Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents

OBJECTIVE: To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns. DESIGN: Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered). SETTING: Spain. SUBJECTS: In total, 3850 children and youths aged 2-24 years residing in Spain. RESULTS: Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age. CONCLUSIONS: The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.     

Self-administration of a food security scale by adolescents: item functioning, socio-economic position and food intakes

OBJECTIVE: To evaluate the reliability and validity of a six-item food security scale when self-administered by adolescents. DESIGN: Cross-sectional questionnaire survey including the six-item food security measure, socio-economic variables and a food-frequency questionnaire. SETTING: Representative sample of 29 schools in Trinidad. SUBJECTS: In total 1903 students aged approximately 16 years. RESULTS: Item affirmatives ranged from 514 (27%) for the 'balanced meal' item to 128 (7%) for the 'skipped or cut meals often' item and 141 (7%) for the 'hungry' item. Item-score correlations ranged from 0.444 to 0.580. Cronbach's alpha was 0.77. Relative item severities from the Rasch model ranged from -1.622 (standard error 0.043) for the 'balanced meal' item to 1.103 (0.068) for the 'skipped or cut meals often' item and 0.944 (0.062) for the 'hungry' item. The 'hungry' item gave a slightly lower relative severity in boys than girls. Food insecurity was associated with household overcrowding (adjusted odds ratio comparing highest and lowest quartiles 2.61, 95% confidence interval 1.75 to 3.91), lack of pipe-borne water in the home, low paternal education or paternal unemployment. After adjusting for socio-economic variables, food insecurity was associated with less frequent consumption of fruit (0.75, 0.60 to 0.94) or fish (0.72, 0.58 to 0.88) but more frequent consumption of biscuits or cakes (1.47, 1.02 to 2.11). CONCLUSIONS: The food security scale provides a valid, reliable measure in adolescents, although young people report being hungry but not eating relatively more frequently than adults. Food-insecure adolescents have low socio-economic position and may eat less healthy diets.     

Gender, environmental tobacco smoke, and pulmonary function in rural children and adolescents: the Humboldt study

We examined the gender-related association between household exposure to environmental tobacco smoke (ETS) and pulmonary function among 862 children and adolescents aged 6 to 17 years living in the town of Humboldt, Saskatchewan, in 1993. Pulmonary function tests included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow rate (FEF25-75), and flow rates at 75%, 50%, and 25% of vital capacity (Vmax75, Vmax50, and Vmax25). Each pulmonary function test variable was regressed on age, height, weight, and their quadratic and cubic polynomials, with the terms significant at the alpha level of 0.10 being retained. Residuals for the pulmonary function test variables, which are the differences between the observed and predicted values, were calculated. Estimations of ETS exposure were parental smoking status, number of household smokers, total daily cigarette consumption, and number of cigarettes smoked daily at home by household members. Maternal smoking status was significantly related to residual FEF25-75, Vmax75, Vmax50, and Vmax25. Number of household smokers and daily cigarette consumption by household members were significantly associated with FEV1, FEF25-75, Vmax75, Vmax50, and Vmax25, and the association between ETS exposure and pulmonary function was stronger in girls than in boys. Interaction of gender and number of cigarettes smoked daily at home was significantly related to FEF25-75, Vmax75, Vmax50, and Vmax25 among the non-smoking subjects. We concluded that ETS exposure had a larger effect on pulmonary function in girls than in boys.     

Saturated fat in the diet of Spanish children: relationship with anthropometric, alimentary, nutritional and lipid profiles

OBJECTIVE: To compare the anthropometric, alimentary, nutritional and lipid profiles and global diet quality of Spanish children according to saturated fat intake. DESIGN: This was a cross-sectional study. Food data were collected using a food-frequency questionnaire. SUBJECTS AND METHODS: The sample included 1112 children of both sexes, aged between 6 and 7 years, selected by means of random cluster sampling in schools. The plasma lipid profile included measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein A1 (apoA1) and apolipoprotein B (apoB). Global diet quality was evaluated by the Dietary Variety Index (DVI) and the Healthy Eating Index (HEI). RESULTS: Energy intake, DVI and HEI of children from the lower quartile of saturated fat intake (LL) were higher (P<001) than in the remaining children (UL). However, there were no significant differences in average height or weight between groups. The UL children had lower intakes of meat, fish, vegetables, fruits and olive oil and a higher intake of dairy products (P<0.001). The intakes of fibre, vitamins C, D, B6, E and folic acid were higher in the LL children, who had lower intakes of vitamin A and calcium. The ratios LDL-C/HDL-C and apoB/apoA1 were lower (P=0.04) in the LL children (1.87 and 0.52, respectively) than in the UL children (2.02 and 0.54, respectively). CONCLUSIONS: The growth rate of children does not seem to be affected by the level of saturated fat intake. Furthermore, at the levels of intake observed in this study, diets with less saturated fat are associated with better alimentary, nutritional and plasma lipid profiles.     

Variation of hydrogen, carbon, nitrogen, and oxygen stable isotope ratios in an American diet: fast food meals

The stable isotopes of hydrogen, carbon, nitrogen, and oxygen provide insights into a heterotrophic organism's diet and geographic origin. Although the contribution of food delta (2)H and delta (18)O to the final tissue signal will not vary for constrained diets, it will for animals eating varied diets, that is, humans. This study surveyed the isotopic range in one portion of the American diet, fast food meals. Hamburger patties, buns, and French fries from national chain restaurants across the United States and from local restaurants (Salt Lake City, UT, and Charleston, SC) were analyzed for delta (2)H, delta (13)C, delta (15)N (patties only) and delta (18)O values. Patties and buns from local Utah restaurants were more depleted for delta (2)H, delta (13)C, and delta (18)O values than samples from other restaurants. There were no significant differences in delta values among French fries. All three components of the fast food meal displayed significant linear delta (2)H versus delta (18)O relationships (delta (2)H = 7.8delta (18)O - 237 per thousand, delta (2)H = 5.9delta (18)O - 258 per thousand, and delta (2)H = 3.3delta (18)O - 231 per thousand for patties, buns, and fries, respectively). The findings show that significant predictable variation exists in the stable isotopic composition of fast food meals. It is proposed that the variation in delta (13)C values of hamburger (beef) patties is indicative of differences in cattle-rearing practices, whereas delta (2)H and delta (18)O values are evidence of geographic variation in food sources. Although the patterns support the concept of a "continental" supermarket diet, there appears to be a strong regional component within the diet.     

Beyond-brand effect of television food advertisements on food choice in children: the effects of weight status

OBJECTIVE: To investigate the effect of television food advertising on children's food intake, specifically whether childhood obesity is related to a greater susceptibility to food promotion. DESIGN: The study was a within-subject, counterbalanced design. The children were tested on two occasions separated by two weeks. One condition involved the children viewing food advertisements followed by a cartoon, in the other condition the children viewed non-food adverts followed by the same cartoon. Following the cartoon, their food intake and choice was assessed in a standard paradigm. SETTING: The study was conducted in Liverpool, UK. SUBJECTS: Fifty-nine children (32 male, 27 female) aged 9-11 years were recruited from a UK school to participate in the study. Thirty-three children were normal-weight (NW), 15 overweight (OW) and 11 obese (OB). RESULTS: Exposure to food adverts produced substantial and significant increases in energy intake in all children (P < 0.001). The increase in intake was largest in the obese children (P = 0.04). All children increased their consumption of high-fat and/or sweet energy-dense snacks in response to the adverts (P < 0.001). In the food advert condition, total intake and the intake of these specific snack items correlated with the children's modified age- and gender-specific body mass index score. CONCLUSIONS: These data suggest that obese and overweight children are indeed more responsive to food promotion, which specifically stimulates the intake of energy-dense snacks.     

Selecting a healthy diet score: lessons from a study of diet and health in early old age (the Boyd Orr cohort)

OBJECTIVES: To describe the selection and modification of an appropriate diet score to assess diet quality in early old age. DESIGN AND SETTING: Cross-sectional analyses of the Boyd Orr cohort - a long-term follow-up of men and women whose families took part in a survey of diet and health in pre-war Britain. Dietary data were obtained from a 113-item food-frequency questionnaire. A nine-item Healthy Diet Indicator (HDI) developed by Huijbregts and colleagues was identified from the literature and modified because some dietary variables were unavailable and to accord more closely with recommendations of the UK Committee on Medical Aspects of Food Policy. SUBJECTS: In total, 1475 traced, surviving cohort members aged 60 years and over. RESULTS: Modification resulted in a 12-item Healthy Diet Score (HDS). We found that about half the variation in the HDS was explained by variation in the HDI (r=0.71). There was, however, little misclassification of subjects (<10%) into extreme thirds of the distribution by the HDS compared with the HDI. Items of the score most strongly correlated with overall score were saturated fat (r=-0.57), red meat (r=-0.46), dietary fibre (r=0.58), fruit and vegetables (r=0.54) and percentage energy from carbohydrates (r=0.51). Modifying existing items had greater impact on agreement between HDI and HDS than the addition of new items. CONCLUSIONS: The selection and modification of diet scores is more complicated than often assumed. Furthermore, modest changes to an existing score can produce a score that is different from the original, and although it was not possible to test this issue, it may no longer predict subsequent health experience.     

Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour

OBJECTIVES: To examine the association between education level and food purchasing behaviour and the contribution of dietary knowledge to this relationship; and the association between household income and purchasing behaviour and the contribution made by subjective perceptions about the cost of healthy food.DESIGN AND SETTING: The study was conducted in Brisbane City (Australia) in 2000. The sample was selected using a stratified two-stage cluster design. Data were collected by face-to-face interview from residents of private dwellings (n=1003), and the response rate was 66.4%. Dietary knowledge was measured using a 20-item index that assessed general knowledge about food, nutrition, health and their interrelationships. Food-cost concern was measured using a three-item scale derived from principal components analysis (alpha=0.647). Food purchasing was measured using a 16-item index that reflected a household's purchase of grocery items that were consistent (or otherwise) with dietary guideline recommendations. Associations among the variables were analysed using linear regression with adjustment for age and sex.RESULTS: Significant associations were found between education, household income and food purchasing behaviour. Food shoppers with low levels of education, and those residing in low-income households, were least likely to purchase foods that were comparatively high in fibre and low in fat, salt and sugar. Socio-economic differences in dietary knowledge represented part of the pathway through which educational attainment exerts an influence on diet; and food purchasing differences by household income were related to diet in part via food-cost concern.CONCLUSIONS: Our findings suggest that socio-economic differences in food purchasing behaviour may contribute to the relationship between socio-economic position and food and nutrient intakes, and, by extension, to socio-economic health inequalities for diet-related disease. Further, socio-economic differences in dietary knowledge and concerns about the cost of healthy food play an important role in these relationships and hence should form the focus of future health promotion efforts directed at reducing health inequalities and encouraging the general population to improve their diets.     

Cadmium soil sorption at low concentrations: I. Effect of time,cadmium load,pH, and calcium

Sorption of Cd at low concentrations onto two Danish soils (loamy sand, sandy loam) was examined in terms of kinetics and governing factors. From an environmental point of view soil sorption of Cd is a fast process: More than 95% of the sorption takes place within 10 min, equilibrium is reached in 1 hr, and exposures up to 67 wk did not reveal any long term changes in Cd sorption capacities. The soils have very high affinity for Cd at pH = 6.00 (10^?3 M CaCl₂) exhibiting distribution coefficients in the order of 200 to 250 (soil Cd concentration/solute Cd concentration). However, the sorption isotherms describing the distribution of Cd between soil and solute are slightly curvelinear. In the pH-interval 4 to 7.7, the sorption capacity of the soil approximately increases 3 times for a pH increase of one unit. Increasing the Ca concentration from 10^?3 to 10^?2 M reduces the sorption capacity of the sandy loam to one third.     

Television food advertising to children: the extent and nature of exposure

OBJECTIVE: To describe the pattern and prevalence of food and drink advertisements to children on commercial television in Sydney, Australia, and compare these with advertising regulations set out in the Children's Television Standards and results from a similar study in 2002. DESIGN: Data were collected by recording television from 06.00 hours until 23.00 hours on all three commercial channels from Sunday 14 May 2006 to Saturday 20 May 2006 (357 h). The study analysed advertisements in two children's viewing periods, one as defined in the 2002 study and the other according to current standards. Food advertisements were coded using 18 food categories and were analysed by time period and popular children's programmes. RESULTS: Food advertisements occurred in similar proportions during children's viewing hours and adult's viewing hours (25.5 vs. 26.9% of all advertisements, respectively), although there was a higher rate of high-fat/high-sugar food advertisements during children's viewing hours (49 vs. 39% of all food advertisements, P < 0.001). There were even more advertisements for high-fat/high-sugar foods during popular children's programmes, contributing to 65.9% of all food advertisements. Estimates of exposure indicate that children aged 5-12 years were exposed to 96 food advertisements, including 63 high-fat/high-sugar advertisements per week. Since 2002, there has been a reduction in overall food and high-fat/high-sugar food advertisements.CONCLUSION: Despite reductions in overall levels of food advertising, children continue to experience high levels of exposure to food advertisements, which remain skewed towards unhealthy foods. Further food advertising regulation should be required to curtail the current levels of advertising of high-fat/high-sugar foods to children, to make them commensurate with recommended levels of consumption.     

Genetic and environmental impact on iron, zinc, and phytate in food sorghum grown in Benin

Seventy-six farmers' varieties of sorghum from Benin were distinguished by amplified fragment length polymorphism (AFLP) and clustered into 45 distinct genotypes. The genotype clusters were evaluated for their Fe, Zn, and phytate concentrations to assess the impact of genetic and environmental effects on the composition of the grains and to identify farmers' varieties with high potential Fe and Zn availability. The Fe concentration of the grains ranged from 30 to 113 mg/kg with an average of 58 mg/kg. The Zn concentration ranged from 11 to 44 mg/kg with an average of 25 mg/kg. The phytate concentration of the grain ranged from 0.4 to 3.5% with a mean of 1.2%. The grain-Fe and grain-Zn did not show consistent linkage to genetic variation, but varied significantly across field locations, suggesting a predominant environmental impact. The phytate concentration of the grains appeared to be environmentally as well as genetically determined. No varieties provide adequate Zn to meet nutritional requirements of sorghum consumers. The most promising varieties for Fe supply were tokogbessenou, mahi swan, biodahu, sa? ma?, mare dobi, sakarabokuru, and chabicouma, as they showed a [phytate]/[Fe] ratio of <14, which is the critical value above which Fe availability is strongly impaired. These varieties could therefore be recommended for the preparation of food products such as dibou, in which processing methods have only a slight diminishing effect on phytate levels. Further research is needed to test these varieties for the stability of [phytate]/[Fe] molar ratio across various environmental conditions.     

Potential food additives from Carex distachya roots: identification and in vitro antioxidant properties

In the present study, the chemical composition and antioxidant properties of root methanol extract of Carex distachya Desf. (Cyperaceae) were assessed to use this plant as sources of food additives and nutraceuticals. The IC50 of the extract (4.2 microg/mL), derived from the DPPH radical scavenging capacity assay, was similar to those of ascorbic acid, alpha-tocopherol, and BHT. These results revealed a strong antioxidant activity because of the presence of an extraordinary quantity of bioactive phytochemicals. The phytochemical study of the root extract led to the isolation and identification of new and known polyphenols, most of them common constituents of plant foods. A total of 16 polyphenols, identified on the basis of spectroscopic data as 7 lignans, 4 phenylethanoids, 3 resveratrol derivatives, a monolignol, and a secoiridoid glucoside, were isolated. The tentative structural elucidation of the new metabolites 5'-O-beta-D-glucopyranosyloxy-3,3'-dimethoxy-7,9'-epoxylignan-4,8',9-triol and 3,5-bis-O-beta-D-glucopyranosyloxy-3'-methoxy-trans-stilben-4'-ol have been performed by a combined approach using ESI/TQ/MS techniques and 1D and 2D NMR experiments. All of the compounds have been tested for their antioxidant activity using six different antioxidant and radical scavenging tests. Interestingly, the extract contained high quantities of polyphenols, most of them reported as constituents of edible plants, such as grape and olive, suggesting that the methanol root extract of this plant could be used as a source of natural antioxidants useful as potential food additives.     

Gut load and transit time in Hormogaster elisae (Oligochaeta,Hormogastridae) in laboratory cultures

The gut load and gut transit time (GTT) of the endogeic earthworm Hormogaster elisae in laboratory cultures at 18 °C and 23 ºC were studied. The GTT, 5.25 h ± 0.40 at 18 ºC and 3.63 h ± 0.46 at 23 ºC, was determined by staining the soil with alimentary colouring (tartrazine). The gut load was calculated with two methods: earthworm mass difference, before and after voiding the gut, and dry mass of the gut content. The gut load ranged between 168 and 261 mg wet mass g live earthworm mass^–1 (mass difference method) or 137–196 mg dry mass g live earthworm mass^–1 (dry mass method). With the obtained data a potential annual soil turnover for H. elisae was calculated: 211–470 kg wet soil mass kg live earthworm mass^–1 year^–1 (mass difference method) or 176–325 kg dry soil mass kg live earthworm mass^–1 year^–1 (dry mass method).