Search

Objective: The aims of this study were to assess the changes that have occurred in food patterns in Europe over the last 40 years based on food availability data and to compare the stability of the traditional Mediterranean diet in the south of Europe in this period.Design: An ecological study carried out on the basis of Food and Agriculture Organization food balance sheets for three geographical areas of Europe (Mediterranean, north and east) over two time periods: 1961-1963 and 1998-2000. The average availability of total energy, energy provided from macronutrients and food groups was calculated for each area and each period studied.Results: Over the last 40 years total energy availability and energy availability from lipids have increased considerably in the three European areas, while the percentage of energy from carbohydrates has fallen. The greatest changes have occurred in Mediterranean Europe, with an increase of 20.1% in total energy availability, an increase of 48.1% in energy availability from lipids and a fall of 20.5% from carbohydrates. Moreover, Mediterranean Europe showed a significant fall in the energy supplied by cereals (29.9%) and wine (55.2%), while the contribution of milk (77.8%) and dairy products (23.6%) increased.Conclusions: The results of this study suggest that European Mediterranean countries should take nutrition policy action to maintain their traditional healthy food pattern, with a cultural added value. This implies actions at all levels, including raising awareness of consumers, collaboration with the food sector and a call to set the agenda of the concerned politicians and stakeholders. [ABSTRACT FROM AUTHOR]

Summary: Aims: To evaluate the effect of a whole formula diet on nutritional and cognitive status in Alzheimer''s disease patients. Methods: Patients were randomly assigned to two interventions: a whole formula diet based on lyophilised foods (Treatment Group, ) or nutritional advice (Control Group, ). Energy intake, body weight, biochemistry, Mini Nutritional Assessment (MNA) and Pfeiffer''s tests were determined at baseline and at 3 months of treatment. Results: No differences were observed between groups at baseline. Energy intake tended to increase in the Treatment Group and to decrease in the Control Group, although differences were not significant. The improvement in MNA and Pfeiffer test scores was not significantly different between groups. Body weight increased by 2.06±1.9kg in the Treatment Group and by 0.32±3.04kg in the Control Group (). The increases in albumin (), haemoglobin () and serum ferritin () were higher in the Treatment Group than in controls. A similar rate of serious adverse events (hospitalisation or death) was observed in both groups. Conclusions: Administration of this whole formula has a positive impact on nutritional status. The great diversity in textures and tastes enable these formulations to be administered to a wide range of patients with or without liquid dysphagia. [Copyright &y& Elsevier]

Background and aims: The main objective of the PREDyCES(R) study was twofold. First, to analyse the prevalence of hospital malnutrition in Spain, both at admission and at discharge, and second, to estimate the hospital costs associated with disease-related malnutrition. Methods: The study was a nationwide, cross-sectional, observational, multicentre study in routine clinical practice, which assessed the prevalence of hospital malnutrition both at patient admission and discharge using NRS-2002(R). A study extension analysed the incidence of complications associated with malnutrition, excess hospital stay and healthcare costs associated with hospital malnutrition. Results: Malnutrition was observed in 23.7% of patients according to NRS-2002(R). Multivariate analysis revealed that age, gender, presence of malignant disease, diabetes mellitus, dysphagia and polymedication were the main factors associated with the presence of malnutrition. Malnutrition was associated with an increase in length of hospital stay, especially in patients admitted without malnutrition but who presented malnutrition at discharge (15.2 vs. 8.0 days, p < 0.001), with an associated additional cost of 5,829 per patient. Conclusion: In Spanish hospitals, almost one in four patients is malnourished. This condition is associated with increased length of hospital stay and associated costs, especially in patients developing malnutrition during hospitalization. Systematic screening for malnutrition should be generalised in order to implement nutritional interventions with well-known effectiveness. [ABSTRACT FROM AUTHOR]

It is well known that hospital malnutrition is a highly prevalent condition associated to increase morbidity and mortality as well as related healthcare costs. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regional or even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown in Spain. The PREDyCES(R) (Prevalence of hospital malnutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs. Some aspects made this study unique: a) It was the first study in a representative sample of hospitals of Spain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System. [ABSTRACT FROM AUTHOR]

Objective: Abdominal fat ultrasound (US) is a simple clinical tool that may allow measures of fat depots not visible using common dual-energy X-ray absorptiometry (DEXA) or computerized tomography (CT) imaging. The aim of this study was to validate the technique, give measures of superficial and profound subcutaneous , preperitoneal , omental and perirenal (retroperitoneal) fat and correlate them with MS markers., Methods: Sequential US measures of these five abdominal fat layers were done at 397 adults. Blood pressure (BP), body mass index (BMI), waist, body fat %, HOMA-IR index (homeostatic model assessment of insulin resistance), lipid profile and leptin were recorded. Metabolic syndrome (MS) was defined according to Cholesterol education programme adult treatment panel III (ATPIII) criteria., Results: Subcutaneous and omental fat were increased among people with obesity, whereas preperitoneal and perirenal fat did not show any difference according to BMI or waist. Women showed thicker subcutaneous fat (both superficial and profound), whereas men had bigger omental fat. Both postmenopausal and diabetic patients had changes in omental fat only, whereas patients with fatty liver showed thicker preperitoneal and perirenal fat, as well. MS patients showed both thicker perirenal and omental fat. A cut-off of 54 mm in male (M)/34 mm in female (F) of omental fat and 22.5 mm (M)/12.5 mm (F) of perirenal fat could be predictive of later MS onset., Conclusions: US is a valid method to measure all different abdominal fat depots. Omental and perirenal fat measures may classify patients at risk for MS. Preperitoneal fat depot may also correlate with fatty liver disease., Competing Interests: All the authors have declared no having any conflict of interest and send the form to the corresponding author., (© 2020 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Al-Andalus society (711-1492) based its idea of health on the wisdom of Classical Greece, the Hippocratic-Galenic theories, as well as the Persian and Hindu cultures. The twelfth century in al-Andalus is considered to be the most prolific period for works of a scientific and technical nature. At the time, the main treatises on dietetics were written and this science reached its widest expression with such leading figures as Ibn Wāfīd, Avenzoar, Averroes and Maimonides, whose works revealed the first scientific knowledge on the nutritional processes of the human body. Diet was regarded as being essential for health and the prevention of disease. Dietary guidelines were written for different age groups, different body types and different seasons of the year. The amount of food to be ingested, the number of meals recommended and the order in which the food should be consumed were all issues that were discussed. A variety of foods were thought to have medicinal properties, some of which are known today. The diet in al-Andalus was varied and very probably made a substantial contribution to the origin of the present-day Mediterranean diet, rich in olive oil, wholemeal cereals, fruit and vegetables, fish, lamb, poultry, nuts and spices. We also find that many of the terms in current use in diet and agriculture are a living testimony to the Arabic influence, as are many of the dishes of our varied Mediterranean gastronomy.

Recent evidences from epidemiological and intervention trials suggest that a higher calcium intake is associated with a lower body weight and a reduction in total and central body fat. The potential role of calcium intake in the regulation of body adiposity has been explained by the intracellular calcium, which is able to promote adipocyte fat accumulation by exerting a coordinate regulation stimulating lipogenesis and suppressing lipolysis. Moreover, the intracellular calcium has been implicated on the etiopathogenesis of hypertension, insulin resistance and dyslipidemia, appearing as a potential common substrate in the metabolic syndrome. Dietary modulation of intracellular calcium through calciotropic hormones opens an exciting possibility to prevent and tackle obesity and its associated complications by increasing the calcium intake. However, available evidences are mostly indirect and further studies specifically designed for this purpose are needed.

Nuts are foods with a high energy density, due in part to its small water content. They also present a low saturated fat content (<7%) but a high unsaturated fat contribution (40-60%). They represent one of the richest sources of dietary fiber, which is basically of the insoluble type. The effects of nut intake on health have been widely studied. Several prospective epidemiological studies performed on large cohorts have consistently shown that regular consumption of small amounts of nuts is negatively related to the risk of cardiovascular disease and to the risk of cardiovascular or all-cause mortality. From these studies can be concluded that regular consumption of small amounts of nuts leads to a 30-50% reduction in the risk of cardiovascular disease. Additionally, intervention studies have shown a positive effect of nut intake on lipid profile with significant reductions in total and LDL cholesterol levels and small or null effects on the HDL fraction. More recently, some studies have focused on the effect of nuts on body weight. At present, no evidences support a detrimental effect of nut consumption on body weight. On the contrary some weight loss studies suggest a beneficial effect of nut intake on body weight regulation.

The hypocholesterolemic effects of phytosterols have not been evaluated in bakery products, and the addition of liposoluble antioxidants to the carrier has never been tested. We investigated the effects of consuming croissants and magdalenas (Spanish muffins) enriched with sterol esters, alpha-tocopherol and beta-carotene on plasma lipid and fat-soluble antioxidant concentrations in normocholesterolemic, habitual consumers of bakery products following their usual diet and lifestyle. Using a randomized, double-blind, placebo-controlled design, the control (C) group (n = 29) received two pieces daily (standard croissant and muffin) and the sterol ester (SE) group (n = 28), the same products with sterol esters added (3.2 g/d) for 8 wk. Total and LDL cholesterol (LDL-C) decreased in the SE group by 0.24 mmol/L (P < 0.01) and 0.26 mmol/L (P < 0.005), respectively, whereas these variables did not change in the control group. The total difference in total and LDL-C changes between groups was 0.38 mmol/L (8.9%) and 0.36 mmol/L (14.7%), respectively (P < 0.001). Within-group changes in HDL cholesterol, triacylglycerol or lipoprotein(a) concentrations did not differ. Similarly, within-group changes over time in plasma tocopherol and carotenoid concentrations did not differ between groups. Our findings suggest that bakery products are excellent carriers for phytosterols, and their consumption is associated with a decrease in total and LDL-C concentrations, with no changes in alpha-tocopherol and beta-carotene. The ability of bakery products to include sufficient quantities of beta-carotene to compensate for a potential deficiency, and the fact that their efficacy was not associated with the time of day at which they were consumed, are interesting findings.

Background: Although doctors, students and teachers all coincide in acknowledging the need for an appropriate knowledge of human nutrition in order to practice medicine, the inclusion of this discipline in the undergraduate curriculum has been rather scant. Until a few years ago, there were only two medical schools in Spain with a compulsory course in nutrition as part of the syllabus., Goal: An attempt will be made to assess the current status of the teaching of nutrition within the syllabuses for a degree in Medicine and Surgery at Spanish universities., Materials: The syllabuses of 27 Faculties of Medicine in Spain have been consulted to find out: 1) if there are specific subjects on nutrition, feeding and/or dietetics, 2) if these subjects are compulsory or optional, and 3) if there are specific issues from this area included within other subjects., Results: The results of the query show that 7 schools (approximately 25% of the total) teach a compulsory subject on nutrition or dietetics whereas 17 have at least one optional subject in this field, particularly during the second or specialization stage, with a mean content worth 4.5 credits. Furthermore, 3 of the schools offer both compulsory and optional courses simultaneously. Within the course material of the core subjects included in the second stage of the degree, the subjects of Endocrinology, Metabolism and Paediatrics seem to be the ones most commonly including clinical nutrition topics, generally with a very small relative weight., Conclusions: The results obtained show an increasing interest in the creation of distinctive subjects for nutrition and/or dietetics. Nonetheless, this is still mainly an optional subject and the integration of human nutrition into the syllabus for core subjects seems insufficient for its to be considered a good alternative.

Background: Our aim was to measure the plasma concentrations of various vitamins and micronutrients involved in the immune response and antioxidant systems of an HIV+ population and to determine how they are related to the inflammatory response., Patients and Method: We studied 86 subjects with known HIV-infection who were divided into three groups (asymptomatic HIV+; AIDS without opportunistic infection; and AIDS with active opportunistic infection) which were compared with a control group. Serum concentrations of vitamin A, vitamin E, copper and zinc were measured, as well as several inflammatory parameters. Absorption tests for fat and sugar were performed in all patients., Results: Serum vitamin A and E levels were below the reference range in 36.4% and 14.3% patients, respectively, but not in controls subjects. The prevalence of vitamin A deficiency increased with the severity of the disease. Fewer patients than controls had values below the reference range regarding serum copper. AIDS patients with active opportunistic infection showed significantly lower serum concentrations of vitamin A (p < 0.001) and significantly higher serum concentrations of copper (p < 0.0001). Both serum concentrations of vitamin A and copper were correlated with various inflammatory parameters., Conclusions: Micronutrient deficiencies are prevalent in HIV-infected patients including asymptomatic patients. Vitamin A and copper were significantly correlated with inflammatory parameters, suggesting that their serum concentrations have more to do with the inflammatory response than with the nutritional status.

Aims: To investigate the determinants of leptinemia in a cohort of morbid obese females compared to those of normal weight and mild-to-moderate obesity, and the relationships between leptin and metabolic derangements associated with obesity., Methods: Recruited females were: moderately obese [n=44; body mass index (BMI) 25-40 kg/m2], morbidly obese (n=34; BMI > or = 40 kg/m2) and normal weight volunteers (n=12; BMI 19-25 kg/m2). Fat mass assessed by bioelectrical impedance and fat distribution by waist-to-hip ratio (WHR) were determined in all subjects. Biochemical determinations included plasma leptin, lipoprotein profile, fasting insulin and cortisol., Results: Plasma leptin values were significantly increased in morbid obese patients (54.95 +/- 1.8 ng/ml) compared to those moderately obese (30.2 +/- 1.7 ng/ml; p<0.001) and to controls (9.77 +/- 1.4 ng/ml; p<0.001). Fat and age-adjusted leptin values were not different between groups. When subjects with a BMI <40 kg/m2 were considered, plasma leptin was significantly and positively related to anthropometric variables (BMI, percentage body fat and WHR), total cholesterol, LDL-cholesterol, plasma triglycerides, AST, ALT and uric acid; and negatively with HDL-cholesterol. In contrast, when morbidly obese patients were analyzed separately, no relationships were observed between leptin concentrations and BMI, percentage of adiposity or biochemical variables. For obese patients no significant differences were observed in the adjusted leptin values with respect to the presence of diabetes, dyslipidemia or hypertension., Conclusions: In morbidly obese women, the plasma leptin concentrations, although increased, do not reflect the amount of adipose stores, and as such, factors other than simply adiposity need to be invoked to explain the variation in leptin values.

Background: To assess a possible role of systemic inflammation in the resting metabolic response in AIDS patients with active secondary infections., Methods: Fifty-two patients with AIDS-defined criteria and concomitant active infections and 19 healthy subjects were studied. Measurements were as follows: body composition assessed by bioelectrical impedance; resting energy expenditure (REE) by 30-minute indirect calorimetry; cytokine concentrations (IL-6, IFNalpha, TNFalpha, sTNF-R1) by ELISA; C-reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, and nutritional parameters by standard techniques., Results: REE adjusted for fat-free mass (REEFFM) was significantly increased in AIDS patients despite 39% of them not being hypermetabolic. The patients were undernourished and were found to have increased levels of acute-phase proteins and increased concentrations of IL-6 and sTNF-R1 relative to controls. REE parameters were positively related to CRP, ESR, ferritin, IL-6, and sTNF-R1 and negatively related to albumin, prealbumin, and transferrin. CRP was an independent predictor of REEFFM in AIDS patients and explained 25% of its variability. Patients with severe inflammation (CRP > or = 37 mg/dL) were significantly hypermetabolic with respect to patients without inflammation (CRP < 6 mg/dL) and had higher levels of IL-6 and sTNF-R1 and lower levels of albumin and prealbumin. Although no significant differences were observed with respect to the infection type, patients with tuberculosis and Pneumocystis carinii infections had higher resting metabolic and inflammatory responses, whereas patients with recurrent bacterial pneumonia were normometabolic and had lower levels of inflammatory markers., Conclusions: Resting hypermetabolism observed in AIDS patients with concurrent active infections is related to the presence and severity of systemic cytokine-driven inflammatory response, which could reflect the type of secondary infection.

A group of obese women (BMI>27 kg/m2; N=73) was studied together with lean controls (BMI <27 kg/m2; N=25). Three groups were defined by the compliance with: BMI lower than 27 kg/m2, glycaemia lower than 5.5 mM and insulinaemia lower than 0.2 nM (controls, group 1, N=19). The subjects with BMI>27 kg/m2, glucose >5.5 mM and insulin >0.2 nM constituted group 3 (N=41), and those with BMI>27 with glycaemia and/or insulinaemia lower than the limits set constituted group 2 (N=32). The women in group 3 had higher fat content, BMI and fat-free mass than those in group 2 and the controls. There were no changes in most plasma parameters, such as free estrone and beta-estradiol. Leptin levels were higher in groups 2 and 3 than in controls. In controls, leptin and acyl-estrone levels were well correlated with BMI and fat content; this correlation was not found in groups 2 and 3 for acyl-estrone, although it was found for leptin. Acyl-estrone levels were lower than expected in most obese women when compared to those of controls, suggesting an altered availability or function of this hormone. In obese women, acyl-estrone levels -and probably function- are lower than expected, contrasting with maintained leptin-BMI correlations. The role of insulin in the control of body weight, perhaps through acyl estrone-mediated effects, should be re-evaluated.

Background and Goals: Professionals in primary health care have to face a large number of patients with pathologies arising out of nutritional and dietary disorders as well as cope with society's growing interest in such issues. For this reason, we have attempted to assess the extent of the knowledge in questions of nutrition and dietetics that primary health care doctors feel they have received in comparison with what they might have considered necessary, as well as assess the capacity that these doctors feel they have to cope with clinical situations requiring a knowledge of nutrition. SCOPE AND SUBJECTS: 250 doctors working in Primary Health Care and belonging to the Tarragona Province Medical Association., Action: Participants received a self-administered questionnaire in which they had to: a) answer closed questions on their sense of clinical ability to handle dietary and nutritional problems; b) give a score for the importance that 62 previously-defined subjects should have in their general medical training; and c) give a score for the attention paid to these topics during their undergraduate training., Results: 36 doctors (age: 38.6 +/- 10 years) with an average accumulated experience in medicine of 12.5 +/- 9.2 years replied to the survey. Respondents reported that 42.5 +/- 25% of their patients required nutritional or dietary action and only 28 +/- 24% receive the same. As for their undergraduate training in nutrition, 19.4% of them considered it to be non-existent and 58.4% described it as insufficient. Respondents reported little ability to handle different clinical situations, particularly involving the identification of patients requiring secondary vitamin therapy or nutritional support and the prescription of low lactose diets. Except for the area of biochemistry and nutritional physiology, respondents reported a great discrepancy between the attention that should have been given during their undergraduate years to the subjects proposed and the training they really received, particularly in questions of clinical dietetics, diet and the prevention of disease as well as nutritional support in disease., Conclusions: The undergraduate training in questions of dietetics and nutrition is clearly seen to be scant according to primary health care physicians. This might explain in part the insufficient clinical capacity that these professionals feel they have in such matters and the high percentage of patients who do not receive the nutritional and dietary attention these doctors feel is necessary.

Objective: To assess the influence of malabsorption on nutritional status and energy expenditure in patients at different stages of HIV infection., Design and Methods: Fifty HIV patients were classified into three groups: Group 1, HIV asymptomatic patients (n=17); Group 2, AIDS without opportunistic infection (n=16); Group 3, AIDS patients with active infection (n=17). Clinically-healthy subjects (n=19) were used as controls. Parameters measured were: anthropometry, body composition by tetrapolar bioelectrical impedance; resting energy expenditure (REE) by open-circuit indirect calorimetry; malabsoption by D-xylose absorption and triolein breath tests., Results: Malabsorption (defined as abnormality of xylose and/or fat absorption test) was found in 34 (68%) of patients: 9 (53%) Group 1; 11 (69%) Group 2; 14 (82%) Group 3. Twenty-seven (54%) had sugar malabsorption and 21 (42%) fat malabsorption. A significant relationship was observed between malabsorption and weight loss. REE measured was significantly lower in malabsorptive patients than in non-malabsorptive patients and controls (6006.3+/-846.5 versus 6443.4 + 985.5 versus 6802.1+/-862.7 kJ/day, respectively; P < 0.05). The REE adjusted for fat-free mass was lower in malabsorptive than in non-malabsorptive patients and slightly higher than in controls, although the differences were not statistically significant., Conclusions: The results suggest that malabsorption is a frequent feature in HIV infection and is related to the HIV-related weight loss. Hypermetabolism is not a constant phenomenon in HIV infection since, in the presence of malabsorption, our patients show an appropriate metabolic response with a compensatory decrease in REE.