Long-Term Impact of Nutritional Intervention with Increased Polyphenol Intake and Physical Activity Promotion on Oxidative and Inflammatory Profiles in Patients with Metabolic Syndrome.

Obesity and overweight pose significant risks to health, contributing to the prevalence of chronic conditions like type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). The current study aimed to assess the impact of a 6-year nutritional and lifestyle intervention on oxidative and inflammatory markers in individuals aged 55 to 75, specifically those at high risk of CVD. A study was carried out in a group of 80 participants with metabolic syndrome (MetS) residing in Mallorca, Spain, who underwent nutritional intervention based on a low-calorie Mediterranean diet (MedDiet) and promotion of physical activity. Before and after the intervention, several parameters including anthropometric data, haematological factors, blood pressure, and physical activity level were measured. Oxidative and inflammatory biomarkers in plasma were analysed. After the 6-year intervention, participants who managed to reduce their body mass index (BMI) had greater reductions in abdominal obesity, waist to heigh ratio (WHtR), diastolic blood pressure, and glucose levels, and increased high density protein cholesterol (HDL-c) compared to those who did not reduce BMI. This higher reduction in BMI was related to reduced energy intake and increased adherence to MedDiet, with greater polyphenol intake, and total physical activity (PA). Furthermore, improvements in oxidative stress and proinflammatory status were observed in participants who reduced their BMI. Significant reductions in the activity of the prooxidant enzyme, myeloperoxidase (MPO), levels of the lipid oxidation marker, malondialdehyde (MDA), and the proinflammatory chemokine, monocyte chemoattractant protein-1 (MCP-1,) were found in those who reduced their BMI. In contrast, participants who did not improve their BMI exhibited higher levels of proinflammatory markers such as MCP-1 and tumour necrosis factor α (TNFα), as well as increased activity of the antioxidant enzyme catalase (CAT). Current findings suggest that an effective way to reduce BMI is a hypocaloric MedDiet combined with tailored physical activity to improve oxidative stress and proinflammatory status, and potentially reducing the risk of CVD.

Food Neophobias in Spanish Adults with Overweight or Obesity by Sex: Their Association with Sociodemographic Factors and the Most Prevalent Chronic Diseases.

Food neophobia has been defined as the reluctance to try new foods. Food neophobia is common in children and older people, but until now, scarce research has been carried out on food neophobia in the adult population. The aim of this study was to assess the most usual food neophobias in Spanish adults with overweight and obesity by sex, and their association with sociodemographic factors and the most prevalent chronic diseases. A cross-sectional observational study was carried out on adults (mean age of 43.5 ± 13.7 years old; n = 590; 50% female) with overweight or obesity. Their anthropometrics, adherence to the Mediterranean diet, age, educational level, economic level, smoking and sleeping habits, physical activity, chronic diseases, and food neophobias were assessed. The highest food neophobias in Spanish adults with overweight or obesity were directed toward vegetables, meat, fish, pulses, game meat, and fruits, mostly among females, with differences between sexes. Phobias of the soft texture of foods were also observed, without differences between sexes. Age, educational level, sleeping habits, and physical activity were directly related, and economical level and smoking were inversely related to food neophobia, mainly to healthy foods, and more obvious in males than in females. There were associations between body mass index (BMI) and chronic diseases and food neophobia. Adherence to the adaption of healthy and sustainable diets is low within food neophobics, increasing the risk of diet-related chronic diseases.

Effect of a nutritional intervention based on an energy-reduced Mediterranean diet on environmental impact.

OBJECTIVE: To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up. METHODS: Baseline and 1-year follow-up data were used for 5800 participants aged 55-75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact. RESULTS: We observed a significant reduction in the intervention group compared to the control group in acidification levels (-13.3 vs. -9.9 g SO2-eq), eutrophication (-5.4 vs. -4.0 g PO4-eq) and land use (-2.7 vs. -1.8 m2). Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %. CONCLUSIONS: A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters.

Effects of Regular Exercise on the Biochemical, Oxidative, and Inflammatory Profiles and Quality of Life in Older Spaniards with Metabolic Syndrome.

Metabolic syndrome increases the risk of developing diabetes and cardiovascular disease. The regular practice of physical activity is a crucial factor for healthy aging and for controlling and preventing chronic diseases. To assess the effects of regular physical activity on the biochemical and inflammatory profiles, as well as the quality of life of older adults diagnosed with metabolic syndrome. Participants (aged 55-70 years; living in the Balearic Islands, Spain) were divided into two groups (n = 50 each) according to the degree of physical activity measured by metabolic equivalents of task (METs). Anthropometric parameters, blood pressure, biochemical and hematological parameters, and inflammatory biomarkers were measured. Beck Depression Inventory and adherence to the Mediterranean diet questionnaires, as well as the Dietary Inflammatory Index, chair test, health-related quality of life (HRQoL), and Rapid Assessment of Physical Activity, were also determined. The characterization of the patients was similar in both groups, showing a homogeneous sample. The group with the highest METs experienced a decrease in depression and an increase in the intensity of physical activity. Adherence to the Mediterranean diet and HRQoL physical dimensions increased in participants with the highest METs, also showing a decrease in glycemia and glycosylated hemoglobin values. Inflammatory biomarkers, including tumor necrosis factor alpha, interleukin-6, interleukin-1ß, and osteoprotegerin, decreased in patients practicing more physical activity. High levels of physical activity are related to a healthier lifestyle, characterized by high adherence to the Mediterranean diet, decreased depressive behavior, oxidative stress, and inflammatory status in older people with metabolic syndrome.

Impact of Adherence to the Mediterranean Diet on Antioxidant Status and Metabolic Parameters in NAFLD Patients: A 24-Month Lifestyle Intervention Study.

BACKGROUND: The Mediterranean Diet (MedDiet) is recognized as a healthy dietary pattern. Non-alcoholic fatty liver disease (NAFLD) is characterized by the excessive accumulation of fat in the liver. OBJECTIVES: To assess the antioxidant status in erythrocytes, plasma, and peripheral blood mononuclear cells (PBMCs) of NAFLD patients following a 24-month lifestyle intervention based on the MedDiet. Adult patients (n = 40; aged 40-60 years) diagnosed with NAFLD by magnetic resonance imaging were divided into two groups based on their adherence to the MedDiet. Consumption was assessed using a validated 143-item semiquantitative Food Frequency Questionnaire. Anthropometrics, biochemistry parameters, intrahepatic fat contents (IFC), antioxidants, and inflammatory biomarkers were measured in plasma and erythrocytes before and after the intervention. RESULTS: After the intervention, body mass index (BMI) and plasma levels of total cholesterol, low-density lipoprotein cholesterol (LDL-chol), triglycerides, malondialdehyde (MDA), and cytokeratin-18 (CK18) decreased, and high-density lipoprotein cholesterol (HDL-chol) increased. Participants with high adherence to MedDiet showed lower IFC, hepatic enzyme (AST, ALT, and GGT), glycemia, oxidase LDL (oxLDL) plasma levels, and erythrocyte MDA levels. Higher antioxidant activity (erythrocyte catalase-CAT, superoxide dismutase-SOD, glutathione peroxidase-GPx, glutathione reductase-GRd, and total glutathione-GSH as well as PBMCs-CAT gene expression) was observed in these patients, along with a reduction of PBMCs reactive oxygen species production and Toll-like receptor 4 (TLR4) expression. Inverse associations were observed between adherence to the MedDiet and BMI, glycemia, AST, IFC, and CK18 plasma levels and oxLDL, CAT, SOD, and GRd activities in erythrocytes. A significant linear regression was observed between adherence to the MedDiet and antioxidant score. CONCLUSIONS: Adherence to the MedDiet is associated with improved plasma and PBMC antioxidant and inflammatory biomarker profiles and high antioxidant defences in erythrocytes.

Multicomponent (bio)markers for obesity risk prediction: a scoping review protocol.

INTRODUCTION: Despite international efforts, the number of individuals struggling with obesity is still increasing. An important aspect of obesity prevention relates to identifying individuals at risk at early stage, allowing for timely risk stratification and initiation of countermeasures. However, obesity is complex and multifactorial by nature, and one isolated (bio)marker is unlikely to enable an optimal risk stratification and prognosis for the individual; rather, a combined set is required. Such a multicomponent interpretation would integrate biomarkers from various domains, such as classical markers (eg, anthropometrics, blood lipids), multiomics (eg, genetics, proteomics, metabolomics), lifestyle and behavioural attributes (eg, diet, physical activity, sleep patterns), psychological traits (mental health status such as depression) and additional host factors (eg, gut microbiota diversity), also by means of advanced interpretation tools such as machine learning. In this paper, we will present a protocol that will be employed for a scoping review that attempts to summarise and map the state-of-the-art in the area of multicomponent (bio)markers related to obesity, focusing on the usability and effectiveness of such biomarkers. METHODS AND ANALYSIS: PubMed, Scopus, CINAHL and Embase databases will be searched using predefined key terms to identify peer-reviewed articles published in English until January 2024. Once downloaded into EndNote for deduplication, CADIMA will be employed to review and select abstracts and full-text articles in a two-step procedure, by two independent reviewers. Data extraction will then be carried out by several independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Peer Review of Electronic Search Strategies guidelines will be followed. Combinations employing at least two biomarkers from different domains will be mapped and discussed. ETHICS AND DISSEMINATION: Ethical approval is not required; data will rely on published articles. Findings will be published open access in an international peer-reviewed journal. This review will allow guiding future directions for research and public health strategies on obesity prevention, paving the way towards multicomponent interventions.

Nitrite Attenuates the In Vitro Inflammatory Response of Immune Cells to the SARS-CoV-2 S Protein without Interfering in the Antioxidant Enzyme Activation.

SARS-CoV-2 induces a hyperinflammatory reaction due to the excessive release of cytokines during the immune response. The bacterial endotoxin lipopolysaccharide (LPS) contributes to the low-grade inflammation associated with the metabolic syndrome, enhancing the hyperinflammatory reaction induced by the SARS-CoV-2 infection. The intake of sodium nitrate, a precursor of nitrite and nitric oxide, influences the antioxidant and pro-inflammatory gene expression profile after immune stimulation with LPS in peripheral blood mononuclear cells from metabolic syndrome patients. We aimed to assess the inflammatory and antioxidant responses of immune cells from metabolic syndrome patients to exposure to the SARS-CoV-2 spike protein (S protein) together with LPS and the effect of nitrite in these responses. Whole blood samples obtained from six metabolic syndrome patients were cultured for 16 h at 37 °C with four different media: control medium, control medium plus LPS (100 ng/mL), control medium plus LPS (100 ng/mL) plus S protein (10 ng/mL), and control medium plus LPS (100 ng/mL) plus S protein (10 ng/mL) plus nitrite (5 µM). Immune stimulation with the LPS/S protein enhanced nitrate biosynthesis from nitrite oxidation and probably from additional organic precursors. In vitro incubations with the LPS/S protein enhanced the expression and/or release of pro-inflammatory TNFα, IL-6, IL-1ß, and TLR4, as well as the expression of the anti-inflammatory IL-1ra and IL-10 and antioxidant enzymes. Nitrite attenuated the pro- and anti-inflammatory response induced by the S protein without interfering with the activation of TLR4 and antioxidant enzyme expression, raising the possibility that nitrite could have potential as a coadjutant in the treatment of COVID-19.

Association between Beverage Consumption and Environmental Sustainability in an Adult Population with Metabolic Syndrome.

Beverages are an important part of the diet, but their environmental impact has been scarcely assessed. The aim of this study was to assess how changes in beverage consumption over a one-year period can impact the environmental sustainability of the diet. This is a one-year longitudinal study of 55-75-year-old participants with metabolic syndrome (n = 1122) within the frame of the PREDIMED-Plus study. Food and beverage intake were assessed using a validated food frequency questionnaire and a validated beverage-specific questionnaire. The Agribalyse® 3.0.1 database was used to calculate environmental impact parameters such as greenhouse gas emission, energy, water, and land use. A sustainability beverage score was created by considering the evaluated environmental markers. A higher beverage sustainability score was obtained when decreasing the consumption of bottled water, natural and packed fruit juice, milk, and drinkable dairy, soups and broths, sorbets and jellies, soft drinks, tea without sugar, beer (with and without alcohol), and wine, as well as when increasing the consumption of tap water and coffee with milk and without sugar. Beverage consumption should be considered when assessing the environmental impact of a diet. Trial registration: ISRCTN, ISRCTN89898870. Registered 5 September 2013.

Cross-Sectional Study of the Anthropometric Profile and Nutrient Status of Elite Female Ice Hockey Players: Differences by Play Position.

Both the characteristics of ice hockey and the environmental conditions in which it is played affect the maintenance of the player's nutritional status and, therefore, their state of health and performance. The primary aim of this work was to examine the anthropometric profile, estimated energy expenditure, and macronutrient and micronutrient dietary intake of elite female ice hockey players by play position. As a secondary aim, their dietary intakes were compared with the recommendations. Hypotheses suggest variations in body composition based on ice hockey players' positions, with the expectation that these athletes may not align with energy and nutrient recommendations. Fifteen elite female ice hockey players were anthropometrically measured, basal metabolic rate and total energy expenditure were estimated, a 3-day, 24 h recall questionnaire was registered, and the results were compared with the recommended dietary intake for the Spanish population. Each player's position on the field requires an individualized physical and nutritional approach. There are no significant imbalances (p > 0.05) between energy and nutrient intake in relation to the Recommended Daily Intake (RDI); however, increasing the consumption of vegetables and seafood while reducing meat and fat intake would assist these athletes in maintaining a healthier energy balance, optimizing body composition, and aligning with nutritional parameters that are better suited to enhance physical performance.

Carbon Dioxide (CO2) Dietary Emissions Are Related to Oxidative and Inflammatory Status in Adult Population.

BACKGROUND: Carbon dioxide (CO2) is a primary greenhouse gas (GHG) causing global temperature to rise. Unsustainable diets induce an increment in the risk of obesity and noncommunicable diseases but also contribute to the global GSG burden. OBJECTIVE: To assess whether CO2 dietary emissions influence the inflammatory and oxidative status of subjects with metabolic syndrome (MetS). METHODS: As part of the PREDIMED-Plus study, 100 adults (55-75 years old) from the Balearic Islands, Spain, were recruited and classified according to their dietary CO2 emissions. Anthropometric parameters were determined, fasting blood samples were collected and plasma, neutrophils, and peripheral blood mononuclear cells (PBMCs) were obtained. Dietary inflammatory index (DII), adherence to a Mediterranean diet (ADM), fatty liver index (FLI), and estimated glomerular filtration (eGFR) were calculated. Clinical biochemical parameters, blood count, and oxidative stress and inflammatory biomarker levels were also determined. RESULTS: DII was higher in participants with high dietary CO2 emissions. Adherence to the MedDiet was inversely associated with CO2 emissions. Malondialdehyde (MDA) levels were higher in urine and plasma samples from subjects with high dietary CO2 emissions. Reactive oxygen species (ROS) production by PBMCs was greater in participants with high CO2 emissions. Interleukin-15, resistin, and leptin plasma levels were increased in participants with high dietary CO2 emissions. CONCLUSION: Dietary CO2 emissions influence oxidative status and inflammation in relation to the increased prooxidative and proinflammatory status in PBMCs and plasma. These biomarkers were useful for monitoring diet sustainability and health.

Perceived Quality of Life Is Related to a Healthy Lifestyle and Related Outcomes in Spanish Children and Adolescents: The Physical Activity, Sedentarism, and Obesity in Spanish Study.

BACKGROUND: Maintaining a healthy lifestyle is crucial for safeguarding the well-being and quality of life perception, appropriate growth, and development of children and adolescents, while also mitigating the risk of future adult-onset diseases. OBJECTIVE: To assess associations between perceived quality of life and healthy lifestyle and related outcomes in Spanish children and adolescents. METHODS: Cross-sectional analysis of 8-16-year-old children and adolescents (n = 3534) were included in the nationwide study of Physical Activity, Sedentarism, and Obesity in Spanish Youth (PASOS). Data were collected through (1) questionnaires on health-related quality of life (HRQoL), healthy lifestyle outcomes (dietary intake, physical fitness, sleep, and screen time), and (2) anthropometric measurements for weight status assessment. Data were analysed by logistic regression, using the health-related quality of life (HRQoL) as the grouping variable. RESULTS: Participants with a lower HRQoL were those with a lower adherence to the MedDiet and lower achievement of the recommended daily intake of fruit and vegetables. They were also less likely to follow the recommendations for screen time and sleep (with the exception of the weekend) compared to participants with a higher HRQoL. Participants with a lower HRQoL showed a lower healthy weight status and poorer physical fitness than those with a higher HRQoL. CONCLUSIONS: Healthy eating habits, healthy weight status (normal weight), appropriate sleep time, physical fitness, and limited screen time play a crucial role in the perceived quality of life in children and adolescents.

Nutrition Status of Female Winter Sports Athletes.

Eating disorders, especially restrictive eating, are common among female athletes. There are two main types of winter sports: those that are practiced outdoors on snow (-25 to +5 °C and 2500 m), such as alpine skiing and snowboarding, and those that are practiced indoors on ice (5-10 °C at low altitude), such as figure skating and ice hockey. The aim of this research was to identify the nutritional status and potential risk of female athletes practicing winter sports, considering the altitude of training. The sample was composed of 58 women (aged 19.81 years (SD: 12.61)) who were competitors in some winter sports. Anthropometrics and nutritional variables were taken. Statistically significant differences were found between HA and LA groups for all the characteristics except thigh skinfold, and neither group had an energy intake (EI) that matched their total energy expenditure (TEE). Both groups met at least two-thirds of the RDI for all minerals and vitamins except iodine, fluorine, vitamin D, vitamin E, and retinol. This study suggests that female winter sports athletes have insufficient energy, vitamin, and mineral intake, which can be worsened with altitude.

Assessing Food Preferences and Neophobias among Spanish Adolescents from Castilla-La Mancha.

Food neophobia is a reaction of dislike or fear of food, which may be due to a wide variety of factors (taste, texture, exposure at an early age, genetics, or diversity in feeding practices and food consumption). The aim of this study was to assess the preferences for tastes and foods and food neophobias among Spanish adolescents and to compare the differences between boys and girls. This was a cross-sectional observational study on 11-18-year-old healthy adolescents (n = 600; 50% female) recruited in the Castilla-La Mancha region (central Spain). Information on taste preferences, food neophobias, anthropometric measurements, and sociodemographic data was recorded. The highest taste preference was found for sweet, salty, and umami. Most adolescents usually did not try new foods outside the home, nor did they like to try foods from other countries. More than half of them also acknowledged being selective eaters or were very particular about the foods they ate. There were no significant associations between taste preference and neophobias with obesity, waist-to-height ratio (WtHR), sleep, and smoking. Adolescents showed a high unwillingness to change food habits, and most of the food neophobias found in the current study were related to new, novel, or previously unknown foods. Spanish adolescents from central Spain (Castilla-La Mancha region) showed a preference for sweet, salty, and umami tastes of foods, as well as food neophobia towards foods that they do not regularly consume, mainly those with a bitter taste. Gender and body weight showed little influence, and age had a moderate influence on food neophobias. Familiarity with foods, as well as educational activities, are suggested as useful to decrease food neophobias among adolescents.

The Relationship between Social Media Use and Body Image in Lebanese University Students.

Well-being is not only defined as being physically healthy; multiple factors can affect a person's well-being. Social media is strongly correlated with the body dissatisfaction of an individual. High exposure to lean and toned body shapes has created new standards and "idealized" body types. The aim of this article was to assess the relationship between social media and body image among university students in Lebanon. Data were obtained from 292 university students (median age: 22 years), selected from different Lebanese regions by using convenience sampling. Demographic data, social media addiction, body satisfaction, levels of physical activity, eating behaviors, and ultimate well-being were expressed as median and interquartile range. People who relied more on social media were younger than those who did not. Individuals addicted to social media had higher odds of having moderate and marked body image concerns. A significant association was found between social media addiction and emotional overeating, food responsiveness, and feeling hunger. These findings stress the need for rising regional and national awareness among social media users, especially the younger ones, and the implementation of intervention and prevention techniques to help prevent body image dissatisfaction, disordered eating patterns, and the alteration of overall well-being.

Dietary Patterns, Foods, and Nutrients to Ameliorate Non-Alcoholic Fatty Liver Disease: A Scoping Review.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease without pharmacological treatment yet. There is also a lack of specific dietary recommendations and strategies to treat the negative health impacts derived from NAFLD. OBJECTIVE: This scoping review aimed to compile dietary patterns, foods, and nutrients to ameliorate NAFLD. METHODS: A literature search was performed through MEDLINE, Scopus, Web of Science, and Google Scholar. RESULTS: Several guidelines are available through the literature. Hypocaloric Mediterranean diet is the most accepted dietary pattern to tackle NAFLD. Coffee consumption (sugar free) may have a protective effect for NAFLD. Microbiota also plays a role in NAFLD; hence, fibre intake should be guaranteed. CONCLUSIONS: A high-quality diet could improve liver steatosis. Weight loss through hypocaloric diet together with physical activity and limited sugar intake are good strategies for managing NAFLD. Specific dietary recommendations and a Mediterranean plate have been proposed to ameliorate NAFLD.

Priorización de políticas alimentarias en España mediante el Índice Food-EPI de entornos alimentarios saludables: panel de expertos / Prioritization of food policies in Spain through the Food-EPI Index of healthy eating environments: panel of experts

Fundamentos: La conducta alimentaria de los individuos y las influencias ejercidas desde el entorno alimentario es un elementoclave para promover y facilitar el acceso a alimentos saludables. Sin embargo, el conocimiento sobre la implementación de políticassobre entornos alimentarios saludables en España es escaso. El objetivo de este trabajo fue identificar y evaluar el nivel de implementación de políticas alimentarias en España, así como priorizar acciones necesarias para crear entornos alimentarios saludables,con la ayuda por un panel de personas expertas. Métodos: Se creó un panel de personas del mundo académico y la Administración expertas en salud pública, nutrición, políticasalimentarias o de salud, que evaluaron el nivel de implementación de políticas alimentarias en España durante 2018-2020, identificando y priorizando acciones concretas, utilizando elÍndice de Políticas Ambientales de Alimentos de Entornos Alimentarios Saludables(Food-EPI). Se consideraron seis dominios para entornos alimentarios y seis dominios de infraestructura alimentaria. La confiabilidadentre evaluadores se midió utilizandoAgreeStat 2015.6.2 a través de Gwet AC2. Se utilizó la calificación media de los indicadores. Seaplicó el método Delphi.Resultados: Las acciones políticas necesarias en alimentación saludable en España se consideraron bajas (58%) en com-posición, etiquetado, promoción y precios de los alimentos, y muy bajas (25%) en comercio minorista de alimentos. Las accionesprioritarias necesarias de apoyo a las infraestructuras alimentarias saludables se consideraron de importancia media (52%) paraliderazgo y monitorización, y de importancia baja (48%) en gobernanza, financiación y plataformas.Conclusiones: España muestra un gran potencial para crear entornos alimentarios saludables, con una necesidad baja o muy bajade políticas de implementación de entornos alimentarios saludables.(AU)

Background: The eating behaviour of individuals and the influences exerted from the food environment is a key element to promote and facilitate access to healthy foods. However, knowledge about the implementation of policies on healthy food environmentsin Spain is scarce. The aim of this paper was to identify and assess the level of implementation of environmental food policies anddetermine and prioritize actions necessary to create healthy food environments in Spain, helped by a panel of experts. Methods: A panel of experts from the University and the government administration specialized in public health, nutrition, food, orhealth policies was created and invited to participate, asking them to evaluate the level of implementation of food policies in Spain during2018-2020, holding workshops to identify and prioritize concrete actions, using theHealthy Food Environmental Policy Index (Food-EPI).Six key policy domains of food environments, and 6 domains of food infrastructure were considered. Interrater reliability was measuredusingAgreeStat 2015.6.2 through Gwet AC2. The mean rating of the indicators was used. Data analysis was a three-step process byapplication of the Delphi method. Results: The necessary political actions in healthy eating in Spain were considered low (58%) in food composition, labelling, promo-tion, and prices, and very low (25%) in food retail trade. The priority actions needed to support healthy food infrastructures were considered of medium importance (52%) for leadership and monitoring, and of low importance (48%) in governance, financing, and platforms.Conclusions: Spain shows great potential to create healthy food environments, with a low or very low need for policies toimplement healthy food environments, and medium or low support for healthy food infrastructures.(AU)

Parents' Diet Quality and Physical Activity Are Associated with Lifestyle in Spanish Children and Adolescents: The PASOS Study.

BACKGROUND: Non-communicable chronic diseases are associated with a low-quality diet, low physical activity, and sedentary behavior. OBJECTIVE: To assess how parents' diet and physical activity habits were associated with their offsprings' lifestyles. STUDY DESIGN: A cross-sectional analysis of 8-16-year-old children and adolescents (n = 2539; 51.9% girls) was carried out within the frame of the first edition of the Physical Activity, Sedentarism, Lifestyles, and Obesity in Spanish Youth study (PASOS-2019). Data on adherence to the Mediterranean Diet (MedDiet), daily moderate-vigorous physical activity (MVPA), and screen time per day (television, computer, video games, and mobile phone) were collected from children and adolescents, and data on parents' diet quality and physical activity were compiled. Logistic regression models were used to assess the association between parents' lifestyles and those of children and adolescents. RESULTS: High diet quality of parents was associated with higher adherence to the MedDiet of children and adolescents, as well as high consumption of fruit, vegetables, fish, nuts, and legumes. The high physical activity level of parents was associated with the low consumption of fast foods, sweets, and candies in children and adolescents. Children with high levels of physical activity were those whose parents showed better diet quality and physical activity levels. CONCLUSIONS: Parents' high diet quality and physical activity were associated with healthy lifestyles, higher adherence to the MedDiet, and physical activity of their offspring, mainly in adolescents.

Association of monetary diet cost of foods and diet quality in Spanish older adults.

Background: A major barrier to a healthy diet may be the higher price of healthy foods compared to low-quality foods. Objectives: This study aimed to assess the association between the monetary cost of food and diet quality in Spanish older adults at high risk of cardiovascular disease. Methods: Cross-sectional analysis was carried out in Spanish older adults (n = 6,838; 48.6% female). A validated food frequency questionnaire was used to assess dietary intake. Metabolic syndrome severity, adherence to the Mediterranean diet (MedDiet), adherence to a provegetarian dietary pattern, and dietary inflammatory index were assessed. The economic cost of the foods was obtained from the Spanish Ministry of Agriculture Fisheries and Food database (2015-2017, the period of time when the participants were recruited). The total cost of diet adjusted per 1,000 kcal was computed. Results: The healthier dietary pattern was associated with a higher cost of the diet. Higher adherence to the MedDiet, anti-inflammatory diet, and the healthy version of the provegetarian dietary pattern were related to higher costs of the diet. Conclusion: Higher diet quality was associated with a higher dietary cost of the diet per 1,000 kcal/day. Food prices can be an important component of interventions and policies aimed at improving people's diets and preventing diet-related chronic diseases. Clinical trial registry number: The trial was registered in 2014 at the International Standard Randomized Controlled Trial (ISRCT; http://www.isrctn.com/ISRCTN89898870) with the number 89898870.

Oxidative Stress and Inflammatory Biomarkers Are Related to High Intake of Ultra-Processed Food in Old Adults with Metabolic Syndrome.

In the last few decades the consumption of ultra-processed foods (UPFs) worldwide has substantially augmented. Increasing evidence suggests that high UPF consumption is associated with an increase in non-communicable diseases, being overweight, and obesity. The aim of this study was to assess how UPF consumption affects oxidative and inflammatory status in the plasma, neutrophils, and urine of old adults with metabolic syndrome. Participants (n = 92) were classified into two groups according to UPF consumption. Dietary intakes were measured by a validated semi-quantitative 143-item food frequency questionnaire and UPF consumption was determined according to the NOVA classification system. Low UPF consumers showed higher adherence to the Mediterranean diet than high UPF consumers. A high intake of fiber and a high concentration of polyphenols in urine were also observed in subjects with low UPF consumption. Despite the absence of differences in biochemical profile, oxidative and inflammatory biomarkers showed some significant changes. Catalase and superoxide dismutase activities were lower in high UPF consumers, whereas myeloperoxidase activity was higher. ROS production in neutrophils stimulated with zymosan was higher in high UPF consumers than in low UPF consumers. Biomarkers such as xanthine oxidase, tumor necrosis factor α (TNFα), interleukin (IL)-6, IL-15, and leptin levels were higher in participants with high intake of UPF. No differences were found in malondialdehyde and other inflammatory cytokines. The current study evidenced that MetS participants with high UPF consumption have a more pro-oxidant and inflammatory profile than those with low UPF consumption, despite showing similar blood biochemical profiles.

Plasma Fatty Acid Composition, Oxidative and Inflammatory Status, and Adherence to the Mediterranean Diet of Patients with Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is a complex and increasingly prevalent cardiometabolic disorder worldwide. As of today, NAFLD is a pathology without specific pharmacological treatment, with the Mediterranean diet (MedDiet) being the most widely used approach for its management. The objective of this study is to assess the effects of adherence to the Mediterranean diet on fatty acid plasma levels, as well as on the oxidative and inflammatory status of NAFLD patients. A total of 100 adult patients (40-60 years old) diagnosed with NAFLD and from the Balearic Islands, Spain, were classified into three groups according to their adherence to the MedDiet. Consumption was assessed using a validated 143-item semiquantitative Food Frequency Questionnaire. Food items (g/day) were categorised according to their processing using the NOVA system. Anthropometrics, blood pressure, aminotransferases, Dietary Inflammatory Index (DII), inflammatory biomarkers, and fatty acid levels were measured in the plasma of NAFLD patients. High adherence to the MedDiet is associated to a highly plant-based diet, low ultra-processed food (UPF) consumption, low intake of dietary lipids, low intake of animal fats, high intake of monounsaturated fatty acid (MUFA; mainly palmitoleic acid), low intake of saturated fatty acids (SFAs; practically all dietary SFAs), low intake of trans-fatty acids, high intake of omega-3 fatty acids (mainly eicosapentaenoic acid), a higher n-6:n-3 in ratio, low intake of omega-6 fatty acids, and a low level of interleukin-6 (IL-6). High adherence to the MedDiet is related to a better fatty acid profile in the plasma, fewer SFAs and more MUFA and polyunsaturated fatty acids (PUFAs), a plasma biochemical profile, better proinflammatory status, and decreased ultra-processed food consumption of NAFLD patients.