LINE-1 methylation in leukocyte DNA, interaction with phosphatidylethanolamine N-methyltransferase variants and bladder cancer risk.

BACKGROUND: Aberrant global DNA methylation is shown to increase cancer risk. LINE-1 has been proven a measure of global DNA methylation. The objectives of this study were to assess the association between LINE-1 methylation level and bladder cancer risk and to evaluate effect modification by environmental and genetic factors. METHODS: Bisulphite-treated leukocyte DNA from 952 cases and 892 hospital controls was used to measure LINE-1 methylation level at four CpG sites by pyrosequencing. Logistic regression model was fitted to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Interactions between LINE-1 methylation levels and environmental and genetic factors were assessed. RESULTS: The risk of bladder cancer followed a nonlinear association with LINE-1 methylation. Compared with subjects in the middle tertile, the adjusted OR for subjects in the lower and the higher tertiles were 1.26 (95% CI 0.99-1.60, P=0.06) and 1.33 (95% CI 1.05-1.69, P=0.02), respectively. This association significantly increased among individuals homozygous for the major allele of five single-nucleotide polymorphisms located in the phosphatidylethanolamine N-methyltransferase gene (corrected P-interaction<0.05). CONCLUSIONS: The findings from this large-scale study suggest that both low and high levels of global DNA methylation are associated with the risk of bladder cancer.

Work in the textile industry in Spain and bladder cancer.

BACKGROUND/OBJECTIVE: Textile manufacturing is a complex industry that has frequently been associated with bladder cancer. However, results have not been consistent. This study investigated the risk of bladder cancer in Spanish textile workers. METHODS: We analysed data from a multicentre hospital-based case-control study carried out in Spain (1998-2001) including 1219 cases of bladder cancer and 1271 controls. Of those, 126 cases and 122 controls reported a history of employment in the textile industry. Lifetime occupational history was obtained using a computer-assisted personal interview. Occupations, locations and materials used in the textile industry were assessed using a detailed questionnaire and expert assessment. RESULTS: Overall, no increased risk of bladder cancer was found for textile workers, including duration of employment analysis. Increased risks were observed for weavers (OR = 1.82, 95% CI 0.95 to 3.47), for workers in winding/warping/sizing (OR 4.11, 95% CI 1.58 to 10.71) and for those exposed to synthetic materials (OR 1.89, 95% CI 1.00 to 3.56). Working for more than 10 years appeared to be associated with an increased risk for weavers (OR 2.27, 95% CI 0.97 to 5.34), for those who had ever worked in winding/warping/sizing (OR 11.03, 95% CI 1.37, 88.89), for workers in the weaving room (OR 2.94, 95% CI 1.24 to 7.01) and for those exposed to synthetic (OR 2.62, 95% CI 1.14 to 6.01) or cotton (OR 2.00, 95% CI 1.04 to 3.87) materials. Statistically significant higher risks were also found for specific combinations of occupations or locations with exposure to synthetics and cotton. CONCLUSIONS: There was no overall increased risk for textile workers, but increased risks were found for specific groups of workers. Our findings indicate that observed risks in previous studies may be better evaluated by analysis of materials used or section worked within the industry and occupation.

Occupation and bladder cancer in a hospital-based case-control study in Spain.

OBJECTIVES: We investigated the association between occupation and bladder cancer in a hospital-based case-control study conducted in Spain. METHODS: 1219 patients with transitional cell carcinoma of the urinary bladder and 1271 controls selected from 18 hospitals in Spain between June 1998 and September 2000 provided detailed information on life-time occupational history, smoking habits, medical history, and other factors. We used unconditional logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for each occupation and industry, adjusting for age, hospital region, smoking duration, and employment in a high-risk occupation for bladder cancer. RESULTS: Statistically significant increased risks were observed among men employed as machine operators in the printing industry (OR 5.4; 95% CI 1.6 to 17.7), among men employed in the transportation equipment industry (OR 1.6; 95% CI 1.1 to 2.6) and among those who had worked for >/=10 years in the electrical/gas/sanitary services (OR 3.9; 95% CI 1.5 to 10.4) and in hotels and other lodgings (OR 3.1; 95% CI 1.3 to 7.3). Men who worked as miscellaneous mechanics and repairers (OR 2.0; 95% CI 1.1 to 3.6) and as supervisors in production occupations (OR 2.1; 95% CI 1.2 to 3.6) also had excess risks for bladder cancer. Male farmers and those who worked in crop and livestock production had decreased risks for bladder cancer. We found no significant associations between occupation or industry and bladder cancer risk among women. CONCLUSIONS: We did not observe excess bladder cancer risk for many of the occupations identified as being a priori at high risk. Examination of more detailed job exposure information should help clarify these associations.

Assessment of lifetime exposure to trihalomethanes through different routes.

OBJECTIVES: To evaluate lifetime exposure to trihalomethanes (THM) through ingestion, inhalation, and dermal absorption in a hospital based case-control study of bladder cancer conducted between 1998 and 2001 in five areas of Spain. The study base was comprised of subjects living in the catchment areas of the participating hospitals. METHODS: Individual information on water related habits was obtained from personal interviews of 1219 cases and 1271 controls: residential and occupational history, drinking water source at each residence and job, amount of water consumption, frequency and duration of showering, bathing, and swimming pool attendance. THM levels, water source history, and year when chlorination started in study areas were ascertained through measurements in drinking water samples and questionnaires to water companies and local authorities. Estimates of THM levels covered 79% of the subjects' person-years of exposure. RESULTS: Current and historical average THM levels in water were correlated. Control subjects reported that drinking water source in the last residence was municipal for 63%, bottled for 22%, private well for 2%, and other sources for 13%. For the time window between age 15 and the time of interview, average residential THM level was 32.2 mug/l. THM exposure through ingestion was 23.7 mug/day on average, and was correlated with the ingestion THM level in the workplace. Overall, 79% usually took showers, 16% usually took baths, and 13% had ever attended a swimming pool. Between 21% and 45% of controls unexposed to THM through ingestion were evaluated as moderately or highly exposed through showering or bathing, and 5-10% were exposed through swimming in pools. CONCLUSION: The importance of evaluating different routes is underscored by findings from experimental studies showing substantial differences in THM uptake and internal distribution by route.

Gender-related differences in clinical and pathological characteristics and therapy of bladder cancer.

OBJECTIVE: To confirm the very high male:female ratios previously observed among Spanish bladder cancer patients and to assess gender differences in tumoral characteristics, diagnostic procedures, and treatment in a large series of consecutive bladder cancer patients. PATIENTS AND METHODS: All newly diagnosed bladder cancer patients (n=615) in 17 Spanish hospitals, between 1997-2000, were included. Information was collected both through personal interviews to patients and from medical records using a structured form. RESULTS: Seventy-six percent of tumours were superficial. The male:female ratio was 6.7 and it was similar for superficial and infiltrating tumours. Women were older than men at the diagnosis of bladder cancer (68.2+/-9.4 years versus 65.7+/-9.7 years, p=0.01). Ten percent of superficial tumours in women, versus 3% in men, were classified as "other histological types" (p=0.008). T1GIII tumours were more frequent among men (17% versus 7%, p=0.047). On the other hand, women were more likely to present with 0a-stage tumours (48.6% versus 35.5%, p=0.04), multiple tumours (50% versus 29%, trend test: 0.005), multi-centric tumours (54% versus 38%, p=0.019), and larger infiltrating masses (5.2 cm versus 3.8 cm, p=0.03) than men. Among 0a-stage tumours, only 23% of women compared to 54% of men received transurethral resection (TUR) alone (p=0.002). Women were almost five-fold more likely to receive additional therapies to TUR (p=0.004) after adjusting for age, geographical area, stage, tumoral size, nuclear grade, and multiplicity. CONCLUSION: The study confirms the very high male:female ratio of bladder cancer in Spain. We found substantial differences in the pathological characteristics of tumours from men and women. There was a tendency for women to receive more frequently non-standard, more aggressive, therapy than men.

Comparative analysis of nutrition data from national, household, and individual levels: results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain.

STUDY OBJECTIVE: This project determined to what extent data on diet and nutrition, which were collected in a non-uniform manner, could be harmonised and pooled for international and national comparison. DESIGN: Direct comparisons of dietary data between studies were made using food balance sheets (FBS), household budget surveys (HBS), and individual dietary data (IDS); comparisons were also made within countries. Differences in study design and methodological approaches were taken into consideration. Data from research projects from the following four World Health Organisation (WHO) Countrywide Integrated Noncommunicable Disease Intervention (CINDI) countries were included-Canada, Finland, Poland, and Spain. MAIN RESULTS: FBS overestimated food consumption and nutrient intake compared to IDS. Results between HBS and IDS were quite similar, except for fish, meat, pulses and vegetables, which were underestimated by HBS, and sugar and honey and cereals, which were overestimated. Percentages of energy from fat, carbohydrates and proteins were higher when estimated from FBS, HBS, and IDS respectively. CONCLUSIONS: Results suggest that estimations from these three sources of dietary data are difficult to compare because they are measuring different levels of dietary information. The understanding of their relations may be important in formulating and evaluating a nutrition policy.

Determinants of nutrient intake among children and adolescents: results from the enKid Study.

BACKGROUND: Although adequacy of nutrient intake has been studied considerably in children and adolescents across Europe, the factors associated with nutritional risk have rarely been addressed. This study was developed in order to explore the nutritional intakes of Spanish children and the factors influencing the risk of nutritional inadequacy. OBJECTIVES: To evaluate socio-economic and lifestyle variables associated with nutritional adequacy in Spanish children and adolescents. METHODS: A cross-sectional study utilising face-to-face interviews. A random sample of 3,534 individuals aged 2-24 years were interviewed by a team of 43 dieticians in the subjects' homes. Interviews included two 24-hour recalls (a second 24-hour recall in 25% of the sample) and other questions, including lifestyle. Weight and height were measured in all subjects. Under-reporters (18%) were excluded from the present analysis. An unconditional logistic regression analysis was used to identify variables associated with greater nutritional risk. RESULTS: The participation rate was 68%. Twenty percent of males and 50% of females were classified as being at high nutritional risk. Variables associated with increased nutritional risk were: age between 14 and 24 years, being female, low social class, low educational level of the mother, having more than one sibling, smoking, watching TV during meals, sedentary habits at leisure time, infrequent meals and a poor quality breakfast. One dietary factor closely associated with nutritional risk was a failure to consume ready-to-eat cereals. CONCLUSIONS: Nutritional risk during infancy and adolescence is associated with socio-economic and educational variables of the family, and some lifestyle factors including physical activity and the quality of the breakfast meal.

Food patterns of Spanish schoolchildren and adolescents: The enKid Study.

OBJECTIVE: To evaluate dietary habits and nutritional status of Spanish schoolchildren and adolescents. DESIGN: Cross-sectional study by face-to-face interview. METHODS: A random sample of 3534 people aged 2 to 24 years were interviewed by a team of 43 dietitians in the subjects' homes. Interviews included 24-hour recalls (a second 24-hour recall in 30% of the sample), a food-frequency questionnaire and other questions including lifestyles, knowledge and food preferences. RESULTS: The participation rate was 68%. Mean daily energy consumption was 2189 kcal among males and 1781 kcal among females, and the percentage of energy from fat and saturated fat was 39.8% and 13.4%, respectively, without any differences by gender. Of females, 95% showed folic acid intakes below 200 microg day(-1). Consumption expressed as food groups reflected a westernised Mediterranean pattern. CONCLUSIONS: The enKid Study provides reliable and useful nutrition information for children and adolescents in Spain, having incorporated a rigorous methodological design within a representative sample.

[Distribution of blood lipids in a representative sample of the adult population of Catalonia. Research Group on Assessment of the Nutritional Status of the Catalonian Population: Biochemical Assessment]. / Distribución de la concentración de lípidos séricos en una muestra representativa de la población adulta de Cataluña. Grupo de Investigación sobre Evaluación del Estado Nutricional de la Población Catalana: Evaluación Bioquímica.

BACKGROUND: The leading cause of mortality in Spain are cardiovascular diseases. Their prevention largely depends on the control of hypercholesterolemia. The aim of this study is to describe the serum concentration of total cholesterol (TC), HDL-cholesterol (HDLc), LDL-cholesterol (LDLc) and triglycerides in the population of Catalonia (Spain). SUBJECTS AND METHODS: We obtained a representative sample of the catalan population 18-75 years-old in 1993. The concentrations of HDLc was analyzed after precipitation, the concentration of TC and triglycerides was obtained by enzimatic methods, and the concentration of LDLc was calculated using the Friedewald formula. RESULTS: We obtained a sample of 487 women and 393 men (participation rate: 38%). The mean concentrations of TC, LDLc, HDLc and triglycerides was, respectively, of 203.9 mg/dl (SD = 39.7 mg/dl) (5.24 mmol/l, SD = 1.02 mmol/l), 127.5 mg/dl (SD = 35.9 mg/dl) (3.28 mmol/l, SD = 0.92 mmol/l), 55.8 mg/dl (SD = 14.0 mg/dl) (1.45 mmol/l, SD = 0.36 mmol/l) and 103.9 mg/dl (SD = 75.4 mg/dl) (1.15 mmol/l, SD = 0.84 mmol/l). Nineteen percent of the sample had a concentration of TC > 240 mg/dl (6.42 mmol/l), 3.0% a concentration of HDLc < 35 mg/dl (0.91 mmol/l), 17.2% a concentration of LDL > 160 mg/dl (4.11 mmol/l) and 7.4% a concentration of triglycerides > 7.4 mg/dl (2.22 mmol/l). The concentrations of LDLc and triglycerides and the atherogenic index (TC/HDLc) were higher in men than in women and they increased with age. CONCLUSIONS: The cholesterol levels could be considered lower in Catalonia, Spain, than in other developed countries, and there is a tendency to decrease accordingly to the decrease in the cardiovascular mortality rates. However, the lipid profile in men older than 35 years and in women older than 50 years is still a cause of concern.

Intake of specific carotenoids and flavonoids and the risk of gastric cancer in Spain.

OBJECTIVES: To investigate the relationship between gastric cancer and the intake of specific carotenoids (alpha-carotene, beta-carotene, lutein, and lycopene) and flavonoids (quercetin, kaempferol, myricetin, and luteolin) using new data on their concentration in foods. METHODS: Case-control study carried out in Spain that included 354 cases of gastric cancer and 354 controls, matched by age, gender, area of residence and hospital. Usual food intake was assessed using a dietary history questionnaire. RESULTS: In a multivariate model adjusted for several dietary factors, no association was found between intake of any of the studied carotenoids and the risk of gastric cancer. The adjusted OR of gastric cancer for the highest quartile of total flavonoid intake versus the lowest quartile was 0.44 (95 percent confidence interval [CI] = 0.25-0.78; P for trend = 0.003). Kaempferol intake was found to be protective (OR = 0.48; CI = 0.26-0.88; P for trend = 0.04) comparing the highest versus the lowest quartile of intake. A trend toward lower risk of stomach cancer with higher intake of quercetin was also found. CONCLUSIONS: The results of this study support the hypothesis that the well-established protective effect of fruit and vegetables against gastric cancer could, in part, be due to the presence of flavonoids.

[Dietary sources of vitamin A, C, E and beta-carotene in a adult Mediterranean population]. / Fuentes alimentarias de vitaminas A, C, E y beta-caroteno en una población adulta mediterránea.

OBJECTIVE: Estimation of vitamin A, C, E and beta-carotene food sources, as well as its nutritional intake and density in adult Catalonian population. METHODOLOGY: A cross-sectional study was conducted over 2,346 individuals obtained from the sample of Catalonian Survey of Nutritional Status aged 18 to 75 years old to estimate usual dietary intake of vitamins A, C, E and beta-carotene using two 24 hour dietary recalls administered in two periods (june-july and november-december of 1992). Replicated 24 hour Recalls allowed for estimation of usual intake. Calculation of food sources for vitamins encompassed three phases: foods transformation into nutrients, aggregation of foods in categories and sum of nutrients by food categories. RESULTS: Intake of vitamin A (equivalents of retinol of provitamin A and vitamin A), E, C were closely near or higher than RDA. Nutritional density of vitamin C, E and beta-carotene were higher in female group. Nutritional density was positively associated to age for vitamins C, E and beta-carotene. Addition fat was the first source of vitamin E and it reached 33.8% of total vitamin E intake. Vegetables contributed in 17.3 % to the total vitamin C, whereas fruits accounted for 57.9%. Fruits recached 40.6% of the total beta-carotene intake, whereas vegetables accounted for 34.8%. The major contributors of vitamin A were milk and dairy products. CONCLUSIONS: Nutritional intake of vitamin A, C and E are over the RDA parameters suggesting an healthy nutritional status that must be confirmed and ratify by biochemical assessment. Nutritional densities were higher in female gender than in males in vitamins C, E, and beta-carotene possibly due to a higher intake of total lipids in male gender than in females. Nutritional density was positively associated to age in the same group of vitamins, suggesting a higher intake of empty calories in younger group. Fruits and Vegetables accounted for more than 70% of vitamin C and beta-carotene and major contributors were citrics, carrots, tomatoes, spinach, and cauliflower, highlighting their importance in elaboration of dietary guide lines.

Which statin is most efficient for the treatment of hypercholesterolemia? A cost-effectiveness analysis.

A review of the cost-effectiveness literature indicated that the hydroxymethylglutaryl coenzyme A-reductase inhibitor fluvastatin is more cost-effective for achieving minor-to-moderate reductions in low-density lipoprotein cholesterol (LDL-C) levels than 3 other statins: lovastatin, pravastatin, and simvastatin. The main goal of this study was to verify the applicability of these conclusions to Spanish health care costs and patterns of resource consumption related to the treatment of hypercholesterolemia. A stochastic simulation model was used to predict both the costs and effects of treating high-risk hypercholesterolemic patients with fluvastatin, lovastatin, pravastatin, or simvastatin. Epidemiologic data were used to find a suitable theoretic probability distribution model for baseline LDL-C values in high-risk hypercholesterolemic patients. The model was then used to generate 10,000 random observations of baseline LDL-C values; the corresponding LDL-C values after a 2-year treatment period were predicted as a function of the baseline value and the percentage reduction expected with a particular statin and dose, according to the results obtained in 2 meta-analyses. The probability of treatment discontinuation was also taken into account using estimates obtained in usual practice. The effects of treatment were expressed as the rate of success in achieving the goal level of LDL-C, as defined in the current Spanish recommendations for the treatment of hypercholesterolemia. The average costs of treatment were computed from both the social and public-financing perspectives, including the cost of lipid-lowering drugs, physician visits, laboratory tests, and days off work, as appropriate. The occurrence of nonscheduled visits and workdays lost because of side effects were taken into account to compute indirect costs relevant to the social perspective. The potential costs of treating side effects were ignored. A cost-effectiveness analysis was performed to compare the cost-effectiveness ratios obtained with each of the 4 statins considered in this study. Model-based predictions of the effects, total costs, and cost-effectiveness ratios were made. Cost-effectiveness ratios were interpreted as the cost per patient meeting the goal of therapy, according to current Spanish recommendations. The data showed that fluvastatin had the lowest cost-effectiveness ratios when LDL-C levels required reduction to < or =25% of baseline levels. In this situation, fluvastatin was more cost-effective than lovastatin, pravastatin, or simvastatin from public-financing and social perspectives.

Intake of specific carotenoids and flavonoids and the risk of lung cancer in women in Barcelona, Spain.

Newly available data of a case-control study of lung cancer in women in Spain were analyzed to assess the relationship with the intake of specific carotenoids (alpha-carotene, beta-carotene, lutein, and lycopene) and flavonoids (quercetin, kaempferol, myricetin, and luteolin). The study included 103 cases and 206 hospital controls, matched by age and residence. Usual food intake was estimated through a food-frequency questionnaire. With adjustment for smoking habit and vitamin E, vitamin C, and total flavonoid intake, no association was found for the intake of alpha-carotene, beta-carotene, or lutein. The odds ratio (95% confidence interval) for women in the highest tertile of lycopene intake with respect to the lowest was 0.56 (0.26-1.24), with p for trend = 0.15. A nonsignificant association was observed for the highest vs. lowest tertile intake of kaempferol (odds ratio = 0.51, 95% confidence interval = 0.22-1.17), with p for trend = 0.10, after adjustment for smoking and vitamin E, vitamin C, and total carotenoid intake. No protective effect was observed for quercetin or luteolin or for total flavonoid intake.

Determinants of the nutritional status of vitamin E in a non-smoking Mediterranean population. Analysis of the effect of vitamin E intake, alcohol consumption and body mass index on the serum alpha-tocopherol concentration.

OBJECTIVE: Study was conducted in order to investigate the association of vitamin E intake and other factors with plasma alpha-tocopherol concentration in a non-smoking Mediterranean population. DESIGN: A cross-sectional study was conducted in a subsample of a representative sample of the Catalan population. SUBJECTS: Sample size was 143 men and women, aged between 18 and 75 y, and final response rate reached 61.9% of the initial sample. INTERVENTIONS: Serum alpha-tocopherol concentration standardized by serum total lipids was used as a proxy of the nutritional status of vitamin E. Vitamin E intake and alcohol consumption were estimated by a replicated 24 h recall method. Dietary data were collected in two different periods, winter and summer, in order to account for seasonal variation in nutrient intake, and were corrected for random within-person variability in order to account for day-to-day variation in nutrient intake. Multivariate linear regression models were fitted in order to estimate the determinants of serum alpha-tocopherol concentration. RESULTS: In this population study, for each one mg increase in vitamin E intake, serum alpha-tocopherol concentration increased, on average, 0.66 micromol/L, after adjusting for age, gender, Body Mass Index (BMI), alcohol consumption and energy intake. BMI also influenced significantly serum alpha-tocopherol concentration, whereas alcohol intake, age and gender did not show significant associations with serum alpha-tocopherol. CONCLUSIONS: The study showed that vitamin E nutritional status was associated to vitamin E intake and BMI in non-smokers.

A cross-sectional study of dental caries, intake of confectionery and foods rich in starch and sugars, and salivary counts of Streptococcus mutans in children in Spain.

In this cross-sectional study of 236 schoolchildren living in Manresa, Spain, we evaluated the association between prevalence of dental caries and frequency of consumption of various food groups, including sweetened baked goods and similar foods (rich in starch and sugars) and confectionery (rich in sugars but not starch), using a food-frequency questionnaire. Because Streptococcus mutans is associated with the cariogenicity of carbohydrates, we also evaluated the modification of these associations by salivary counts of this microorganism. Odds ratios (ORs) were used to measure the association between caries and tertiles of consumption. Sex, age, use of fluorides, tooth-brushing frequency, frequency of dental visits, socioeconomic status, and intake of other potentially cariogenic food groups were considered as potential confounders. We did not find a significant association between any of the food groups evaluated and caries prevalence. Failure to detect an association could have been due to the low prevalence of caries in our population (decayed, missing, or filled permanent teeth = 1.3 at age 10.6 y) or to underestimation of the association due to diet misclassification. In this population, the association between consumption of sweetened baked goods and caries appeared to be modified by the numbers of S. mutans [OR = 6.1 (95% CI: 1.6, 23.0) for low compared with high intake in children with moderate-to-high S. mutans counts and OR = 0.3 (95% CI: 0.1, 1.6) for low compared with high intake in children with low S. mutans counts]. These results suggest that a high intake of sweetened baked goods may be a determinant of caries prevalence in children with moderate-to-high salivary counts of S. mutans.

Fish consumption, omega-3 fatty acids and the Mediterranean diet.

Many epidemiological, interventional and animal studies have concluded that consumption of polyunsaturated fatty acids of marine origin may confer special benefits in reducing cardiovascular heart disease (CHD) mortality rates by different physiological mechanisms. The available epidemiological data, although limited, suggest that a dietetic recommendation on the consumption of one or two servings per week (200-300 g = 2-4 g eicosapentaenoic acid) of cold water marine fish could lead to a reduction of the CHD risk. Nevertheless, there are important methodological shortcomings and contradictory findings in most published investigations on the omega-3 fatty acids. In order to assess the role of fish consumption in the Mediterranean diet, we have compared data on average fish and fatty fish consumption trends in some Mediterranean (Spain, Yugoslavia and Italy) and northern European (Norway, Denmark) countries. Fish consumption is not positively correlated with ischaemic heart disease mortality. That suggests that dietary factors other than fish, such as the lower meat consumption associated to the higher fish intake, or other differences of lifestyle have perhaps intervened, helping to explain the healthy nature of the Mediterranean diet.

Dietary habits and dental caries in a population of Spanish schoolchildren with low levels of caries experience.

The aim of this study was to analyze the relationship between current dietary habits and dental caries in schoolchildren from an area of Spain on which the prevalence of caries was low. The results of an epidemiological study conducted on a random sample of 893 children from the cities of Girona and Figueres are presented. The method of dietary interview consisted of a food-frequency questionnaire. This showed a positive relationship between dental caries and consumption of ice cream, pastries, cakes, sliced bread, on the one hand, and sugar-free chewing gum and sugar-free candies, on the other. A protective effect of skimmed milk and artificial sweeteners was also observed. Results reflect the role of certain foods in caries development, but also the outcome of selective dietary counseling to high-risk children.