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      Macronutrient Distribution and Dietary Sources in the Spanish Population: Findings from the ANIBES Study

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          Abstract

          Our aim was to analyze dietary macronutrient intake and its main sources according to sex and age. Results were derived from the ANIBES (“Anthropometry, Intake and Energy Balance in Spain”) cross-sectional study using a nationally-representative sample of the Spanish population (9–75 years old). Mean dietary protein intake was 74.5 ± 22.4 g/day, with meat and meat products as the main sources (33.0%). Mean carbohydrate intake was 185.4 ± 60.9 g/day and was higher in children and adolescents; grains (49%), mainly bread, were the main contributor. Milk and dairy products (23%) ranked first for sugar intake. Mean lipid intake was 78.1 ± 26.1 g/day and was higher in younger age groups; contributions were mainly from oils and fats (32.5%; olive oil 25.6%) and meat and meat products (22.0%). Lipid profiles showed relatively high monounsaturated fatty acid intake, of which olive oil contributed 38.8%. Saturated fatty acids were mainly (>70%) combined from meat and meat products, milk and dairy products and oils and fats. Polyunsaturated fatty acids were mainly from oils and fats (31.5%). The macronutrient intake and distribution in the Spanish population is far from population reference intakes and nutritional goals, especially for children and adolescents.

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          Primary prevention of cardiovascular disease with a Mediterranean diet.

          Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639.).
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            A Randomized Trial of a Low-Carbohydrate Diet for Obesity

            New England Journal of Medicine, 348(21), 2082-2090
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              Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies.

              Saturated fatty acid (SFA) intake increases plasma LDL-cholesterol concentrations; therefore, intake should be reduced to prevent coronary heart disease (CHD). Lower habitual intakes of SFAs, however, require substitution of other macronutrients to maintain energy balance. We investigated associations between energy intake from monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and carbohydrates and risk of CHD while assessing the potential effect-modifying role of sex and age. Using substitution models, our aim was to clarify whether energy from unsaturated fatty acids or carbohydrates should replace energy from SFAs to prevent CHD. This was a follow-up study in which data from 11 American and European cohort studies were pooled. The outcome measure was incident CHD. During 4-10 y of follow-up, 5249 coronary events and 2155 coronary deaths occurred among 344,696 persons. For a 5% lower energy intake from SFAs and a concomitant higher energy intake from PUFAs, there was a significant inverse association between PUFAs and risk of coronary events (hazard ratio: 0.87; 95% CI: 0.77, 0.97); the hazard ratio for coronary deaths was 0.74 (95% CI: 0.61, 0.89). For a 5% lower energy intake from SFAs and a concomitant higher energy intake from carbohydrates, there was a modest significant direct association between carbohydrates and coronary events (hazard ratio: 1.07; 95% CI: 1.01, 1.14); the hazard ratio for coronary deaths was 0.96 (95% CI: 0.82, 1.13). MUFA intake was not associated with CHD. No effect modification by sex or age was found. The associations suggest that replacing SFAs with PUFAs rather than MUFAs or carbohydrates prevents CHD over a wide range of intakes.

                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                22 March 2016
                March 2016
                : 8
                : 3
                : 177
                Affiliations
                [1 ]Spanish Nutrition Foundation (FEN), C/General Álvarez de Castro 20, 1 pta, Madrid 28010, Spain; eruiz@ 123456fen.org.es (E.R.); jmavila@ 123456fen.org.es (J.M.Á.); tvalero@ 123456fen.org.es (T.V.); susanadelpozo@ 123456fen.org.es (S.P.); prodriguez@ 123456fen.org.es (P.R.)
                [2 ]Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea 1, Pamplona 31008, Spain; jaranceta@ 123456unav.es or javieraranceta@ 123456hotmail.com
                [3 ]Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Sciences, University of Granada. Campus de la Salud, Avda. del Conocimiento, Armilla, Granada 18100, Spain; agil@ 123456ugr.es
                [4 ]ImFINE Research Group, Department of Health and Human Performance, Technical University of Madrid, C/Martín Fierro 7, Madrid 28040, Spain; marcela.gonzalez.gross@ 123456upm.es
                [5 ]Department of Nutrition, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal s/n, Madrid 28040, Spain; rortega@ 123456ucm.es
                [6 ]Research Institute of Biomedical and Health Sciences, Universidad de Las Palmas de Gran Canaria, Facultad de Ciencias de la Salud, C/Doctor Pasteur s/n Trasera del Hospital, Las Palmas de Gran Canaria, Las Palmas 35016, Spain; lluis.serra@ 123456ulpgc.es
                [7 ]Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, Urb. Montepríncipe, Crta. Boadilla Km 53, Boadilla del Monte, Madrid 28668, Spain
                Author notes
                [* ]Correspondence: gvarela@ 123456ceu.es or gvarela@ 123456fen.org.es ; Tel.: +34-913724726; Fax: +34-913510496
                Article
                nutrients-08-00177
                10.3390/nu8030177
                4808903
                27011202
                db5d8daa-ca56-4d0b-a329-0a8cb1064cc6
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

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

                History
                : 29 October 2015
                : 15 March 2016
                Categories
                Article

                Nutrition & Dietetics
                macronutrient intake,dietary protein,dietary fat,carbohydrate intake,dietary fat quality sources,anibes study

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