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Nutritional adequacy according to carbohydrates and fat quality

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Abstract

Purpose

To investigate the association between carbohydrate quality, fat quality or adherence to the Mediterranean diet and intake adequacy of 19 micronutrients in the PREDIMED (PREvención con DIeta MEDiterránea) trial, a multicenter, randomized, controlled, parallel group and primary prevention trial conducted in Spain.

Methods

We assessed baseline dietary intake of 6,542 elderly subjects at high cardiovascular risk through a validated food frequency questionnaire (FFQ) and a validated 14-item Mediterranean diet (Med-diet) score. We used a multidimensional carbohydrate quality index (CQI) using four criteria and a fat quality index (FQI) according to the ratio (MUFA + PUFA)/(SFA + TFA). The probability of intake adequacy was calculated comparing the intakes to DRI, and also using the probabilistic approach. Absolute and adjusted probability of having inadequate intake for either ≥6 DRI or ≥8 DRI were estimated to assess nutritional adequacy according to quintiles of each index.

Results

The lowest prevalence of inadequate micronutrient intake (≥8 DRI) was found in the highest quintile of CQI or Med-diet score, and in the lowest quintile of FQI (adjusted fold risk: 1.4, 3.4 and 10.2 respectively in comparison with the lowest quintile). P for trend <0.001 in three multivariable models. A higher CQI or Med-Diet score and a lower FQI were significantly associated with a lower fold risk of unmet EAR values.

Conclusions

A multidimensional assessment of CQI can be a useful tool to evaluate the quality of carbohydrates. This score and a 14-item Med-diet score were positively related to overall micronutrient adequacy in elderly participants.

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Acknowledgments

We thank the participants in the trial for their enthusiastic and sustained collaboration and Joan Vila from Municipal Institute for Medical Research (IMIM), Barcelona, for expert assessment in the statistical analyses. Supported by the official funding agency for biomedical research of the Spanish government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial (RTIC G03/140; RTIC RD 06/0045 and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, and P11/02505), Ministerio de Ciencia e Innovación (AGL-2009-13906-C02 and AGL2010-22319-C03), Fundación Mapfre 2010, Consejería de Salud de la Junta de Andalucía (PI0105/2007), Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (ACOMP06109, GVACOMP2010-181, GVACOMP2011-151, CS2010-AP-111, and CS2011-AP-042), and Regional Government of Navarra (P27/2011).

Conflict of interest

Funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Author information

Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, School of Medicine–Clinica Universidad de Navarra, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra, Spain

    Ana Sánchez-Tainta, Itziar Zazpe, Maira Bes-Rastrollo & Miguel Angel Martínez-González

  2. Department of Nutrition and Food Sciences, University of Navarra, Irunlarrea 1, 31008, Pamplona, Navarra, Spain

    Itziar Zazpe

  3. Biomedical Research Centre Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain

    Itziar Zazpe, Maira Bes-Rastrollo, Jordi Salas-Salvadó, Mónica Bullo, José Vicente Sorlí, Dolores Corella, Mª Isabel Covas, Fernando Arós, Mario Gutierrez-Bedmar, Miquel Fiol, F. García de la Corte, Lluis Serra-Majem, Xavier Pinto, Emilio Ros, Ramón Estruch & Miguel Angel Martínez-González

  4. Human Nutrition Unit, Sant Joan Hospital, IISPV, Universitat Rovira i Virgili, Reus, Spain

    Jordi Salas-Salvadó

  5. Human Nutrition Department, University Rovira i Virgili, Reus, Spain

    Mónica Bullo

  6. Primary Care Division, Valencia Institute of Health and Department of Preventive Medicine, University of Valencia, Valencia, Spain

    José Vicente Sorlí

  7. Department of Preventive Medicine, University of Valencia, Valencia, Spain

    Dolores Corella

  8. Cardiovascular Epidemiology Unit, Municipal Institute for Medical Research (IMIM), Barcelona, Spain

    Mª Isabel Covas

  9. IMIM-Hospital del Mar Medical Research Institute and CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain

    Helmut Schröeder

  10. Department of Cardiology, University Hospital Txagorritxu-University Hospital of Alava, Vitoria, Spain

    Fernando Arós

  11. Department of Preventive Medicine and Public Health, University of Málaga, Málaga, Spain

    Mario Gutierrez-Bedmar

  12. Instituto de Investigación Sanitaria de Palma (IdISPa), Hospital Son Espases, Palma de Mallorca, Spain

    Miquel Fiol

  13. Primary Care Division of Sevilla, Department of Family Medicine, San Pablo Health Center, Sevilla, Spain

    F. García de la Corte

  14. Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain

    Lluis Serra-Majem

  15. Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

    Xavier Pinto

  16. Lipid Clinic, Department of Endocrinology and Nutrition, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain

    Emilio Ros

  17. Department of Nutrition and Food Science, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain

    M. Carmen López-Sabater

  18. Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain

    Ramón Estruch

  19. Instituto de Salud Carlos III, Madrid, Spain

    Helmut Schröeder

Authors
  1. Ana Sánchez-Tainta
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  2. Itziar Zazpe
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  3. Maira Bes-Rastrollo
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  4. Jordi Salas-Salvadó
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  5. Mónica Bullo
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  6. José Vicente Sorlí
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  7. Dolores Corella
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  8. Mª Isabel Covas
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  9. Fernando Arós
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  10. Mario Gutierrez-Bedmar
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  11. Miquel Fiol
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  12. F. García de la Corte
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  13. Lluis Serra-Majem
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  14. Xavier Pinto
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  15. Helmut Schröeder
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  16. Emilio Ros
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  17. M. Carmen López-Sabater
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  18. Ramón Estruch
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  19. Miguel Angel Martínez-González
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Consortia

For the PREDIMED study investigators

Corresponding author

Correspondence to Itziar Zazpe.

Additional information

The PREDIMED study investigators are listed in "Appendix"

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 kb)

Appendix

Appendix

PREDIMED study investigators

University of Navarra, Primary Care Centres, Pamplona, Spain: E Toledo, B. Sanjulian, A. Marti, JA. Martínez, P. Buil-Cosiales, M. Serrano-Martinez, J. Diez-Espino, A. Garcia-Arellano, J. Basterra-Gortari, V. Extremera-Urabayen, Garcia-Perez L, Arroyo-Azpa C, Sola Larraza A, Barcena F, Oreja Arrayago C, Lasante Saez MJ, Quintana Pedraza L, Amezqueta Goñi C, Cia Lecumberri P, Elcarte Lopez T, Artal Moneva F, Esparza Lopez JM, Figuerido Garmendia E, Ruiz Millan H, Oses Primo R, Tabar Sarrias JA, Fernandez Urzainqui L, Ariz Arnedo MJ.

Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain: M. Serra, A. Perez-Heras, C. Vinas, R. Casas, L. de Santamaria, S. Romero, J.M. Baena, M. Garcia, M. Oller, J. Amat, I. Duaso, Y. Garcia, C. Iglesias, C. Simon, Ll. Quinzavos, Ll. Parra, M. Liroz, J. Benavent, J. Clos, I. Pla, M. Amoros, M.T. Bonet, M.T. Martin, M.S. Sanchez, J. Altirruba, E. Manzano, A. Altes, M. Cofan, C. Valls-Pedret, A. Sala-Vila, and M. Domenech.

University Rovira i Virgili, Reus, Spain:, J. Basora, R. Gonzalez, C. Molina, F. Marquez, N. Babio, P, Martinez, N. Ibarrola, R. Balanza, M. Sorli, J. Garcia Roselló, F. Martin, R. Tort, A. Isach, B. Costa, J.J. Cabre, and J. Fernandez-Ballart.

Institute de Recerca Hospital del Mar, Barcelona, Spain: M. Fito, S. Tello, J. Vila, R. de la Torre, D. Munoz-Aguayo, R. Elosua, J. Marrugat, and M. Ferrer.

University of Valencia, Valencia, Spain: P. Carrasco, C. Ortega-Azorín, E.M. Asensio, R. Osma, R. Barragán, F. Francés, M. Guillén, J.I. González, C. Saiz, O. Portolés, F.J. Giménez, O.Coltell, P. Guillem-Saiz, L. Quiles, V. Pascual, C. Riera, M.A. Pages, D. Godoy, A. Carratalá-Calvo, M.J. Martín-Rillo, E. Llopis-Osorio, J. Ruiz-Baixauli, and A. Bertolín-Muñoz

University Hospital of Alava, Vitoria, Spain: I. Salaverria, T. del Hierro, J. Algorta, S. Francisco, A. Alonso, J. San Vicente, A. Casi, E. Sanz, I. Felipe, J. Rekondo and A. Loma-Osorio.

University of Malaga, Malaga, Spain: R. Benitez Pont, M. Bianchi Alba, Navajas, J. Warnberg, R. Gomez-Huelgas, J. Martinez-Gonzalez, V. Velasco Garcia, J. de Diego Salas, A. Baca Osorio, J. Gil Zarzosa, J.J. Sanchez Luque, and E. Vargas Lopez.

Instituto de la Grasa, Consejo Superior de Investigaciones Cientificas, Sevilla, Spain: V. Ruiz-Gutierrez, J. Sanchez Perona, E. Montero Romero, M. Garcia-Garcia and E. Jurado-Ruiz.

Institute of Health Sciences IUNICS, University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca, Spain: M. Garcia-Valdueza, M. Monino, A. Proenza, R. Prieto, G. Frontera, M. Ginard, A. Jover, D. Romaguera and J. Garcia.

Department of Family Medicine, Primary Care Division of Sevilla, Sevilla, Spain: M. Leal, E. Martinez, J.M. Santos, M. Ortega-Calvo, P. Roman, F. Jose Garcia, P. Iglesias, Y. Corchado, E. Mayoral, L. Mellado, L. Miró, JM. Lozano and C. Lama.

School of Pharmacy, University of Barcelona, Barcelona, Spain: R.M. Lamuela-Raventos, A.I. Castellote-Bargallo, A. Medina-Remon, and A. Tresserra-Rimbau.

University of Las Palmas de Gran Canaria, Las Palmas, Spain: J. Alvarez-Perez, E. Diez Benitez, I. Bautista Castaño, I. Maldonado Diaz, A. Sanchez-Villegas, M.J. Férnandez-Rodríguez, F. Sarmiendo de la Fe, C. Simon Garcia, I. Falcon Sanabria, B. Macias Gutierrez, and A.J. Santana Santana.

Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain: E. de la Cruz, A. Galera, Y. Soler, F. Trias, I. Sarasa, E. Padres, and E. Corbella.

Primary Care Division, Catalan Institute of Health, Barcelona, Spain: M.A. Muñoz, C. Cabezas, E. Vinyoles, M.A. Rovira, L. Garcia, G. Flores, J.M. Verdu, P. Baby, A. Ramos, L. Mengual, P. Roura, M.C. Yuste, A. Guarner, A. Rovira, M.I. Santamaria, M. Mata, C. de Juan, and A. Brau.

Other investigators of the PREDIMED network: J.A. Tur (University of Balearic Islands), M.P. Portillo (University of Basque Country) and G. Saez (University of Valencia)

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Sánchez-Tainta, A., Zazpe, I., Bes-Rastrollo, M. et al. Nutritional adequacy according to carbohydrates and fat quality. Eur J Nutr 55, 93–106 (2016). https://doi.org/10.1007/s00394-014-0828-3

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