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      Nut Consumptions as a Marker of Higher Diet Quality in a Mediterranean Population at High Cardiovascular Risk

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      Nutrients
      MDPI
      nut consumption, nutrient adequacy, diet quality, Mediterranean diet, cardiovascular risk disease

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          Abstract

          Background: Nut consumption has been associated with improved nutrient adequacy and diet quality in healthy adult populations but this association has never been explored in individuals at high cardiovascular risk. Objective: to assess the associations between consumption of nuts and nutrient adequacy and diet quality in a Mediterranean population at high cardiovascular risk. Design: baseline assessment of nutritional adequacy in participants ( n = 6060, men and women, with ages 55–75 years old, with overweight/obesity and metabolic syndrome) in the PREDIMED-PLUS primary cardiovascular prevention randomized trial. Methods: nut intake was assessed using a validated food frequency questionnaire. Participants who reported consuming zero quantity of nuts were classified as ‘non-nut consumers’. ‘Nut consumers’ were participants who reported consuming any quantity of nuts. Nineteen micronutrients were examined (vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine). The proportion of micronutrient inadequacy was estimated using the estimated average requirements (EAR) or adequate intake (AI) cut-points. Diet quality was also assessed using a 17-item Mediterranean dietary questionnaire (Mediterranean diet score, MDS), a carbohydrate quality index (CQI) and a fat quality index (FQI). Results: eighty-two percent of participants were nut consumers (median of nut consumption 12.6 g/day; interquartile range: 6.0–25.2). Nut consumers were less likely to be below the EAR for vitamins A, B1, B2, B6, C, D, E, folic acid, and Ca, Mg, Se and Zn than non-nut consumers. Nut consumers were also more likely to be above the AI for K and Cr than non-nut consumers. Nut consumers had lower prevalence of inadequate micronutrient intakes, but also higher CQI, higher FQI, and better scores of adherence to the Mediterranean diet (Mediterranean diet score, MDS). Conclusions: nut consumers had better nutrient adequacy, diet quality, and adherence to the MedDiet than those non-nut consumers.

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          Reproducibility of an FFQ validated in Spain.

          To evaluate the reproducibility of a semi-quantitative FFQ used in the Seguimiento Universidad de Navarra (SUN) project. The data that were analysed were collected from an FFQ answered twice by a 326-participant subsample of the SUN project (115 men, 35.3 %; 211 women, 64.7 %), with either less than 1 year or more than 1 year between responses. The questionnaire included 136 items. Pearson correlation coefficients (r) were calculated to evaluate the magnitude of the association between both measures after energy adjustment and correcting for within-person variability. We also evaluated misclassification by quintiles distribution. The highest corrected correlations among participants who answered before 1 year were found for PUFA (r = 0.99). Among participants who answered after 1 year between both questionnaires, olive oil had the highest corrected correlation (r = 0.99). The highest percentage of gross misclassification, lowest quintile in FFQ1 and highest quintile in FFQ2 or highest quintile in FFQ1 and lowest quintile in FFQ2 was for cereals, fish or seafood, and n-3 fatty acids (7.6 %). Alcoholic drinks had the highest percentage of reasonable classification, same or adjacent quintile, in FFQ1 and FFQ2 (86.4 %). Our study suggests that FFQ reproducibility is acceptable for participants who answered the same questionnaire twice less than 1 year apart. Participants who answered FFQ more than 1 year apart showed worse values on reproducibility. We consider this Spanish FFQ as an important, valid and reproducible tool in nutritional epidemiology.
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            The Mediterranean Diet and Nutritional Adequacy: A Review

            The Mediterranean dietary pattern, through a healthy profile of fat intake, low proportion of carbohydrate, low glycemic index, high content of dietary fiber, antioxidant compounds, and anti-inflammatory effects, reduces the risk of certain pathologies, such as cancer or Cardiovascular Disease (CVD). Nutritional adequacy is the comparison between the nutrient requirement and the intake of a certain individual or population. In population groups, the prevalence of nutrient inadequacy can be assessed by the probability approach or using the Estimated Average Requirement (EAR) cut-point method. However, dietary patterns can also be used as they have moderate to good validity to assess adequate intakes of some nutrients. The objective of this study was to review the available evidence on the Nutritional Adequacy of the Mediterranean Diet. The inclusion of foods typical of the Mediterranean diet and greater adherence to this healthy pattern was related to a better nutrient profile, both in children and adults, with a lower prevalence of individuals showing inadequate intakes of micronutrients. Therefore, the Mediterranean diet could be used in public health nutrition policies in order to prevent micronutrient deficiencies in the most vulnerable population groups.
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              Projected Prevalence of Inadequate Nutrient Intakes in Europe

              Background: The purpose of this study was to analyze the prevalence of nutrient intake inadequacy in Europe, applying the Nordic Nutritional Recommendations in the context of the EURRECA Network of Excellence. Methods: Nutrient data was obtained from the European Nutrition and Health Report II. Those nutritional surveys using a validated food frequency questionnaire or diet history and a food diary/ register with at least 7 days of registers or with an adjustment for intraindividual variability were included. The nutrients analyzed were: vitamin C, vitamin D, vitamin B 12 , folic acid, calcium, iron, zinc, selenium, copper, and iodine. The estimated average requirement cut point was applied to estimate inadequacy. The Nordic and Institute of Medicine nutrient recommendations were used as references. Results: The mean prevalence of inadequacy was below 11% for zinc, iron, and vitamin B 12 (only in the elderly), and it was 11–20% for copper in adults and the elderly and for vitamin B 12 in adults and vitamin C in the elderly. The prevalence was above 20% for vitamin D, folic acid, calcium, selenium, and iodine in adults and the elderly and for vitamin C in adults. Conclusions: Vitamin C, vitamin D, folic acid, calcium, selenium, and iodine were the nutrients showing a higher prevalence of inadequate intakes in Europe.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                30 March 2019
                April 2019
                : 11
                : 4
                : 754
                Affiliations
                [1 ]CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; mar.bibiloni@ 123456uib.es (M.d.M.B.); aliciajulibert@ 123456gmail.com (A.J.); cristinabouvel@ 123456gmail.com (C.B.); mamartinez@ 123456unav.es (M.A.M.-G.); dolores.corella@ 123456uv.es (D.C.); jordi.salas@ 123456urv.cat (J.S.-S.); mariaadoracion.romaguera@ 123456ssib.es (D.R.); jalfmtz@ 123456unav.es (J.A.M.); jwarnberg@ 123456uma.es (J.W.); jlopezmir@ 123456gmail.com (J.L.-M.); restruch@ 123456clinic.cat (R.E.); aborau@ 123456secardiologia.es (F.A.); fjtinahones@ 123456hotmail.com (F.T.); lluis.serra@ 123456uplgc.es (L.S.-M.); jlapetra@ 123456ono.com (J.L.); cvazquezma@ 123456gmail.com (C.V.); xpinto@ 123456bellvitgehospital.cat (X.P.); eros@ 123456clinic.cat (E.R.); rebeca.fernandez@ 123456uv.es (R.F.-G.); angariaros2004@ 123456yahoo.es (A.G.-R.); mazulet@ 123456unav.es (M.A.Z.); mfito@ 123456imim.es (M.F.); monica.bullo@ 123456urv.cat (M.B.); jbasora.tgn.ics@ 123456gencat.cat (J.B.); jc.cenoz.osinaga@ 123456cfnavarra.es (J.C.C.); javierdiezesp@ 123456ono.com (J.D.-E.); etoledo@ 123456unav.es (E.T.)
                [2 ]Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain
                [3 ]Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
                [4 ]Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, 31008 Pamplona, Spain
                [5 ]Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
                [6 ]Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain
                [7 ]Human Nutrition Unit, Biochemistry and Biotechnology Department, IISPV, Universitat Rovira i Virgili, 43201 Reus, Spain
                [8 ]Cardiovascular Risk and Nutrition Research Group (CARIN), Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; mzomeno@ 123456imim.es (M.D.Z.); hschroeder@ 123456imim.es (H.S.)
                [9 ]Human Nutrition Unit, Blanquerna-Ramon Llull University, 08022 Barcelona, Spain
                [10 ]Miguel Hernandez University, ISABIAL-FISABIO, 46020 Alicante, Spain; vioque@ 123456umh.es (J.V.); abueno@ 123456ugr.es (A.B.-C.); vicente.martin@ 123456unileon.es (V.M.); dorozcobeltran@ 123456gmail.com (D.O.-B.)
                [11 ]CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; mdelgado@ 123456ujaen.es
                [12 ]Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
                [13 ]Cardiometabolics Nutrition Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain
                [14 ]School of Nursing, School of Health Sciences, University of Málaga-IBIMA, 29010 Málaga, Spain
                [15 ]Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain
                [16 ]Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
                [17 ]Department of Preventive Medicine, University of Granada, 18016 Granada, Spain
                [18 ]Department of Cardiology, OSI ARABA, University Hospital Araba, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain
                [19 ]Department of Endocrinology, Virgen de la Victoria Hospital, University of Málaga, 29010 Málaga, Spain
                [20 ]Institute for Biomedical Research, University of Las Palmas de Gran Canaria, 35001 Las Palmas, Spain
                [21 ]Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
                [22 ]Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain
                [23 ]Department of Endocrinology, Fundación Jiménez-Díaz, 28040 Madrid, Spain
                [24 ]Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
                [25 ]Department of Endocrinology, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain; jovidal@ 123456clinic.cat
                [26 ]CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
                [27 ]Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain; lidia.daimiel@ 123456imdea.org
                [28 ]Department of Health Sciences, University of Jaen, 23071 Jaen, Spain
                [29 ]Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; pilar.matia@ 123456gmail.com
                [30 ]Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, 08036 Barcelona, Spain
                Author notes
                [* ]Correspondence: pep.tur@ 123456uib.es
                Author information
                https://orcid.org/0000-0002-3917-9808
                https://orcid.org/0000-0002-2366-4104
                https://orcid.org/0000-0003-2700-7459
                https://orcid.org/0000-0003-1280-7680
                https://orcid.org/0000-0002-2284-148X
                https://orcid.org/0000-0001-5218-6941
                https://orcid.org/0000-0002-8408-316X
                https://orcid.org/0000-0003-1260-4445
                https://orcid.org/0000-0002-0649-3016
                https://orcid.org/0000-0003-0552-2804
                https://orcid.org/0000-0001-9898-6629
                https://orcid.org/0000-0002-2573-1294
                https://orcid.org/0000-0002-3926-0892
                https://orcid.org/0000-0002-0218-7046
                https://orcid.org/0000-0002-6263-4434
                https://orcid.org/0000-0002-6940-0761
                Article
                nutrients-11-00754
                10.3390/nu11040754
                6521169
                30935087
                b921061b-c1d4-46ea-b3b4-9def8ca52bd5
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 February 2019
                : 28 March 2019
                Categories
                Article

                Nutrition & Dietetics
                nut consumption,nutrient adequacy,diet quality,mediterranean diet,cardiovascular risk disease

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