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      Adequacy of usual macronutrient intake and macronutrient distribution in children and adolescents in Spain: A National Dietary Survey on the Child and Adolescent Population, ENALIA 2013–2014

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          Abstract

          Objectives

          To describe the nutritional profile and assess the National Dietary Survey on the Child and Adolescent Population project in Spain (ENALIA) regarding usual total energy and macronutrient intake.

          Methods

          A cross-sectional nationally representative sample of 1862 children and adolescents (age 6 months to 17) was surveyed between 2013 and 2014 following European methodology recommendations. Dietary information was collected using two methods, dietary records (for children from age 6 months to 9 years) and 24-h dietary recall (participants age 10 and older). Usual intake was estimated by correcting for within-person intake variance using the Iowa State University (ISU) method. A probability analysis was used to assess compliance with dietary reference intakes in the target population.

          Results

          Protein consumption in the age 1–3 group as a percentage of total energy exceeded the upper limit of the Acceptable Macronutrient Distribution Range (AMDR) by 4.7% for boys and 12.1% for girls. 42.9% of girls age 4–8 were under the lower limit of the AMDR for carbohydrates. 43.4% of boys and 46.9% of girls between 4 and 17 exceeded the AMDR in total fat intake, saturated fatty acids (SFAs) accounting for 12.3% of total energy.

          Conclusions

          The results suggest that Spanish children and adolescents could improve macronutrient distribution by reducing fat and increasing carbohydrate intake across all age groups, and decreasing protein intake, especially in young children.

          Electronic supplementary material

          The online version of this article (10.1007/s00394-018-1676-3) contains supplementary material, which is available to authorized users.

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          Most cited references55

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          Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations.

          To re-state the principles underlying the Goldberg cut-off for identifying under-reporters of energy intake, re-examine the physiological principles and update the values to be substituted into the equation for calculating the cut-off, and to examine its use and limitations. New values are suggested for each element of the Goldberg equation. The physical activity level (PAL) for comparison with energy intake:basal metabolic rate (EI:BMR) should be selected to reflect the population under study; the PAL value of 1.55 x BMR is not necessarily the value of choice. The suggested value for average within-subject variation in energy intake is 23% (unchanged), but other sources of variation are increased in the light of new data. For within-subject variation in measured and estimated BMR, 4% and 8.5% respectively are suggested (previously 2.5% and 8%), and for total between-subject variation in PAL, the suggested value is 15% (previously 12.5%). The effect of these changes is to widen the confidence limits and reduce the sensitivity of the cut-off. The Goldberg cut-off can be used to evaluate the mean population bias in reported energy intake, but information on the activity or lifestyle of the population is needed to choose a suitable PAL energy requirement for comparison. Sensitivity for identifying under-reporters at the individual level is limited. In epidemiological studies information on home, leisure and occupational activity is essential in order to assign subjects to low, medium or high PAL levels before calculating the cut-offs. In small studies, it is desirable to measure energy expenditure, or to calculate individual energy requirements, and to compare energy intake directly with energy expenditure.
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            Issues in dietary intake assessment of children and adolescents.

            Studies of food habits and dietary intakes face a number of unique respondent and observer considerations at different stages from early childhood to late adolescence. Despite this, intakes have often been reported as if valid, and the interpretation of links between intake and health has been based, often erroneously, on the assumption of validity. However, validation studies of energy intake data have led to the widespread recognition that much of the dietary data on children and adolescents is prone to reporting error, mostly through under-reporting. Reporting error is influenced by body weight status and does not occur systematically across different age groups or different dietary survey techniques. It appears that the available methods for assessing the dietary intakes of children are, at best, able to provide unbiased estimates of energy intake only at the group level, while the food intake data of most adolescents are particularly prone to reporting error at both the group and the individual level. Moreover, evidence for the existence of subject-specific responding in dietary assessments challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Only limited progress has been made in understanding the variables associated with misreporting in these age groups, the associated biases in estimating nutrient intakes and the most appropriate way to interpret unrepresentative dietary data. Until these issues are better understood, researchers should exercise considerable caution when evaluating all such data.
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              Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union

              (2013)
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                Author and article information

                Contributors
                asobaler@ucm.es
                araparic@ucm.es
                jrubiom@msssi.es
                VMarcos@msssi.es
                rsanchidrian@msssi.es
                +34913380909 , ssantos@msssi.es
                napoleon.perez@uma.es
                mdalre@msssi.es
                cvillar@msssi.es
                mjyusta@msssi.es
                trobledo@msssi.es
                preaecosan@msssi.es
                rortega@ucm.es
                Journal
                Eur J Nutr
                Eur J Nutr
                European Journal of Nutrition
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1436-6207
                1436-6215
                22 May 2018
                22 May 2018
                2019
                : 58
                : 2
                : 705-719
                Affiliations
                [1 ]GRID grid.436087.e, Spanish Agency for Consumer Affairs, Food Safety and Nutrition, , Ministry of Health, Social Services and Equality, ; Alcalá 56, 28071 Madrid, Spain
                [2 ]ISNI 0000 0001 2157 7667, GRID grid.4795.f, Department of Nutrition and Food Science, Faculty of Pharmacy, , Complutense University of Madrid, ; Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
                [3 ]ISNI 0000 0001 2298 7828, GRID grid.10215.37, Department of Public Health and Psychiatry, , Faculty of Medicine, University of Málaga, ; Boulevard Louis Pasteur, 32, 28071 Málaga, Spain
                Article
                1676
                10.1007/s00394-018-1676-3
                6437129
                29789933
                e00d699f-cc11-41be-a723-607a4626b9a4
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 27 July 2017
                : 23 March 2018
                Categories
                Original Contribution
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2019

                Nutrition & Dietetics
                dietary surveys,usual intake,nutrient intake,europe,child,adolescent
                Nutrition & Dietetics
                dietary surveys, usual intake, nutrient intake, europe, child, adolescent

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