Nuestros investigadores

Itzíar Zazpe García

Departamento
Ciencias de la Alimentación y Fisiología
Facultad de Farmacia y Nutrición. Universidad de Navarra
Líneas de investigación
Epidemiología Nutricional, Dietética práctica
Índice H
15, (WoS, 26/02/2018)

Publicaciones científicas más recientes (desde 2010)

Autores: Santiago, Susana, (Autor de correspondencia); Bes-Rastrollo, Maira; Martínez, Miguel Ángel; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 36  2019  págs. 39 - 46
Introduction: Navarra is a Community that presents a great geographical and climatic variety, which results in a wide food supply. Objectives: to review the typical gastronomy of Navarra, as well as the available evidence on dietary patterns, nutritional profile and health indicators of Navarra population. Results: Navarra has 7 Protected Designations of Origin and 6 Protected Geographical Indications. Its gastronomic identity is mainly associated with vegetables, lamb, veal and local sausages, which is reflected in dietary patterns. Comparatively, Navarra population consumes more vegetables and fresh fruits, but also has a frequent and excessive intake of meat (especially red) and sausages. The studies available on nutritional profile show high intakes of proteins and fats in the adult population, and inadequacy in some micronutrients in children. In the national context, Navarra has lower rates of overweight, obesity and sedentariness in the adult population, and there is a downward trend in the prevalence of childhood obesity. Conclusions: the food and gastronomic offer of Navarra is varied and with a great prominence of vegetables, although dietary patterns can be improved. To achieve a healthy and sustainable diet, it is essential to promote culinary knowledge and skills from an early age.
Autores: Zazpe I; et al.
Revista: OBESITY FACTS
ISSN 1662-4025  Vol. 12  Nº Supl. 1  2019  págs. 112
Autores: Martínez, Miguel Ángel, (Autor de correspondencia); Hershey, M. S.; Zazpe I, (Autor de correspondencia); et al.
Revista: NUTRIENTS
ISSN 2072-6643  Vol. 10  Nº 7  2018  págs. 823
Autores: Papadaki, A.; Johnson, L.; Toumpakari, Z.; et al.
Revista: NUTRIENTS
ISSN 2072-6643  Vol. 10  Nº 2  2018  págs. E318
The aim of this study was to examine the validity of the English version of the PREvencion con DIetaMEDiterranea (PREDIMED) 14-item Mediterranean Diet Adherence Screener (MEDAS), a brief questionnaire assessing adherence to the Mediterranean diet (MedDiet), which was used in the PREDIMED trial for assessment and immediate feedback. This instrument (MEDAS) was administered to 96 adults with a high cardiovascular risk (66% women, mean age 68.3 ± 6.0 years), recruited from general practices in Bristol, UK. Participants then completed a 3-day estimated food record, and the MEDAS was administered again one month later. A MedDiet score (range = 0-14) was calculated from the MEDAS' administrations and food record to assess concurrent validity and test-retest reliability. Predictive validity was assessed by examining the association of the MEDAS-derived score with cardiometabolic risk factors and dietary intakes derived from the food records. The MEDAS-derived MedDiet score was higher by 1.47 points compared to food records (5.47 vs.4.00, p < 0.001), correlated moderately with the record-derived score (r = 0.50, p < 0.001; ICC = 0.53, p < 0.001) and there was borderline fair agreement between the two methods (¿ = 0.19, 95% CI 0.07-0.31, p = 0.002; 95% limits of agreement -2.2, 5.1). Exact agreement within score categories and gross misclassificationwere 45.8% and 21.9%, respectively. The distribution of dietary intakes, reported on the food records by the MEDAS-derived total MedDiet score, was in the expected direction, but no association was observed with cardiometabolic risk factors. The two administrations of the MEDAS produced similar mean total MedDiet scores (5.5 vs. 5.4, p = 0.706), which were correlated (r and ICC = 0.69, p < 0.001) and agreed fairly (¿ = 0.38, 95% CI 0.24-0.52, p < 0.001; 95% limits of agreement -3.1, 3.2). The English version of the MEDAS has acceptable accuracy and reliability for assessing MedDiet adherence among individuals with a high cardiovascular risk, in the UK, and can be used to rank individuals according to MedDiet adherence in research and practice.
Autores: Alvarez, Ismael; Zazpe I; Pérez de Rojas, J.; et al.
Revista: PREVENTIVE MEDICINE
ISSN 0091-7435  Vol. 106  2018  págs. 45 - 52
The health benefits of the Mediterranean diet (MedDiet) and of physical activity (PA) have been widely documented. However, no longitudinal studies have investigated their combined effect on mortality. We assessed the individual and combined effects of adherence to the MedDiet and PA on all-cause mortality. We used data from 19,467 participants from a prospective cohort of Spanish university graduates, the SUN cohort, followed-up between December 1999 and February 2016. Adherence to the MedDiet was assessed using four different dietary scores, categorizing the quantitative scores into tertiles of adherence. To assess multiple dimensions of PA, an 8-item score was built. Multivariable Cox regression models were used to study the individual and combined relationship of adherence to the MedDiet and PA with all-cause mortality. During a median follow-up of 10.3 years, we registered 305 deaths. Compared with the lowest adherence to the MedDiet (< 20 in the modified Mediterranean diet score), better adherence (23¿30 points) was associated with lower mortality (multivariable-adjusted hazard ratio [HR] = 0.66, 95% confidence interval [CI]: 0.46¿0.96). Engaging in moderate or high levels of PA (versus lower levels) was associated with 44% and 52% relative reductions in mortality, respectively. High adherence to the MedDiet combined with engaging in higher amounts of PA showed a HR = 0.36 (95% CI: 0.19¿0.67). We documented that the combined effect of better adherence to the MedDiet and increased PA had multiplicative effects on mortality risk reduction.
Autores: Lahortiga F; Unzueta, C.; Zazpe I; et al.
Revista: BMC PSYCHIATRY
ISSN 1471-244X  Vol. 18  Nº 1  2018  págs. 241
BACKGROUND: Emerging evidence suggests a possible etiologic role of certain personality traits (not necessary dysfunctional) in the risk of depression, but the longitudinal long-term available evidence is currently scarce. We longitudinally assessed whether 3 common personality traits (competitiveness, tension and dependency) were associated with the risk of depression after a maximum follow-up of 15 years. METHODS: We assessed 15,604 university graduates free of depression at baseline through a self-administered questionnaire including personality traits. Simple, Likert-type, questions with 11 possible answers ranging from 0 to 10 were used at baseline to assess the 3 personality traits. We compared participants with high scores (7-10) versus those with low scores (0-4). New medical diagnoses of depression during follow-up were used as the outcome. RESULTS: During a median follow-up of 10.1 y, we prospectively identified 902 new medical diagnoses of depression. The multivariable-adjusted hazard ratios (95% confidence intervals) for depression were 1.85 (1.52-2.24) for participants with higher baseline tension (7-10 versus 0 to 4), P-trend <¿0.001; and 1.23 (1.06-1.44) for high versus low baseline dependence levels, P-trend¿=¿0.004. Higher levels of competitiveness were marginally associated with lower risk of depression, with hazard ratio¿=¿0.78 (0.61-1.01), P-trend¿=¿0.105. CONCLUSION: A simple scoring system of personality traits shows an independent association with the future occurrence of depression. This finding underscores, with now prospective evidence, the importance of personality traits in the aetiology of depression and can provide a clinically useful tool for gathering valid information about depression-related personality traits.
Autores: Zazpe I; et al.
Revista: NUTRIENTS
ISSN 2072-6643  Vol. 10  Nº 10  2018  págs. 1500
High rates of childhood obesity require integral treatment with lifestyle modifications that achieve weight loss. We evaluated a lifestyle intervention on nutrient adequacy and diet quality in children and adolescents with abdominal obesity. A randomized controlled trial was performed on 107 participants, assigned either to a usual care group or to an intensive care group that followed a moderate hypocaloric Mediterranean diet and received nutritional education. Intake adequacy was evaluated using Dietary Reference Intakes and diet quality through the Diet Quality Index for Adolescents (DQI-A), the Healthy Lifestyle Diet-Index (HLD-I) and the Mediterranean Diet Quality Index (KIDMED). Both groups achieved a significant reduction in BMI standard deviation score (BMI-SDS), glucose and total cholesterol levels. Intake of Calcium, Iodine and vitamin D were higher in the intensive care group, with enhanced compliance with recommendations. Higher dietary scores were associated with lower micronutrient inadequacy. DQI-A and HLD-I were significantly higher in the intensive care group vs. usual care group after the treatment. In conclusion, we observed that an intensive lifestyle intervention was able to reduce BMI-SDS in children with abdominal obesity. Furthermore, participants significantly improved dietary indices getting closer to the nutritional recommendations. Therefore, these diet quality indices could be a valid indicator to evaluate micronutrient adequacy.
Autores: Zazpe I; Santiago, Susana; et al.
Revista: NUTRIENTS
ISSN 2072-6643  Vol. 10  Nº 12  2018  págs. 1875
Parental nutrition knowledge and attitudes play a fundamental role in their children's food knowledge. However, little is known about their influence on their children's diet quality and micronutrient intake. Thus, we aimed to assess the association of parental nutrition knowledge and healthy-eating attitudes with their children's adherence to the Mediterranean dietary pattern and micronutrient adequacy. Parental healthy-eating attitudes and knowledge of the quality of their child's diet as well as anthropometric, lifestyle, and nutrient intake characteristics were recorded with a basal questionnaire that included a 140-item-food frequency-questionnaire. A total of 287 pre-school children were included in the analyses. Intake adequacy was defined using the Estimated Average Requirements (EAR) cut-off point method. We developed a parental nutrition knowledge and healthy-eating attitudes scores and evaluated whether they were independently associated with 1) children's inadequate intake (probability of failing to meet 3 EAR) of micronutrients, using logistic regression analyses, and 2) children's diet quality (adherence to the Mediterranean Diet according to a Mediterranean Diet Quality Index for children and adolescents, the KIDMED index), using multiple linear regression models. A higher score in the parental healthy-eating attitudes score was associated with lower risk of failing to meet 3 EAR compared with the reference category (odds ratio (OR): 0.3; 95% confidence interval (CI) 0.12-0.95; p for trend: 0.037) and a higher adherence to the Mediterranean diet in the most adjusted model ( coefficient: 0.34; 95% CI 0.01-0.67; p for trend: 0.045). Our results suggest a positive association of parental healthy-eating attitudes with nutritional adequacy and diet quality in a sample of Spanish preschoolers. Public health strategies should focus on encouraging parental healthy-eating attitudes rather than simply educating parents on what to feed their children, recognizing the important influence of parental behavior on children's practices.
Autores: Unzueta, C. R.; Lahortiga F; Santiago, Susana; et al.
Revista: PUBLIC HEALTH
ISSN 0033-3506  Vol. 157  2018  págs. 32 - 42
OBJECTIVE: The objective of this study is to assess the differences in lifestyles according to levels of self-perceived competitiveness, psychological tension, and dependency in a Mediterranean cohort of university graduates. STUDY DESIGN: Levels of personality traits, food consumption, nutrient intake, eating attitudes, physical activity, sedentary lifestyle, and alcohol and tobacco consumption were assessed through a questionnaire administered at baseline. This was a cross-sectional study in the context of the Seguimiento Universidad de Navarra cohort. Participants are 15,346 Spanish adults. RESULTS: Participants with a high level of self-perceived competitiveness consumed more vegetables and fish but less refined grains; they had higher protein intake and healthier eating attitudes. They were more physically active and less likely to be smokers. Participants with a high level of tension or dependency were less physically active, and participants more dependent also had poorer adherence to the Mediterranean diet. CONCLUSIONS: Self-perceived personality traits, especially the trait of competitiveness, are likely to be associated with healthier dietary patterns, better nutrient profile, better eating attitudes, physical activity, and less exposure to smoking. The use of short questions about self-perceived levels of competitiveness, psychological tension, and dependency can contribute to add additional information when assessing lifestyles and diet in adults.
Autores: Peñafel-Freire, D. M.; Martín, Nerea; García-Blanco, L.; et al.
Revista: REVISTA PEDIATRICA DE ATENCION PRIMARIA
ISSN 2174-4106  Vol. 20  2018  págs. 45 - 52
Introducción: la leche y los derivados lácteos son alimentos importantes para el desarrollo. Sin embargo, la creencia de que se asocian con infecciones respiratorias está provocando que se limite su consumo o se sustituya por bebidas vegetales. El objetivo del estudio fue analizar si el consumo de lácteos se asocia con determinadas infecciones respiratorias en la infancia. Material y métodos: estudio transversal con 169 voluntarios de entre 4 y 7 años. Información recogida mediante cuestionarios en papel. Información dietética recogida mediante cuestionario de frecuencia de consumo de alimentos semicualitativo de 151 ítems. Se valoró la asociación del consumo de leches, quesos y yogures con determinadas enfermedades respiratorias (otitis media aguda, sinusitis, mastoiditis, neumonía), comparando dos categorías de consumo definidas a partir de la mediana de cada alimento, mediante regresión logística multivariable. Resultados: no se encontraron asociaciones entre el consumo de lácteos y las enfermedades respiratorias analizadas (odds ratio: 0,85; intervalo de confianza del 95%: 0,44 a 1,64]). Al analizar cada lácteo por separado, se encontró una asociación inversa entre el consumo de quesos y las enfermedades respiratorias en conjunto (odds ratio: 0,50; intervalo de confianza del 95%: 0,26 a 0,98), pero no para cada una de las infecciones por separado (otitis media aguda ni neumonía). No se encontró asociación significativa con los desenlaces para ningún otro derivado lácteo (leche o yogures). Conclusiones: los resultados no apoyan una asociación directa entre el consumo de leche y derivados con infecciones respiratorias en la infancia. Con los datos actuales no está justificado restringir el consumo de leche o derivados en niños en edad escolar
Autores: Zazpe I; et al.
Revista: EUROPEAN JOURNAL OF NUTRITION
ISSN 1436-6207  Vol. 57  Nº 7  2018  págs. 2409 - 2419
PURPOSE: The aim of the study was to prospectively assess the association between micronutrient intake adequacy and risk of depression. METHODS: This dynamic cohort study involves Spanish university graduates (SUN Project). Dietary intake was assessed at baseline and after 10 years of follow-up with a semi-quantitative food frequency questionnaire. Micronutrient intake adequacy for vitamins B1, B2, B3, B6, B12, C, A, D, E, folic acid, zinc, iodine, selenium, iron, calcium, potassium, phosphorus, magnesium and chrome was estimated. Inadequate intake for each nutrient was defined when the intake of the nutrient was below the estimated average requirements (EAR) if available or the adequate intake levels, if EARs were not available. We compared participants with inadequate intake for ¿4 nutrients vs. those with one nutrient. Participants were classified as having incident depression if they had no previous history of depression or antidepressants use at baseline, but they reported during follow-up a new clinical diagnosis of depression by a physician, use of antidepressant drugs, or both. Time-dependent multivariable Cox regression models were fitted. RESULTS: After a median follow-up of 8.5 years, 953 new cases of depression were observed among 13,983 participants. Participants with inadequate intake for ¿4 nutrients showed a significantly higher risk of depression [multivariable hazard ratio (HR) = 1.37; 95% confidence interval (CI) 1.01-1.85]. When the analyses were updated with repeated assessments of intakes, the association was attenuated and it was no longer statistically significant (Multivariable HR = 1.11; 95% CI 0.82-1.51). CONCLUSIONS: Micronutrient inadequacy in four or more micronutrients could exert a moderate role in the development of depression.
Autores: Santiago, Susana; Zazpe I; Gea, Alfredo; et al.
Revista: JOURNAL OF NUTRITION HEALTH AND AGING
ISSN 1279-7707  Vol. 22  Nº 4  2018  págs. 526 - 533
To examine the association between a dietary fat quality index (FQI), and the risk of incident cardiovascular events or deaths in the Seguimiento Universidad de Navarra (SUN) cohort. Longitudinal analysis during 10.1 years of median follow-up. Cox models were used to estimate adjusted hazard ratios (HR) of incident cardiovascular diseases (CVD) according to tertiles of FQI and of different fat subtypes. University of Navarra, Spain. 19,341 middle-aged adults. Fat intake was measured with a validated food-frequency questionnaire. The FQI was calculated according to the ratio: (monounsaturated+polyunsaturated) / (saturated+trans fatty acids). We observed 140 incident cases of CVD. No association was found for FQI (HR=0.94, 95 %CI 0.61-1.47 for the highest vs the lowest tertile, p for trend=0.884). No significant associations were found for different dietary fat subtypes on CVD risk. The results suggest no clear association between a higher FQI and a higher amount of energy from fat and incidence of CVD (p for interaction: 0.259 and p for trend only among participants with a percentage of energy from fat ae<yen>35% of total energy: 0.272). In this Mediterranean cohort, the FQI was not associated with cardiovascular events. A "heart-healthy diet" should focus its attention on dietary fat sources and should use an overall dietary pattern approach, rather than limiting the focus on fat subtypes. More research is needed to validate dietary advice on specific fatty acids intake or saturated fatty acids replacements for reducing CVD risk.
Autores: Alvarez, Ismael; de Rojas, J. P.; Fernández-Montero, Alejandro; et al.
Revista: EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY
ISSN 2047-4873  Vol. 25  Nº 11  2018  págs. 1186 - 1197
Background Inverse associations of the Mediterranean diet (MedDiet) and physical activity with cardiovascular disease have been previously reported. We investigated the individual and combined contributions of both to this inverse association in a Mediterranean cohort. Design We used data from 19,536 participants from a prospective cohort of Spanish university graduates, the 'Seguimiento Universidad de Navarra' (SUN) cohort, followed up between December 1999 and December 2016. Methods Adherence to the MedDiet was obtained from a 136-item validated food-frequency questionnaire and categorized in tertiles using four previously reported dietary scores. A validated questionnaire assessed the physical activity levels according to volume, intensity and frequency. Results Participants were followed up during a median time of 10.4 years. Compared with the lowest category of adherence to the MedDiet (¿3 in the Mediterranean Diet Score), higher adherence (6-9 points) was strongly inversely associated with cardiovascular disease (multivariable adjusted hazard ratio¿=¿0.33; 95% confidence interval (CI) 0.20-0.55). Also, engaging in an active lifestyle (6-8 points in an eight-item score) compared with low activity (<2 points) was associated with a reduced risk of incident cardiovascular disease (hazard ratio¿=¿0.43; 95% CI 0.20-0.90). Greater adherence to the MedDiet and engaging in high levels of active lifestyle showed a 75% relatively reduced risk of cardiovascular disease (hazard ratio¿=¿0.25; 95% CI 0.13-0.48). Conclusions The combined effect of adherence to the MedDiet and adopting an active lifestyle showed a synergistic inverse association with cardiovascular disease risk.
Autores: de la Fuente-Arrillaga, Carmen; Bes-Rastrollo, Maira; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 35  Nº 1  2018  págs. 153 - 161
Introduction and objectives: Our aim was to prospectively evaluate the association between egg consumption and dyslipidemia in a Mediterranean cohort. Methods: We followed-up 13,104 Spanish university graduates for a mean period of 8 years. Dietary habits at baseline were assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Self-reported blood concentrations of total cholesterol, high-density lipoproteins cholesterol (HDL-c) and triglycerides were evaluated according to categories of egg consumption after 6 and 8 years of follow-up. We also assessed the association between baseline egg consumption and the incidence of hypercholesterolemia, low HDL-c concentrations and hypertriglyceridemia during follow-up. Results: We observed a significant inverse association for intermediate levels of egg consumption (2 to 4 eggs/week vs. less than 1 egg/week) and hypertriglyceridemia with OR = 0.71 (95% confidence interval [CI]: 0.54 to 0.93, p < 0.05) in the multivariable-adjusted model. Using HDL-c values after 8-year follow-up, we found an association between higher egg consumption and lower HDL-c levels (p for trend = 0.02) with an adjusted difference of -4.01 mg/dl (-7.42 to -0.61) for > 4 vs. < 1 egg/week. Lower means of triglycerides were found in each of the three upper categories of egg consumption compared to the lowest category (< 1 egg/week) with significant results for some of these categories both after 6 and 8 year follow-up. Conclusions: Our data do not support that higher egg consumption was associated with abnormal blood levels of total cholesterol or triglycerides; an inverse association with HDL-c as a quantitative variable was found only in one of our analyses.
Autores: Martínez, Miguel Ángel; Zazpe I; et al.
Revista: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN 0014-2972  Vol. 48  Nº Supl 1  2018  págs. 174 - 175
Autores: Alvarez, Ismael; Zazpe I; de Rojas, J. P.; et al.
Revista: EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
ISSN 0014-2972  Vol. 48  Nº Supl 1  2018  págs. 170
Autores: Mari-Bauset, S.; Llopis-Gonzalez, A.; Zazpe I; et al.
Revista: AUTISM
ISSN 1362-3613  Vol. 21  Nº 3  2017  págs. 310 - 322
This case-control study investigated nutrient intake, healthy eating index with 10 items on foods and nutrients, on 3-day food diaries and anthropometric measurements in 105 children with autism spectrum disorder and 495 typically developing children (6-9years) in Valencia (Spain). Children with autism spectrum disorder were at a higher risk for underweight, eating more legumes, vegetables, fiber, and some micronutrients (traditional Mediterranean diet) but fewer dairy and cereal products, and less iodine, sodium, and calcium than their typically developing peers. Differences existed in total energy intake but healthy eating index and food variety score differences were not significant. Autism spectrum disorder group failed to meet dietary recommendations for thiamin, riboflavin, vitamin C, or calcium. Risk of inadequate intake of fiber, vitamin E, and sodium was lower in children with autism spectrum disorder than typically developing children. Results suggest that (1) risk of inadequate intake of some micronutrients in children with autism spectrum disorder and (2) cultural patterns and environment may influence food intake and anthropometric characteristics in autism spectrum disorder. Primary care should include anthropometric and nutritional surveillance in this population to identify intervention on a case-by-case basis. Future research should explore dietary patterns and anthropometric characteristics in different autism spectrum disorder populations in other countries, enhancing our understanding of the disorder's impact.
Autores: Sanchez-Villegas, A.; Zazpe I; Santiago, Susana; et al.
Revista: BRITISH JOURNAL OF NUTRITION
ISSN 0007-1145  Vol. 119  Nº 2  2017  págs. 211 - 221
The association between added sugars or sugar-sweetened beverage consumption and the risk of depression, as well as the role of carbohydrate quality in depression risk, remains unclear. Among 15 546 Spanish university graduates from the Seguimiento Universidad de Navarra (SUN) prospective cohort study, diet was assessed with a validated 136-item semi-quantitative FFQ at baseline and at 10-year follow-up. Cumulative average consumption of added sugars, sweetened drinks and an overall carbohydrate quality index (CQI) were calculated. A better CQI was associated with higher whole-grain consumption and fibre intake and lower glycaemic index and consumption of solid (instead of liquid) carbohydrates. Clinical diagnoses of depression during follow-up were classified as incident cases. Multivariable time-dependent Cox regression models were used to estimate hazard ratios (HR) of depression according to consumption of added sugars, sweetened drinks and CQI. We observed 769 incident cases of depression. Participants in the highest quartile of added sugars consumption showed a significant increment in the risk of depression (HR=1·35; 95 % CI 1·09, 1·67, P=0·034), whereas those in the highest quartile of CQI (upper quartile of the CQI) showed a relative risk reduction of 30 % compared with those in the lowest quartile of the CQI (HR=0·70; 95 % CI 0·56, 0·88). No significant association between sugar-sweetened beverage consumption and depression risk was found. Higher added sugars and lower quality of carbohydrate consumption were associated with depression risk in the SUN Cohort. Further studies are necessary to confirm the reported results.
Autores: Andrade, L.; Zazpe I; Santiago, Susana; et al.
Revista: JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
ISSN 0731-5724  Vol. 36  Nº 5  2017  págs. 319 - 329
OBJECTIVE: The objective of this study was to assess the within-subject longitudinal changes in self-perceived healthy eating attitudes after 10 years of follow-up and to identify predictors of long-term changes in a middle-aged adult cohort. METHODS: Four thousand five hundred seventy-two participants completed a validated food frequency questionnaire (FFQ) at baseline and after 10 years of follow-up. The FFQ was expanded with a brief 10-item questionnaire about eating attitudes with 2 possible answers: yes or no. A baseline score and a 10-year score were calculated with these 10 items (range from 0 to 10). Participants were categorized into 3 groups according to this score. Linear and logistic regressions were used to examine changes at follow-up and associations between baseline characteristics and improvement in the score. RESULTS: After 10 years of follow-up, a statistically significant favorable change (p < 0.001) was achieved in all questions about eating attitudes, particularly in these items: "Do you try to eat less sweets and pastries?" (12%), "Do you try to eat less meat?" (11.1%), and "Do you try to reduce your fat intake?" (10%). Being female (odds ratio [OR] = 1.19, 95% confidence interval [CI], 1.02-1.39), being 35-50 or ¿ 50 years old (OR = 1.24, 95% CI, 1.07-1.44 and OR = 1.74, 95% CI, 1.38-2.18, respectively), a high level of physical activity (OR for third vs first tertile = 1.20, 95% CI, 1.02-1.41), and a higher Mediterranean diet score (OR for second and third tertiles = 1.18, 95% CI, 1.01-1.37 and OR = 1.26, 95% CI, 1.04-1.52, respectively) were associated with a higher probability of improving the eating attitudes score, while a low body mass index (BMI; OR = 0.71, 95% CI, 0.51-1.00) and snacking between meals (OR = 0.84, 95% CI, 0.73-0.97) were associated with a lower probability of improving their score. CONCLUSIONS: The eating attitudes of the participants in the Seguimiento Universidad de Navarra (SUN) cohort became more favorable after 10 years of follow-up. Certain sociodemographic or clinical variables may predict a positive change.
Autores: Santiago, Susana; Zazpe I; Gea, Alfredo; et al.
Revista: INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION
ISSN 0963-7486  Vol. 68  Nº 5  2017  págs. 595 - 604
There is an emerging use of brief dietary questionnaires to investigate diet-health relation. We prospectively assess the association between eating attitudes (yes/no) and incident cardiovascular disease (CVD) in 19,138 participants of the Seguimiento Universidad de Navarra (SUN) Cohort. We calculated a baseline healthy-eating attitudes score (in quartiles), positively weighting answers on more fruit, vegetables, fish and fiber and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. We observed 139 incident cases of CVD. A higher score was associated with a lower risk of CVD [3-5 points Hazard Ratio (HR): 0.38 (95% confidence interval: 0.18-0.81); 6-8 points: 0.57 (0.29-1.12); 9-10 points: 0.31 (0.15-0.67), compared to 0-2 points]. Key contributors were the attitude to increase fruit [HR: 0.59 (0.40-0.87)], vegetables [HR: 0.57 (0.29-1.12)] and fiber intake [HR: 0.69 (0.48-0.98)]. Brief questionnaire on attitudes towards healthy-eating may be a useful tool for the primary prevention of CVD.
Autores: Martínez, Miguel Ángel; Hershey, M. S.; Zazpe I; et al.
Revista: NUTRIENTS
ISSN 2072-6643  Vol. 9  Nº 11  2017  págs. Article number: 1226
Substantial evidence has verified the Mediterranean diet¿s (MedDiet) nutritional adequacy, long-term sustainability, and effectiveness for preventing hard clinical events from cardiovascular disease (CVD), as well as increasing longevity. This article includes a cumulative meta-analysis of prospective studies supporting a strong inverse association between closer adherence to the MedDiet and the incidence of hard clinical events of CVD. The MedDiet has become an increasingly popular topic of interest when focusing on overall food patterns rather than single nutrient intake, not only in Mediterranean countries, but also globally. However, several myths and misconceptions associated with the traditional Mediterranean diet should be clearly addressed and dispelled, particularly those that label as ¿Mediterranean¿ an eating pattern that is not in line with the traditional Mediterranean diet. The transferability of the traditional MedDiet to the non-Mediterranean populations is possible, but it requires a multitude of changes in dietary habits. New approaches for promoting healthy dietary behavior consistent with the MedDiet will offer healthful, sustainable, and practical strategies at all levels of public health. The following article presents practical resources and knowledge necessary for accomplishing these changes.
Autores: de la Fuente-Arrillaga, Carmen; Bes-Rastrollo, Maira; Zazpe I; et al.
Revista: REVISTA ESPAÑOLA DE NUTRICION HUMANA Y DIETETICA
ISSN 2173-1292  Vol. 21   Nº Supl. 1  2017  págs. 28 - 29
Autores: de la Fuente-Arrillaga, Carmen; Zazpe I; Santiago, Susana; et al.
Revista: BMC PUBLIC HEALTH
ISSN 1471-2458  Vol. 16  Nº 209  2016  págs. 203
Nutritional adequacy implies sufficient intake of essential nutrients needed to [...] Background The assessment of changes in dietary habits provides interesting information on whether or not the observed trends are in line with accepted nutritional guidelines. The objective was to evaluate within-subject longitudinal changes in food consumption and nutrient intake and in a 10-year follow-up study. Methods The SUN ( ) project is a prospective Spanish cohort study. Diet was assessed using a 136-item food-frequency questionnaire (FFQ), previously validated in Spain. The participants were 3036 university graduates (55.8 % women) of Spain and the main outcome measures the changes in dietary quality and in food consumption and nutrient intake. Paired t-tests and conditional logistic regression models were used to evaluate within-subject longitudinal dietary changes and the risk of inadequacy respectively, after 10 years of follow-up. Results During follow-up, participants showed a relevant and significant increase (p 0.001) in the consumption of fruits (7.4 %), vegetables (8.6 %), low-fat dairy products (35.2 %), lean meat (12.4 %), fish (2.9 %), whole grains (53.2 %), nuts (52.4 %) and a significant decrease in legumes (-7.4 %), whole-fat dairy products (-44.2 %), red meat (-17.6 %), sugar-sweetened beverages (-58.7 %) and wine (-11.9 %). With respect to nutrients, we found a higher proportion of carbohydrates (3.6 %) and fiber (7.4 %) and a decrease in total energy intake (2.7 %), total fat (-4.5 %), SFA (-9.4 %), MUFA (-4.9 %), PUFA (-12.7 %), w-3 and w-6 fatty acids (-9.1 and -20.5 % respectively) and cholesterol (-9.6 %). Conclusions In this Mediterranean cohort study, mainly beneficial changes in the consumption of most foods and macronutrients were observed after 10 years of follow-up.
Autores: Sánchez Tainta, Ana; Zazpe I; Bes-Rastrollo, Maira; et al.
Revista: EUROPEAN JOURNAL OF NUTRITION
ISSN 1436-6207  Vol. 55  Nº 1  2016  págs. 93 - 106
Purpose To investigate the association between carbohydrate quality, fat quality or adherence to the Mediterranean diet and intake adequacy of 19 micronutrients in the PREDIMED (PREvención con DIeta MEDiterránea) trial, a multicenter, randomized, controlled, parallel group and primary prevention trial conducted in Spain. Methods We assessed baseline dietary intake of 6,542 elderly subjects at high cardiovascular risk through a validated food frequency questionnaire (FFQ) and a validated 14-item Mediterranean diet (Med-diet) score. We used a multidimensional carbohydrate quality index (CQI) using four criteria and a fat quality index (FQI) according to the ratio (MUFA + PUFA)/(SFA + TFA). The probability of intake adequacy was calculated comparing the intakes to DRI, and also using the probabilistic approach. Absolute and adjusted probability of having inadequate intake for either ¿6 DRI or ¿8 DRI were estimated to assess nutritional adequacy according to quintiles of each index. Results The lowest prevalence of inadequate micronutrient intake (¿8 DRI) was found in the highest quintile of CQI or Med-diet score, and in the lowest quintile of FQI (adjusted fold risk: 1.4, 3.4 and 10.2 respectively in comparison with the lowest quintile). P for trend <0.001 in three multivariable models. A higher CQI or Med-Diet score and a lower FQI were significantly associated with a lower fold risk of unmet EAR values. Conclusions A multidimensional assessment of CQI can be a useful tool to evaluate the quality of carbohydrates. This score and a 14-item Med-diet score were positively related to overall micronutrient adequacy in elderly participants.
Autores: Marí-Bauset, S.; Llopis-González, A.; Zazpe I; et al.
Revista: NUTRITIONAL NEUROSCIENCE
ISSN 1028-415X  Vol. 19  Nº 9  2016  págs. 377 - 386
OBJECTIVE: Children with autism spectrum disorder (ASD) have been found to have alterations in dietary fat intake and fat quality. The fat intakes of the foods consumed by children with and without ASD were compared, and the deficiency and excess of these nutrients were examined. METHODS: In a matched case-control study, 3-day food diaries were completed by 105 children with ASD and 495 typically developing (TD) 6- to 9-year-old children in Valencia (Spain). We used the probabilistic approach and estimated average requirement cut-point to evaluate the risk of inadequate nutrients intakes. These were compared between groups and with Spanish recommendations using linear and logistic regression, respectively. RESULTS: Groups did not differ significantly in age, total dietary intake, Healthy Eating Index, or food variety score. Children with ASD had lower saturated fatty acids (SFAs) and ¿-3 polyunsaturated fatty acids (PUFAs) intakes, but their total PUFAs and (PUFAs¿+¿monounsaturated fatty acids (MUFAs)/SFAs, PUFAs/SFAs intakes and ¿-6/¿-3 ratios were higher than TD children. The total fat and cholesterol intakes of both groups were slightly above Spanish recommendations. Both groups had low ¿-6 intakes, very low ¿-3 intakes, and high ¿-6/¿-3 ratios. CONCLUSION: Further research is required to clarify associations between ASD symptomatology, fat-eating patterns and health status. KEYWORDS: Autism; Autism spe
Autores: Downer, M. K.; Gea, A.; Stampfer, M.; et al.
Revista: INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY
ISSN 1479-5868  Vol. 13  2016  págs. 67
Background: Dietary intervention success requires strong participant adherence, but very few studies have examined factors related to both short-term and long-term adherence. A better understanding of predictors of adherence is necessary to improve the design and execution of dietary intervention trials. This study was designed to identify participant characteristics at baseline and study features that predict short-term and long-term adherence with interventions promoting the Mediterranean-type diet (MedDiet) in the PREvencion con DIeta MEDiterranea (PREDIMED) randomized trial. Methods: Analyses included men and women living in Spain aged 55-80 at high risk for cardiovascular disease. Participants were randomized to the MedDiet supplemented with either complementary extra-virgin olive oil (EVOO) or tree nuts. The control group and participants with insufficient information on adherence were excluded. PREDIMED began in 2003 and ended in 2010. Investigators assessed covariates at baseline and dietary information was updated yearly throughout follow-up. Adherence was measured with a validated 14-point Mediterranean-type diet adherence score. Logistic regression was used to examine associations between baseline characteristics and adherence at one and four years of follow-up. Results: Participants were randomized to the MedDiet supplemented with EVOO (n = 2,543; 1,962 after exclusions) or tree nuts (n = 2,454; 2,236 after exclusions). A higher number of cardiovascular risk factors, larger waist circumference, lower physical activity levels, lower total energy intake, poorer baseline adherence to the 14-point adherence score, and allocation to MedDiet + EVOO each independently predicted poorer adherence. Participants from PREDIMED recruiting centers with a higher total workload (measured as total number of persons-years of follow-up) achieved better adherence. No adverse events or side effects were reported. Conclusions: To maximize dietary adherence in dietary interventions, additional efforts to promote adherence should be used for participants with lower baseline adherence to the intended diet and poorer health status. The design of multicenter nutrition trials should prioritize few large centers with more participants in each, rather than many small centers.
Autores: Marí-Bauset, S.; Llopis-González, A.; Zazpe I; et al.
Revista: JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
ISSN 0162-3257  Vol. 46  Nº 2  2016  págs. 673 - 684
We compared anthropometric values, nutrient intake, the Healthy Eating Index and food variety in children with autism spectrum disorder (ASD), 20 on a gluten-free casein-free (GFCF) diet and 85 on a regular diet in Valencia (Spain) using 3-days food diaries. Those on the GFCF diet had a lower weight, body mass index, and total energy, pantothenic acid, calcium, phosphorus and sodium intake, but a higher intake of fiber, legumes, and vegetables. Further, the GFCF diet group had a better quality of fat intake, but needed supplementation with vitamin D. Randomized controlled trials are required to explore long-term effects of this diet on anthropometric and nutritional status (the focus of our study), but also behavioral symptoms, in children with ASD.
Autores: Buil-Cosiales, P.; Toledo, E.; Salas-Salvadó, J.; et al.
Revista: BRITISH JOURNAL OF NUTRITION
ISSN 0007-1145  Vol. 116  Nº 3  2016  págs. 534 - 546
Prospective studies assessing the association between fibre intake or fibre-rich food consumption and the risk of CVD have often been limited by baseline assessment of diet. Thus far, no study has used yearly repeated measurements of dietary changes during follow-up. Moreover, previous studies included healthy and selected participants who did not represent subjects at high cardiovascular risk. We used yearly repeated measurements of diet to investigate the association between fibre intake and CVD in a Mediterranean cohort of elderly adults at high cardiovascular risk. We followed-up 7216 men (55-80 years) and women (60-80 years) initially free of CVD for up to 7 years in the PREvencion con DIeta MEDiterranea study (registered as ISRCTN35739639). A 137-item validated FFQ was repeated yearly to assess diet. The primary end point, confirmed by a blinded ad hoc Event Adjudication Committee, was a composite of cardiovascular death, myocardial infarction and stroke. Time-dependent Cox's regression models were used to estimate the risk of CVD according to baseline dietary exposures and to their yearly updated changes. We found a significant inverse association for fibre (P-for trend = 0.020) and fruits (P-for trend = 0.024) in age-sex adjusted models, but the statistical significance was lost in fully adjusted models. However, we found a significant inverse association with CVD incidence for the sum of fruit and vegetable consumption. Participants who consumed in total nine or more servings/d of fruits plus vegetables had a hazard ratio 0.60 (95% CI 0.40, 0.96) of CVD in comparison with those consuming <5 servings/d.
Autores: Zazpe I; Santiago, Susana; Gea, Alfredo; et al.
Revista: NUTRITION METABOLISM AND CARDIOVASCULAR DISEASES
ISSN 0939-4753  Vol. 26  Nº 11  2016  págs. 1048 - 1058
BACKGROUND AND AIMS: Beyond the quantity of carbohydrate intake, further research is needed to know the relevance of carbohydrate quality following operational indices. No previous longitudinal study has assessed the association between an index for quality of dietary carbohydrate intake and the risk of cardiovascular disease (CVD). Here, we examined the association between a carbohydrate quality index (CQI) and the risk of CVD. METHODS AND RESULTS: We used a validated semi-quantitative 136-item food-frequency questionnaire (FFQ) in a prospective follow-up study of 17,424 middle-aged adults from Spain. The CQI was defined by four criteria: dietary fiber intake, glycemic index, whole-grain/total-grain carbohydrate ratio, and solid/total carbohydrate ratio. We observed 129 incident cases of CVD during 10.1 y of median follow-up. An inverse association for CQI was found (hazard ratio = 0.44, 95% confidence interval (CI): 0.25-0.78 for the highest versus the lowest tertile, p for trend = 0.008). Participants in the highest tertile of the whole-grain/total-grain carbohydrate ratio had 47% lower risk of CVD (95% CI: 0.33-0.85, p for trend = 0.008). Participants with higher baseline CQI and higher baseline energy from carbohydrates had the lowest risk of CVD. CONCLUSION: In this Mediterranean cohort, a better quality of dietary carbohydrates measured by the CQI, showed a significant inverse association with the incidence of CVD. Specially, a higher proportion of carbohydrates from whole grains was strongly inversely associated with CVD. "Heart-healthy" diets should be focused not only on carbohydrate quantity but also on a multidimensional assessment of the type and quality of carbohydrates.
Autores: Villacis; Zazpe I; Santiago, Susana; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 31  Nº 1  2015  págs. 466 - 474
Objetivo: Investigar la asociación entre la frecuencia de comidas fuera de casa (CFC) con a) la calidad de hidratos de carbono y b) la calidad de grasas. Materiales y métodos: Se evaluaron 19.371 participantes de la cohorte SUN que completaron un cuestionario basal de frecuencia de consumo de alimentos previamente validado. Se utilizaron los índices de calidad de hidratos de carbono (ICHC) en una escala de 4 a 20 y de grasas (ICG) en una escala de 0,62 a 5,92. En ambos casos, a mayor puntuación mayor calidad. Se utilizó la regresión lineal múltiple para determinar la asociación entre la frecuencia de CFC (4 categorías) y la puntuación de ambos índices, y la regresión logística para medir la asociación entre la frecuencia de CFC y un bajo ICHC o ICG (<percentil 25). Resultados: Los participantes mostraron una media de ICHC e ICG de 11,3 (DE 3,2) y 1,7 (DE 0,5), respectivamente. Una mayor frecuencia de CFC (¿ 2 veces / semana) se asoció con un menor ICHC (ß: -0,29, IC 95%: -0,41 a -0,17, p <0,001), y con un menor ICG (ß: -0,02, IC 95%: -0,03 a -0,001, p <0,03). Los participantes con CFC ¿ 2 veces/semana tuvieron mayor riesgo de peor ICHC (OR: 1,31, IC 95%: 1,17-1,46, p <0,001), pero no de peor ICG (OR: 0,93 IC 95%: 0,83-1,03, p 0,194). Conclusiones: Hacer con mayor frecuencia CFC se asoció con una peor calidad de grasas en la dieta y especialmente con peor calidad de hidratos de carbono. Estos resultados destacan la importancia de la educación nutricional dirigida a los consumidores de CFC.
Autores: Marí-Bauset, S.; Llopis-González, A.; Zazpe I; et al.
Revista: JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS
ISSN 0162-3257  Vol. 45  Nº 1  2015  págs. 203 - 212
Children with autism spectrum disorder (ASD) have problems of food selectivity, implying risks of nutritional deficiencies. The aim was to compare intakes of macro and micronutrients and body mass index in ASD and typically developing (TD) children. In a case-control study, 3-day food diaries and anthropometric measurements were completed for ASD (n = 40) and TD (n = 113) children (aged 6-10 years) living in the same area. Body mass indices were below the 5th percentile in 20 % of ASD versus 8.85 % of TD children. We found intakes were lower for fluoride (p = 0.017) and higher for vitamin E (p = 0.001). There was limited food variety and inadequacy of some intakes suggests that routine monitoring of ASD children should include assessment of their dietary habits, as well as anthropometric measurements.
Autores: Santiago, Susana; Zazpe I; Bes-Rastrollo, Maira; et al.
Revista: EUROPEAN JOURNAL OF CLINICAL NUTRITION
ISSN 0954-3007  Vol. 69  Nº 3  2015  págs. 297 - 302
Background/ Objectives: To evaluate the association between the carbohydrate quality (CQI) and weight change or incident overweight/obesity (BMI¿25 kg/m2) in the ¿Seguimiento Universidad de Navarra (SUN)¿ cohort. Subjects/ Methods: 8 741 participants initially free of overweight/obesity were followed¿up for a median of 7.9 years. We evaluated at baseline the CQI following 4 criteria: dietary fibre intake, glycemic index (GI), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Subjects were classified into quintiles according to CQI. Weight was recorded at baseline and updated every 2 years during follow¿up. Results: Increasing CQI of diet was not significantly associated with lower weight gain, although participants in the highest quintile had the lowest average crude weight gain (+211 g/year). We observed 1 862 incident cases of overweight/obesity during followup. CQI was significantly associated (p for trend 0.006) with lower risk of overweight/obesity: adjusted OR for the 4rd and 5th quintiles: 0.81 (95% CI 0.66 to 0.99), and 0.74 (95% CI 0.60 to 0.92), respectively. Conclusions: In this Mediterranean cohort, CQI showed a significant inverse association with the incidence of overweight/obesity, which highlights that carbohydrate intake guidelines related to obesity prevention should be focused in improving the CQI of the diet.
Autores: Pimenta, A. M.; Bes-Rastrollo, Maira; Gea, Alfredo; et al.
Revista: PUBLIC HEALTH NUTRITION
ISSN 1368-9800  Vol. 19  Nº 4  2015  págs. 658 - 666
OBJECTIVE: To evaluate the association of snacking between main meals with the risk of developing metabolic syndrome. DESIGN: A dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Snack consumption was evaluated using the question: 'Do you have the habit of snacking between main meals?' Metabolic syndrome was defined according to the updated harmonizing criteria. We estimated multivariable-adjusted relative risks (RR) of metabolic syndrome and their 95 % confidence intervals using Poisson regression models. An exploratory factor analysis was also used to identify patterns of snacking. SETTING: University of Navarra, Spain. SUBJECTS: The study included 6851 university graduates, initially free of metabolic syndrome, and followed-up them for a median of 8·3 years. RESULTS: Among our participants, 34·6 % reported usual snacking between main meals. The cumulative incidence of metabolic syndrome was 5·1 % (9·5 % among men and 2·8 % among women). Snacking between main meals was significantly associated with higher risk for developing metabolic syndrome after multivariable adjustment (RR=1·44; 95 %CI 1·18, 1·77). Higher adherence to an 'unhealthy snacking pattern' was also independently associated with increased incidence of metabolic syndrome (fourth quartile of adherence compared with non-snacking: RR=1·68; 95 % CI 1·23, 2·29; P for trend <0·001). CONCLUSIONS: Our findings suggest that avoidance of snacking between main meals can be included among the preventive approaches to reduce the risk of metabolic syndrome development, especially when snacks contain foods of poor nutritional quality.
Autores: Fernández-Montero, Alejandro; Zazpe I; Sánchez Tainta, Ana; et al.
Revista: SEGURIDAD Y MEDIO AMBIENTE
ISSN 1888-5438  Vol. 138  2015  págs. 32 - 40
Autores: Ruiz-Canela, Miguel; Zazpe I; Shivappa, N.; et al.
Revista: BRITISH JOURNAL OF NUTRITION
ISSN 0007-1145  Vol. 113  Nº 6  2015  págs. 984 - 995
The dietary inflammatory index (DII) is a new tool to assess the inflammatory potential of the diet. In the present study, we aimed to determine the association between the DII and BMI, waist circumference and waist:height ratio (WHtR). We conducted a cross-sectional study of 7236 participants recruited into the PREvencion con DIeta MEDiterranea trial. Information from a validated 137-item FFQ was used to calculate energy, food and nutrient intakes. A fourteen-item dietary screener was used to assess adherence to the Mediterranean diet (MeDiet). Sex-specific multivariable linear regression models were fitted to estimate differences (and 95% CI) in BMI, waist circumference and WHtR across the quintiles of the DII. All nutrient intakes, healthy foods and adherence to the MeDiet were higher in the quintile with the lowest DII score (more anti-inflammatory values) except for intakes of animal protein, saturated fat and monounsaturated fat. Although an inverse association between the DII and total energy was apparent, the DII was associated with higher average BMI, waist circumference and WHtR after adjusting for known risk factors. The adjusted difference in the WHtR for women and men between the highest and lowest quintiles of the DII was 1·60% (95% CI 0·87, 2·33) and 1·04% (95% CI 0·35, 1·74), respectively. Pro-inflammatory scores remained associated with obesity after controlling for the effect that adherence to a MeDiet had on inflammation. In conclusion, the present study shows a direct association between the DII and indices of obesity, and supports the hypothesis that diet may have a role in the development of obesity through inflammatory modulation mechanisms.
Autores: Marí-Bauset, S.; Zazpe I; Marí-Sanchís, A.; et al.
Revista: JOURNAL OF CHILD NEUROLOGY
ISSN 0883-0738  Vol. 29  Nº 12  2014  págs. 1718 - 1727
In autism spectrum disorders, many parents resort to alternative treatments and these are generally perceived as risk free. Among these, the most commonly used is the gluten-free, casein-free diet. The objective of this work was to conduct a systematic review of studies published from 1970 to date related to the gluten-free, casein-free diet in autism spectrum disorder patients. Few studies can be regarded as providing sound scientific evidence since they were blinded randomized controlled trials, and even these were based on small sample sizes, reducing their validity. We observed that the evidence on this topic is currently limited and weak. We recommend that it should be only used after the diagnosis of an intolerance or allergy to foods containing the allergens excluded in gluten-free, casein-free diets. Future research should be based on this type of design, but with larger sample sizes.
Autores: Zazpe I; Sánchez Tainta, Ana; Santiago, Susana; et al.
Revista: BRITISH JOURNAL OF NUTRITION
ISSN 0007-1145  Vol. 111  Nº 11  2014  págs. 2000 - 2009
Epidemiological research confirms that the prevalence of suboptimal micronutrient intakes across Europe is an emerging concern in terms of public health. The aim of the present study was to investigate the association between a new index of carbohydrate (CHO) quality and micronutrient intake adequacy in the `Seguimiento Universidad de Navarra (SUN)¿ cohort. The baseline assessment extended from 1999 to March 2012. We assessed 16 841 participants who completed a validated 136-item semi-quantitative FFQ at baseline. We created a new index to evaluate CHO quality for the following four criteria: dietary fibre intake; glycaemic index; whole grains:total grains ratio; solid CHO:total CHO ratio. The subjects were classified into quintiles according to this index. We evaluated the intakes of Zn, I, Se, Fe, Ca, K, P, Mg, Cr and vitamins B1, B2, B3, B6, B12, C, A, D, E and folic acid. The probability of intake adequacy was evaluated using the estimated average requirement cut-point approach and the probabilistic approach. Logistic regression analysis was used to assess the nutritional adequacy according to the CHO quality index (CQI). Participants in the highest quintile of CQI were found to have the lowest prevalence of inadequacy. A higher quality of CHO intake was found to be associated with a lower risk of nutritional inadequacy in comparison with the lowest quintile of CQI (adjusted OR 0·06, 95 % CI 0·02, 0·16; P for trend < 0·001). A higher CQI was found to be strongly associated with better micronutrient intake adequacy in the young Mediterranean cohort, stressing the importance of focusing nutritional education not only on CHO quantity, but also on quality.
Autores: Buil-Cosiales, P.; Zazpe I; Toledo, Estefanía Ainhoa; et al.
Revista: AMERICAN JOURNAL OF CLINICAL NUTRITION
ISSN 0002-9165  Vol. 100  Nº 6  2014  págs. 1498 - 1507
Few observational studies have examined the effect of dietary fiber intake and fruit and vegetable consumption on total mortality and have reported inconsistent results. All of the studies have been conducted in the general population and typically used only a single assessment of diet. OBJECTIVE: We investigated the association of fiber intake and whole-grain, fruit, and vegetable consumption with all-cause mortality in a Mediterranean cohort of elderly adults at high cardiovascular disease (CVD) risk by using repeated measurements of dietary information and taking into account the effect of a dietary intervention. DESIGN: We followed up 7216 men (55-75 y old) and women (60-75 y old) at high CVD risk in the Prevención con Dieta Mediterránea (PREDIMED) trial for a mean of 5.9 y. Data were analyzed as an observational cohort. Participants were initially free of CVD. A 137-item validated food-frequency questionnaire administered by dietitians was repeated annually to assess dietary exposures (fiber, fruit, vegetable, and whole-grain intakes). Deaths were identified through the continuing medical care of participants and the National Death Index. An independent, blinded Event Adjudication Committee adjudicated causes of death. Cox regression models were used to estimate HRs of death during follow-up according to baseline dietary exposures and their yearly updated changes. RESULTS: In up to 8.7 y of follow-up, 425 participants died. Baseline fiber intake and fruit consumption were significantly associated with lower risk of death [HRs for the fifth compared with the first quintile: 0.63 (95% CI: 0.46, 0.86; P = 0.015) and 0.59 (95% CI: 0.42, 0.82; P = 0.004), respectively]. When the updated dietary information was considered, participants with fruit consumption >210 g/d had 41% lower risk of all-cause mortality (HR: 0.59; 95% CI: 0.44, 0.78). Associations were strongest for CVD mortality than other causes of death. CONCLUSION: Fiber and fruit intakes are associated with a reduction in total mortality. PREDIMED was registered at controlled-trials.com as ISRCTN35739639.
Autores: Zazpe I; Sánchez Tainta, Ana; Toledo, Estefanía Ainhoa; et al.
Revista: ACADEMY OF NUTRITION AND DIETETICS. JOURNAL
ISSN 2212-2672  Vol. 114  Nº 1  2014  págs. 37 - 47
Background: Different dietary patterns have been associated with several health outcomes, including morbidity and mortality. There is little evidence on the association between empirically derived dietary patterns and all-cause mortality in Southern European populations. Objective: The aim of our study was to prospectively evaluate the association between an empirically derived dietary pattern and all-cause mortality. Design: The Seguimiento Universidad de Navarra (SUN) Project is an ongoing, multipurpose, prospective and dynamic Spanish cohort. Participants/setting: Participants were a prospective cohort of 16,008 middle-aged Spanish adults. All of them were university graduates (alumni) (59.6% women, mean age 38 years). Usual diet was assessed at baseline with a validated semiquantitative food frequency questionnaire. Main Outcome Measures: Deaths were confirmed by review of medical records and of the National Death Index. Statistical Analysis: Dietary patterns were ascertained through a factor (principal component) analysis based on 30 predefined food groups. Participants were classified according to tertiles of adherence to the three main dietary patterns identified with factor analysis. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios and 95% CIs for mortality. Results: Three major dietary patterns were identified. They were labelled Western dietary pattern (rich in red and processed meat, potatoes, and fast food), Mediterranean dietary pattern (rich in vegetables, fish and seafood, fruits, and olive oil), and alcoholic beverages dietary pattern. During follow-up, 148 deaths were reported (mean age at death 54.5 years). After adjustment for potential confounders, the lowest risk of all-cause mortality was found in the tertile of highest adherence to the Mediterranean dietary pattern (adjusted hazard ratio for third vs first tertile 0.53, 95% CI 0.34 to 0.84) (P for trend &lt;0.01). The Western dietary pattern and alcoholic beverages dietary pattern showed no significant association with mortality. Conclusions: Greater adherence to an empirically derived dietary pattern approaching the traditional Mediterranean diet was associated with a reduction in the risk of all-cause mortality among middle-aged Mediterranean adults.
Autores: Azcona-Salvatierra, A.; Zazpe I; Santiago, Susana; et al.
Revista: REVISTA DE LA ASOCIACION ESPAÑOLA DE ESPECIALISTAS DE MEDICINA DEL TRABAJO
ISSN 1132-6255  Vol. 23  Nº 2  2014  págs. 318 - 325
El objetivo del trabajo es valorar el impacto y los resultados de una campaña encaminada a promover hábitos de alimentación saludable entre los trabajadores de un centro universitario. Material y Métodos: Estudio epidemiológico descriptivo de tipo transversal que evalúa en 343 trabajadores de la Universidad de Navarra los hábitos alimentarios basales y tras la intervención, así como el impacto mediático y el grado de satisfacción de la campaña. Resultados: La mayoría de los hábitos alimentarios mejoran tras un año de implantación de la campaña, aunque ninguno de forma significativa. Por otro lado, el 38% IC95% (29%-47%) de los trabajadores cree que la campaña ha servido para mejorar su alimentación en cafeterías o comedores universitarios. Aunque los resultados no son significativos, se puede decir que se ha encontrado una tendencia hacia el cambio en los hábitos alimentarios. La valoración por parte de los trabajadores ha sido muy positiva, hecho que anima a continuar con la campaña (AU)
Autores: Goñi, Leticia; Cuervo, M; Santiago, Susana; et al.
Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627  Vol. 37  Nº 3  2014  págs. 349 - 362
Autores: Santiago, Susana; Cuervo, M; Zazpe I; et al.
Revista: ANALES DE PEDIATRIA
ISSN 1695-4033  Vol. 80  Nº 2  2014  págs. 89 - 97
Introducción La obesidad infantil es una enfermedad multifactorial en la que una alimentación inadecuada y el sedentarismo tienen un papel decisivo. El objetivo de este trabajo ha sido evaluar la situación ponderal, los hábitos alimentarios y de actividad física en escolares de Castilla-La Mancha. Sujetos y métodos Estudio transversal en 3.061 niños de entre 6 y 12 años participantes en el plan «Alimenta su salud», mediante la aplicación de una encuesta sobre variables antropométricas, frecuencia de consumo de alimentos, hábitos alimentarios y actividad física, analizando diferencias por sexo, grupos de edad y provincias. Resultados La prevalencia de sobrecarga ponderal fue del 24,0% y la de obesidad del 14,3%, encontrando diferencias en la distribución por provincias. Las chicas realizan más frecuentemente la toma de media mañana, consumen más suplementos y practican menos deporte que los chicos. El seguimiento de dietas especiales y la realización de actividades deportivas es menor en el grupo de 6 a 9 años respecto al de 10-12. En relación con las recomendaciones, el consumo de verduras y frutas es bajo, y elevado para embutidos, bollería, aperitivos salados, golosinas y comida rápida, encontrando diferencias por grupos de edad. Conclusiones En la población infantil estudiada, la sobrecarga ponderal afecta casi a uno de cada 4 niños, no alcanzándose las recomendaciones de frutas y verduras, y existiendo un consumo elevado de alimentos que se asocian con riesgo de obesidad. El sedentarismo es más frecuente el fin de semana y entre las chicas.
Autores: Bujanda, Elena; Beitia, G.; Zazpe I; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 30  Nº 1  2014  págs. 132 - 139
Introducción: La adhesión a un patrón de Dieta Mediterránea está asociado a una reducción de la morbi-mortalidad, y a una mejora de la calidad de vida. Objetivos: Evaluar una intervención nutricional en personas mayores independientes a través de un programa de educación que favorezca el conocimiento de los alimentos y la confección de dietas adecuadas, promocionando un patrón de dieta saludable. Métodos: Estudio cuasi-experimental realizado en un colectivo de personas mayores que residen en apartamentos tutelados del Ayuntamiento de Pamplona (n = 41). La intervención consistió en seis sesiones de educación grupal y una entrevista motivacional individual en un periodo de tres meses. Se evaluó la adhesión a la Dieta Mediterránea a través de un cuestionario de 14 puntos previamente validado. Resultados: El 80,5% de los participantes fueron mujeres, con una mediana de edad de 79 años, en gran proporción viudas (48,8%) y con estudios primarios (58,5%). Tras la intervención nutricional el porcentaje de participantes que consumió dos o más raciones de verduras u hortalizas aumentó significativamente con respecto al grupo control (p = 0,042). De forma similar en comparación con el grupo control hubo un mayor incremento en el porcentaje de individuos que consumían 3 raciones de legumbres a la semana (p = 0,042), 3 o más veces por semana frutos secos (p = 0,003) y que tomaban preferentemente carne de pollo, pavo o conejo en vez de ternera, cerdo, hamburguesas o salchichas (p = 0,011).
Autores: Bes-Rastrollo, Maira; Gea, Alfredo; et al.
Revista: BRITISH JOURNAL OF NUTRITION
ISSN 0007-1145  Vol. 112  Nº 6  2014  págs. 984 - 991
Reported associations between the consumption of fried foods and the incidence of obesity or weight gain make it likely that fried food consumption might also be associated with the development of hypertension. However, evidence from long-term prospective studies is scarce. Therefore, the aim of the present study was to longitudinally evaluate this association in a prospective cohort. The SUN (Seguimiento Universidad de Navarra) project is a Mediterranean cohort study of university graduates conducted in Spain, which started in December 1999 and is still ongoing. In the present study, we included 13,679 participants (5059 men and 8620 women), free of hypertension at baseline with a mean age of 36·5 (SD 10·8) years. Total fried food consumption was estimated at baseline. The outcome was the incidence of a medical diagnosis of self-reported hypertension during the follow-up period. To assess the association between the consumption of fried foods and the subsequent risk of developing incident hypertension during the follow-up period, Cox regression models were used. During a median follow-up period of 6·3 years, 1232 incident cases of hypertension were identified. After adjusting for potential confounders, the adjusted hazard ratios for developing hypertension were 1·18 (95% CI 1·03, 1·36) and 1·21 (95% CI 1·04, 1·41) for those consuming fried foods 2-4 and >4 times/week, respectively, compared with those consuming fried foods < 2 times/week (P for trend = 0·009). In conclusion, frequent consumption of fried foods at baseline was found to be associated with a higher risk of hypertension during the follow-up period in a Mediterranean cohort of university graduates.
Autores: Marí-Bauset, S.; Zazpe I; Marí-Sanchis, A.; et al.
Revista: JOURNAL OF CHILD NEUROLOGY
ISSN 0883-0738  Vol. 29  Nº 12  2014  págs. 1718 - 1727
In autism spectrum disorders, many parents resort to alternative treatments and these are generally perceived as risk free. Among these, the most commonly used is the gluten-free, casein-free diet. The objective of this work was to conduct a systematic review of studies published from 1970 to date related to the gluten-free, casein-free diet in autism spectrum disorder patients. Few studies can be regarded as providing sound scientific evidence since they were blinded randomized controlled trials, and even these were based on small sample sizes, reducing their validity. We observed that the evidence on this topic is currently limited and weak. We recommend that it should be only used after the diagnosis of an intolerance or allergy to foods containing the allergens excluded in gluten-free, casein-free diets. Future research should be based on this type of design, but with larger sample sizes.
Autores: Cuervo, M; Goñi, Leticia; Santiago, Susana; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 29  Nº 2  2014  págs. 337 - 343
Background: The maintenance of healthy lifestyles is of great importance to prevent pregnancy-related diseases at early stages. For this reason, the knowledge of the overall wellbeing of women at childbearing-age is necessary to provide appropriate advice to maintain or improve the nutritional status. The aim of this research was to assess the lifestyles of childbearing-age women planning a pregnancy and to examine the difference between primiparae and multiparae women on these lifestyles. Methods: This cross-sectional survey involving 4,471 Spanish women at childbearing-age that were planning a pregnancy. Information was collected through a questionnaire by community health professionals. Results: The profile of childbearing-age recruited women planning a pregnancy were in her early thirties (31.4 ± 4.8 years) and 72.5% were seeking for her first baby. They had a good self-perception of their nutritional and health status and followed a balanced diet. Interestingly, primiparae women had lower risk of health complications but they were greater consumers of tobacco and alcohol (p<0.001), and consumed less fortified milk, iodine and iron supplements than multiparae women. Additionally, the examined population showed a more sedentary pattern in primiparae women as compared to the remaining group concerning hours/day lying, sitting and standing. Conclusion: Differences between both preconceptional conditions (primiparae and multiparae women) bring a great opportunity to promote healthy habits among childbearing-aged women, according to the personal profile, in order to prevent burdens in future pregnancies underlying modifiable or preventable factors.
Autores: de la Fuente-Arrillaga, Carmen; Martínez, Miguel Ángel; Zazpe I; et al.
Revista: BMC PUBLIC HEALTH
ISSN 1471-2458  Vol. 14  Nº 1091  2014 
Background To evaluate prospectively the relationship between white, or whole grain bread, and glycemic index, or glycemic load from diet and weight change in a Mediterranean cohort. Methods We followed-up 9 267 Spanish university graduates for a mean period of 5 years. Dietary habits at baseline were assessed using a semi-quantitative 136-item food-frequency questionnaire. Average yearly weight change was evaluated according to quintiles of baseline glycemic index, glycemic load, and categories of bread consumption. We also assessed the association between bread consumption, glycemic index, or glycemic load, and the incidence of overweight/obesity. Results White bread and whole-grain bread were not associated with higher weight gain. No association between glycemic index, glycemic load and weight change was found. White bread consumption was directly associated with a higher risk of becoming overweight/obese (adjusted OR (¿2 portions/day) versus (¿1 portion/week): 1.40; 95% CI: 1.08-1.81; p for trend: 0.008). However, no statistically significant association was observed between whole-grain bread, glycemic index or glycemic load and overweight/obesity. Conclusions Consumption of white bread (¿2 portions/day) showed a significant direct association with the risk of becoming overweight/obese.
Autores: Martínez, Miguel Ángel; Zazpe I; Razquin, Cristina; et al.
Revista: CLINICAL NUTRITION
ISSN 0261-5614  Vol. 34  Nº 5  2014  págs. 859 - 867
Background& Aims: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). Design: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item food-frequency questionnaire was administered. Baseline DP were ascertained through factor analysis based on 34 predefined groups. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) for cardiovascular disease (CVD) or mortality across quartiles of DP within each of the three arms of the trial. Results: We identified two major baseline DP: the first DP was rich in red and processed meats, alcohol, refined grains and whole dairy products and was labeled Western dietary pattern (WDP). The second DP corresponded to a "Mediterranean-type" dietary pattern (MDP). During follow-up, 328 participants died. After controlling for potential confounders, higher baseline adherence to the MDP was associated with lower risk of CVD (adjusted HR for fourth vs. first quartile: 0.52; 95% CI (Confidence Interval): 0.36, 0.74; p-trend <0.001) and all-cause mortality (adjusted HR: 0.53; 95% CI: 0.38, 0.75; p-trend <0.001), regardless of the allocated arm of the trial. An increasing mortality rate was found across increasing quartiles of the WDP in the control group (allocated to a low-fat diet), though the linear trend was not statistically significant (p = 0.098). Conclusions: Higher adherence to an empirically-derived MDP at baseline was associated with a reduced risk of CVD and mortality in the PREDIMED trial regardless of the allocated arm. The WDP was not associated with higher risk of mortality or cardiovascular events.
Autores: Zazpe I; Sánchez Tainta, Ana; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 28  Nº 5  2013  págs. 1673 - 1680
Introduction: Universities and workplaces are important targets for the promotion of the nutritional interventions in adult population. Objectives: The aim of this study was to assess the dietary habits and attitudes towards change in workers and university students from different academic fields. Methods: The study data came from a cross-sectional study of a Spanish University population of 1,429 participants. We analyzed the dietary habits and the attitudes toward dietary change. Results: The mean age of workers and students was 37 and 23 years, respectively. Both groups reported eating four meals per day. Among students, the consumption of vegetables, wine, fish and nuts was less frequent whereas carbonated beverages, commercial bakery, fast food and red meat was higher. On the other hand, overall dietary pattern of science students was healthier than other students. Although no significant differences were found between students and workers in attitudes towards change, 32% of employees and 39% of students said they were seriously considering changing them. Conclusions: The dietary pattern was healthier among workers than among students, particularly those participants that studied social sciences degrees. They constituted the most vulnerable segment of the university population from a nutritional point of view. About a third of workers and students considered changing their habits.
Autores: Marí-Bauset, S.; Zazpe I; Marí, Amelia; et al.
Revista: JOURNAL OF CHILD NEUROLOGY
ISSN 0883-0738  Vol. 29  Nº 11  2013  págs. 1554 - 1561
Autism spectrum disorders are characterized by difficulties with reciprocal social interactions and restricted patterns of behavior and interest; one of these characteristic behaviors is food selectivity. The objective of this study was to perform a systematic review of the literature published between 1970 and 2013 concerning this eating behavior. The articles identified were analyzed in terms of sample size, study design, and criteria for assessment and intervention, as well as the results, level of evidence and grade of recommendation. The main search was conducted in Medline, Cochrane Library, Scielo, ScienceDirect, and Embase). There is empirical evidence and an overall scientific consensus supporting an association between food selectivity and autism spectrum disorders.
Autores: Zazpe I; Bes-Rastrollo, Maira; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 28  Nº 1  2013  págs. 105-111
Introduction & Aim: The prevalence of diabetes is increasing at an alarming rate in nearly all countries. Some studies from non-Mediterranean populations suggest that higher egg consumption is associated with an increased risk of diabetes. The aim of our study was to prospectively assess the association between egg consumption and the incidence of type 2 diabetes in a large cohort of Spanish university graduates. Methods: In this prospective cohort including 15,956 participants (mean age: 38.5 years) during 6.6 years (median), free of diabetes mellitus at baseline. Egg consumption was assessed at baseline through a semi-quantitative food-frequency questionnaire repeatedly validated in Spain. Incident diabetes mellitus diagnosed by a doctor was assessed through biennial follow-up questionnaires and confirmed subsequently by medical reports or records, according to the American Diabetes Association criteria. Analyses were performed through multivariable non-conditional logistic regression. Results: After adjustment for confounders, egg consumption was not associated with the development of diabetes mellitus, comparing the highest versus the lowest quartile of egg consumption (>4 eggs/week vs <1 egg/week): odds ratio = 0.7; 95% CI 0.3-1.7. Conclusion: Egg consumption was not associated with the development of diabetes mellitus in this Mediterranean cohort. (Nutr Hosp. 2013;28:105-111) DOI: 10.3305/nh.2013.28.1.6124
Autores: Martínez, Miguel Ángel; Fernández-Montero, Alejandro; et al.
Revista: BRITISH JOURNAL OF NUTRITION
ISSN 0007-1145  Vol. 110  Nº 9  2013  págs. 1722 - 1731
The incidence of the metabolic syndrome (MetS) is increasing and lifestyle behaviours may play a role. The aim of the present study was to prospectively assess the association between changes in the consumption of sugar-sweetened beverages (SSB) and the incidence of the MetS and its components in a Spanish cohort of university graduates. We included 8157 participants initially free of the MetS and followed up during at least 6 years. SSB consumption was collected by a FFQ previously validated in Spain. The change in SSB consumption was calculated as the difference between SSB consumption at a 6-year follow-up and baseline consumption. The MetS was defined according to the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute's new definition of the MetS that had harmonised previous definitions. The associations between changes in SSB intake and the MetS were examined using multiple logistic regression. We observed 361 incident cases of the MetS. Participants who increased their consumption of SSB (upper v. lower quintile) had a significantly higher risk of developing the MetS (adjusted OR 2·2, 95 % CI 1·4, 3·5; P for trend = 0·003). Similarly, they presented a significantly higher risk of developing high blood pressure (adjusted OR 1·6, 95 % CI 1·3, 2·1), central obesity (adjusted OR 2·3, 95 % CI 1·9, 2·7), hypertriacylglycerolaemia (adjusted OR 1·7, 95 % CI 1·1, 2·6) or impaired fasting glucose (adjusted OR 1·6, 95 % CI 1·1, 2·2). In conclusion, an increase in SSB consumption was associated with a higher risk of developing the MetS and other metabolic disorders after 6 years of follow-up in a Mediterranean cohort of university graduates.
Autores: Santiago, Susana; Zazpe I; Marti A; et al.
Revista: OBESITY RESEARCH AND CLINICAL PRACTICE
ISSN 1871-403X  Vol. 7  Nº 5  2013  págs. e391 - e400
Objective The association between sleep duration, extracurricular sport, screen-based activities and dietary variables with prevalence of overweight in middle childhood, regarding gender differences, was assessed. Methods Cross-sectional study involving 2814 children (age 6¿12 years). Measured weight and height and reported lifestyle variables were obtained by health professionals previously trained. Univariate and multivariate logistic regression analyses were performed to examine the associations between variables and the likelihood of being overweight. Results Prevalence of overweight (including obesity) was 31.9% in boys and 30.4% in girls. In boys, engaging ¿3h/week in sports activities (OR 0.7, 95% CI 0.5¿0.9), eating daily breakfast (OR 0.6, 95% CI 0.4¿0.9) and consuming ¿2fruits/day (OR 0.8, 95% CI 0.6¿0.9) were independent protective factors against overweight, whereas children consuming fast food weekly and sweets daily were estimated to be 30% and 40%, respectively, more likely to be overweight. Only buns consumption resulted associated with overweight in girls (OR 1.3, 95% CI 1.1¿1.7). Conclusions Prevalence of overweight in a sample of Southern European children is high and underlines gender differences in lifestyle determinants. Engaging in extracurricular sport, promoting daily breakfast, adequate fruit consumption and reducing high energy-dense foods, should be encouraged in boys, whereas further investigation on girls behaviours would be valuable.
Autores:  Bountziouka, V.; Bathrellou, E.; Zazpe I; et al.
Revista: FOOD AND NUTRITION BULLETIN
ISSN 0379-5721  Vol. 33  Nº 4  2012  págs. 288 - 295
Background: Accuracy of a measurement is a cornerstone in research in order to make robust conclusions about the research hypothesis. Objective: To examine whether the number of items (questions) and the number of responses of consumption included in nutritional assessment tools influence their repeatability. Methods: During 2009, 400 participants (250 from Greece, 37±13 yrs, 34% males and 150 participants from Spain, 39±17 yrs, 41% males) completed a diet index with 11-items and binary (yes/no) responses, a diet-index with 11-items and 6-scale responses, a 36-item and a 76-item food frequency questionnaire (FFQ) with 6-scale responses. Participants completed these tools, twice, within 15-days period. Spearman-Brown (rsb), Kendall¿s tau coefficients and the Bland-Altman method were applied to answer the research hypothesis. Results: The highest repeatability coefficient was observed for the 11-items with binary responses index (rsb=0.948, p<0.001), followed by the 11-items with 6-scale responses index (rsb=0.943, p<0.001), the 36-item (rsb=0.936, p<0.001) and the 76-item FFQs (rsb=0.878, p<0.001). Statistical comparisons revealed no significant differences between repeatability coefficients of the first three tools (p>0.23); whereas the aforementioned tools had significantly higher repeatability coefficients as compared with the 76-item FFQ (p=0.002). Sub-group analyses by gender, education, smoking and clinical status, confirmed the aforementioned results. Conclusion: Repeatability has been revealed for all food frequency assessment tools used, irrespective of the number of items or the number of responses included.
Autores: Bauset, S. M.; Zazpe I; Sanchís, A. M.; et al.
Revista: JOURNAL OF CHILD NEUROLOGY
ISSN 0883-0738  Vol. 28  Nº 10  2012  págs. 1226 - 1232
Anthropometric development and growth were assessed in 2 groups of 6- to 9-year-olds: children with autism spectrum disorders and typically developing children. In a case-control study conducted in Valencia, Spain, we compared the body mass index (kg/m(2)) of 40 children with autism spectrum disorders (cases) and 113 typically developing children (controls) from the same area of residence. The sex- and age-adjusted odds ratios for being underweight in cases was 2.41 compared to controls. Furthermore, the body mass index distribution of the cases was significantly offset to lower values with respect to that of the controls (P = .024). In particular, 20% of the cases had a body mass index below the fifth percentile versus just 8.85% of the controls. Our data suggest that the anthropometric development of children with autism spectrum disorders should be monitored as part of routine care.
Autores: Santiago, Susana; Zazpe I; Cuervo, M; et al.
Revista: Nutricion Hospitalaria
ISSN 0212-1611  Vol. 27  Nº 2  2012  págs. 599 - 605
Introduction & aims: The identification of determinants of childhood overweight is crucial to early diagnosis and prevention. The aim of this study was to assess perinatal and parental related risk factors concerning children for having excessive body weight. Methods: Cross-sectional study involving 3,101 children participating in the programme "Alimenta su salud" conducted in Castilla-La Mancha (Spain). Anthropometric and sociodemographic data were obtained from a general questionnaire. Analysed factors as potential predictors of childhood overweight were sex, age, birth weight, infant feeding, number of siblings, as well as parental marital status, educational level and obesity. Prevalence of overweight stratified by potential determinants was assessed. Univariate and multivariate logistic regression analyses were used to examine the associations between variables and the likelihood of being overweight. Results: The overweight prevalence (including obesity) was 30.3% in boys and 28.3% in girls, according to the IOTF criteria. Higher rates in younger subjects and some gender differences were observed. Parental obesity was the most important predictive variable for childhood overweight in both sexes and birth weight over 3,500 g in girls (OR 1.8,95% CI 1.3-2.3). Having one or more siblings (OR 0.7, 95% CI 0.5-0.9) and higher paternal education (OR 0.8,95% CI 0.6-0.9) in boys, and older age in girls (OR 0.7, 95% CI 0.5-.09), resulted protective factors against childhood overweight. No independent effects of marital status, maternal education and infant feeding patterns on childhood excess weight were identified. Conclusions: Perinatal and parental factors could contribute to predict the risk of being overweight/obese in children aged 6 to 12 years, which should be considered when formulating obesity prevention and intervention strategies, stressing the importance of targeting obese parents with young children.
Autores: Zazpe I; Bes-Rastrollo, Maira; et al.
Revista: European Journal of Clinical Nutrition
ISSN 0954-3007  Vol. 65  Nº 6  2011  págs. 676 - 682
BACKGROUND/OBJECTIVES: Egg consumption has been associated with the risk of cardiovascular diseases (CVDs), but evidence is scarce and inconsistent. Our aim was to examine the association between egg consumption and incidence of CVD in a prospective dynamic Mediterranean cohort of 14,185 university graduates. SUBJECTS/METHODS: Egg intake was assessed using a 136-item-validated food-frequency questionnaire. Baseline consumption was categorized into no consumption or <1 egg/week, 1 egg/week, 2-4 eggs/week and >4 eggs/week. The presence of cardiovascular risk factors was assessed by questionnaire at baseline, and the incidence of CVD was assessed using biennial assessments. The median follow-up was 6.1 years. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios (HRs) for CVD (myocardial infarction, revascularization procedures or stroke). Outcomes were confirmed by review of medical records. RESULTS: During a median follow-up of 6.1 years, 91 new confirmed cases of CVD were observed. No association was found between egg consumption and the incidence of CVD (HR: 1.10, 95% confidence interval: 0.46-2.63) for the highest versus the lowest category of egg consumption after adjusting for age, sex, total energy intake, adherence to the Mediterranean food pattern and other cardiovascular risk factors. Results were robust to different analytical scenarios. CONCLUSIONS: No association between egg consumption and the incidence of CVD was found in this Mediterranean cohort.
Autores: Zazpe I; Bes-Rastrollo, Maira; Ruiz-Canela, Miguel; et al.
Revista: BRITISH JOURNAL OF NUTRITION
ISSN 0007-1145  Vol. 105  Nº 5  2011  págs. 765 - 775
Assessment of eating habits (EH) through closed questions could be an alternative tool to assess diet as a predictor of weight change in epidemiological studies. The aim was to assess the association between baseline EH and the risk of weight gain or becoming overweight/obese in a Spanish dynamic prospective cohort (the Seguimiento Universidad de Navarra Project) of 10 509 participants. The baseline questionnaire included ten short questions with two possible answers: yes or no. We calculated a baseline EH score, categorised in quartiles, positively weighting answers on more fruit, vegetables, fish and fibre and less meat, sweets and pastries, fat, butter, fatty meats and added sugar in drinks. Reducing the consumption of meat or fat and removing fat from meat were significantly associated with lower weight gain. The partial correlation coefficient between EH score and weight change was ¿ 0·033 (P = 0·001). We observed 1063 cases of incident overweight/obesity among 7217 participants without overweight/obesity at baseline. Trying to eat more fruit, fish or fibre and less meat was inversely significantly associated with incident overweight/obesity. Those participants in the upper quartile of the score were at a 38 % (adjusted OR 0·62; 95 % CI 0·48, 0·81) lower risk of developing overweight/obesity during the follow-up compared with those in the lower quartile. However, the receiver-operating characteristic curves for the model with and without the EH score were materially identical. Despite the apparent significant inverse association, this score had a low predictive value for future weight gain and for incident overweight/obesity in a Mediterranean population, although some EH were independently and positively associated with weight gain.
Autores: Santiago, Susana; Zazpe I; Cuervo, M; et al.
Revista: REVISTA ESPAÑOLA DE NUTRICION HUMANA Y DIETETICA
ISSN 2173-1292  Vol. 15  Nº 3  2011  págs. 144
Autores: Lohse, B; Psota, T; Estruch, R; et al.
Revista: JOURNAL OF NUTRITION
ISSN 0022-3166  Vol. 140  Nº 7  2010  págs. 1322 - 1327
Eating competence (EC), a bio-psychosocial model for intrapersonal approaches to eating and food-related behaviors, is associated with less weight dissatisfaction, lower BMI, and increased HDL-cholesterol in small U.S. studies, but its relationship to nutrient quality and overall cardiovascular risk have not been examined. Prevención con Dieta Mediterránea (PREDIMED) is a 5-y controlled clinical trial evaluating Mediterranean diet efficacy on the primary prevention of cardiovascular diseases (CVD) in Spain. In a cross-sectional study, 638 PREDIMED participants (62% women, mean age 67 y) well phenotyped for cardiovascular risk factors were assessed for food intake and EC using validated questionnaires. Overall, 45.6% were eating-competent. EC was associated with being male and energy intake (P < 0.01). After gender and energy adjustment, participants with EC compared with those without showed higher fruit intake and greater adherence to the Mediterranean diet (P < 0.05) and tended to consume more fish (P = 0.076) and fewer dairy products (P = 0.054). EC participants tended to have a lower BMI (P = 0.057) and had a lower fasting blood glucose concentration and serum LDL-:HDL-cholesterol ratio (P < 0.05) and a higher HDL-cholesterol concentration (P = 0.025) after gender adjustment. EC participants had lower odds ratios (OR) of having a blood glucose concentration >5.6 mmol/L (0.71; 95% CI 0.51-0.98) and HDL-cholesterol <1.0 mmol/L (0.70; 95% CI 0.68-1.00). The OR of actively smoking, being obese, or having a serum LDL-cholesterol concentration > or =3.4 mmol/L were <1.0, but the 95% CI included the 1.0 (P > 0.1). Our findings support further examination of EC as a strategy for enhancing diet quality and CVD prevention.
Autores: Zazpe I; Estruch, R; Toledo, E; et al.
Revista: European Journal of Nutrition
ISSN 1436-6207  Vol. 49  Nº 2  2010  págs. 91 - 99
BACKGROUND: Determinants of dietary changes obtained with a nutritional intervention promoting the Mediterranean diet have been rarely evaluated. AIM: To identify predictors of higher success of an intervention aimed to increase adherence to a Mediterranean diet (MeDiet) in individuals at high cardiovascular risk participating in a trial for primary prevention of cardiovascular disease: the PREDIMED (PREvención con DIeta MEDiterránea) trial. Candidate predictors included demographic and socioeconomic characteristics, cardiovascular risk factors, and baseline dietary habits. METHODS: A total of 1,048 asymptomatic subjects aged 55-80 years allocated to the active intervention groups (subjects in the control group were excluded). Participants' characteristics were assessed at baseline among subjects. Dietary changes were evaluated after 12 months. Main outcome measures were: attained changes in five dietary goals: increases in (1) fruit consumption, (2) vegetable consumption, (3) monounsaturated fatty acid (MUFA)/saturated fatty acid (SFA) ratio, and decreases in (4) sweets and pastries consumption, (5) and meat consumption. Univariate and multivariate logistic regression analyses were used to examine associations between the candidate predictors and likelihood of attaining optimum dietary change (improved adherence to a MeDiet). RESULTS: Among men, positive changes toward better compliance with the MeDiet were more frequent among non-diabetics, and among those with worse dietary habits at baseline (higher consumption of meat, higher SFA intake, lower consumption of fruit and vegetables). Among women, marital status (married) and worse baseline dietary habits (high in meats, low in fruits and vegetables) were the strongest predictors of success in improving adherence to the MeDiet. CONCLUSIONS: Some participant characteristics (marital status and baseline dietary habits) could contribute to predicting the likelihood of achieving dietary goals in interventions aimed to improve adherence to a MeDiet, and may be useful for promoting individualized long-term dietary changes and improving the effectiveness of dietary counseling.
Autores: Santiago, Susana; Zazpe I;
Revista: Aula de la Farmacia (Versión impresa)
ISSN 1697-543X  Vol. 6  Nº 73  2010  págs. 7 - 19
Autores: Fernández-Ballart, JD; Piñol, JL; Zazpe I; et al.
Revista: British Journal of Nutrition (Print Edition)
ISSN 0007-1145  Vol. 103  Nº 12  2010  págs. 1808 - 1816
The aim of the present study was to assess reproducibility and relative validity of a self-administered FFQ used in the PREDIMED Study, a clinical trial for primary prevention of CVD by Mediterranean diet in a population at high cardiovascular risk. The FFQ was administered twice (FFQ1 and FFQ2) to explore reproducibility at 1 year. Four 3 d dietary records (DR) were used as reference to explore validity; participants therefore recorded their food intake over 12 d in the course of 1 year. The degree of misclassification in the FFQ was also evaluated by a contingency table of quintiles comparing the information from the FFQ2 and the DR. A total of 158 men and women (aged 55¿80 years) were asked not to modify their dietary habits during the study period. Reproducibility for food groups, energy and nutrient intake, explored by the Pearson correlation coefficient (r) ranged 0·50¿0·82, and the intraclass correlation coefficient (ICC) ranged from 0·63 to 0·90. The FFQ2 tended to report higher energy and nutrient intake than the DR. The validity indices of the FFQ in relation to the DR for food groups and energy and nutrient intake ranged (r) from 0·24 to 0·72, while the range of the ICC was between 0·40 and 0·84. With regard to food groups, 68¿83 % of individuals were in the same or adjacent quintile in both methods, a figure which decreased to 55¿75 % for energy and nutrient intake. We concluded that FFQ measurements had good reproducibility and a relative validity similar to those of FFQ used in other prospective studies.
Autores: García-Unciti, M; Zazpe I; et al.
Revista: NUTRICION HOSPITALARIA
ISSN 0212-1611  Vol. 25  Nº Supl. 1  2010  págs. 220
Autores: Piernas Sánchez, C.; Martín, Nerea; Zazpe I; et al.
Libro:  Conceptos de salud pública y estrategias preventivas
2018  págs. 249 - 253
El objetivo de esta obra es facilitar a los estudiantes de "Medicina Preventiva y Salud Pública" de todas las facultades de medicina en universidades de habla española un texto sintético, actualizado, científico y completo. También sirve como material de texto para otros grados que contengan la asignatura "Salud Pública" como Farmacia. Esta segunda edición incorpora nuevos capítulos como Ensayos de campo y otros ensayos: diseño, método y análisis, Epidemiología y prevención de enfermedades digestivas, Enfermedad pulmonar obstructiva crónica o Guías y recomendaciones alimentarias.
Autores: Sanchez-Villegas, A.; Zazpe I;
Libro:  The Prevention of cardiovascular disease throught the Mediterranean Diet
2017  págs. 1 - 24
Autores: Muñoz-Hornillos, M. M.; Marti A; Zazpe I;
Libro:  Nutrición y Dietética Clínica
2014  págs. 111 - 130
Autores: Ruiz-Canela, Miguel; Zazpe I;
Libro:  Conceptos de salud pública y estrategias preventivas. Un manual para ciencias de la salud
2013  págs. 297 - 302
Autores: Martínez, Miguel Ángel; Toledo, Estefanía Ainhoa; Sánchez Tainta, Ana; et al.
Libro:  Compendio de salud pública
2011  págs. 435 - 448
Autores: Sánchez, Elena; Zazpe I;
Libro:  Fundamentos de nutrición y dietética : bases metodológicas y aplicaciones
2011  págs. 309 - 316
Autores: Santiago, Susana; Zazpe I;
Libro:  Alimentación, ejercicio físico y salud
2010  págs. 139 - 173
Autores: García-Unciti, M, (Editor); Zazpe I, (Editor); et al.
2010 
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