Iden i ica ion o oods con ibu ing o he die a y lipid p o ile o
a Medi e anean popula ion
Isabel Bondia-Pons
1
, Lluı
´s Se a-Majem
2
, Ana I. Cas ello e
1
and M. Ca men Lo
´pez-Saba e
1
*
1
Dep . o Food and Nu i ional Science, Re e ence Cen e in Food Technology, Facul y o Pha macy, Uni e si y o Ba celona, A .
Joan XXIII, s/n E-08028 Ba celona, Spain
2
Dep . o Clinical Sciences, Cen e o Heal h Sciences, Uni e si y o Las Palmas de G an Cana ia, PO Box 550, Las Palmas de
G an Cana ia, E-35080 Las Palmas, Spain
(Recei ed 3 Augus 2006 – Re ised 22 Feb ua y 2007 – Accep ed 22 Feb ua y 2007)
The iden i ica ion o he a ge oods ha mos a ec he a con en o a die , independen ly whe he o no hey con ain a , can be a use ul ool
in he p ocess o d awing up mo e e ec i e die a y guidelines wi h nu i ional educa ion s a egies mo e di ec ed a he needs o each popu-
la ion. Wi h his pu pose, he con ibu ion analysis designed by Block and colleagues and mul iple linea eg ession models we e applied o a
ep esen a i e sample o Ca alonia. Oli e oil was he ood ha p o ided he highes absolu e and ela i e pe cen age o a -de i ed ene gy
in ake and cheese he ood ha p o ided he highes pe cen age o sa u a ed a -de i ed ene gy in ake. Acco ding o he esul s o he p esen
wo k, du ing he las 10 yea s he consump ion o ui s and ege ables in Ca alonia has inc eased, mo e in women han men. The in ake o
whi e ish is signi ican ly highe han he in ake o blue ish, which should be inc eased in bo h men and women, and ed mea is s ill he
i s mea sou ce in his popula ion. Special a en ion should be paid o he inc easing swee ce eal consump ion, which is a sou ce o in isible
a o he die .
Die a y lipid p o ile: Ta ge oods: Plasma a y acids
Obesi y, hype ension, diabe es melli us, dyslipidaemia and
insulin esis ance a e inc easing in equency and becoming
majo causes o CVD
1
. The excess in ake o ene gy and a
seden a y li es yle a e majo causes o hese mo bid con-
di ions. Excess o SFA
1
and a ela i e de iciency in unsa u-
a ed a y acids, especially n-3 PUFA, ha e been iden i ied
as con ibu ing ac o s
2
.
To al a and SFA ha e been conside ed as common nu i-
ional a ge s in public heal h
3
. P esen nu i ional goals aim o
limi he consump ion o o al a o 30 % o he daily ene gy
in ake – in he case o Medi e anean coun ies such as Spain,
cha ac e ized by a la ge consump ion o oli e oil, a maximum
o 35 % ene gy in ake has been accep ed
4
– and he consump-
ion o SFA o less han 10 %
5
.
Bo h nu ien s, o al a and SFA, can be conside ed a use ul
ool o iden i y po en ial a ge oods in he die o di e en
popula ions in o de o desc ibe consump ion pa e ns and
u u e ood-based die a y guidelines.
The e o e, he aim o he p esen wo k was o iden i y hose
ood g oups ha had he g ea es e ec on he a ia ion in he
pe cen age o ene gy in ake and con ibu ed mos o absolu e
in ake supplied by o al and sa u a ed lipids in he consump-
ion o a ep esen a i e sample o he Medi e anean Ca alan
popula ion.
Subjec s and me hods
Subjec s
The subjec s we e a subg oup o a la ge sample (1600 sub-
jec s) andomly ec ui ed in Ca alonia, a Medi e anean
egion in no h-eas Spain, o a c oss-sec ional nu i ional
su ey
6
. The p ima y objec i e o he su ey was o collec
ele an in o ma ion on he die a y habi s o he Ca alan popu-
la ion and assess hei ood consump ion pa e ns. The
sampling echnique included s a i ica ion acco ding o geo-
g aphical a ea and municipali y size, age and gende o inhabi-
an s. The pa icipa ion a e (65 %) in he p esen s udy can be
ega ded as ep esen a i e o he adul popula ion in Ca alonia.
A o al o 550 pa icipan s ag eed o ha e blood d awn and
unde wen physiological and an h opome ic measu emen s
in a clinical session a e in o med consen . The e we e no sig-
ni ican di e ences be ween he die a y in ake o he subjec s
who did no comple e he clinical assessmen and hose who
did comple e i (da a no shown). F om he o me g oup,
se en een people unde - epo ed hei ene gy in ake and
we e he e o e no included o ood consump ion analysis.
In he absence o di ec measu emen o BMR, es ima es o
BMR we e calcula ed om s anda d equa ions o Eu opeans
based on weigh , heigh , age and gende
7
. Each iden i ica ion
*Co esponding au ho : M. Ca men Lo
´pez-Saba e , ax þ34-93 403 59 31, email [email p o ec ed]
Abb e ia ions: SP, s anda d po ion; VPA, igo ous physical ac i i y.
B i ish Jou nal o Nu i ion (2007), 98, 583–592 doi: 10.1017/S0007114507727435
qThe Au ho s 2007
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o unde - epo ed ood in ake was made using Goldbe g cu -
o (ene gy in ake/BMR $1·14 classi ied he indi idual as
an unde - epo e )
8
. O he 533 Ca alans, se en een did no
as o .12 h be o e blood sampling and we e he e o e
also excluded. The inal sample consis ed o 516 subjec s,
203 men and 313 women. The s udy p o ocol was app o ed
by he egional e hics commi ee, ollowing he Decla a ion
o Helsinki 1975 s anda ds.
An h opome ic measu emen s
The an h opome ic measu es used in he p esen s udy we e
heigh (m), weigh (kg), BMI (calcula ed as kg/m
2
) and
wais and hip ci cum e ences. The an h opome ic cha ac e -
is ics o he s udy pa icipan s a e shown in Table 1, as well
as he p e alence o igo ous physical ac i i y (VPA).
Heigh was de e mined using a mobile an h opome e o he
nea es mm. Body weigh was de e mined o he nea es 100 g
using a digi al scale. Wais and hip ci cum e ences we e
measu ed using a non-s e chable measu ing ape. Hip ci cum-
e ence was measu ed a he ip o he hip bone in men and a
he wides poin be ween he hips and he bu ocks in women.
Cu -o limi s o hip ci cum e ence de e mined by A ance a-
Ba ina and cowo ke s
9
we e es ablished o his s udy.
Physical ac i i y da a
The equency o VPA was used o e alua e he physical
ac i i y o he pa icipan s. VPA e e s o ac i i ies ha
caused swea ing and ha d b ea hing o a leas 20 min on a
leas 3 o he 7 d p eceding he su ey. VPA include un-
ning/jogging (5 miles/h), bicycling (.10 miles/h), swimming
( ees yle laps), ae obics, walking e y as (4 miles/h),
hea y ya d wo k, weigh li ing, baske ball (compe i i e)
10
.
The e we e six ca ego ies o VPA equency (daily; wo o
h ee pe week; once pe week; wo o h ee pe mon h;
occasionally; disabled).
Nu i ion da a
Da a on ood in ake we e ob ained wi h he use o a FFQ,
which was p e iously alida ed
11
and applied o o he s udies
and su eys o e he Spanish popula ion
12,13
. The FFQ, which
asked he subjec o ecall a e age use o e he pas yea , con-
sis ed o 118 i ems. The FFQ was a anged by ood ype and
meal pa e n. F equency ca ego ies we e based on he numbe
o imes ha i ems we e consumed pe d, week o mon h. Con-
sump ion less han once pe mon h was conside ed no con-
sump ion. Daily consump ion (g) was de e mined by
di iding he epo ed amoun o he in ake by he equency
(d). The ele an pe iod o consump ion o seasonal i ems
was also aken in o accoun . Edible ac ions o oods we e
eco ded in he da abase. Food alues we e con e ed in o
nu ien alues by alida ed so wa e de eloped by he
Cen e o Supe io S udies in Nu i ion and Die e ics, which
is based on Spanish ables o ood composi ion
14
. Foods
we e di ided in o he ollowing g oups: ed mea ; poul y
and game; p ocessed mea ; eggs; whi e ish; blue ish;
educed- a milk and yoghu ; whole- a milk and yoghu ;
cheese; swee ce eals (b eak as ce eals, cakes, biscui s);
sa ou y ce eals (such as pas a and ice bu no b ead);
b ead; oils; bu e ; ma ga ine; g een ege ables; ui ; pulses;
ube s; suga s; wine and spi i s. The numbe o po ions o
each ood g oup consumed by he popula ion was calcula ed.
The g ams consumed o each ood g oup we e di ided by he
size o he s anda d po ion (SP) o di e en age g oups
(Table 2). These SP ha e al eady been used in p e ious
s udies in he Spanish popula ion
15
.
S a is ical analyses
The ‘con ibu ion analysis’ me hod de eloped by Block e al.
16
was applied o iden i y hose op wen y- i e oods o ood
g oups ha mos con ibu e o he a and sa u a ed a
in ake o he Ca alan ep esen a i e sample. B ie ly, his
Table 1. Cha ac e is ics o he s udy sample o he Ca alan popula ion†
(Mean alues and s anda d de ia ions)
All (n516) Men (n203) Women (n313)
Mean SD Mean SD Mean SD
Age 41·5 14·3 42·1 14·4 41·3 14·1
Body weigh (kg) 70·1 10·8 78·2** 10·2 64·3 11·1
BMI (kg/m
2
) 25·4 4·8 26·3** 4·0 24·8 5·2
Hip ci cum e ence (cm) 101·5 9·7 101·8 7·4 101·5 9·7
WHR 0·8 0·1 0·9*** 0·1 0·8 0·1
WHR .cu -o limi s 11·2 12·8*** 10·2
Ene gy in ake (kJ) 8482·2 2352·7 9403·2*** 2875·2 8304·2 2273·9
VPA o a leas 20 min (%)
Daily 13·0 19·9*** 11·4
2–3 imes pe week 21·1 25·5*** 20·1
once pe week 9·0 10·7 8·6
2–3 imes pe mon h 9·6 9·3 10·0
Occasionally 38·0 28·4*** 43·5
Disabled 6·3 6·2 6·4
Mean alues we e signi ican ly di e en om women: **P,0·01; *P,0·001 (x2 es ).
† Fo de ails o subjec s and p ocedu es, see Subjec s and me hods.
Cu -o limi s: men’s wais :hip a io (WHR) .1, women’s WHR .0·90.
VPA, P e alence o igo ous physical ac i i y.
I. Bondia-Pons e al.584
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p ocedu e selec s in o ma i e oods based on hei a e age
pe cen age con ibu ion o absolu e nu ien in ake in a
a ge popula ion. Food i ems ou o a comp ehensi e i em
lis a e hen anked acco ding o hei mean con ibu ion o
nu ien in ake in he s udy popula ion.
Two models o mul iple linea eg essions de eloped by
Cuco
´e al. we e applied
15
. The i s model was based on cal-
cula ing he a ia ion in he pe cen age o a - and SFA-
de i ed ene gy in ake o a SP o ood. This model p edic s
he change in pe cen age o a - and SFA-de i ed ene gy
in ake when he consump ion o a pa icula ood g oup
inc eases in a SP. The equa ion o he model is:
P edic ed pe cen age o ene gy p o ided by he mac o-
nu ien ¼aþb
1
ed mea þb
2
poul y and game þb
3
p o-
cessed mea þb
4
eggs þb
5
whi e ish þb
6
blue ish þb
7
educed- a milk and yoghu s þb
8
whole- a milk and yog-
hu s þb
9
cheese þb
10
swee ce eals þb
11
sa ou y ce eals þ
b
12
b ead þb
13
oils þbbu e
14
þb
15
ma ga ine þb
16
ege ables þb
17
ui pulses þb
18
ube s þb
19
suga s þb
20
wine þb
21
spi i s.
The second model was applied o de e mine he e ec o an
indi idual’s a e age ood consump ion on he pe cen ages o
a - and SFA-de i ed ene gy in ake. Ins ead o using SP as
he independen a iable, as in he i s model, he po ion ela-
i e o he consump ion o he popula ion was used. This a i-
able is he a io be ween he numbe o SP o a ood consumed
by a subjec and he a e age numbe o SP o ha ood con-
sumed by he popula ion.
All mul iple eg essions we e applied in condi ions ha
ensu ed a sui able i . These condi ions we e explo ed using
ele an esidual analyses. The le el o signi icance P,0·05
o bila e al con as s was used.
Da a we e analysed wi h he so wa e SPSS 12.0 o Win-
dows (SPSS Inc., Chicago, IL, USA). The x
2
es was used
o es di e ences be ween g oups.
Resul s
Men showed a highe mean body weigh , BMI, p e alence o isk
alues o wais :hip a io as well as a highe daily VPA han
women. No signi ican di e ences we e obse ed in he epo ed
ene gy in ake acco ding o gende (123·1 (SD 43·0) kJ/kg
body weigh o men . 129·3 (SD 43·5) kJ/kg body weigh o
women) and a e s a i ying he sample o obesi y.
The op wen y- i e con ibu o s o die a y sou ces o a
and sa u a ed a a e espec i ely shown in Table 3 and
Table 4 acco ding o he Block me hod p ocedu e
16
. Oli e
oil was he la ges single con ibu o o o al a wi h a
mean con ibu ion o 70 % o al a . Cheese was he second
mos impo an sou ce, closely ollowed by ed mea . The
i s i e ood g oups explained 89 % o o al a con ibu ion
in men and 93 % o o al a con ibu ion in women. Signi i-
can di e ences we e ound o he ollowing ood g oups
acco ding o gende : eggs; p ocessed mea ; sa ou y ce eals;
poul y; ice c eam; oli e oil; whi e ish. The p e ious ood
g oups we e highe in men han women excep o oli e oil
and whi e ish. Acco ding o Table 4, cheese was he main
con ibu o o sa u a ed a in he Ca alan die , wi h a mean
con ibu ion o 40 % o al a . Red mea made a con ibu ion
close o 20 %, ollowed by whole- a milk and yoghu s in
Table 2. Size o s anda d po ions pe g oup o age and mean numbe o s anda d po ion consumed
pe day and gende †
S anda d
po ions (g) Numbe o s anda d po ions
Age (yea s) Men (n203) Women (n313)
Food g oup 18–59 $60 P*
25
P
50
P
75
P
25
P
50
P
75
Red mea 100 100 0·3 0·5 0·8 0·3 0·5 0·8
Poul y and game 100 100 0·3 0·4 0·6 0·3 0·4 0·6
P ocessed mea 50 50 0·2 0·3 0·6 0·1 0·2 0·4
Eggs 100 50 0·1 0·2 0·3 0·1 0·2 0·2
Whi e ish 120 100 0·1 0·2 0·4 0·2 0·4 0·4
Blue ish 120 100 0·1 0·1 0·3 0·1 0·1 0·3
Reduced- a milk and yoghu 200 200 0·0 0·8 1·2 0·0 1·0 1·9
Whole- a milk and yoghu 200 200 0·0 0·2 1·0 0·0 0·1 1·0
Cheese 50 50 0·2 0·5 0·9 0·2 0·5 1·0
Swee ce eals 60 50 0·1 0·3 0·7 0·1 0·3 0·7
Sa ou y ce eals 70 40 0·3 0·6 0·7 0·3 0·5 0·7
B ead 65 50 1·3 2·4 2·7 0·8 1·9 2·4
Oil 25 25 0·5 1·1 1·4 0·9 1·1 1·3
Bu e 25 25 0·0 0·0 0·0 0·0 0·0 0·0
Ma ga ine 25 25 0·0 0·0 0·0 0·0 0·0 0·1
G een ege ables 225 150 0·8 1·3 2·0 0·9 1·3 2·1
F ui 130 130 1·0 2·1 3·7 1·5 2·4 3·4
Pulse 60 40 0·2 0·3 0·5 0·2 0·2 0·4
Tube s 350 200 0·1 0·2 0·3 0·1 0·2 0·3
Suga s 15 15 0·0 0·1 0·4 0·0 0·2 0·6
Wine 100 100 0·0 0·2 1·3 0·0 0·0 0·2
Spi i s 50 50 0·0 0·0 0·1 0·0 0·0 0·0
P*
n
–n h pe cen ile.
† Fo de ails o subjec s and p ocedu es, see Subjec s and me hods.
Fa die a y p o ile o a Medi e anean popula ion 585
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Table 4. Majo con ibu o s o o al sa u a ed a in he Ca alan die †
Men (n203) Women (n313)
Rank Food/ ood g oups % o al SFA Cumula i e % SFA % o al SFA Cumula i e % SFA
1 Cheese 39·51 39·51 43·83 43·83
2 Red mea 17·27 56·78 17·00 60·83
3 Whole- a milk and yoghu 11·56 68·34 11·19 72·02
4 Eggs 5·66 74·00 5·39 77·41
5 Swee ce eals 4·61 78·62 4·43 81·84
6 Oil 3·54** 83·95 0·61 84·47
7 P ocessed mea 2·42** 86·37 1·84 86·21
8 Suga s 1·50 87·87 1·66 87·87
9 F ench ies and sal y snacks 1·31 89·18 1·39 89·26
10 Pulse 1·13 90·31 1·12 90·38
11 Ice c eam 1·06 91·37 0·96 91·34
12 Chocola e 0·97 92·34 0·89 92·23
13 Tube s 0·86** 93·20 0·75 92·98
14 Biscui s 0·75 93·95 0·72 93·70
15 Soups 0·64 94·59 0·67 94·36
16 Bu e 0·23 94·82 0·23 94·59
17 Ma ga ine 0·20 95·02 0·18 94·77
18 Sa ou y ce eals 0·15 95·17 0·14 94·91
19 Blue ish 0·09 95·26 0·08 94·99
20 Poul y and game 0·05 95·31 0·06 95·05
21 Whi e ish 0·02 95·33 0·02 95·07
22 G een ege ables 0·01 95·34 0·01 95·08
23 Reduced- a milk and yoghu 0·01 95·35 0·01 95·09
24 B ead 0·01 95·36 0·01 95·10
25 Jams and ma malade 0·01 95·37 0·01 95·11
Values we e signi ican ly di e en om women: **P,0·01 (x
2
es ).
† Fo de ails o subjec s and p ocedu es, see Subjec s and me hods.
Table 3. Majo con ibu o s o o al a in he Ca alan die †
Men (n203) Women (n313)
Rank Food/ ood g oup % o al a Cumula i e % a % o al a Cumula i e % a
1 Oil 67·12** 67·12 73·52 73·52
2 Cheese 9·63 76·75 9·56 83·08
3 Red mea 6·38 83·13 5·87 88·96
4 Eggs 3·47** 86·60 2·25 91·21
5 Whole- a milk and yoghu 2·47 89·06 2·08 93·29
7 P ocessed mea 1·34** 90·40 0·85 94·14
8 Sa ou y ce eals 1·32** 91·72 0·86 95·00
9 Blue ish 1·28 93·00 1·27 96·27
10 Poul y and game 0·84** 93·85 0·58 96·85
11 G een ege ables 0·61 94·46 0·66 97·50
12 Swee ce eals 0·48 94·94 0·37 97·87
13 F ench ies and sal y snacks 0·41 95·35 0·36 98·24
14 Pulse 0·34 95·69 0·32 98·55
15 Reduced- a milk and yoghu 0·31 96·01 0·39 98·95
16 Whi e ish 0·17** 96·18 0·36 99·31
17 Suga s 0·14 96·31 0·14 99·45
18 Soups 0·09 96·41 0·08 99·53
19 Tube s 0·08 96·49 0·09 99·62
20 Biscui s 0·06 96·55 0·05 99·67
21 Bu e 0·03 96·59 0·02 99·69
22 Ma ga ine 0·02 96·62 0·02 99·71
23 Ice c eam 0·02** 96·64 0·01 99·72
24 F ui 0·01 96·65 0·01 99·73
25 B ead 0·01 96·66 0·01 99·74
Values we e signi ican ly di e en om women: **P,0·01 (x
2
).
† Fo de ails o subjec s and p ocedu es. see Subjec s and me hods.
I. Bondia-Pons e al.586
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an o de o 10 %. F om ank numbe 5 (swee ce eals), all
componen s in he lis con ibu ed o less han 5 % o sa u a ed
a in he Ca alan die .
The a ia ion o he ela i e pe cen age o a -de i ed ene gy
in ake pe SP o ood consumed by gende is shown in Table 5,
acco ding o he i s model by Cuco
´and colleagues
15
. Oil was
he ood ha was associa ed wi h he g ea es ela i e pe cen age
o a -de i ed ene gy in ake pe SP consumed, in bo h men and
women. Ma ga ine, bu e , p ocessed mea and ed mea also
ela ed o high ela i e pe cen ages o a -de i ed ene gy
in ake. Con e sely, poul y and game, b ead, sa ou y ce eals
and educed- a milk and yoghu p o ided a lowe ela i e pe -
cen age o a -de i ed ene gy in akes.
The consump ion o a SP o bu e p o ided he g ea es
ela i e pe cen age o SFA-de i ed ene gy in ake in women
and a SP o eggs in men (Table 6). A SP o whi e ish o
women and a SP o poul y and game o men p o ided he
lowes ela i e pe cen age o SFA-de i ed ene gy in ake.
Fig. 1 shows how changes in he ela i e po ion a ec ed
he pe cen age o a -de i ed ene gy in ake in he die o he
Ca alan popula ion a e applica ion o he second model
de eloped by Cuco
´and colleagues
15
. Oli e oil was he ood
g oup ha was associa ed wi h he highes ela i e pe cen age
o a -de i ed ene gy in ake o bo h gende s. B ead was he
ood ha con ibu ed mos o dec ease he ela i e pe cen age
o a , ollowed by ui .
Cheese and whole- a milk, yoghu and ed mea we e he
ood g oups ela ed o he g ea es ela i e pe cen ages o
SFA-de i ed ene gy in ake. I is in e es ing o no e ha oil
did no con ibu e o inc ease he SFA-de i ed ene gy in ake
in ei he gende (Fig. 2). As occu ed wi h he o al a -de i ed
ene gy in ake, b ead and ui s also p o ided he lowes ela-
i e pe cen ages o SFA-de i ed ene gy in ake.
Acco ding o he second eg ession model, he o al a
ene gy in ake was 37·1 (SD 4·6) % o men and 38·3
(SD 4·5) % o women in he Ca alan sample. In bo h cases,
mo e han 25 % o pa icipan s p esen ed o al a in akes
lowe han he ecommended amoun o he Spanish popu-
la ion
17
. The calcula ed SFA in ake ene gy was 11·3
(SD 2·3) % o men and 12·1 (SD 2·4) % o women. The
pe cen age o men wi h hei SFA in akes wi hin he ec-
ommended guidelines
5
was signi ican ly highe han he
pe cen age o women (30 % men . 18 % women). Mo e
han hal o he Ca alan sample showed SFA in akes lowe
han 12 % (65 % men and 55 % women).
Discussion
The Block me hod
16
as well as wo eg ession models
designed by Cuco
´e al.
15
we e used o iden i y he a ge
oods ha mos con ibu ed o he absolu e and ela i e
inc ease and dec ease o he a and SFA-con en in he cu en
die o a ep esen a i e sample o he Ca alan popula ion.
Acco ding o he ou comes om he Block me hod, oli e,
cheese and ed mea a e he h ee main ood componen s
con ibu ing o he absolu e o al a in ake in he cu en
Table 5. Compa ison o he change in he ela i e pe cen age o a -de i ed ene gy in ake pe in ake o one s anda d po ion
by gende †
% a -de i ed ene gy in ake
Men (n203) Women (n313)
95 % CI 95 % CI
Food g oup Reg ession coe icien LL UL Reg ession coe icien LL UL
Red mea 2·1*** 0·7 3·5 1·7 0·7 2·7
Poul y and game 22·5*** 24·4 20·5 20·3 21·8 21·1
P ocessed mea 2·7*** 1·0 4·5 1·9 0·6 3·1
Eggs 2·2*** 1·4 5·8 0·5 4·2 3·2
Whi e ish 20·8*** 22·7 21·2 22·9 24·5 21·3
Blue ish 1·3*** 1·4 4·0 21·2 23·0 20·7
Reduced- a milk and yoghu 21·1 21·6 0·7 21·0 21·3 20·6
Whole- a milk and yoghu 0·3 20·2 0·8 0·3 20·1 0·7
Cheese 1·0*** 0·2 1·8 1·8 1·3 2·3
Swee ce eals 0·0** 20·7 20·6 20·4 21·2 20·3
Sa ou y ce eals 21·8 23·3 20·2 21·6 22·7 20·5
B ead 22·0 22·4 21·5 22·2 22·6 21·8
Oil 6·3 5·4 7·2 6·5 5·7 7·3
Bu e 2·4*** 1·9 10·8 2·9 0·9 6·6
Ma ga ine 4·0 22·4 10·3 4·1 0·3 7·8
G een ege ables 20·1 20·6 0·5 0·0 20·5 0·4
F ui 20·8 21·1 20·5 21·1 21·4 20·8
Pulse 21·0*** 23·3 24·3 20·5 22·6 21·5
Tube s 2·2* 0·9 5·3 20·9 23·4 21·5
Suga s 20·1** 21·2 21·0 0·3 0·4 0·9
Wine 0·1 20·3 0·5 0·2 20·3 0·8
Spi i s 20·7 22·1 0·7 22·7 25·9 0·5
Reg ession cons an , a36·2 34·1 38·2 38·6 37·0 40·2
cR
2
£100 73·2 70·1
F o Snedeco om ANOVA o he mul iple linea eg ession, in men/in women: **P,0·01; ***P,0·001.
† Fo de ails o subjec s and p ocedu es, see Subjec s and me hods.
LL, lowe limi ; UL, uppe limi ; cR
2
, co ec ed squa e o he mul iple co ela ion coe icien .
Fa die a y p o ile o a Medi e anean popula ion 587
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Table 6. Compa ison o he change in he ela i e pe cen age o SFA-de i ed ene gy in ake pe in ake o one s anda d po ion
by gende †
% SFA-de i ed ene gy in ake
Men (n203) Women (n313)
95 % CI 95 % CI
Food g oup Reg ession coe icien LL UL Reg ession coe icien LL UL
Red mea 1·1 20·5 1·7 1·2 20·8 1·7
Poul y and game 21·0*** 21·8 20·2 20·1 20·7 20·5
P ocessed mea 1·2** 0·5 2·0 0·8 0·3 1·3
Eggs 1·7 20·2 3·2 1·5 20·0 3·0
Whi e ish 20·5*** 21·3 20·3 21·6 22·3 21·0
Blue ish 20·2*** 21·3 20·9 20·9 21·7 20·2
Reduced- a milk and yoghu 20·1 20·3 0·0 20·0 20·2 0·1
Whole- a milk and yoghu 1·0 20·8 1·3 1·1 20·9 1·3
Cheese 1·6 21·3 2·0 1·7 21·5 1·9
Swee ce eals 0·9 20·6 1·2 0·8 20·5 1·1
Sa ou y ce eals 20·7*** 21·4 20·1 20·3 20·8 20·2
B ead 20·6 20·8 0·3 20·7 20·9 0·6
Oil 0·1 20·3 0·5 20·2 220·5 0·1
Bu e 1·5*** 2·0 5·1 4·6 3·1 6·2
Ma ga ine 20·7*** 23·4 22·0 0·3 1·2 1·8
G een ege ables 20·1 20·3 0·2 20·2 20·4 0·0
F ui 20·2 20·4 0·1 20·4 20·5 0·3
Pulse 20·2*** 21·2 20·8 20·6 21·4 20·3
Tube s 20·1*** 21·4 21·2 21·1 22·1 20·2
Suga s 0·4** 0·1 0·8 0·7 0·4 0·9
Wine 0·0 0·2 0·2 0·0 20·2 0·3
Spi i s 20·2 20·8 0·4 20·3 21·6 1·0
Reg ession cons an , a11·2 10·3 12·0 12·8 12·1 13·4
cR
2
£100 76·1 79·6
F o Snedeco om ANOVA o he mul iple linea eg ession, in men/in women: **P,0·01; ***P,0·001.
† Fo de ails o subjec s and p ocedu es, see Subjec s and me hods.
LL, lowe limi ; UL, uppe limi ; cR
2
, co ec ed squa e o he mul iple co ela ion coe icien .
Fig. 1. Change in he pe cen age o a -de i ed ene gy in ake pe ela i e po ion o he popula ion in ake. Numbe o cases: men (A) 203; women ( ) 313. Men:
co ec ed R
2
0·752; cons an o eg ession 36·1. Women: co ec ed R
2
0·701; cons an o eg ession 38·7. Reduced- a MY, educed- a milk and yoghu ; Whole-
a milk, whole- a milk and yoghu ; Swee c, swee ce eals; Sa ou y c, sa ou y ce eals; G. ege ables, g een ege ables. Fo de ails o subjec s and p ocedu es,
see Subjec s and me hods.
I. Bondia-Pons e al.588
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Ca alan die . I is in e es ing o no e ha some o he mo e
classical sou ces o a , such as bu e and ice c eam, a e a
down in he lis o main con ibu o s o o al a , wi h low
con ibu ions among Ca alans. A ew i ems, such as g een
ege ables and pulses, made a con ibu ion o o al a in ake
chie ly by i ue o addi i es, such as d essings, which a e
mainly composed o oli e oil o o he oils, no abula ed
sepa a ely.
No su p isingly, he anking o oods was in gene al simila
o ha seen o o al a , al hough he high con ibu ion o
cheese o he o al sa u a ed a in he ange o 40 % was unex-
pec ed. I is in e es ing o highligh ha oli e oil, which was
he main con ibu o o o al a , occupied he anks 6 and
15 in he lis o sa u a ed a con ibu o s o men and
women espec i ely. This ac is ela ed o he heal hy compo-
si ion in MUFA bu no in sa u a ed a in oli e oil, which is
he cha ac e is ic main lipid sou ce in he Medi e anean
egions.
On he o he hand, he sui abili y o bo h models designed
by Cuco
´was con i med by he high alues ob ained o he
espec i e co ec ed squa e o he mul iple eg ession coe i-
cien s (in he ange o 0·7–0·8) o he sample unde s udy.
The i s model desc ibed he e ec ha consuming one SP
om each ood g oup would ha e on he die a y a p o ile o
he subjec s’ die . This model was use ul o iden i y he ood
g oups ha mos con ibu e o he ela i e pe cen age o a
and SFA. Howe e , he die s o he subjec s con ained oods
ha , as can be expec ed, we e consumed a a e y di e en
equency han one po ion pe d. This is why he second
model was applied o de e mine he e ec o an indi idual’s
a e age ood consump ion on he ela i e pe cen ages o a
and SFA-de i ed ene gy in ake.
As expec ed o a Medi e anean egion such as Ca alonia,
and as was p e iously ound wi h he Block me hod, oli e oil
was he ood ha p o ided he highes ela i e pe cen age o
a -de i ed ene gy in ake in he cu en Ca alan die . The
same ou come was ound in he Ca alan die in he 1990s
15
.
The p esen esul s he e o e con i m ha du ing he las
decade he Ca alan popula ion has s ill main ained one o
he undamen al cha ac e is ics o he adi ional Medi e a-
nean die . The heal h bene i s de i ed om a egula consump-
ion o oli e oil ha e been widely epo ed
18,19
.
Bu e and ma ga ine a e a sou ces widely used in Wes e n
socie ies
20
bu hei con ibu ion o he o al a and SFA-
de i ed ene gy in ake was no ele an in he Ca alan die
due o he low consump ion o bo h i ems.
The second ood g oup in impo ance o he a -de i ed
ene gy in ake was dai y p oduc s. In Wes e n popula ions
wi h high in akes o dai y p oduc s, he consump ion o
hese oods a ec s bo h he a and SFA-de i ed ene gy
in ake
21,22
. Howe e , in he Ca alan die , his e ec was
obse ed only o he consump ion o cheese. O he dai y p o-
duc s, such as whole- a milk and yoghu s, inc eased he ela-
i e SFA-de i ed ene gy in ake bu did no signi ican ly
inc ease ela i e a -de i ed ene gy in ake, since he subjec s
who usually consume mo e milk and yoghu s do no consume
o he ood ha is e en iche in a s.
The consump ion o mea has been gene ally ela ed o a
g ea e o al in ake o a in many popula ions
15,23
. In he
p esen wo k, ed mea and p ocessed mea led o no able
highe ela i e pe cen ages o a -de i ed ene gy in ake,
while he consump ion o poul y and game had he con a y
e ec . Howe e , acco ding o he second eg ession model,
he con ibu ion o p ocessed mea in he SFA-de i ed
Fig. 2. Change in he pe cen age o SFA-de i ed ene gy in ake pe ela i e po ion o he popula ion in ake. Numbe o cases: men (A) 203; women ( ) 313.
Men: co ec ed R
2
0·751; cons an o eg ession 11·2. Women: co ec ed R
2
0·795; cons an o eg ession 12·8. Reduced- a MY, educed- a milk and yoghu ;
Whole- a milk, whole- a milk and yoghu ; Swee c, swee ce eals; Sa ou y c, sa ou y ce eals; G. ege ables, g een ege ables. Fo de ails o subjec s and
p ocedu es, see Subjec s and me hods.
Fa die a y p o ile o a Medi e anean popula ion 589
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ene gy in ake was no o impo ance in compa ison wi h he
calcula ion o ed mea . On he o he hand, he posi i e con-
ibu ion o poul y and game o dec ease he SFA-de i ed
ene gy in ake was signi ican ly highe o men han o
women. This is p obably due o he high consump ion o poul-
y and game by men han by women. Red mea was he hi d
ood ha con ibu ed o inc ease he ela i e a and SFA-
de i ed ene gy in ake in he Ca alan sample. Howe e , his
con ibu ion was lowe han ha calcula ed o he Ca alan
die in he 1990s
15
, e lec ing a cu en end o balance he
consump ion o ed mea wi h ha o poul y and game.
Ce eals we e he oods ela ed o lowe ela i e pe cen ages
o a -de i ed ene gy in ake in he Ca alan sample. No signi i-
can di e ences we e obse ed in he e ec o consuming a
SP o b ead and a SP o sa ou y ce eals on he ela i e pe cen-
age o a -de i ed ene gy in ake. This was mainly due o he
ac ha b ead included no only whi e b ead, which is he
mos consumed by he Spanish popula ion, bu also b own
and ce eal-en iched b ead. As b ead was consumed mo e
han he sa ou y ce eals, he e ec o a ela i e po ion o
b ead was signi ican ly g ea e . In e es ing o no e is he con-
sump ion o in isible a implied by he ela i e pe cen age o
SFA-de i ed ene gy in ake om he swee ce eals. Swee
ce eal is a a ge g oup o ha e in mind in nu i ional ec-
ommenda ions, mainly in child en. The consump ion o in is-
ible a has become an inc easing p oblem in de eloped
Wes e n popula ions
24,25
and, wi h he inc easing incidence
o o e weigh and obese people in Eu opean coun ies
26,27
,
indus ial ood wi h conside able amoun s o in isible a
should be es ic ed in he die o he new gene a ions. Acco d-
ing o he p esen s udy da a, an inc ease in he consump ion
o sa ou y ce eals, such as ice and pas a, should be ec-
ommended in he Ca alan popula ion.
The second ood g oup in impo ance o dec ease he ela-
i e a and SFA-de i ed ene gy in ake was ui . The a e age
in ake o ui s among he Ca alan sample ag eed wi h he
nu i ional ecommenda ions o consuming wo o h ee po -
ions o ui pe d. This ac was no accomplished in he
las decade in Ca alonia
15
.
The consump ion o ege ables in he Ca alan die helped o
dec ease he ela i e pe cen age o SFA-de i ed ene gy in ake,
bu had no con ibu ion o dec ease he o al a . This could be
explained by he ac ha in he Spanish popula ion a g ea e
consump ion o ege ables usually leads o a g ea e in ake o
added a s. These added a s mainly consis o oli e oil i sel
o as he main ing edien in salad d essings. The high mono-
unsa u a ed and low sa u a ed a con en in he oli e oil
would indi ec ly be esponsible o he dec easing e ec o
SFA-de i ed ene gy in ake by he ege ables g oup. Acco d-
ing o he p esen da a, men should be ecommended o
inc ease hei consump ion o ui s and ege ables, a leas
o he le els shown by women.
The p esen wo k also con i med he need o encou age he
Ca alan popula ion o inc ease hei ish consump ion. Bo h
men and women p e e ed whi e ish o e blue ish. The a e -
age o consump ion was no e en a po ion o blue ish pe
week o bo h gende s. Howe e , he a e age in ake o
whi e ish was almos h ee po ions pe week o women,
double ha obse ed o men. The educ ion in he ela i e
SFA-de i ed ene gy in ake o a 0·5 % pe ela i e po ion
obse ed in women, oge he wi h he epo ed heal hy
p ope ies
28,29
due o a egula consump ion o ish, mainly
oily ish, should be aken in o accoun in o de o p omo e
he consump ion o ish among he Ca alan popula ion.
Some limi a ions o he p esen s udy mus howe e be
no ed. Al hough a FFQ is conside ed one o he majo die a y
da a collec ion ins umen s and he p ima y ins umen in epi-
demiology
30
, no die a y me hod can measu e die a y in ake
wi hou e o and i is impo an o be awa e o he s eng hs
and limi a ions o he FFQ applica ion o he p esen da a.
The FFQ by Ma in-Mo eno e al. used in his s udy
11
was
de eloped aking in o accoun he cul u al Medi e anean
backg ound o Spain and he exis ing geog aphical di e ences
o die in his coun y. To assess he app op ia eness and el-
e ance o he ood i ems con ained in an ini ial ex ensi e ood
lis including 290 oods, wo di e en app oaches o he 24-h
ecall s a egy we e implemen ed (in-pe son in e iews and
in e iews by elephone, bo h in each o he ou seasons).
To iden i y he mos impo an ood sou ces o speci ic nu i-
en s, all epo ed oods we e ini ially anked in e ms o hei
con ibu ion o o al nu ien in ake by all indi iduals and hey
we e inally educed o a inal o m o he FFQ based on 118
ood i ems. The numbe o ood i ems on a ques ionnai e ends
o a y widely, in he ange om i e o 350, se en y-nine
being he median numbe
31
. The non excessi ely high
numbe o ood i ems in ou FFQ did no con ibu e o apidly
dec ease ma ginal gain in in o ma ion, which has been
epo ed wi h inc easing de ailed ques ionnai es
32
.
Howe e , he ac ha ou FFQ was sel -adminis e ed could
ha e con ibu ed o a lack o in o ma ion due o incomple e
answe s, because some esponden s end o comple e he
FFQ o i ems ha hey usually ea . We a e awa e ha FFQ
pe se a e hampe ed by he inabili y o indi iduals o accu-
a ely epo hei ood in ake e ospec i ely o e a long
pe iod o ime. Fu he mo e, co ela ion coe icien s (in e -
iewe . sel -adminis e ed) be ween FFQ and e e ence
measu es a e gene ally highe o in e iewe -adminis e ed
FFQ han o sel -adminis e ed FFQ o a (0·55 . 0·50)
and ene gy (0·55 . 0·46)
31
. When he con e sion o equency
es ima es o ood in ake o nu ien alues was compu ed o
he p esen popula ion sample, c oss-check ques ions we e
used o co ec o mis epo ing o ce ain ood g oups
(mainly ui s and ege ables, which o en end o be o e -
epo ed). Al hough he in oduc ion o his me hodology
was e ec i e o oods om plan o igin, i s applica ion o
a was no signi ican ly impo an , as has been p e iously
epo ed
33
.
On he o he hand, alida ion o he FFQ me hod is essen-
ial
34
. The alida ion o he FFQ by Ma in-Mo eno was
designed ollowing he me hods used by Wille e al.
35
in a
sample o he Spanish popula ion (n180) du ing a pe iod o
1 yea . The ep oducibili y o he FFQ nu ien s was in he
ange om 0·35 o 0·90 wi h an a e age 0·50 ( alues
exp essed as Pea son co ela ion coe icien s), alues wi hin
he common ange ob ained in o he s udies
36,37
. The nu ien s
on which he p esen s udy was ocused, o al a and sa u a ed
a p esen ed ep oducibili y alues o 0·59 and 0·51
espec i ely, con ibu ing o he bias de i ed om he use o
he ques ionnai e o assess he Ca alan die a y in ake. In
addi ion, he ac ha he e we e no signi ican di e ences
in he epo ed die a y in ake o he pa icipan s a e s a i i-
ca ing by obesi y could imply a possible limi a ion o he
I. Bondia-Pons e al.590
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p esen s udy o de ec unde - epo ing o o e weigh and
obese subjec s. The p esen esul s a e ne e heless in ag ee-
men wi h p e ious s udies in o he Medi e anean popu-
la ions, in which his endency o die a y in ake unde -
epo ing by obese pa icipan s has also been obse ed
38
.
Despi e hei limi a ions, he scien i ic e idence de i ed
om he nu i ional s udies, in which his FFQ and o he simi-
la FFQ ha e been used, con i m ha i is no ime o abandon
his ool in nu i ional s udies
39
.
An addi ional limi a ion o he p esen s udy could also be
he lack o da a conce ning socio-economic s a us as well as
e hnical cha ac e is ics o he sample. I has been p e iously
epo ed ha he s a i ica ion o he popula ion by socio-econ-
omic ac o s can signi ican ly in luence he die quali y
40
. Fu -
he mo e, Ca alonia is one o he Spanish egions whe e he
pe cen age o immig a ion is highe han 10, and, he e o e,
changes in ea ing pa e ns and ood consump ion in oduced
by he inc easing mul icul u al popula ion could a ec he
Medi e anean die a y pa e ns in he nea u u e. Fu u e su -
eys in he Ca alan popula ion should ake his s a emen
in o accoun when ec ui ing s udy pa icipan s.
As Cuco
´e al.
15
sugges ed, mo e easible s a egies o ood
consump ion by iden i ying and quan i ying he oods ha
mos a ec he a ia ion o he a and he SFA in ake in he
die o popula ions a e needed. Bea ing in mind ha he cha ac-
e is ics o popula ions a e nowadays in cons an change, due o
di e en ac o s such as immig a ion o ageing o popula ion in
some de eloped coun ies, he change in ea ing habi s and ood
consump ion should be pe iodically e i ied. Acco ding o he
p esen s udy, oli e oil is s ill he main a sou ce in his Med-
i e anean egion. Fu he mo e, du ing he las decade some
heal hy imp o emen s ha e been de ec ed in he Ca alan die ,
such as he inc ease in he a e age in ake o ui s, ege ables,
poul y and game. A new end in he consump ion o dai y p o-
duc s has also been obse ed, he in ake o cheese being espon-
sible o he highes SFA-de i ed ene gy in ake.
Acknowledgemen s
The au ho s a e g a e ul o he Public Heal h Di ision o he
Depa men o Heal h o he Au onomous Go e nmen o Ca -
alonia o p o iding he blood samples o he s udy. This s udy
was pa o he s udies ca ied ou by he Xa xa Tema
` ica en
Nu icio
´(Gene ali a de Ca alunya) and he Nu i ional Ca alan
Cen e o he Ins i u e o Ca alan S udies in ela ion o he
Heal h Su ey o Ca alonia, ESCA 2002–2003. Many special
hanks o M L. Moshell o he English manusc ip co ec ion.
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