Dietary flavonoids of Spanish youth: intakes, sources, and association with the mediterranean diet

Submi ed 7 Ma ch 2017 Accep ed 12 Ap il 2017 Published 17 May 2017 Co esponding au ho Helmu Sch öde , [email p o ec ed], [email p o ec ed] Academic edi o Ma ia C is ina Albe ini Addi ional In o ma ion and Decla a ions can be ound on page 10 DOI 10.7717/pee j.3304 Copy igh 2017 Bawaked e al. Dis ibu ed unde C ea i e Commons CC-BY 4.0 OPEN ACCESS Die a y la onoids o Spanish you h: in akes, sou ces, and associa ion wi h he Medi e anean die Rowaedh Ahmed Bawaked1,2, Helmu Sch öde 1,3, Lou des Ribas-Ba ba4,5, Gab iela Cá denas1,2, Luis Peña-Quin ana5,6, Ca men Pé ez-Rod igo7, Mon se a Fí o1,5and Lluis Se a-Majem5,6,8 1Ca dio ascula Risk and Nu i ion Resea ch G oup (CARIN), Hospi al del Ma Medical Resea ch Ins i u e (IMIM), Ba celona, Spain 2Depa men o Expe imen al and Heal h Sciences, Uni e si y o Pompeu Fab a, Ba celona, Spain 3CIBER Epidemiology and Public Heal h (CIBERESP), Ins i u o de Salud Ca los III, Mad id, Spain 4Fundación pa a la In es igación Nu icional (Nu i ion Resea ch Founda ion), Ba celona, Spain 5CIBER Physiopa hology o Obesi y and Nu i ion (CIBEROBN), Ins i u o de Salud Ca los III, Mad id, Spain 6Reseach Ins i u e o Biomedical and Heal h Sciences, Uni e si y o Las Palmas de G an Cana ia, G an Cana ia, Spain 7FIDEC Founda ion, Uni e si y o he Basque Coun y (UPV/EHU) Bilbao, Bilbao, Spain 8Depa men o Nu i ion, Food Sciences and Gas onomy, Uni e si y o Ba celona, Ba celona, Spain ABSTRACT Backg ound. Plan -based die s ha e been linked o high die quali y and educed isk o ca dio ascula diseases. The heal h impac o plan -based die s migh be pa ially explained by he concomi an in ake o la onoids. Es ima ion o la onoids in ake in adul s has been impo an o he de elopmen o die a y ecommenda ions and in e en ions o he p e en ion o weigh gain and i s consequences. Howe e , es ima ion o la onoids in ake in child en and adolescen s is limi ed. Me hods. A e age daily in ake and sou ces o la onoids we e es ima ed o a ep esen- a i e na ional sample o 3,534 child en and young people in Spain, aged 2–24 yea s. The da a was collec ed be ween 1998 and 2000 by 24-h ecalls. The Phenol-Explo e da abase and he USDA da abase on la onoids con en we e used. Adhe ence o he Medi e anean die was measu ed by he KIDMED index. Resul s. The mean and median in akes o o al la onoids we e 70.7 and 48.1 mg/day, espec i ely. The mos abundan la onoid class was la an-3-ols (35.7%), wi h ui being he op ood sou ce o la onoids in ake (42.8%). To al la onoids in ake was posi i ely associa ed wi h he KIDMED index (p<0.001). Conclusion. The esul s o his s udy p o ide p ima y in o ma ion abou la onoids in ake and main ood sou ces in Spanish child en, adolescen s and young adul s. Pa icipan s wi h high daily mean in ake o la onoids ha e highe adhe ence o he Medi e anean die . Subjec s Epidemiology, Nu i ion, Public Heal h Keywo ds Fla onoids, Medi e anean die , Child en, Adolescen s, KIDMED index, Fla onoids in ake, Plan -based die s, Fla an-3-ols How o ci e his a icle Bawaked e al. (2017), Die a y la onoids o Spanish you h: in akes, sou ces, and associa ion wi h he Medi e - anean die . Pee J 5:e3304; DOI 10.7717/pee j.3304 INTRODUCTION Fla onoids, a la ge g oup o polyphenolic compounds in plan s, a e he mos abundan polyphenols in he human die . O e 5,000 hyd oxyla ed polyphenolic compounds ha e been isola ed and iden i ied (Shashank & Abhay, 2013). Die a y la onoids a e classi ied in o six subclasses acco ding o hei chemical s uc u e: an hocyanidins, la onols, la anones, la ones, iso la ones and la an-3-ols. Obse a ional s udies ha e epea edly sugges ed a bene icial heal h e ec o la onoids in ake, al hough hey a e inconclusi e (Mu su e al., 2008;Vogia zoglou e al., 2015). Fla onoids in ake has been associa ed wi h educing he isk o majo ch onic diseases, such as ca dio ascula diseases (Knek e al., 2002;Kim, Vance & Chun, 2016b), some ypes o cance s (Hui e al., 2013;Geybels e al., 2013), Alzheime and diabe es (Zamo a-Ros e al., 2013a). Fu he mo e, inc eased in ake o mos la onoid subclasses has shown in e se e- la ionship wi h weigh gain in men and women aged 27–65 yea s (Be oia e al., 2016), wi h incidence o hype ension in middle-aged women (Lajous e al., 2016), and wi h isk o dep ession in olde women (Chang e al., 2016). The e ec o a plan -based die on he isk o ch onic diseases and mo ali y may pa ly be due o la onoid compounds and o he plan me aboli es (Wa zl, 2008). Fla onoids ha e been ound o dec ease in lamma ion, sca enge ee adicals (Shashank & Abhay, 2013), and imp o e ascula endo helial unc ion (Hoope e al., 2008). Al hough desc ip i e s udies in adul popula ions ha e es ima ed die a y la onoids in ake, da a on la onoids in ake in child en and adolescen s is sca ce despi e g owing e idence o he p e en i e e ec s o die a y la onoids. High in ake o plan -based oods such as ui s and ege ables is an essen ial cha ac e is ic o high die quali y and linked o a o able heal h ou comes (Hu, 2003;C owe e al., 2011). The Medi e anean die is a adi ional plan -based die a y pa e n, well known o i s high ege ables and ui in ake and o e all heal hy ea ing pa e n (Sebas ian e al., 2015b; Sebas ian e al., 2015a). The heal h impac o plan -based die s migh be pa ially explained by he concomi an in ake o la onoids, bu e idence on he associa ion be ween la onoids in ake and die quali y is sca ce in adul popula ions (Sebas ian e al., 2015b) and essen ially nonexis en in younge people. Simila ly, he associa ion be ween Medi e anean die a y pa e n and la onoids in ake has no been s udied in child en. Knowledge o popula ion-based la onoids in ake pa e n is impo an o he de el- opmen o die a y ecommenda ions. Addi ionally, he iden i ica ion o die a y pa e ns ela ed o inc eased la onoids consump ion is ele an because o he po en ial impac o hese bioac i e compounds in disease p e en ion. The e o e, his s udy aimed o es ima e he in ake o la onoids; desc ibe majo sou ces o la onoids; and e alua e he associa ion be ween la onoids in ake and die quali y i.e., measu ed by he adhe ence o Medi e anean die ; among Spanish child en, adolescence and young adul s. Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 2/14 METHODS S udy design The enKid S udy, desc ibed in de ail elsewhe e (Se a-Majem e al., 2003), was a c oss- sec ional su ey o he nu i ional s a us and ood habi s o 3,534 Spanish child en and young adul s, ca ied ou be ween 1998 and 2000. Pa icipan s we e selec ed by mul is age andom sampling p ocedu es based on a popula ion egis e . The objec i e o he EnKid s udy was wo- old: (1) o es ablish he p e alence o mic onu ien de iciencies in he popula ion aged 2–24 yea s; and (2) o analyze he associa ion o hese mic onu ien s wi h g oup membe ship by sex and age. The sample size o 3,850 pa icipan s was calcula ed acco ding o he es ima ed p e alence o mos mic onu ien s, wi h 95% con idence in e al and accu acy o ±2.5% o he a e age alue o he mic onu ien , and a s a is ical powe o 80% o de ec signi ican di e ences be ween wo g oups (=10% o he mean o he mic onu ien s, se ing he alpha e o a p=0.05). Taking in o accoun an an icipa ed 70% pa icipa ion a e, we o e sized he s udy sample size o 5,500 pa icipan s (an icipa ed p e alence o non-pa icipa ion: n=1,650 (30%)). Rec ui men achie es a sample o 3,534 indi iduals. Pa en al w i en consen was ob ained on behal o each pa icipan younge han 18 yea s. The e hics commi ee o he Spanish Socie y o Communi y Nu i ion app o ed he s udy p o ocol. Die a y and li es yle da a collec ion Die a y da a was collec ed du ing in-home in e iews ca ied ou by 43 ained die i ians and nu i ionis s using household measu es o es ima e po ion sizes. Die a y in ake was assessed by 24-hou ecall. The same ield s a en e ed su ey da a in o so wa e speci ically designed o he s udy. The 24-hou ecall did no include he bs and spices. The nu ien da abase so wa e used o he s udy consis ed o a Spanish da abase (Ma aix Ve dú, A ance a Ba ina & Se a-Majem, 1995), comple ed wi h in o ma ion om F ench and B i ish (Holland e al., 1991) ood composi ion ables. Pa icipan s esponding o an in e iewe -adminis e ed ques ionnai e epo ed da a on ma e nal educa ion, which was eco ded in i e ca ego ies: (i) no educa ion (ne e wen o school), (ii) p ima y educa ion no comple ed, (iii) comple ed p ima y educa ion, (i ) seconda y educa ion, and ( ) uni e si y. Fla onoid ood composi ion da abase The Phenol-Explo e da abase, a comp ehensi e da abase on polyphenol con en in oods, was he main sou ce o la onoid, iso la one, and p oan hocyanin con en used in es ima ing die a y la onoid in ake in he enKid s udy. This da abase has been ex ac ed om mo e han 1,300 scien i ic publica ions and includes 35,000 con en alues o 500 di e en polyphenols in mo e han 400 oods (Ro hwell e al., 2013). In addi ion, US De- pa men o Ag icul u e (USDA) da abases we e used o de e mine he la onoids con en o oods no a ailable om Phenol-Explo e da a (Bhagwa , Hay owi z & Holden, 2011). Fla onoid in akes om ood we e measu ed by mul iplying he consump ion equency o each ood by i s la onoid con en . Fla onoid in ake om oods wi h se e al a ie ies was Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 3/14 a e aged. Fo example, la onoid con en o ‘‘apples’’ was a e aged o he wo ypes o apples lis ed in Phenol Explo e , cide apples and whole aw desse apples.We measu ed he la onoid in ake o he six subclasses: la onols (que ce in, kaemp e ol, my ice in, and iso hamne in), la ones (lu eolin and apigenin), la anones (e iodic yol, hespe e in, and na ingenin), la an-3-ols (ca echin, galloca echin, epica echin, epigalloca echin, epica echin-3-galla e, epigalloca echin-3-galla e, hea la in, hea la in 3-galla e, hea la in 30-galla e, hea la in 3,30digalla e, and hea ubigins), an hocyanidins (cyanidin, delphinidin, mal idin, pela gonindin, pe unidin, and peonidin), and iso la ones (daidzein, genis ein, and glyci ein). To al la onoids we e calcula ed as he sum o hese subclasses. KIDMED index Adhe ence o he Medi e anean die was es ima ed by he KIDMED index, de i ed om a 16-i em ques ionnai e adminis e ed sepa a ely om he 24-hou ecalls as pa o he enKid su ey (Se a-Majem e al., 2004). The KIDMED index was c ea ed speci ically o es ima e adhe ence o he Medi e anean die in child en and young adul s, based on he p inciples ha sus ain he Medi e anean die a y pa e n and hose ha unde mine i . Fou i ems deno ing lowe adhe - ence we e assigned a alue o −1 (Goes mo e han once a week o a as - ood es au an ; skips b eak as ; has comme cially baked goods o pas ies o b eak as ; akes swee s and candy se e al imes e e y day) and he 12 i ems ela ed o highe adhe ence we e sco ed +1 (Takes a ui o ui juice e e y day; has a second ui e e y day; egula ly has esh o cooked ege ables once a day; has esh o cooked ege ables mo e han once a day; consumes ish egula ly; likes pulses and ea s hem mo e han once a week; consumes pas a o ice almos e e y day ( i e o mo e imes pe week); has ce eals o g ains (b ead, e c.) o b eak as ; consumes nu s egula ly (a leas 2–3 imes pe week); uses oli e oil a home; has a dai y p oduc o b eak as (yoghu , milk, e c.); akes wo yoghu s and/o some cheese (40 g) daily). Sco es ange om −4 o 12, wi h highe sco es indica ing g ea e adhe ence o he Medi e anean die . A low, in e media e, and high adhe ence o he Medi e anean die was de ined as sco ing below 4, be ween 4 and 7, and mo e han 7 poin s o he KIDMED index, espec i ely. S a is ical analysis Gene al linea modeling p ocedu es we e used o compa e baseline pa icipan cha ac e is- ics by quin iles o o al la onoids in ake. Polynomial con as was used o de e mine o e all p o linea end o con inuous a iables wi h no mal dis ibu ion, and K uskal-Wallis es o de e mine o e all p o non-no mal dis ibu ions. P o linea end o ca ego ical a iables was ob ained by Man el-Haenszel linea -by-linea associa ion chi-squa e es . To de e mine he associa ion be ween la onoids and he KIDMED index, we i ed gen- e al linea models adjus ed o sex, age, ma e nal educa ion le el, ene gy in ake, egion, and communi y size. Polynomial con as was used o de e mine o e all p o linea end. Associa ions we e conside ed signi ican i P< 0.05. The SPSS o Windows e sion 18 (SPSS, Inc., Chicago, IL, Uni ed S a es) was used o all s a is ical analysis. Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 4/14 Table 1 Main cha ac e is ics o s udy pa icipan s acco ding o qua iles o o al la onoid in ake. Q1 Q2 Q3 Q4 Pa N=843 N=782 N=819 N=818 Male n(%) 392 (46.5) 347 (44.4) 387 (47.3) 383 (46.8) <0.001 Age (yea s) 15.51 (6.4) 14.65 (6.4) 14.88 (6.36) 16.35 (6.17) <0.001 Ma e nal educa ion le el n(%)b558 (66.8) 538 (69.5) 573 (70.6) 563 (69.8) <0.001 Ene gy in ake (Kcal/day) 1915 (741) 2042 (719) 2122 (777) 2217 (894) <0.001 Kidmed sco e (%) 6.65 (2.19) 7.13 (2.07) 7.39 (1.94) 7.62 (2.06) <0.001 Communi y size n(%)c0.001 <10,000 200 (23.7) 167 (21.4) 159 (19.4) 193 (23.6) 10,000–50,000 231 (27.4) 206 (26.3) 199 (24.3) 209 (25.6) 50,000–350,000 225 (26.7) 214 (27.4) 234 (28.6) 201 (24.6) >350,000 187 (22.2) 195 (24.9) 227 (27.7) 215 (26.3) Region n, (%)d<0.001 Cen al 220 (26.1) 176 (22.5) 181 (22.1) 211 (25.8) No heas 218 (25.9) 183 (23.4) 194 (23.7) 202 (24.7) No h 172 (20.4) 180 (23.0) 200 (24.4) 172 (21.0) Sou h and Cana y Islands 129 (15.3) 156 (19.9) 145 (17.7) 133 (16.3) Eas 104 (12.3) 87 (11.1) 99 (12.1) 100 (12.2) No es. ap alues we e ob ained by ANOVA, K uskal Wallis, and Pea son chi-squa e o no mal con inuous, non-no mal con inuous, and ca ego ical a iables, espec i ely; mean and s anda d de ia ion o con inuous a iables age, ene gy in ake; p opo ions wi hin quin iles o ca ego ical a iables (male sex, communi y size, and egion). bMa e nal educa ion abo e p ima y school. cPe cen age exp essed as p opo ion wi hin communi y size. dPe cen age exp essed as p opo ion wi hin egion. RESULTS Pa icipan s wi h high Fla onoid in ake we e mo e likely o be emale, we e olde , and had highe ma e nal educa ion le el. Daily ene gy in ake and adhe ence o he Medi e anean die inc eased ac oss he o al la onoids in ake (Table 1). The mean and median in ake o o al la anols o child en and young adul s aged 2–24 yea s in Spain was 70.7 and 48.1 mg/day, espec i ely. The mean in ake was wice he median in ake o o al la onoids, indica ing skewed dis ibu ions o low alues. The mean in ake o la an-3-ols was 25.2 mg/day, ep esen ing he main con ibu o o o al la onoids in ake by (35.7%), ollowed by la anones a 19.7 mg/day (27.8%), la onols a 15.6 mg/day (22.1%), and an hocyanins a 7.7 mg/day (10.9%). The lowes con ibu ions we e om la ones, 2.2 mg/day (3.2%), and iso la ones, 0.1 mg/day (1.2%) (Table 2). In s a i ied analysis adjus ed o age, ma e nal educa ion le el, ene gy in ake, egion and communi y size, la onoids in ake was g ea e among gi ls, and inc eased wi h age. The mean o al la onoids in ake o gi ls was 72.1 mg/day, and o boys was 69.1 mg/day. The mean in ake o o al la onoids was 81.5 mg/day in he age g oup ‘‘18–24 yea s’’, 62.9 mg/day in ‘‘12–17 yea s’’, 63.5 mg/day in ‘‘6–11 yea s’’, and 61.8 mg/day o he age g oup 2–5 yea s old. The majo die a y sou ces o o al la onoids in ake we e ui s (including ui juices), ege ables, and chocola e p oduc s (Table 3). F ui s we e he majo con ibu o s, Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 5/14 Table 2 Fla onoid in ake o Spanish you h.a Age Fla onoids in ake (mg/day) Mean Median SD 25 h 50 h 75 h To al la onoids All 70.7 48.1 84.1 19.3 48.0 93.1 2–5 54.7 41.4 56.5 17.7 41.4 76.8 6–11 62.3 48.5 54.4 23.7 48.5 86.4 10–13 65.1 44.4 75.6 18.8 44.4 89.3 18–24 82.4 51.8 102.8 18.9 51.8 105.7 Fla onols All 15.6 5.9 30.6 1.8 5.9 17.2 2–5 10.3 4.4 18.4 1.4 4.4 11.0 6–11 11.7 4.3 20.3 1.9 4.3 12.6 12–17 14.1 4.9 28.0 1.5 4.9 15.9 18–24 19.6 8.2 37.4 2.3 8.2 22.8 Fla ones All 2.2 0.3 9.1 0.0 0.3 1.1 2–5 1.6 0.3 3.8 0.0 0.3 1.6 6–11 1.6 0.3 5.8 0.0 0.4 1.2 12–17 1.8 0.2 7.1 0.0 0.2 0.9 18–24 2.9 0.3 11.9 0.0 0.3 1.1 Fla anones All 19.7 0.1 34.1 0 0.1 28.1 2–5 16.7 8.7 24.4 0 8.7 27.7 6–11 18.2 0.1 28.9 0 0.1 28.1 12–17 17.2 0.1 32.0 0 0.07 25.3 18–24 22.8 0.3 39.7 0 0.3 28.2 Fla an-3-ols All 25.2 14.1 47.1 4.7 14.1 28.1 2–5 21.0 13.4 34,6 6.3 13.4 24.6 6–11 23.8 19.0 24.6 9.3 19.0 30.1 12–17 24.4 15.6 44.7 6.1 15.6 27.9 18–24 27.5 11.2 57.6 2.2 11.2 27.8 An hocyanins All 7.7 0.3 27.1 0 0.3 4.2 2–5 4.9 0.5 12.4 0 0.5 6.4 6–11 6.5 0.4 22.1 0 0.4 4.7 12–17 7.3 0.0 28.6 0 0.0 3.5 18–24 9.3 0.5 30.4 0 0.5 4.8 Iso la ones All 0.1 0 1.4 0 0 0 2–5 0.1 0 1.8 0 0 0 6–11 0.1 0 2.1 0 0 0 10–13 0.0 0 0.1 0 0 0 18–24 0.1 0 1.3 0 0 0 No es. aIn ake is exp essed as mean and median wi h s anda d de ia ion (SD) and qua ile dis ibu ion. Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 6/14 Table 3 Con ibu ion o di e en ood g oups o o al la onoids in akes. Food g oups Mean la onoid in ake (mg/d) SD P opo ion o in ake (%) Majo ood sou ces o o al la onoid in ake F ui s and ui juices 38.2 56.8 42.8 O anges Na u al ui Juice Apples Comme cial ui juice Vege ables 11.1 29.1 22.0 Spinach Onions A ichokes G een beans/ Le uce Chocola e 10.9 31.7 23.5 Cocoa powde Ins an cocoa powde Da k chocola e Milk chocola e Alcoholic be e ages 0.66 19.4 0.31 Red wine (2–17) yea s old Sang ia Alcoholic be e ages 11.2 58.6 6.0 (18–24) yea s old Legumes 3.40 14.3 4.6 Whi e beans Red beans Len ils Non-alcoholic be e ages 1.64 20.5 1.7 Tea Apple cide Nu s 0.08 0.86 0.4 Pis achios Almonds Oil and a 0.08 0.15 1.4 Vi gin oli e oil Oli e oil accoun ing o 42.8% o daily o al la onoids in ake. Vege ables, pa icula ly spinach, onions, a ichokes and le uce con ibu ed 22% o he daily o al; he highes la onoids in ake om ege ables was in he olde age g oup (18–24 yea s). Cocoa powde and chocola e con ibu ed 23.5% o o al la onoid in ake (Table 3), wi h he highes daily in ake among child en aged 6–11 yea s. A e adjus ing o sex, age, ma e nal educa ion, ene gy in ake, egion, and communi y size, he mean o o al la onoids in ake was posi i ely associa ed wi h he KIDMED index sco e. The same was ue o all la onoid compounds excep o la ones (Table 4). DISCUSSION This s udy explo ed he la onoids in ake in he Spanish you h popula ion o he ENKID s udy. The es ima ed mean o al la onoids in ake was 70.7 mg/d, wi h la an-3-ols as he main subclass and ui s and ui juice as he majo die a y sou ce. Ene gy-adjus ed la onoids in ake was sligh ly highe in gi ls han boys, and inc eased wi h age. Highe adhe ence o he Medi e anean die was co ela ed wi h highe la onoids in ake. Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 7/14 Table 4 Associa ion be ween la onoid in ake and adhe ence o he Medi e anean die measu ed by he KIDMED index.a KIDMED sco e Poo < 3 Medium 4–7 High > 10 Pb Mean 95% CI Mean 95% CI Mean 95% CI To al la onoids 50.76 35.9–65.54 63.6 59.9–67.39 80.8 76.2–85.4 <0.001 Fla onols 12.24 6.88–17.6 13.6 12.3–15.0 18.1 16.3–19.8 <0.001 Fla ones 1.64 0.10–3.19 2.07 1.62–2.53 2.43 1.99–2.86 0.3 Fla anones 8.30 3.50–13.1 17.6 16.0–19.3 23.1 21.3–24.9 <0.001 Fla an-3-ols 21.5 13.8–29.2 23.8 21.6–5.32 27.5 24.9–29.9 0.05 An hocyanins 7.02 2.42–11.6 6.36 5.32–7.41 9.54 7.90–11.1 0.01 Iso la ones 0.03 0.00–0.05 0.04 0.01–0.07 0.15 0.05–0.25 0.08 No es. aGene al linea models adjus ed o sex, age, egion, communi y size, ma e nal educa ion and ene gy in ake. bp alues we e ob ained by ANOVA es . Da a on la onoids in ake in child en a e limi ed. In compa ison wi h p e ious s udies, he mean in ake in his popula ion; i.e., 70.7 mg/day o ages 2–24 yea s, was lowe han he in ake epo ed o he US NHANSE 2007–2010 s udy, i.e., 108.5 mg/day o ages 2–19 yea s (Sebas ian e al., 2016). Based on age g oups, o al la onoid in akes o he NHANSE s udy we e 59.5 mg/d o ages 2–5 yea s, 79.8 mg/d o ages 6–11 yea s, and 153.6 mg/d o ages 12–17 yea s (Sebas ian e al., 2015a). Compa ing la onoids in ake be ween di e en s udies could be in luenced by se e al ac o s; o example, by he die a y assessmen me hod, s udy sample, and he la onoid da abase. An Aus alian s udy es ima ed he in ake o la onoids in child en, adolescences and young adul used a single 24HR die a y assessmen , simila o ou s udy (Johanno & Some se , 2006). The s udy epo ed a mean la onoids in ake o 24.0–181.0 mg/d in 2–24 yea s old Aus alians (Johanno & Some se , 2006). Compa ing o ou indings in small age g oups 2–5 and 6–11 yea -old in akes we e a ound 62 mg/d, he in ake in he Aus alian s udy simila age g oups is conside ably lowe . In he NHANSE s udy, la onoids in ake was highe in boys han gi ls (Sebas ian e al., 2016). In ou s udy, howe e , la onoids in ake was highe in boys han gi ls only be o e adjus ing o ene gy in ake. A s udy by Yng e e al. (2005) ound ha child en om Spain and Iceland had he lowes ui and ege ables consump ion, and ha , among 11-yea -olds, boys consumed less ege ables and ui s han gi ls in i e ou o nine Eu opean coun ies—bu in Spain, boys consumed sligh ly mo e han gi ls. Simila o ou s udy, la an-3-ols we e he mos abundan class o die a y la onoids in child en and adul s in he US (Kim, Vance & Chun, 2016a). In he Aus alian s udy, la an- 3-ols accoun ed o 75% o la onoids in ake o he popula ion aged 2 yea s and olde , and up o 92% in adul s aged 19 yea s and olde . Aus alians’ high le el o ea consump ion con ibu ed 67% o la onoids in ake (Johanno & Some se , 2006). This inding explains he no iceable di e ence in la onoids in ake be ween he Aus alian popula ion aged 19–24 yea s and he same age g oup in ou s udy. A e excluding ea la onoids, he Aus alian popula ion aged 19–24 yea s dec eased in la onoids in ake om mo e han 200 mg/day o less han 50 mg/day (Johanno & Some se , 2006). Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 8/14 Tea was also he majo sou ce o la onoids in ake in a US adul popula ion (Kim, Vance & Chun, 2016a). Tea con ibu ed 155.9 mg/d o daily o al la onoids in ake in he US adul s, compa ed o 2.3 mg/day in he young adul s o ou s udy. One explana ion o his ex eme di e ence is ha he EnKid die a y da a we e collec ed be ween 1998 and 2000, a pe iod when ea was consumed in low quan i ies in he Spanish popula ion (Conso ium e al., 2012). In he Spanish EPIC s udy, ea in ake con ibu ed 2.2% (6.8 mg/d) o o al la onoids in ake (Zamo a-Ros e al., 2010). In Medi e anean coun ies, ui s and wine a e he p incipal sou ces o la onoids in- ake in adul s (Zamo a-Ros e al., 2013b). The indings o he p esen s udy con i m he ole o ui s as he main die a y con ibu o s o la onoids in ake in child en, adolescen s, and young adul s. Ou esul s a e in line wi h he Spanish EPIC s udy inding ha ui s we e he main sou ce o la onoids in younge Medi e anean popula ions (Zamo a-Ros e al., 2010). Compa isons o la onoid in akes be ween di e en popula ions and ime pe iods ha e ce ain limi a ions, depending on he deg ee o consis ency in he la onoid da a base used, he die a y assessmen me hod selec ed, and he iming o he die a y assessmen s. Ou s udy used a ecen ly de eloped la onoid da abase (Bhagwa , Hay owi z & Holden, 2011; Ro hwell e al., 2013), which was no a ailable when mos o he ci ed s udies we e ca y ou . Acco ding o he mos ecen epo o ood consump ion in Spain, in ake o ui and eg- e ables has dec eased (Minis e io de Ag icul u a y Pesca, 2015). The e o e, i is easonable o assume ha cu en la onoid in akes o Spanish you h a e lowe han hose epo ed in he EnKid s udy (Johanno & Some se , 2006). Simila ly, he pe cen age o he Aus alian adul s no mee ing he ecommended in ake o ege ables and ui s has inc eased (Canbe a: Na ional Heal h and Medical Council, 2013). Ou s udy used he KIDMED index as a measu e o die quali y o es ou hypo hesis ha la onoids in ake is ela ed o highe die quali y in you h. All classes o la onoids excep la ones we e posi i ely associa ed wi h KIDMED index. Ou esul s suppo a p e ious s udy which ound an associa ion be ween consuming he ecommended se ings o ui s and ege ables and signi ican ly highe phy onu ien in ake, including la onoids in ake, compa ed o pa icipan s who did no mee he ecommended consump ion le els (Mu phy e al., 2012). O he s udies ha e ound ha die quali y, measu ed by he heal hy-ea ing index (HEI), was posi i ely associa ed wi h la onoids in ake and nea ly all heal hy-ea ing index componen s inc eased ac oss qua iles o la onoids in ake (Sebas ian e al., 2015b;Sebas ian e al., 2015a). A limi a ion o he p esen s udy is i s c oss-sec ional design, which p ecludes d awing causal ela ionships. Fu he mo e, 24-hou ecalls—and pa icula ly a single day’s ecall— ha e inhe en limi a ions in he indi idual assessmen o die a y in ake due o daily a ia ions in ood in ake. Howe e , he sample size o 3,534 pa icipan s was la ge enough o cha ac e ize g oup in akes. Majo s eng hs o ou s udy a e he na ionwide popula ion- based sample and in e iewe -guided comple ion o alida ed ques ionnai es. In conclusion, his s udy p o ides he i s basic da a o es ima ed la onoids in ake and hei sou ces in Spanish you h. F ui s we e he main sou ce o die a y la onoids. Fla an-3-ol was he majo con ibu o o o al la onoids in ake. Fla onoids in ake was posi i ely associa ed wi h good die quali y, indica ed by highe adhe ence o he Medi e anean die . Bawaked e al. (2017), Pee J, DOI 10.7717/pee j.3304 9/14