual polyphenols with fruit, tea, cocoa and whole grain cereals as the main dietary sources may contribute to body weight maintenance in adults. Individual HCAs may have different roles in body weight change depending on their dietary source.Instituto De Salud Carlos III (European Regional Development Fund, ERDF, a way to build Europe) European Commission PI18/00191World Health Organization 2005328Department of Epidemiology and Biostatistics, School of Public Health, Imperial College LondonDanish Cancer SocietyLigue Contre le Cancer (France) Institut Gustave Roussy (France) Mutuelle Generale de l'Education Nationale (France)Institut National de la Sante et de la Recherche Medicale (Inserm)Deutsche Krebshilfe German Cancer Research Center (DKFZ) (Germany) German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) (Germany)Federal Ministry of Education & Research (BMBF)Fondazione AIRC per la ricerca sul cancro Compagnia di San Paolo Consiglio Nazionale delle Ricerche (CNR)Netherlands Government Netherlands Government World Cancer Research Fund International (WCRF)Netherlands GovernmentHealth Research Fund (FIS)-Instituto de Salud Carlos III (ISCIII) (Spain)Junta de Andalucia Principality of Asturias Regional Government of Basque Country (Spain) Regional Government of Murcia (Spain) Regional Government of Navarra (Spain) Catalan Institute of Oncology-ICO (Spain)Swedish Cancer Society Swedish Research Council County Council of Skane (Sweden) County Council of Vaesterbotten (Sweden)Cancer Research UK UK Research & Innovation (UKRI) Medical Research Council UK (MRC) 14136 C8221/A29017 1000143 MR/M012190/1NIHR Cambridge Biomedical Research Centre diet, nutrition and lifestyle theme MC_UU_0006/3Consejo Nacional de Ciencia y Tecnologia (CONACyT) IS-BRC-1215-20014Instituto de Salud Carlos III (European Social Fund (ESF) investing in your future) 693636 FI19/00185 CD20/00071 CPII20/0000

Description of a dietary quality indicator for application in nursing homes: Quality Index For Nutrition In Nursing Homes – QUINN

Introducción: Los indicadores de calidad de la dieta (Diet Quality Indicators, DQIns) son herramientas para evaluar las características de patrones de dieta basados en el conocimiento de la relación entre los factores dietéticos, los estilos de vida y resultados de salud. El objetivo de este artículo fue proponer un nuevo índice de calidad de la dieta utilizando un enfoque a priori para su aplicación en residencias de ancianos, Quality Index for Nutrition in Nursing Homes, índice QUINN. Metodología: La elección de los componentes se basó en una revisión rápida realizada sobre índices previamente publicados y los principales grupos de alimentos relacionados con la prevención de determinados síndromes geriátricos y de las enfermedades crónicas de alta prevalencia en población geriátrica. El índice QUINN se basó en 15 componentes dietéticos-alimentos, 12 de los cuales se referían a alimentos básicos de una dieta saludable (verduras, frutas, legumbres, aceite de oliva –preferiblemente virgen extra–, cereales, lácteos, pescados blancos y mariscos, carnes blancas y huevos, componentes positivos); otras grasas, carnes rojas y procesadas y dulces (componentes negativos), junto con otros 3 componentes adicionales positivos (variedad de verduras y frutas, pescado azul y cereales integrales). Cada componente se clasificó en 4 categorías (0, 1, 2 o 3 puntos), con un rango final de 0 a 45 puntos. Conclusiones: Desde nuestro conocimiento el índice QUINN es el primer índice de calidad de la dieta a priori basado desarrollado específicamente para evaluar los menús ofertados en las residencias de ancianos. Esta herramienta proporcionará información sobre la calidad de la dieta para el diseño de los menús. El índice QUINN podría ser un instrumento útil para implementar estrategias de intervención y así mejorar de forma sencilla la dieta ofertada en las instituciones que redundaría en la mejora del estado nutricional y la salud de la población geriátrica institucionalizada.Introduction: Diet Quality Indicators (DQIns) are tools for assessing the characteristics of dietary patterns based on knowledge of the relationship between dietary factors, lifestyles, and health outcomes. The aim of this paper was to propose a new diet quality index using an a priori approach for application in nursing homes, Quality Index for Nutrition in Nursing Homes, QUINN index. Methodology: The selection of the components was based on a rapid review performed on previously published indexes and the main food groups related to the prevention of geriatric syndromes and chronic diseases of high prevalence in the geriatric population. The QUINN index was based on 15 dietary-food components, 12 of which referred to basic foods of a healthy diet (vegetables, fruits, legumes, olive oil –preferably extra virgin–, cereals, dairy, white fish and shellfish, white meat, and eggs, positive components); other fats, red meat, and sweets (negative components), together with 3 additional positive components (variety of vegetables and fruits, oily fish, and whole grains). Each component was classified into 4 categories (0, 1, 2 or 3 points), with a final range of 0 to 45 points. Conclusions: To our knowledge the QUINN index is the first a priori diet quality index developed specifically to evaluate menus offered in nursing homes. This tool will provide information on diet quality for menu design. The QUINN index could be a useful instrument to implement intervention strategies to improve in a simple way the diet offered in institutions and to improve the nutritional status and health of the institutionalised geriatric population

The Impact of Plant-Based Dietary Patterns on Cancer-Related Outcomes: A Rapid Review and Meta-Analysis

The authors would like to acknowledge Dafina Petrova for her contributions in editing and proofreading the manuscript.Long-term cancer survivors represent a sizeable portion of the population. Plant-based foods may enhance the prevention of cancer-related outcomes in these patients. We aimed to synthesize the current evidence regarding the impact of plant-based dietary patterns (PBDPs) on cancer-related outcomes in the general population and in cancer survivors. Considered outcomes included overall cancer mortality, cancer-specific mortality, and cancer recurrence. A rapid review was conducted, whereby 2234 original articles related to the topic were identified via Pubmed/Medline. We selected 26 articles, which were classified into studies on PBDPs and cancer outcomes at pre-diagnosis: vegan/vegetarian diet (N = 5), provegetarian diet (N = 2), Mediterranean diet (N = 13), and studies considering the same at post-diagnosis (N = 6). Pooled estimates of the associations between the aforementioned PBDPs and the different cancer outcomes were obtained by applying random effects meta-analysis. The few studies available on the vegetarian diet failed to support its prevention potential against overall cancer mortality when compared with a non-vegetarian diet (e.g., pooled hazard ratio (HR) = 0.97; 95% confidence interval (CI): 0.88–1.06). The insufficient number of studies evaluating provegetarian index scores in relation to cancer mortality did not permit a comprehensive assessment of this association. The association between adherence to the Mediterranean diet and cancer mortality reached statistical significance (e.g., pooled HR = 0.84; 95% CI: 0.79–0.89). However, no study considered the influence of prognostic factors on the associations. In contrast, post-diagnostic studies accounted for prognostic factors when assessing the chemoprevention potential of PBDPs, but also were inconclusive due to the limited number of studies on well-defined plant-based diets. Thus, whether plant-based diets before or after a cancer diagnosis prevent negative cancer-related outcomes needs to be researched further, in order to define dietary guidelines for cancer survivors.CIBER Epidemiologia y Salud Publica CIBERES

Vitamin D Deficiency and COVID-19: A Biological Database Study on Pathways and Gene-Disease Associations

Vitamin D (VD) is a fat-soluble vitamin, and pivotal for maintaining health. Several genetic markers have been related to a deficient VD status; these markers could confer an increased risk to develop osteoporosis and other chronic diseases. A VD deficiency could also be a determinant of a severe COVID-19 disease. This study aimed to interrogate genetic/biological databases on the biological implications of a VD deficiency and its association with diseases, to further explore its link with COVID-19. The genetic variants of both a VD deficiency and COVID-19 were identified in the genome-wide association studies (GWAS) catalog and other sources. We conducted enrichment analyses (considering corrected p-values < 0.05 as statistically significant) of the pathways, and genedisease associations using tools, such as FUMA, REVIGO, DAVID and DisGeNET, and databases, such as the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO). There were 26 and 46 genes associated with a VD deficiency and COVID-19, respectively. However, there were no genes shared between the two. Genes related to a VD deficiency were involved in the metabolism of carbohydrates, retinol, drugs and xenobiotics, and were associated with the metabolic syndrome and related factors (obesity, hypertension and diabetes mellitus), as well as with neoplasms. There were few enriched pathways and disease connections for the COVID-19-related genes, among which some of the aforementioned comorbidities were also present. In conclusion, genetic factors that influence the VD levels in the body are most prominently associated with nutritional and metabolic diseases. A VD deficiency in high-risk populations could be therefore relevant in a severe COVID-19, underlining the need to examine whether a VD supplementation could reduce the severity of this disease.Consejeria de Salud de la Junta de Andalucia - European Regional Development Fund (ERDF-FEDER) PECOVID-0200-202

Calf Circumference, a Valuable Tool to Predict Sarcopenia in Older People Hospitalized with Hip Fracture

Sarcopenia is an important risk factor for hip fracture in older people. Nevertheless, this condition is overlooked in clinical practice. This study aimed to explore the factors associated with sarcopenia among older patients hospitalized for hip fracture, to identify a predictive model of sarcopenia based on variables related to this condition, and to evaluate the performance of screening tools in order to choose the most suitable to be adopted in routine care of older people with hip fracture. A cross-sectional study was undertaken with 90 patients (mean age 83.4 +/- 7.2 years), by assessing sociodemographic and clinical characteristics, anthropometric measures, such as body mass index (BMI) and calf circumference (CC), the functional status (Barthel Index), the nutritional status (MNA-SF), and the adherence to the Mediterranean Diet (MEDAS). Diagnosis of sarcopenia was established according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). The analysis of variables associated with sarcopenia was performed using multivariate logistic regression models. Clusters of sarcopenia were explored with heatmaps and predictive risk models were estimated. Sarcopenia was confirmed in 30% of hip fracture patients. Variables with the strongest association with sarcopenia were BMI (OR = 0.79 [0.68-0.91], p < 0.05) and CC (OR = 0.64 [0.51-0.81], p < 0.01). CC showed a relatively high predictive capacity of sarcopenia (area under the curve: AUC = 0.82). Furthermore, CC could be a valuable tool to predict sarcopenia risk compared with the currently used screening tools, SARC-F and SARC-CalF (AUC, 0.819 vs. 0.734 and 0.576, respectively). More studies are needed to validate these findings in external study populations

Characterizing Meat- and Milk/Dairy-like Vegetarian Foods and Their Counterparts Based on Nutrient Profiling and Food Labels

Vegetarian foods are plant-based (PB) foods, often perceived as healthier foods than animalbased (AB) foods. The objective of this study was to analyze the nutritional quality of a set of PB foods (meat, milk and dairy products) marketed in Spain, and to compare their nutrient profiles with respect to some AB counterparts. Nutritional information per 100 g or mL, ingredients, and nutritional declarations, as well as the Nutri-Score, NOVA, and Eco-Score of each food were collected from Open Food Facts. Differences in the nutrient compositions between PB foods and their counterparts, and between the different groups of PB foods, were assessed at a 5% significance level. A total of 544 PB foods and 373 AB foods were identified. Overall, PB foods had a higher median content of fiber and carbohydrates, but a lower amount of proteins (except PB “meat” analogues: 14 g) and saturated fats (except PB “cheese alternatives”: 12.5 g), than the AB counterparts (p < 0.05). PB “milk alternatives”, particularly oat “milk”, showed a higher median content of total carbohydrates (8 g) and sugars (5.5 g) compared to cow milks (4.7 g carbohydrates/sugars, on average; p < 0.001). PB “meat alternatives” also had a significantly higher value of carbohydrates (9 g) than AB meats (2 g, on average; p < 0.001). PB foods were mostly classified as Nutri-Score A and B (86%). However, more than half of them were of NOVA groups 3 and 4. Thus, there is a great diversity of PB meat and milk/dairy product alternatives on the Spanish market. Despite being products of good nutritional quality compared to AB foods, they also carry drawbacks that could have an impact on nutritional health

Descripción de índices basados en la adhesión al patrón dietético mediterráneo: una revisión

Introduction: diet quality indexes are tools are aimed at quantifying the compliance to a defined dietary pattern. These indexes are a combined measure of dietary factors (food groups, foods, nutrients and ratios) and/or lifestyles factors. The Mediterranean Diet (MD) is a dietary pattern characterized by their positive effects against chronic diseases. There have been many indexes proposed for the assessment of this dietary pattern. An evaluation of their composition and health benefits is therefore convenient. Objective: the objective is to evaluate indexes of adherence to the MD with regard to their definition, methodological issues and validation as reported in epidemiological studies. Methods: we searched in PubMed for studies that developed MD Indexes up to October 2014. Results: a total number of 22 indexes were identified, with differences regarding the number of components (7-28), scoring (0, 1, 2, 3, 4, 5, 8 or 10, in case of compliance), range (0-100) and type of components (which could be food groups/foods or their combination, with nutrients). Among the positive components, fruits and vegetables were the most common and meats, among the negative components. There were also differences with regard to their composition and evaluation (e.g. criteria of moderate alcohol consumption), as well as with the scoring system (in medians, terciles or established servings).Conclusions: this review suggests that since there is great heterogeneity in the definition of MD. It would be therefore convenient to establish more clearly the components to be included and to establish commonly defined criteria to quantify this dietary pattern.Introducción: los índices de calidad la de dieta son herramientas que sirven para cuantificar el cumplimiento de un patrón dietético definido. Estos índices son una medida combinada de factores dietéticos (grupos alimenticios, alimentos, nutrientes y ratios) y/o estilos de vida. La dieta mediterránea (DM) es un patrón dietético que se caracteriza por sus efectos positivos contra ciertas enfermedades crónicas. Existen numerosos índices propuestos para la valoración de este patrón dietético. Es por lo tanto conveniente una evaluación de su composición y sus efectos sobre la salud. Objetivo: el objetivo es evaluar los índices de adhesión al patrón dietético mediterráneo en cuanto a su definición, aspectos metodológicos y validación en estudios epidemiológicos. Métodos: se buscaron en PubMed estudios que desarrollaron índices de DM hasta octubre de 2014. Resultados: se identificaron un total de 22 índices, con diferencias en cuanto al número de componentes (7-28), puntuación (0, 1, 2, 3, 4, 5, 8 o 10, en el caso de cumplimiento), rango (0-100) y tipo de componentes (grupos de alimentos/alimentos o su combinación con nutrientes). Entre los componentes positivos, los más comunes fueron frutas y verduras, y carnes entre los negativos. También hubo diferencias con respecto a su composición y evaluación (p. ej. criterios de consumo moderado de alcohol), así como con el sistema de puntuación (en medianas, terciles o raciones establecidas). Conclusiones: esta revisión sugiere que existe una gran heterogeneidad en la definición de DM. Sería por tanto apropiado establecer con mayor claridad los componentes que deben incluirse, así como definir criterios comunes para cuantificar este patrón dietético.This work was supported by the Spanish Ministry of Health. Health Research Fund. PI12/00002, co-funded ERDF and It’s part of the doctoral thesis named: “Relación entre ingesta y acumulación de productos de Maillard de la dieta con el status endógeno antioxidante/oxidativo/ inflamatorio individual (“Indice de balance oxidativo”) y con la calidad de la dieta