Dietary Diversity and Nutritional Adequacy among an Older Spanish Population with Metabolic Syndrome in the PREDIMED-Plus Study: A Cross-Sectional Analysis
by
Naomi Cano-Ibáñez 1,2,3
, Alfredo Gea 4,5,6, Miguel A. Martínez-González 4,5,6,7, Jordi Salas-Salvadó 6,8,9,10, Dolores Corella 6,11, M. Dolors Zomeño 12,13, Dora Romaguera 6,14, Jesús Vioque 2,15, Fernando Aros 6,16, Julia Wärnberg 6,17, J. Alfredo Martínez 6,18,19, Lluis Serra-Majem 6,20, Ramón Estruch 6,21, Francisco J. Tinahones 6,22, José Lapetra 6,23, Xavier Pintó 6,24, Josep A. Tur 6,25, Antonio García-Ríos 6,26, Blanca Riquelme-Gallego 1, Miguel Delgado-Rodríguez 2,27, Pilar Matía 6,28, Lidia Daimiel 19, Vicente Martín 2,29, Josep Vidal 30,31, Clotilde Vázquez 6,32, Emilio Ros 6,33, Pilar Buil-Cosiales 4,6,34, Andrés Díaz-López 6,8,9,10, Rebeca Fernández-Carrión 6,11, Montserrat Fitó 6,12,13, Jadwiga Konieczna 6,14, Leyre Notario-Barandiaran 2,15, Ángel M. Alonso-Gómez 6,16, Eugenio Contreras-Fernández 35, Itziar Abete 6,18, Almudena Sánchez-Villegas 6,20, Rosa Casas 6,21, Araceli Muñoz-Garach 6,22, José Manuel Santos-Lozano 6,23,36, Laura Gallardo-Alfaro 25, Josep Basora 6,8,9,10, Olga Portoles 6,11, Miguel Ángel Muñoz 37, Manuel Moñino 6,14, Salvador Miralles Gisbert 2,15, Anai Moreno Rodríguez 16, Miguel Ruiz-Canela 4,5,6, Antoni Palau Galindo 6,8,9,38, Karla Alejandra Pérez-Vega 12 and Aurora Bueno-Cavanillas 1,2,3,*
Naomi Cano-Ibáñez 1,2,3, Alfredo Gea 4,5,6, Miguel A. Martínez-González 4,5,6,7, Jordi Salas-Salvadó 6,8,9,10, Dolores Corella 6,11, M. Dolors Zomeño 12,13, Dora Romaguera 6,14, Jesús Vioque 2,15, Fernando Aros 6,16, Julia Wärnberg 6,17, J. Alfredo Martínez 6,18,19, Lluis Serra-Majem 6,20, Ramón Estruch 6,21, Francisco J. Tinahones 6,22, José Lapetra 6,23, Xavier Pintó 6,24, Josep A. Tur 6,25, Antonio García-Ríos 6,26, Blanca Riquelme-Gallego 1, Miguel Delgado-Rodríguez 2,27, Pilar Matía 6,28, Lidia Daimiel 19, Vicente Martín 2,29, Josep Vidal 30,31, Clotilde Vázquez 6,32, Emilio Ros 6,33, Pilar Buil-Cosiales 4,6,34, Andrés Díaz-López 6,8,9,10, Rebeca Fernández-Carrión 6,11, Montserrat Fitó 6,12,13, Jadwiga Konieczna 6,14, Leyre Notario-Barandiaran 2,15, Ángel M. Alonso-Gómez 6,16, Eugenio Contreras-Fernández 35, Itziar Abete 6,18, Almudena Sánchez-Villegas 6,20, Rosa Casas 6,21, Araceli Muñoz-Garach 6,22, José Manuel Santos-Lozano 6,23,36, Laura Gallardo-Alfaro 25, Josep Basora 6,8,9,10, Olga Portoles 6,11, Miguel Ángel Muñoz 37, Manuel Moñino 6,14, Salvador Miralles Gisbert 2,15, Anai Moreno Rodríguez 16, Miguel Ruiz-Canela 4,5,6, Antoni Palau Galindo 6,8,9,38, Karla Alejandra Pérez-Vega 12 and Aurora Bueno-Cavanillas 1,2,3,*
1
Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain
2
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
3
Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
4
University of Navarre, Department of Preventive Medicine and Public Health, Medical School, 31008 Pamplona, Spain
5
Navarra institute for health research (IdisNa), 31008 Pamplona, Spain
6
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
7
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
8
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43002 Reus, Spain
9
Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
10
University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain
11
Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain
12
Unit of Cardiovascular Risk and Nutrition, Institut Mar d´Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
13
Human Nutrition Unit, Blanquerna-Ramon Llull University, 08001 Barcelona, Spain
14
Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
15
Nutritional Epidemiology Unit, Miguel Hernández University, ISABIAL-FISABIO, 03202 Alicante, Spain
16
Department of Cardiology, OSI ARABA, University Hospital Araba, University of the Basque Country UPV/EHU, 48940 Vitoria-Gasteiz, Spain
17
Department of Nursing, School of Health Sciences. University of Malaga- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
18
Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
19
Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain
20
Research Institute of Biomedical and Health Sciences. University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
21
Department of Internal Medicine, Institut d´Investigacion Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
22
Virgen de la Victoria Hospital, Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29016 Málaga, Spain
23
Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain
24
Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
25
Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain
26
Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, 14004 Córdoba, Spain
27
Department of Health Sciences, University of Jaen, 23071 Jaen, Spain
28
Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
29
Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
30
Department of Endocrinology, Institut d‘ Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
31
CIBER Diabetes y enfermedades metabólicas (CIBERDEM), ISCIII, 28029 Madrid, Spain
32
Department of Endocrinology, Fundación Jiménez-Díaz, 28040 Madrid, Spain
33
Lipid Clinic, Department of Endocrinology and Nutrition, IDIBAPS, Hospital Clinic, 08036 Barcelona, Spain
34
Primary Care, Health Service of Navarra-Osasunbidea, 31002 Pamplona, Spain
35
Unidad Gestión Clínica de Prevención, Promoción y Vigilancia de la Salud, Distrito Atención Primaria Costa del Sol, Servicio Andaluz de Salud. Red de Investigación Servicios De Salud en Enfermedades Crónicas (REDISSEC), 29651 Málaga, Spain
36
Department of Medicine. University of Sevilla, 41004 Sevilla, Spain
37
Primary Care Division of Barcelona, Institut Català de la Salud-IDIAP Jordi Gol, 08007 Barcelona, Spain
38
ABS Reus V. Centre d’Assistència Primària Marià Fortuny, SAGESSA, 43203 Reus, Spain
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(5), 958; https://doi.org/10.3390/nu11050958
Received: 16 March 2019 / Revised: 22 April 2019 / Accepted: 24 April 2019 / Published: 26 April 2019
(This article belongs to the Special Issue Diet Diversity and Diet Quality)
Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55–75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80–39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55–18.65), fruits OR = 11.62 (95% CI 6.81–19.81), dairy products OR = 6.54 (95% CI 4.64–9.22) and protein foods OR = 6.60 (95% CI 1.96–22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s.
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Cano-Ibáñez, N.; Gea, A.; Martínez-González, M.A.; Salas-Salvadó, J.; Corella, D.; Zomeño, M.D.; Romaguera, D.; Vioque, J.; Aros, F.; Wärnberg, J.; Martínez, J.A.; Serra-Majem, L.; Estruch, R.; Tinahones, F.J.; Lapetra, J.; Pintó, X.; Tur, J.A.; García-Ríos, A.; Riquelme-Gallego, B.; Delgado-Rodríguez, M.; Matía, P.; Daimiel, L.; Martín, V.; Vidal, J.; Vázquez, C.; Ros, E.; Buil-Cosiales, P.; Díaz-López, A.; Fernández-Carrión, R.; Fitó, M.; Konieczna, J.; Notario-Barandiaran, L.; Alonso-Gómez, Á.M.; Contreras-Fernández, E.; Abete, I.; Sánchez-Villegas, A.; Casas, R.; Muñoz-Garach, A.; Santos-Lozano, J.M.; Gallardo-Alfaro, L.; Basora, J.; Portoles, O.; Muñoz, M.Á.; Moñino, M.; Miralles Gisbert, S.; Moreno Rodríguez, A.; Ruiz-Canela, M.; Palau Galindo, A.; Pérez-Vega, K.A.; Bueno-Cavanillas, A. Dietary Diversity and Nutritional Adequacy among an Older Spanish Population with Metabolic Syndrome in the PREDIMED-Plus Study: A Cross-Sectional Analysis. Nutrients 2019, 11, 958.
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