Public Health Nutrition

To present the Mediterranean diet (MD) pyramid: a lifestyle for today.

A new graphic representation has been conceived as a simplified main frame to be adapted to the different nutritional and socio-economic contexts of the Mediterranean region. This review gathers updated recommendations considering the lifestyle, dietary, sociocultural, environmental and health challenges that the current Mediterranean populations are facing.

Mediterranean region and its populations.

Many innovations have arisen since previous graphical representations of the MD. First, the concept of composition of the ‘main meals’ is introduced to reinforce the plant-based core of the dietary pattern. Second, frugality and moderation is emphasised because of the major public health challenge of obesity. Third, qualitative cultural and lifestyle elements are taken into account, such as conviviality, culinary activities, physical activity and adequate rest, along with proportion and frequency recommendations of food consumption. These innovations are made without omitting other items associated with the production, selection, processing and consumption of foods, such as seasonality, biodiversity, and traditional, local and eco-friendly products.

Adopting a healthy lifestyle and preserving cultural elements should be considered in order to acquire all the benefits from the MD and preserve this cultural heritage. Considering the acknowledgment of the MD as an Intangible Cultural Heritage of Humanity by UNESCO (2010), and taking into account its contribution to health and general well-being, we hope to contribute to a much better adherence to this healthy dietary pattern and its way of life with this new graphic representation.

To develop a targeted FFQ (TFFQ) and evaluate its effectiveness for ranking minority women by their intake of multiple nutrients important to a healthy pregnancy.

In Stage 1, food groups derived from 24 h recall dietary data were entered into a stepwise multiple regression model to identify ‘discriminating’ foods for the TFFQ; in Stage 2, the TFFQ and a 24 h recall were administered to pregnant women. The TFFQ data were used to create a Habitual Multi-Nutrient Intake Scale (H-MNIS) for ranking the women. The effectiveness of the ranking was tested against women’s reported nutrient intakes on the 24 h recall.

Southern Israel.

In Stage 1, 519 Bedouin Arab adults; in Stage 2, 404 pregnant Bedouin women.

Of the ninety-three food groups included in the regression analysis, twenty-eight explained >80 % of the between-person variability in the intake of the target nutrients. Whole-wheat bread was a main discriminator for protein, Fe, Zn, Ca and folate. Fish, poultry and canned tuna explained ≥88 % of the between-person variation in DHA and EPA intakes. The mean daily intakes of pregnant Bedouin women from the 24 h recall data differed significantly across H-MNIS quartiles (P < 0·01) for all but three target nutrients (folate, EPA, DHA); and the P for trend was significant (P < 0·02) for all but EPA.

The TFFQ and H-MNIS represent rapid assessment tools for studying maternal nutrition on a multi-nutrient basis, and effectively ranked pregnant Bedouin women into exposure groups by their intake of the target nutrients.

To evaluate the utility of the Mini-Nutritional Assessment (MNA) in assessing nutritional, physical and psychosocial functions in community-living elderly individuals.

A cross-sectional study of elderly individuals investigated in August 2007 and August–September 2008. Nutritional status was assessed using serum biomarkers, anthropometric measurements and the MNA. Physical function was assessed by measuring grip strength and both usual and maximum walking speeds. The Geriatric Depression Scale (GDS) was used to measure the individual's depressive state.

Elder-care facilities in Tokyo, Japan.

Community-living elderly individuals aged ≥65 years (n 130).

The MNA evaluation classified twenty-seven (20·8 %) individuals as being at risk for malnutrition (MNA score ≤23·5); these at-risk individuals included a high proportion of the elderly aged ≥75 years. MNA scores correlated with nutritional biomarkers (total protein, albumin, cholinesterase, Hb) and anthropometric measurements (triceps skinfold, subscapular skinfold, mid-arm muscle area) and exhibited a strong correlation with grip strength and GDS score. Multivariate analysis revealed that grip strength, GDS score, marital status and maximum walking speed are strong predictors of MNA score.

The MNA is considerably useful in providing a comprehensive assessment of nutritional status in elderly, community-living Japanese. However, larger-scale epidemiological studies are needed to determine the utility and the appropriate cut-off point of the MNA as a screen for risk of malnutrition.

To assess the available data on the prevalence of metabolic syndrome (MS) in Latin-American countries.

Systematic review. Searches were carried out in PubMed, ISIWeb, SCielo and Redalyc, using ‘metabolic syndrome x’ and ‘prevalence’ as keywords for titles and/or abstracts. Articles selected were cross-sectional studies in Latin-American countries, whose main objective was to study MS and whose study population is described below. MS must be determined using Adult Treatment Panel III criteria. Twelve studies with these criteria were selected, one of which was multi-centric.

Latin America.

Apparently healthy subjects aged 18–65 years (including young adult, mature adult and elderly populations) of both genders.

The general prevalence (weighted mean) of MS in Latin-American countries was 24·9 (range: 18·8–43·3) %. MS was slightly more frequent in women (25·3 %) than in men (23·2 %), and the age group with the highest prevalence of MS consisted of those over 50 years of age. The most frequent components of MS were low HDL cholesterol levels (62·9 %) and abdominal obesity (45·8 %). Similar outcomes were obtained from the multi-centre study on Latin-American populations analysed.

The present review brings us closer to an understanding of the prevalence of MS in Latin-American countries. However, it is not possible to know the full scope of the problem, partly because data from some countries are not available, and because the methodological differences among the studies published up to the present limit a joint analysis of their results.

The present study was conducted to assess the current status of iodine-deficiency disorders (IDD) in the National Capital Region of Delhi (NCR Delhi) and evaluate the implementation and impact of the National Iodine Deficiency Disorders Control Programme (NIDDCP).

Cross-sectional study.

School-going children (n 1230) in the age group of 6–12 years were enrolled from thirty primary schools in the Municipal Corporation of Delhi. Thirty schools were selected using the probability-proportional-to-size cluster sampling methodology. In each identified school forty-one children were surveyed. Urine and salt samples were collected and studied for iodine concentration. A total of sixty salt samples from retail level were also collected.

Schoolchildren aged 6–12 years.

The median urinary iodine excretion (UIE) was found to be 198·4 μg/l. The percentage of children with UIE levels of <20·0, 20·0–49·9, 50·0–99·9 and ≥100·0 μg/l was 1·9, 4·3, 9·5 and 84·2 %, respectively. The proportion of households consuming adequately iodized salt (salt with iodine levels of at least 15 ppm at consumption level) was 88·8 %. The assessment of iodine content of salt revealed that only 6·1 % of the families were consuming salt with iodine content less than 7 ppm. At retail level 88·3 % of salt samples had >15 ppm iodine.

Significant progress has been achieved towards elimination of IDD from NCR Delhi. There is a need for further strengthening of the system to monitor the quality of iodized salt provided to the beneficiaries under the universal salt iodization programme and so eliminate IDD from NCR Delhi.

To examine dietary patterns among British adults, associations with Na and macronutrient intakes, and implications for dietary advice.

Principal component analysis of 7 d weighed dietary records.

Adults aged 19–64 years (n 1724).

National Diet and Nutrition Survey (2000/2001).

High Na intake was associated with more energy-dense diets, higher in fat and SFA (percentage of energy) but lower in non-milk extrinsic sugars (NMES). Eight patterns (PC1 to PC8) explained 40 % of the total variance in food intakes. Three patterns – PC3 (high loadings on bread, fats and cheese), PC2 (meat products, eggs and chips) and PC7 (red meat, sauces and alcohol) – were associated with high Na intake. Of these, PC3 correlated with high Na density and Na:K ratio, while PC2 correlated with fat. By contrast, three patterns – ‘health-conscious’ (PC1; vegetables, fruit, fruit juice, fish), ‘breakfast cereals and milk’ (PC6) and ‘chicken and rice’ (PC8) – were associated with modest Na intake, lower Na density and lower fat and SFA. PC2 was positively correlated, and PC1 was negatively correlated, with adding salt to food. Other patterns were ‘tea/coffee and cakes’ (PC4; associated with high SFA and NMES) and ‘soft drinks and snacks’ (PC5; associated with high NMES but not fat or SFA). The dietary patterns of males and females differed slightly.

Dietary patterns PC1, PC6, PC8 (vegetables, fruit, fish, milk, breakfast cereals, poultry) were broadly compatible with guidelines for salt, fat, SFA and NMES. However, other patterns tended to be high in either salt or NMES.

To build up sufficient knowledge of a ‘healthy diet’. Here, we report on the assessment of nutritional knowledge using a uniform method in a large sample of adolescents across Europe.

A cross-sectional study.

The European multicentre HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study conducted in 2006–2007 in ten cities in Austria, Belgium, France, Germany, Greece (one inland and one island city), Hungary, Italy, Spain and Sweden.

A total of 3546 adolescents (aged 12·5–17·5 years) completed a validated nutritional knowledge test (NKT). Socio-economic variables and anthropometric data were considered as potential confounders.

NKT scores increased with age and girls had higher scores compared with boys (62 % v. 59 %; P < 0·0001). Scores were approximately 10 % lower in ‘immigrant’ adolescents or in adolescents with ‘immigrant’ mothers. Misconceptions with respect to the sugar content in food or in beverages were found. Overall, there was no correlation between BMI values and NKT scores. After categorization according to BMI, scores increased significantly with BMI group only in boys. These differences disappeared after controlling for socio-economic status (SES). Smoking status and educational level of the mother influenced the NKT scores significantly in boys, as well as the educational levels of both parents in girls.

Nutritional knowledge was modest in our sample. Interventions should be focused on the lower SES segments of the population. They should be initiated at a younger age and should be combined with environmental prevention (e.g. healthy meals in school canteens).