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We aimed to evaluate the association between three previously defined pro-vegetarian (PVG) food patterns and the cancers of the oesophagus, stomach, and pancreas in a multi case-control study. We analyzed data from a multi-case hospital-based study carried out in two Mediterranean provinces in Spain. A total of 1233 participants were included in the analyses: 778 incident cancer cases, histologically confirmed (199 oesophagus, 414 stomach, and 165 pancreas) and 455 controls. A dietary assessment was performed using a validated food frequency questionnaire (FFQ). Three PVG food patterns (general, healthful, and unhealthful) were estimated using 12 food groups for the general PVG (gPVG), scoring positive plant-based foods and negative animal-based foods, and 18 food groups, for the healthful (hPVG) and unhealthful (uPVG) food patterns. Multinomial logistic regression was used to estimate relative risk ratios (RRR) and confidence intervals (95% CI) for quintiles of adherence to PVG patterns and as a continuous variable. The RRR (95% CI) for the highest vs. the lowest quintile of gPVG were, RRR = 0.37 (0.32, 0.42) for the oesophagus, RRR = 0.34 (0.27, 0.43) for the stomach, and RRR = 0.43 (0.35, 0.52) for pancreas cancer. For the hPVG, the RRR were RRR = 0.72 (0.58, 0.90) for the oesophagus, RRR = 0.42 (0.34, 0.52) for the stomach, and RRR = 0.74 (0.59, 0.92) for pancreas cancer. The uPVG was associated with a higher risk of stomach cancer RRR = 1.76 (1.42, 2.18). Higher adherence to gPVG and hPVG food patterns is associated with a lower risk of oesophageal, stomach, and pancreas cancers, while a higher adherence to a uPVG food pattern is associated with a higher risk of stomach cancer. Funding: This work was supported by the Spanish Ministry of Health (FIS 91/0435, RCESP C03/09), the Generalitat Valenciana (EVES 030/2005, CTGCA/2002/06, G03/136), CIBERESP.

Background & aims: Ultra-processed food and drink products (UPF) consumption has been associated with obesity and its-related comorbidities. Excess of visceral fat, which appears with increasing age, has been considered as the culprit contributing to adiposity-associated adverse health outcomes. However, none of previous studies elucidated the link between UPF and directly quantified adiposity and its distribution. We aimed to prospectively investigate the association between concurrent changes in UPF consumption and objectively assessed adiposity distribution. Methods: A subsample of 1485 PREDIMED-Plus participants (Spanish men and women aged 55-75 years with overweight/obesity and metabolic syndrome) underwent body composition measurements. Consumption of UPF at baseline, 6 and 12 months was evaluated using a validated 143-item semiquantitative Food Frequency Questionnaire. Food items (g/day) were categorized according to their degree of processing using NOVA system. Regional adiposity (visceral fat (in g) and android-to-gynoid fat & nbsp; ratio) and total fat mass (in g) at three time points were measured with dual-energy X-ray absorpti-ometry (DXA) and were normalized using sex-specific z-scores. The association of changes in UPF consumption, expressed as the percentage of total daily intake (daily g of UPF/total daily g of food and beverage intake*10 0), with adiposity changes was evaluated using linear mixed-effects models. Results: On average, the consumption of UPF accounted for 8.11% (SD 7.41%) of total daily intake (in grams) at baseline. In multivariable-adjusted model, 10% daily increment in consumption of UPF was associated with significantly (all p-values

Introduction and objectives Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. Method A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55–75 years with overweight/obesity (body mass index ≥27 and ≤40 kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. Results Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4–86.4) and emotional role scales (mean 86.8, 95% CI; 86.0–87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0–66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4–55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70–75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. Conclusions Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected.

Aim To assess the association between self-reported health (SRH) and mortality from all-causes, cardiovascular disease (CVD) and cancer, in adults 65 years and older in Spain. Methods We analysed data of 894 adults (504 women, 390 men) aged 65 years and above from two population-based studies, the EUREYE-Spain study and the Valencia Nutritional Survey (VNS). SRH was assessed at baseline using a single question which is widely used in epidemiological studies: “Overall, how would you consider your health at present?” and the response options were: 1. Very good, 2. Good, 3. Fair, 4. Poor, 5. Very poor. Deaths were ascertained during a 12-year follow-up period, and we used Cox proportional hazards regression models to obtain adjusted hazard ratios (HR). Results During the 12 years of follow-up (8566.2 person-years), we observed 400 deaths, 158 (39.5%) due to CVD and 89 (22.3%) due to cancer. Fair and poor/very poor SRH were significantly associated with higher all-cause mortality after 12-years of follow-up, HR = 1.29 (95% CI, 1.03–1.61) and HR 1.53 (95% CI, 1.09–2.15), respectively. We observed evidence of higher CVD mortality among those who reported fair and poor/very poor SRH, although the association was attenuated and lost statistical significance in the fully adjusted models. Conclusion This study suggests that a poor SRH status is associated with a higher all-cause mortality risk among older adults in Spain. Checking SHR status may be useful to plan health care in older adults.

Reliable tools to evaluate diet are needed, particularly in life periods such as adolescence in which a rapid rate of growth and development occurs. We assessed the biochemical validity of a self-administered food frequency questionnaire (FFQ) in a sample of Spanish male adolescents using carotenoids and vitamin E and D data. We analyzed data from 122 male adolescents aged 15–17 years of the INMA-Granada birth cohort study. Adolescents answered a 104-item FFQ and provided a non-fasting blood sample. Mean daily nutrient intakes and serum concentration were estimated for main carotenoids (lutein-zeaxanthin, β-cryptoxanthin, lycopene, α-carotene and β-carotene), vitamins E and D and also for fruit and vegetable intake. Pearson correlation coefficients (r) and the percentage of agreement (same or adjacent quintiles) between serum vitamin concentrations and energy-adjusted intakes were estimated. Statistically significant correlation coefficients were observed for the total carotenoids (r = 0.40) and specific carotenoids, with the highest correlation observed for lutein–zeaxanthin (r = 0.42) and the lowest for β-carotene (0.23). The correlation coefficient between fruit and vegetable intake and serum carotenoids was 0.29 (higher for vegetable intake, r = 0.33 than for fruit intake, r = 0.19). Low correlations were observed for vitamin E and D. The average percentage of agreement for carotenoids was 55.8%, and lower for vitamin E and D (50% and 41%, respectively). The FFQ may be an acceptable tool for dietary assessment among male adolescents in Spain., Institute of Health Carlos III (ISCIII), Spanish Ministry of Health (FIS 07/0314; PI11/01007), “Fondo Europeo de Desarrollo Regional” (ISCIII/FEDER) for the Miguel Servet Type I Program granted to C. Freire (grant no. CP16/00085), “Instituto de Salud Carlos III/Agencia Estatal de Investigación”, grant number PI18/00825 Project: Dieta y actividad física en embarazo y tras el nacimiento y longitud del telómero en niños y adolescentes: Proyecto TeloDiPA”, Unión Europea (FEDER) “Una manera de hacer Europa”

[Background and aims]: The aim of this study was to ascertain the association between the consumption of different categories of edible olive oils (virgin olive oils and olive oil) and olive pomace oil and ankle-brachial pressure index (ABI) in participants in the PREDIMED-Plus study, a trial of lifestyle modification for weight and cardiovascular event reduction in individuals with overweight/obesity harboring the metabolic syndrome., [Methods]: We performed a cross-sectional analysis of the PREDIMED-Plus trial. Consumption of any category of olive oil and olive pomace oil was assessed through a validated food-frequency questionnaire. Multivariable linear regression models were fitted to assess associations between olive oil consumption and ABI. Additionally, ABI ≤1 was considered as the outcome in logistic models with different categories of olive oil and olive pomace oil as exposure., [Results]: Among 4330 participants, the highest quintile of total olive oil consumption (sum of all categories of olive oil and olive pomace oil) was associated with higher mean values of ABI (beta coefficient: 0.014, 95% confidence interval [CI]: 0.002, 0.027) (p for trend = 0.010). Logistic models comparing the consumption of different categories of olive oils, olive pomace oil and ABI ≤1 values revealed an inverse association between virgin olive oils consumption and the likelihood of a low ABI (odds ratio [OR] 0.73, 95% CI [0.56, 0.97]), while consumption of olive pomace oil was positively associated with a low ABI (OR 1.22 95% CI [1.00, 1.48])., [Conclusions]: In a Mediterranean population at high cardiovascular risk, total olive oil consumption was associated with a higher mean ABI. These results suggest that olive oil consumption may be beneficial for peripheral artery disease prevention, but longitudinal studies are needed., The authors especially thank the PREDIMED-Plus participants for their enthusiastic collaboration, the PREDIMED-Plus personnel for outstanding support, and the personnel of all associated primary care centres for their exceptional effort. CIBEROBN, CIBERESP and CIBERDEM are initiatives of Instituto de Salud Carlos III, Spain.

Dietary polyphenol intake is associated with improvement of metabolic disturbances. The aims of the present study are to describe dietary polyphenol intake in a population with metabolic syndrome (MetS) and to examine the association between polyphenol intake and the components of MetS. This cross-sectional analysis involved 6633 men and women included in the PREDIMED (PREvenci&oacute, n con DIeta MEDiterranea-Plus) study. The polyphenol content of foods was estimated from the Phenol-Explorer 3.6 database. The mean of total polyphenol intake was 846 &plusmn, 318 mg/day. Except for stilbenes, women had higher polyphenol intake than men. Total polyphenol intake was higher in older participants (&gt, 70 years of age) compared to their younger counterparts. Participants with body mass index (BMI) &gt, 35 kg/m2 reported lower total polyphenol, flavonoid, and stilbene intake than those with lower BMI. Total polyphenol intake was not associated with a better profile concerning MetS components, except for high-density lipoprotein cholesterol (HDL-c), although stilbenes, lignans, and other polyphenols showed an inverse association with blood pressure, fasting plasma glucose, and triglycerides. A direct association with HDL-c was found for all subclasses except lignans and phenolic acids. To conclude, in participants with MetS, higher intake of several polyphenol subclasses was associated with a better profile of MetS components, especially HDL-c.

Introduction and objectives The ankle-brachial index (ABI) is an indicator of peripheral artery disease (PAD). The aim of this study was to assess the association between PAD, measured with the ABI, and cognitive function in persons with overweight or obesity and metabolic syndrome . Methods Cross-sectional study conducted with baseline data from the PREDIMED-Plus study, which included 4898 participants (after exclusion of those without ABI measurements) aged between 55 and 75 years, and with overweight or obesity and metabolic syndrome. At the baseline assessment, we measured the ABI with a standardized protocol and assessed the presence of other cardiovascular risk factors (eg, diabetes, dyslipidemia , hypertension). Cognitive function was evaluated using several tests validated for the Spanish population (mini-mental state examination [MMSE], phonological and semantic verbal fluency test, WAIS-III working memory index [WMI], parts A and B of the trail making test (TMT), and clock drawing test). Generalized linear models were used to assess the association between the ABI and cognitive function. Results Among the participants, 3.4% had PAD defined as ABI ≤ 0.9, and 3.3% had arterial calcification defined as ABI ≥ 1.4. PAD was associated with age, systolic blood pressure and obesity indicators, while arterial calcification was also associated with obesity and diabetes. No significant associations were observed between cognitive function and ABI or PAD. Conclusions In our sample, the presence of PAD increased with age, blood pressure, and obesity. No significant association was observed between ABI, PAD, or cognitive function.

[Purpose]: To assess the association between the consumption of non-soy legumes and different subtypes of non-soy legumes and serum uric acid (SUA) or hyperuricemia in elderly individuals with overweight or obesity and metabolic syndrome. [Methods]:A cross-sectional analysis was conducted in the framework of the PREDIMED-Plus study. We included 6329 participants with information on non-soy legume consumption and SUA levels. Non-soy legume consumption was estimated using a semi-quantitative food frequency questionnaire. Linear regression models and Cox regression models were used to assess the associations between tertiles of non-soy legume consumption, different subtypes of non-soy legume consumption and SUA levels or hyperuricemia prevalence, respectively., [Results]: Individuals in the highest tertile (T3) of total non-soy legume, lentil and pea consumption, had 0.14 mg/dL, 0.19 mg/dL and 0.12 mg/dL lower SUA levels, respectively, compared to those in the lowest tertile (T1), which was considered the reference one. Chickpea and dry bean consumption showed no association. In multivariable models, participants located in the top tertile of total non-soy legumes [prevalence ratio (PR): 0.89; 95% CI 0.82–0.97; p trend = 0.01, lentils (PR: 0.89; 95% CI 0.82–0.97; p trend = 0.01), dry beans (PR: 0.91; 95% C: 0.84–0.99; p trend = 0.03) and peas (PR: 0.89; 95% CI 0.82–0.97; p trend = 0.01)] presented a lower prevalence of hyperuricemia (vs. the bottom tertile). Chickpea consumption was not associated with hyperuricemia prevalence., [Conclusions]: In this study of elderly subjects with metabolic syndrome, we observed that despite being a purine-rich food, non-soy legumes were inversely associated with SUA levels and hyperuricemia prevalence., The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by J.S.-S. and J.Vid., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, and PI17/00926), the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to J.S.-S., the European Research Council (Advanced Research Grant 2013–2018, 340918) to M.Á.M.-G., the Recercaixa Grant to J.S.-S. (2013ACUP00194), Grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, and PI0137/2018), a Grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN Grant, and funds from the European Regional Development Fund (CB06/03). O.C. is supported by ISCIII Grant JR17/00022. M Rosa Bernal-Lopez was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER

OBJECTIVE The long-term impact of intentional weight loss on cardiovascular events remains unknown. We describe 12-month changes in body weight and cardiovascular risk factors in PREvención con DIeta MEDiterránea (PREDIMED)-Plus, a trial designed to evaluate the long-term effectiveness of an intensive weight loss lifestyle intervention on primary cardiovascular prevention. RESEARCH DESIGN AND METHODS Overweight/obese adults with metabolic syndrome aged 55–75 years (n = 626) were randomized to an intensive weight loss lifestyle intervention based on an energy-restricted Mediterranean diet, physical activity promotion, and behavioral support (IG) or a control group (CG). The primary and secondary outcomes were changes in weight and cardiovascular risk markers, respectively. RESULTS Diet and physical activity changes were in the expected direction, with significant improvements in IG versus CG. After 12 months, IG participants lost an average of 3.2 kg vs. 0.7 kg in the CG (P < 0.001), a mean difference of −2.5 kg (95% CI −3.1 to −1.9). Weight loss ≥5% occurred in 33.7% of IG participants compared with 11.9% in the CG (P < 0.001). Compared with the CG, cardiovascular risk factors, including waist circumference, fasting glucose, triglycerides, and HDL cholesterol, significantly improved in IG participants (P < 0.002). Reductions in insulin resistance, HbA1c, and circulating levels of leptin, interleukin-18, and MCP-1 were greater in IG than CG participants (P < 0.05). IG participants with prediabetes/diabetes significantly improved glycemic control and insulin sensitivity, along with triglycerides and HDL cholesterol levels compared with their CG counterparts. CONCLUSIONS PREDIMED-Plus intensive lifestyle intervention for 12 months was effective in decreasing adiposity and improving cardiovascular risk factors in overweight/obese older adults with metabolic syndrome, as well as in individuals with or at risk for diabetes.

Introducción: La obesidad es un problema de salud pública que afecta y que ha aumentado rápidamente en la última década en un gran número de países en el mundo. Además, es un factor de riesgo importante en la enfermedad cardiovascular y se ha mostrado como un posible factor de riesgo en la mortalidad especialmente por enfermedades crónicas. Objetivo: Determinar la prevalencia de obesidad de acuerdo a tres índices antropométricos como el Índice de Masa Corporal (IMC), la Circunferencia de Cintura (CC) y el porcentaje de Grasa Corporal (% GC) medido por impedancia bioeléctrica y estimar los índices de validez y exactitud para definir obesidad según IMC y CC, usando como referencia el % GC.Material y métodos: Estudio transversal que incluye a 141 participantes de la Encuesta de Nutrición de Comunidad Valenciana realizada en 1994 que fueron evaluados de nuevo 10 años después. Se realizaron mediciones antropométricas usando protocolos estandarizados para peso y talla, obteniendo IMC, CC y % GC. Los puntos de corte utilizados para definir obesidad fueron: IMC ≥ 30 kg/m2, CC > 102 cm en hombres y > 88 cm en mujeres, y un % GC > 27 para hombres y > 40 en mujeres. Se estimaron coeficientes de correlación ajustados por edad entre los distintos indicadores antropométricos. Se estimó la sensibilidad, especificidad y valores predictivos para IMC y CC utilizando % GC como referencia. Resultados: La prevalencia de obesidad fue 19,9% (IMC), 37,6% (CC) y 38,3% (%GC). La correlación osciló entre 0,232 para CC-% GC y 0,829 para IMC-CC. Utilizando el % GC como método de referencia, el IMC mostró mayor especificidad (en mujeres 92,6% y en hombres 93,9%) y la CC mayor sensibilidad (en mujeres 83,3% y en hombres 53,7%) para detectar obesidad. Conclusiones: La prevalencia de obesidad difiere según el indicador antropométrico utilizado. La CC, dada su fácil medición, puede ser el indicador más apropiado a utilizar en estudios de base poblacional y programas preventivos para detectar obesidad en adultos.

The PREDIMED (in Spanish: PREvención con DIeta MEDiterránea) primary prevention trial1–3 reported in 2013 that long-term adherence to an energy-unrestricted Mediterranean diet (MedDiet), supplemented with either extra-virgin olive oil (EVOO) or nuts, reduced cardiovascular disease (CVD). PREDIMED showed a 30% relative reduction in the composite cardiovascular primary endpoint (stroke, myocardial infarction or cardiovascular death).2,,3 However, the PREDIMED trial tested only the composition of the diet, but did not test other lifestyle interventions (i.e. energy reduction, increased physical activity (PA) and behavioural modification) frequently applied in the context of the current unprecedented obesity pandemic.4,,5 With the exception of the null results of the Look-AHEAD trial,6 and the successful results of the EXERDIET-HTA study that found improvements in blood pressure, cardio-respiratory fitness and body composition (though they encouraged adherence to an hypocaloric DASH diet, instead of a Mediterranean diet),7 lifestyle interventions including such components have never been tested in long-term randomized trials using hard cardiovascular events as endpoints.

A higher adherence to Mediterranean diet is considered as a protective factor against the large number of deaths attributable to the main chronic degenerative diseases in developed countries. Self-rated health is established as a good indicator of population health status and as a predictor of mortality. Studies exploring the relationship between the adherence to Mediterranean diet and self-rated health are scarce, especially, in young adults. Our aim was to explore the factors related, specially the adherence to a priori-defined Mediterranean diet with self-rated health in a cohort of Spanish university students.We analyzed data from 1110 participants of Spanish DiSA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández) study. Diet was assessed using a validated food frequency questionnaire and the adherence to Mediterranean diet was calculated using the relative Mediterranean Diet Score (rMED; score range: 0-18) according to the consumption of 9 dietary components. Self-rated health was gathered from the question: "In general, how do you consider your health to be? (Excellent, good, fair, poor, very poor). Information on sociodemographic and lifestyle characteristics was also collected. Multinomial logistic regression (using relative risk ratio, RRR) was used to analyze the association between the adherence to Mediterranean diet (low rMED: 0-6 points; medium: 7-10 points; high: 11-18 points) and self-rated health (Excellent (reference), good and fair/ poor/very poor).A low, medium or high adherence to Mediterranean diet conformed to 26.8%, 58.7% and 14.4% of participants, which of them reported an excellent (23.1%), good (65.1%) and fair/poor or very poor health, respectively. In multivariate analysis, a lower adherence to Mediterranean diet was significantly (p.Introducción y objetivo: Una mayor adherencia a la dieta mediterránea es un factor protector de la mortalidad atribuida principalmente a las enfermedades crónico-degenerativas en países desarrollados. La salud auto-percibida constituye un buen indicador para medir el estado de salud poblacional y como predictor de la mortalidad. Son escasos los estudios que han explorado la relación entre la adherencia a la dieta mediterránea y la salud auto- percibida especialmente en población joven. En este estudio analizamos los factores relacionados con el estado de salud auto-percibido en población joven universitaria, prestando especial atención a la adherencia a un patrón de dieta mediterránea definido a priori. Método: Se han analizado los datos de 1110 participantes recogidos en el momento de ingreso en el del Estudio Di- SA-UMH (Dieta, Salud y Antropometría en universitarios de la Universidad Miguel Hernández). La dieta se evaluó mediante cuestionario de frecuencia alimentaria validado y se estimó la adherencia a la dieta mediterránea mediante el índice relative Mediterranean Diet Score que incluye 9 componentes y un rango entre 0-18 puntos. El estado de salud auto-percibida se recogió mediante la pregunta “En general, ¿cómo diría que es su salud?” con cinco opciones: muy buena, buena, regular, mala y muy mala. Se recogió información sobre variables sociodemográficas y estilos de vida. Se usó regresión logística multinomial (usando razón de riesgos relativos RRR) para analizar la asociación entre adherencia a la dieta mediterránea (rMED baja: 0-6; media: 7-10 puntos; alta: 11-18) y salud auto-percibida (muy buena (referencia), buena y regular/mala/muy mala). Resultados: Un 26.8%, 58.7% y 14.4% de los participantes presentaron respectivamente una adherencia a la dieta mediterránea baja, media o alta; un 23.1%, 65.1% y 11.8%, refirieron una salud muy buena, buena o regu lar/mala/muy mala, respectivamente. En el análisis multivariante, una menor adherencia a la dieta mediterránea se asoció significativamente a un peor estado de salud auto-percibido (p.

Objectives: We examined the use of low (= 1000 mu g/day) among pregnant women in Spain, and explored factors associated with the use of these non-recommended dosages. Design: Population-based cohort study. Setting: Spain. Participants: We analysed data from 2332 pregnant women of the INMA study, a prospective mother-child cohort study in Spain. Main outcome measures: We assessed usual dietary folate and the use of FAS from preconception to the 3rd month (first period) and from the 4th to the 7th month (second period), using a validated food frequency questionnaire. We used multinomial logistic regression to estimate relative risk ratios (RRRs). Results: Over a half of the women used low dosages of FAS in the first and second period while 29% and 17% took high dosages of FAS, respectively. In the first period, tobacco smoking (RRR=1.63), alcohol intake (RRR=1.40), multiparous (RRR=1.44), unplanned pregnancy (RRR=4.20) and previous spontaneous abortion (RRR=0.58, lower use of high FAS dosages among those with previous abortions) were significantly associated with low FAS dosages. Alcohol consumption (RRR=1.42), unplanned pregnancy (RRR=2.66) and previous spontaneous abortion (RRR=0.68) were associated with high dosage use. In the second period, only tobacco smoking was significantly associated with high FAS dosage use (RRR=0.67). Conclusions: A high proportion of pregnant women did not reach the recommended dosages of FAS in periconception and a considerable proportion also used FAS dosages >= 1000 mu g/day. Action should be planned by the Health Care System and health professionals to improve the appropriate periconceptional use of FAS, taking into consideration the associated factors., This study was funded by grants from Instituto de Salud Carlos III and Spanish Ministry of Health (Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314; 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867; FIS-PS09/00090, FIS-PI042018, FIS-PI09 02311, FIS PI11/01007, FISPI13/02429) Universidad de Oviedo, Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069) and the Provincial Government of Guipuzcoa (DFG06/004 and DFG08/001).

To identify dietary patterns among participants in a representative nutritional survey in the Valencia Community, and to analyze the association with socio-demographic characteristics and lifestyles.Data for this study were from 1803 participants (973 women) in the Nutrition and Health Survey conducted in 1994 on a representative sample of adult population of Valencia Community. Diet was assessed by a validated food frequency questionnaire. Foods intakes were adjusted for 1,000 calories and grouped in 26 groups. Cluster analysis was used to identify dietary patterns using standardized values of the variables (z-scores).Three dietary patterns were identified and labeled as follows: the Prudent pattern (57.2%), characterized by a low-medium intake of most food of groups; the Mediterranean pattern (29.1%) characterized by high intake of fruits, vegetables, fish, poultry, cheese, and legumes; and the Western pattern (13.7%) characterized by high intake of meat and processed meats, high fat content foods, sweets and sugar, beverages, and alcoholic beverages. The Mediterranean pattern obtained higher scores for known diet quality index defined a priori. Using the Mediterranean pattern as reference, Western pattern included significantly more young people, higher number of men and smokers, and the Prudent pattern higher number of men, lower physical activity and lower alcohol consumption.Three dietary patterns were identified among participants in the Nutrition Survey of Valencia conducted in the mid-1990S: Prudent, Mediterranean and Western. The Prudent pattern was the most prevalent; the Mediterranean pattern was associated with healthier lifestyles and behaviors; and the Western pattern, the less prevalent although more frequently followed by youth, men and smokers. Further Nutrition Surveys should be carried out to make nutritional surveillance and analyze health effects of these observed patterns.Antecedentes/objetivo: El objetivo de este estudio ha sido identificar patrones dietéticos a partir de los datos recogidos en la Encuesta de Nutrición y Salud de la Comunidad Valenciana realizada sobre una muestra representativa de población adulta y explorar los posibles factores asociados a los patrones identificados. Metodología: Un total de 1.803 individuos adultos (973 mujeres) participaron en la encuesta de Nutrición y Salud realizada en 1994 en la Comunidad Valenciana. La dieta fue evaluada mediante cuestionario de frecuencia alimentaria (CFA) validado de 93 ítems alimentarios. Las ingestas de alimentos se ajustaron por mil calorías y se crearon 26 grupos de alimentos usando valores estandarizados (z-scores) para la identificación de patrones dietéticos por el método análisis de k-medias prefijando 3 clúster. Se usó regresión logística multinomial múltiple para explorar la asociación entre patrones y variables sociodemográficas, antropométricas y de estilos de vida. Resultados: Se identificaron tres patrones dietéticos denominados como Prudente, Mediterráneo y Occidental. El patrón Prudente (57,2%) se caracterizó por un consumo intermedio de los principales grupos de alimentos; el Mediterráneo (29,1%) destacó por un elevado consumo de frutas, verduras y pescado; y el Occidental (13,7%) por un alto consumo de carnes rojas, embutidos, platos preparados, croquetas, bebidas azucaradas, dulces, chocolates y bebidas alcohólicas. El patrón Mediterráneo presentó las mayores puntuaciones para varios índices de calidad alimentaria analizados y definidos a priori en la literatura. Usando como referencia el patrón Mediterráneo, los que seguían un patrón Occidental fueron significativamente más jóvenes, un mayor número de hombres y fumadores; los que seguían un patrón Prudente presentaron un mayor número de hombres, no practicaban actividad física regular y menor consumo de alcohol. Conclusión: De los tres patrones dietéticos identificados como Prudente, Mediterráneo y Occidental en adultos de la Comunidad Valenciana a mediados de los noventa, el patrón Prudente fue el más prevalente, el Mediterráneo el que se asoció a conductas y hábitos de vida más saludables, y el Occidental el menos frecuente aunque fue más seguido entre jóvenes, hombres y fumadores. Se deberían realizar encuestas nutricionales que permitan hacer vigilancia nutricional y analizar la evolución de estos patrones dietéticos y sus posibles efectos sobre la mortalidad en población española.

To explore the association between excess weight or body mass index (BMI) and the time spent watching television, self-reported physical activity and sleep duration in a young adult population.We analyzed cross-sectional baseline data of 1,135 participants (17-35 years old) from the project Dieta, salud y antropometría en población universitaria (Diet, Health and Anthrompmetric Variables in Univeristy Students). Information about time spent watching television, sleep duration, self-reported physical activity and self-reported height and weight was provided by a baseline questionnaire. BMI was calculated as kg/m(2) and excess of weight was defined as ≥25. We used multiple logistic regression to explore the association between excess weight (no/yes) and independent variables, and multiple linear regression for BMI.The prevalence of excess weight was 13.7% (11.2% were overweight and 2.5% were obese). A significant positive association was found between excess weight and a greater amount of time spent watching television. Participants who reported watching television2h a day had a higher risk of excess weight than those who watched television ≤1h a day (OR=2.13; 95%CI: 1.37-3.36; p-trend: 0.002). A lower level of physical activity was associated with an increased risk of excess weight, although the association was statistically significant only in multiple linear regression (p=0.037). No association was observed with sleep duration.A greater number of hours spent watching television and lower physical activity were significantly associated with a higher BMI in young adults. Both factors are potentially modifiable with preventive strategies.

Importance Folate intake during pregnancy has been associated with improved neuropsychological development in children, although the effects of high dosages of folic acid (FA) supplements are unclear. Objective To examine the association between the use of high dosages of FA supplements during pregnancy and child neuropsychological development after the first year of life. Design, Setting, and Patients The multicenter prospective mother-child cohort Infancia y Medio Ambiente (INMA) Project recruited pregnant women from 4 areas of Spain (Asturias, Sabadell, Gipuzkoa, and Valencia) between November 2003 and January 2008. Pregnant women completed an interviewer-administered questionnaire on the usual dietary folate intake and FA supplements at 10 to 13 weeks and 28 to 32 weeks of gestation. The main analyses were based on a sample of 2213 children with complete information on neuropsychological development and FA supplement intake during pregnancy. Multiple linear and logistic regression analyses were used to explore the effects of FA supplements on child neuropsychological development. Main Outcomes and Measures Neuropsychological development was assessed using the Bayley Scales of Infant Development. We calculated mental scale and psychomotor scale scores. One SD below the mean established a delay in neurodevelopment (score Results A high proportion of women (57.3%) did not reach the recommended dosages of FA supplements (400 μg/d), but 25.2% women took more than 1000 μg/d of FA supplements (3.5% consuming >5000 μg/d). In multivariate analysis, we observed that children whose mothers used FA supplement dosages higher than 5000 μg/d during pregnancy had a statistically significantly lower mean psychomotor scale score (difference, −4.35 points; 95% CI, −8.34 to −0.36) than children whose mothers used a recommended dosage of FA supplements (400-1000 μg/d). An increased risk of delayed psychomotor development (psychomotor scale score Conclusions and Relevance To our knowledge, this is the first time a detrimental effect of high dosages of FA supplements during pregnancy on psychomotor development after the first year of life has been shown. Further research from longitudinal studies is warranted to confirm these results.