Dietary intake of trans fatty acids in children aged 4–5 in Spain: The INMA cohort study

Trans fatty acid (TFA) intake has been identified as a health hazard in adults, but data on preschool children are scarce. We analyzed the data from the Spanish INMA Project to determine the intake of total, industrial and natural TFA, their main sources and the associated socio-demographic and lifestyle factors in children aged 4–5 (n = 1793). TFA intake was estimated using a validated Food Frequency Questionnaire, and multiple linear regression was used to explore associated factors. The mean daily intakes of total, industrial and natural TFA were 1.36, 0.60, and 0.71 g/day, respectively. Ten percent of the children obtained >1% of their energy intake from TFA. The main sources of industrial TFA were fast food, white bread and processed baked goods. Milk, red and processed meat and processed baked goods were the main sources of natural TFA. Having parents from countries other than Spain was significantly associated with higher natural TFA (in mg/day) intake (β 45.5) and television viewing was significantly associated with higher industrial TFA intake (β 18.3). Higher fruits and vegetables intake was significantly associated with lower intakes of all TFAs, whereas higher sweetened beverages intake was significantly associated with lower total and natural TFA intake. Thus, total and industrial TFA intake was associated with less healthy food patterns and lifestyles in Spanish preschool children

La financiación de la industria alimentaria y la investigación epidemiológica sobre nutrición y salud

El interés de la industria alimentaria por financiar investigaciones en temas de nutrición y salud no se limita solo al avance científico. Algunas revisiones sistemáticas han puesto de manifiesto un sesgo en las conclusiones de los estudios que habían recibido financiación de la industria alimentaria, particularmente cuando comunicaban los efectos de las bebidas azucaradas. En este contexto, coincidiendo con la XXXIV Reunión Científica de la Sociedad Espanola ˜ de Epidemiología, el Grupo de Nutrición de esta sociedad organizó una mesa temática titulada Industria alimentaria e investigación epidemiológica para abordar el tema de la conveniencia o no de que la industria alimentaria financie directamente proyectos de investigación, y los posibles conflictos de intereses que pueden derivarse de esta financiación. Todos/as los/las participantes coincidieron en la necesidad de garantizar el rigor y la calidad necesarios en los estudios, y su realización de forma independiente de la financiación recibida, para evitar sesgos que lleven a una pérdida de credibilidad de los resultados de las investigaciones por los posibles conflictos de intereses. El Dr. Pérez-Farinós y la Dra. Romaguera coincidieron en que una forma de evitar conflictos de intereses era impedir que la industria financiara proyectos de investigación; la Dra. Marcos y el Prof. Martínez-González indicaron la conveniencia de establecer mecanismos para evitar que la financiación de la industria influya tanto en la distribución de fondos entre grupos e instituciones como en el análisis y los resultados de las investigaciones, para garantizar al máximo la independencia de los investigadores, así como su ética profesional.The interests of the food industry to fund nutrition and health research are not limited to promoting scientific advances. Recently, several systematic reviews conducted about the effect of sugar-sweetened beverages and health outcomes have shown some biased conclusions in studies that acknowledge industry sponsorship. In this context, the Nutrition Working Group of the Spanish Epidemiology Society presented a scientific session entitled Food industry and epidemiologic research at its annual meeting. In a round table, four experts in nutrition research presented their points of view about whether the food industry should fund nutrition-related research and the related potential conflicts of interest of the food industry. All the experts agreed not only on defending independence in nutritional epidemiology regarding the design, interpretation and conclusion of their studies but also on the crucial need for guaranteed scientific rigor, scientific quality of the results and measures to protect studies against potential biases related to the conflicts of interest of funding by the food industry. Drs PérezFarinós and Romaguera believe that the most effective way to prevent conflicts of interest would be not to allow the food industry to fund nutrition research; Drs Marcos and Martínez-González suggested the need to establish mechanisms and strategies to prevent the potential influences of the food industry in selecting researchers or institutional sponsorship and in the analysis and results of the studies, to ensure maximum independence for researchers, as well as their professional ethics

Association between leisure screen time and adherence to the Mediterranean diet in a representative sample of Spanish children: A cross-sectional study

Abstract The aim of this study was to assess the association between adherence to the Mediterranean diet and daily leisure screen time. We carried out a cross-sectional study using a representative sample of the Spanish population aged from 3 to 14 years recruited for the 2017 Spanish National Health Survey ( n = 4,633). We derived the adherence to the Mediterranean diet according to a modified Mediterranean Diet Score and computed daily leisure screen time. We estimated crude and adjusted prevalence ratios, and 95% confidence intervals (95% CI) of high versus low, high versus medium and medium versus low adherence to the Mediterranean diet, according to categories of daily leisure screen time, using Poisson regression models. We found that the adjusted probabilities of having high adherence to the Mediterranean diet, versus low and medium adherence, were 23% (aPR 0.77; 95% CI 0.69, 0.86) and 14% (aPR 0.86; 95% CI 0.76, 0.97) lower, respectively, in children spending at least 180 minutes of daily leisure screen time in comparison with children spending less than one hour of daily screen time. This association was also observed when stratifying by age, except for children 12–14 years. In conclusion, high leisure screen time may be associated with lower adherence to the Mediterranean diet

Políticas alimentarias para prevenir la obesidad y las principales enfermedades no transmisibles en España: querer es poder

Introducción: En Espana, ˜ un tercio de los menores y dos tercios de los adultos padecen exceso de peso, una condición que genera un sobrecoste médico directo de 2000 millones de euros. El entorno alimentario obesogénico causa obesidad al promover el consumo de bebidas azucaradas y de alimentos ultraprocesados. Por ello, proponemos cinco políticas prioritarias con el PODER de revertir la epidemia de obesidad y de enfermedades no transmisibles asociadas a ella, mediante la creación de entornos alimentarios saludables. El PODER de las políticas alimentarias: P (Publicidad): regulación de la publicidad de alimentos y bebidas no saludables dirigida a menores por todos los medios y prohibición de patrocinios de congresos o eventos deportivos y avales de asociaciones científicas o profesionales de la salud. O (Oferta): promoción de una oferta 100% saludable en máquinas expendedoras de centros educativos, sanitarios y deportivos. D (Demanda): implantación de un impuesto, al menos del 20%, a las bebidas azucaradas, acompanado ˜ de subvenciones o bajadas de impuestos a alimentos saludables y disponibilidad de agua potable a coste cero en todos los centros y espacios públicos. E (Etiquetado): aplicación efectiva del Nutri-Score mediante el uso de incentivos, regulación y mecanismos de contratación pública. R (Reformulación): reformular los acuerdos de reformulación con la industria con objetivos más ambiciosos y de obligado cumplimiento. Reflexión final: Las cinco intervenciones propuestas, aplicadas con éxito en otros países, contribuirán a concienciar a la población y tendrán un impacto positivo en la salud y en la economía, por una reducción de los costes sanitarios de la obesidad y un aumento de la productividad laboral. Estas medidas deberían formar parte de una gran transformación del sistema alimentario, con políticas agroalimentarias que fomenten una producción sostenible de alimentos saludables.Introduction: In Spain, one third of all children and two-thirds of adults suffer from excess weight, a condition that generates a direct excess medical cost of 2000 million Euros. Obesogenic food environments cause obesity by promoting the consumption of sugar-sweetened beverages and ultra-processed foods. Accordingly, we propose five priority policies capable of reversing the epidemic of obesity and related non-communicable diseases through the creation of healthy food environments. The power (PODER in Spanish) of food policies: Advertising (Publicidad): regulation of unhealthy food and drink advertisements carried by all media and targeted at children, and prohibition of sponsorships of congresses, conferences or sports events and endorsements by scientific associations or health professionals. Supply (Oferta): promotion of a 100% healthy supply of goods on sale in vending machines sited at educational, health and sports centres. Demand (Demanda): levying a tax of at least 20% on sugarsweetened beverages, accompanied by subsidies or reduced taxes on healthy foods and availability of drinking water free of charge at all public venues and areas. Labelling (Etiquetado): effective application of the Nutri-Score through the use of incentives, regulation and public-tender mechanisms. Reformulation (Reformulación): revising and redrawing reformulation agreements with the industry, setting more ambitious goals and mandatory compliance. A final thought: These five proposed interventions, all of which have been successfully applied in other countries, will serve to raise population awareness and have a positive impact on health and the economy, through reducing the health care costs of obesity and enhancing work productivity. These measures should form part of a wide-ranging transformation of the food system, with agri-food policies that foster the sustainable production of healthy food

Políticas alimentarias para prevenir la obesidad y las principales enfermedades no transmisibles en España: querer es poder

Introducción: En Espana, ˜ un tercio de los menores y dos tercios de los adultos padecen exceso de peso, una condición que genera un sobrecoste médico directo de 2000 millones de euros. El entorno alimentario obesogénico causa obesidad al promover el consumo de bebidas azucaradas y de alimentos ultraprocesados. Por ello, proponemos cinco políticas prioritarias con el PODER de revertir la epidemia de obesidad y de enfermedades no transmisibles asociadas a ella, mediante la creación de entornos alimentarios saludables. El PODER de las políticas alimentarias: P (Publicidad): regulación de la publicidad de alimentos y bebidas no saludables dirigida a menores por todos los medios y prohibición de patrocinios de congresos o eventos deportivos y avales de asociaciones científicas o profesionales de la salud. O (Oferta): promoción de una oferta 100% saludable en máquinas expendedoras de centros educativos, sanitarios y deportivos. D (Demanda): implantación de un impuesto, al menos del 20%, a las bebidas azucaradas, acompanado ˜ de subvenciones o bajadas de impuestos a alimentos saludables y disponibilidad de agua potable a coste cero en todos los centros y espacios públicos. E (Etiquetado): aplicación efectiva del Nutri-Score mediante el uso de incentivos, regulación y mecanismos de contratación pública. R (Reformulación): reformular los acuerdos de reformulación con la industria con objetivos más ambiciosos y de obligado cumplimiento. Reflexión final: Las cinco intervenciones propuestas, aplicadas con éxito en otros países, contribuirán a concienciar a la población y tendrán un impacto positivo en la salud y en la economía, por una reducción de los costes sanitarios de la obesidad y un aumento de la productividad laboral. Estas medidas deberían formar parte de una gran transformación del sistema alimentario, con políticas agroalimentarias que fomenten una producción sostenible de alimentos saludables.Introduction: In Spain, one third of all children and two-thirds of adults suffer from excess weight, a condition that generates a direct excess medical cost of 2000 million Euros. Obesogenic food environments cause obesity by promoting the consumption of sugar-sweetened beverages and ultra-processed foods. Accordingly, we propose five priority policies capable of reversing the epidemic of obesity and related non-communicable diseases through the creation of healthy food environments. The power (PODER in Spanish) of food policies: Advertising (Publicidad): regulation of unhealthy food and drink advertisements carried by all media and targeted at children, and prohibition of sponsorships of congresses, conferences or sports events and endorsements by scientific associations or health professionals. Supply (Oferta): promotion of a 100% healthy supply of goods on sale in vending machines sited at educational, health and sports centres. Demand (Demanda): levying a tax of at least 20% on sugarsweetened beverages, accompanied by subsidies or reduced taxes on healthy foods and availability of drinking water free of charge at all public venues and areas. Labelling (Etiquetado): effective application of the Nutri-Score through the use of incentives, regulation and public-tender mechanisms. Reformulation (Reformulación): revising and redrawing reformulation agreements with the industry, setting more ambitious goals and mandatory compliance. A final thought: These five proposed interventions, all of which have been successfully applied in other countries, will serve to raise population awareness and have a positive impact on health and the economy, through reducing the health care costs of obesity and enhancing work productivity. These measures should form part of a wide-ranging transformation of the food system, with agri-food policies that foster the sustainable production of healthy food

Alcohol consumption and gastric cancer risk—A pooled analysis within the StoP project consortium

An association between heavy alcohol drinking and gastric cancer risk has been recently reported, but the issue is still open to discussion and quantification. We investigated the role of alcohol drinking on gastric cancer risk in the “Stomach cancer Pooling (StoP) Project,” a consortium of epidemiological studies. A total of 9,669 cases and 25,336 controls from 20 studies from Europe, Asia and North America were included. We estimated summary odds-ratios (ORs) and the corresponding 95% confidence intervals (CIs) by pooling study-specific ORs using random-effects meta-regression models. Compared with abstainers, drinkers of up to 4 drinks/day of alcohol had no increase in gastric cancer risk, while the ORs were 1.26 (95% CI, 1.08–1.48) for heavy (>4 to 6 drinks/day) and 1.48 (95% CI 1.29–1.70) for very heavy (>6 drinks/day) drinkers. The risk for drinkers of >4 drinks/day was higher in never smokers (OR 1.87, 95% CI 1.35–2.58) as compared with current smokers (OR 1.14, 95% CI 0.93–1.40). Somewhat stronger associations emerged with heavy drinking in cardia (OR 1.61, 95% CI 1.11–2.34) than in non-cardia (OR 1.28, 95% CI 1.13–1.45) gastric cancers, and in intestinal-type (OR 1.54, 95% CI 1.20–1.97) than in diffuse-type (OR 1.29, 95% CI 1.05–1.58) cancers. The association was similar in strata of H. pylori infected (OR = 1.52, 95% CI 1.16–2.00) and noninfected subjects (OR = 1.69, 95% CI 0.95–3.01). Our collaborative pooled-analysis provides definite, more precise quantitative evidence than previously available of an association between heavy alcohol drinking and gastric cancer risk. © 2017 UIC

Tobacco smoking and gastric cancer: Meta-Analyses of published data versus pooled analyses of individual participant data (StoP Project)

Tobacco smoking is one of the main risk factors for gastric cancer, but the magnitude of the association estimated by conventional systematic reviews and meta-Analyses might be inaccurate, due to heterogeneous reporting of data and publication bias. We aimed to quantify the combined impact of publication-related biases, and heterogeneity in data analysis or presentation, in the summary estimates obtained from conventional meta-Analyses. We compared results from individual participant data pooled-Analyses, including the studies in the Stomach Cancer Pooling (StoP) Project, with conventional meta-Analyses carried out using only data available in previously published reports from the same studies. Fromthe 23 studies in the StoP Project, 20 had published reports with information on smoking and gastric cancer, but only six had specific data for gastric cardia cancer and seven had data on the daily number of cigarettes smoked. Compared to the results obtained with the StoP database, conventional meta-Analyses overvalued the relation between ever smoking (summary odds ratios ranging from 7% higher for all studies to 22% higher for the risk of gastric cardia cancer) and yielded less precise summary estimates (SE ≤2.4 times higher). Additionally, funnel plot asymmetry and corresponding hypotheses tests were suggestive of publication bias. Conventional meta-Analyses and individual participant data pooled-Analyses reached similar conclusions on the direction of the association between smoking and gastric cancer. However, published data tended to overestimate the magnitude of the effects, possibly due to publication biases and limited the analyses by different levels of exposure or cancer subtypes. European Journal of Cancer Prevention 27:197-204 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

Education and gastric cancer risk—An individual participant data meta-analysis in the StoP project consortium

Low socioeconomic position (SEP) is a strong risk factor for incidence and premature mortality from several cancers. Our study aimed at quantifying the association between SEP and gastric cancer (GC) risk through an individual participant data meta-analysis within the “Stomach cancer Pooling (StoP) Project”. Educational level and household income were used as proxies for the SEP. We estimated pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) across levels of education and household income by pooling study-specific ORs through random-effects meta-analytic models. The relative index of inequality (RII) was also computed. A total of 9,773 GC cases and 24,373 controls from 25 studies from Europe, Asia and America were included. The pooled OR for the highest compared to the lowest level of education was 0.60 (95% CI, 0.44–0.84), while the pooled RII was 0.45 (95% CI, 0.29–0.69). A strong inverse association was observed both for noncardia (OR 0.39, 95% CI, 0.22–0.70) and cardia GC (OR 0.47, 95% CI, 0.22–0.99). The relation was stronger among H. pylori negative subjects (RII 0.14, 95% CI, 0.04–0.48) as compared to H. pylori positive ones (RII 0.29, 95% CI, 0.10–0.84), in the absence of a significant interaction (p = 0.28). The highest household income category showed a pooled OR of 0.65 (95% CI, 0.48–0.89), while the corresponding RII was 0.40 (95% CI, 0.22–0.72). Our collaborative pooled-analysis showed a strong inverse relationship between SEP indicators and GC risk. Our data call for public health interventions to reduce GC risk among the more vulnerable groups of the population. © 2019 UIC