Appetite 78 (2014) 156–164
Contents lists available at ScienceDirect
Appetite j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / a p p e t
Research report
Adherence to Mediterranean diet in a Spanish university population ☆ María José García-Meseguer a,*, Faustino Cervera Burriel b, Cruz Vico García c, Ramón Serrano-Urrea d a b c d
Faculty of Nursing, University of Castilla-La Mancha, Av España s/n, Campus Universitario, 02071 Albacete, Spain Ministry of Health and Social Affairs of Castilla-La Mancha, Ctra Campillo de Altobuey s/n, 16200 Motilla del Palancar, Cuenca, Spain Primary Health Care Center, Health Service of Castilla-La Mancha, Albacete, Spain Faculty of Computer Science Engineering, University of Castilla-La Mancha, Av España s/n, Campus Universitario, 02071 Albacete, Spain
A R T I C L E
I N F O
Article history: Received 18 September 2013 Received in revised form 17 March 2014 Accepted 19 March 2014 Available online 26 March 2014 Keywords: Food habits University students Mediterranean diet 24 hour recall Healthy Eating Index Mediterranean Diet Score
A B S T R A C T
The aim of this work was to characterize food habits of Spanish University students and to assess the quality of their diet and some possible determinant factors according to Mediterranean food pattern among other indices. Two hundred eighty-four enrolled students during the academic year 2012–2013 participated in this survey. For each individual a questionnaire involving anthropometric measurements, types of housing, smoking habits and levels of physical activity were self-reported. Food consumption was gathered by two nonconsecutive 24 hour recalls including one weekend day. BMI within the normal range was showed by 72.5% of students and 75% of the sample reflected a sedentary lifestyle or low physical activity. The percentage of total energy from each macronutrient was approximately 17% proteins, 40% carbohydrates and 40% lipids. The ratio of polyunsaturated to monounsaturated fat only reached 0.32. Cholesterol consumption in men exceeded the intake in women by 70 mg/day but nutritional objectives were exceeded in both genders. The main source of protein had an animal origin from meat (38.1%), followed by cereals (19.4%) and dairy products (15.6%). The assessment of diet quality conducted by Healthy Eating Index (HEI) and Mediterranean Diet Score (MDS) revealed a low–intermediate score in both (51.2 ± 12.8 and 4.0 ± 1.5, respectively). The main deviations from Mediterranean pattern were a low intake of vegetables and fruit and a high consumption of meat and dairy products. According to HEI classification, 96.1% of subjects scored “poor” or “needs improvement” about the quality of their diet and only 5.3% of students achieved a high adherence to Mediterranean diet. It is necessary to foster changes toward a healthier diet pattern according to cultural context in this population for preventing cardiovascular diseases, type 2 diabetes and insulin resistance. © 2014 Elsevier Ltd. All rights reserved.
Introduction The Mediterranean diet (MD) style eating pattern, a nutritional model inspired by the traditional food regimes of countries bordering the Mediterranean Sea, was declared an Intangible Cultural Heritage of Humanity by UNESCO in 2010. There is no single Mediterranean diet. Each region across Europe – from Spain and North Africa to the Middle East – personalizes the basic diet to take advantage of food availability and cultural preferences, but all of them have common characteristics. The principal aspects of this dietary pattern include high consumption of fruit and vegetables, olive oil as a source of fat, low consumption of meat and dairy products and
☆
Acknowledgments: The authors are very grateful to the professors of University of Castilla-La Mancha (campus of Albacete) who collaborated in the recruitment of students as well as the students who agreed to participate in the research. * Corresponding author. E-mail address: [email protected] (M.J. García-Meseguer). http://dx.doi.org/10.1016/j.appet.2014.03.020 0195-6663/© 2014 Elsevier Ltd. All rights reserved.
moderate consumption of wine. The traditional MD has been associated with a reduced risk of several nontransmittable chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease, and with prolonged survival. Hence, the MD has been promoted as a model for healthy eating (Mendez et al., 2008; Trichopoulou, Costacou, Barnia, & Trichopoulos, 2003).Generally young adults, especially university students, present an important challenge, due to the coincidence of a series of emotional, physiological and environmental changes. They select their food, being very receptive to fashion influence such as following slimming diets, skipping meals or consuming snacks, soft drinks and other new products. Young people usually do not acquire sufficient aptitude and experience to make appropriate decisions and they tend to develop unhealthy eating habits (Papadaki, Hondros, Scott, & Kapsokefalou, 2007; Rakicioglu & Yildiz, 2011; Shimbo et al., 2004). The food pattern is determined by these factors, which will stay for a lifetime in many cases (Alcacera et al., 2008; Arroyo Izaga et al., 2006; Wardle, Haase, & Steptoe, 2006). University students are an important target group among the adult population for the promotion of healthy
M.J. García-Meseguer et al./Appetite 78 (2014) 156–164
lifestyles (Chourdakis, Tzellos, Papazisis, Toulis, & Kouvelas, 2010). Students are normally part of the youth group ages 18–24 years old. They differ from adults in that bone mass peak has not been reached yet which is attained after 25 years of age (Vázquez Martínez, 2007). A 24 hour recall is a retrospective method of dietary assessment where an individual is interviewed about his/her food and beverage consumption during a defined period of time, typically the previous day or the preceding 24 hours. Traditionally the 24 hour recall is undertaken in chronological order of consumption. A more recent development has been the multiple pass recall. The use of this protocol is increasing in Spanish and international studies (ENIDE, 2012; Holmes, Dick, & Nelson, 2008; Jackson, Byrne, Magarey, & Hills, 2008). The administration of at least two nonconsecutive recalls is necessary to assess usual intakes (Strauss & Mir, 2001). Dietary quality indices are composite tools aiming to measure and quantify a variety of clinical conditions, behaviors, attitudes and beliefs that are difficult to be measured quantitatively and accurately regarding food intake. All indices, based on guidelines and recommendations, are combined measures of individual variables. Most of them allow the assessment for young and adult population (Kourlaba & Panagiotakos, 2009). Although some surveys have been conducted on food habits in Spain, most of them have been directed to children and few of them to young adult populations. In many cases, food habits and the quality of the diet in university students are far from the Mediterranean pattern guideline (Durá & Castroviejo, 2011; García Segovia & Martínez-Monzó, 2002). Although they are in optimal weight and they follow a low energy diet (Montero Bravo, Úbeda Martín, & García González, 2006), the omission of breakfast, abuse of snacks and soft drinks and the poor variety of food intake are the main features of the food patterns in this population group, which leads to micronutrient deficiencies (Baldini, Pasqui, Bordoni, & Maranesi, 2009; Bollat & Durá, 2008; Oliveras López et al., 2006). The aim of this work was to characterize food habits of students at the University of Castilla-La Mancha (campus of Albacete, Spain) and to assess the quality of their diet and some possible determinant socio-demographic and lifestyle factors. Material and methods Study design A cross sectional survey was conducted on students enrolled at the University of Castilla-La Mancha during the academic year 2012– 2013. All procedures were in accordance with the Declaration of Helsinki on the human trial performance and informed consent was provided by the participants. The study protocol was approved by the Ethics Committee at University Hospital Complex of Albacete (Spain). Study participants The subjects involved in the sample were recruited, including stratification, according to enrolled students in each degree in the campus of Albacete. Students voluntarily participated in the study. It was established an exclusion limit criterion following the recommended intakes. Men whose daily energy intake was higher than 4000 kcal/day and lower than 800 kcal/day were excluded and women whose daily energy intake was higher than 3500 kcal/day and lower than 500 kcal/day were also excluded (Willet, 1998). The second exclusion criterion was the presence of acute diseases (which affect the diet) present when the surveys were administered. The final sample consisted of 284 students, after cleaning up data and removing individuals fulfilling the exclusion criteria (15 and five individuals were removed from the data base for these reasons, respectively).
157
General data For each enrolled volunteer a self-reported questionnaire including the following items was used: (1) demographic data: gender, age; (2) anthropometric measurements: weight, height; (3) type of housing: family dwelling, university residence, shared apartment cooking for themselves, shared apartment having meals from their family, shared apartment with both, cooking for themselves and having meals from their family; (4) special features of the diet: weight loss diet, consumption of added noncaloric sweeteners, taking vitamins or mineral supplements; (5) diseases: diabetes, gluten intolerance, hypercholesterolemia, others; (6) lifestyle smoking habit: yes/no, ≤5 cigarettes or higher; (7) number of meals per day: breakfast, second breakfast, lunch, afternoon snack, dinner, supper, others and (8) level of physical activity. The level of physical activity (PAL) was classified as the ratio of total to basal daily energy expenditure as: sedentary (1.0 ≤ PAL < 1.4), low active (1.4 ≤ PAL < 1.6), active (1.6 ≤ PAL < 1.9) and very active (1.9 ≤ PAL < 2.5) (Institute of Medicine [IoM], 2005a). The body mass index (BMI) (kg/m2) was calculated from anthropometric data and individuals were classified into four categories: underweight (BMI < 18.5), normal range (18.5 ≤ BMI ≤ 24.9), overweight (25 ≤ BMI ≤ 29.9) and obese (BMI ≥ 30) (World Health Organization [WHO], 2000). Food consumption assessment Food consumption was gathered by two nonconsecutive 24 hour recalls including one weekend day (previously, a pilot study was carried out in a sample of university students of this campus) (Cervera Burriel, Serrano Urrea, Vico Garcia, Milla Tobarra, & Garcia Meseguer, 2013). Well trained dietitian nurses explained to the participants how to fill out the surveys administered to them and checked the registration. Students who agreed to participate filled out the first recall and the general questions in a first appointment. All the consumed food and beverages were registered by the recruited individuals. The students who filled out the surveys in the first appointment picked up the second 24 hour recall, which was back it in a second appointment. To help estimate the portion sizes, images of household measures and a Visual Guide were shown (Gómez, Loria, & Lourenco, 2007). The Dial program 2.12 (Alceingenieria, Madrid, Spain) was used to determine energy and nutrients. The evaluation was carried out using the following references: Consensus of Spanish Community Nutrition Society, Spanish Food Composition Tables and Dietary references of Institute of Medicine (IoM, 2005b; Moreiras, Carbajal, Cabrera & Cuadrado, 2011; Spanish Society of Community Nutrition [SENC], 2001) To determine the whole quality of the diet HEI (Kennedy, Ohls, Carlso, & Fleming, 1995) was used. In addition, the adherence to MD was assessed using the Mediterranean Diet Score (MDS) and the “Greek food pattern” (Trichopoulou et al., 2003). HEI involves 10 components, five of them correspond to the major food group (milk, grains, meat, fruit, vegetables) and four components correspond to total fat, saturated fat, cholesterol and sodium. Each component correlates with nutritional goals. The variety in a person’s diet is the component number 10. Scores range from 0 to 10 for each component. HEI scores higher than 80 imply a “good” diet, HEI scores ranging from 51 to 80 imply the diet “needs improvement” and HEI scores less than 51 imply a “poor” diet. MDS consists of nine components from weekly/daily diet. Total score ranges from 0 (minimum adherence) to 9 (maximum adherence) and each component scores 1 or 0. Score 1 (i.e. healthy food group) was assigned when the consumption of a component which is presumed close to the Mediterranean diet pattern is higher than the statistical median (legumes, cereals, fruit, vegetables, fish, high ratio MUFA/SFA). Score 1 is also assigned for consumption that is less than the statistical median of
158
M.J. García-Meseguer et al./Appetite 78 (2014) 156–164
a component which is presumed to be not close to Mediterranean diet pattern (dairy and meat). Sex-specific median was used. For the alcohol, men who consumed 10–50 g/day and women who consumed 5–25 g/day were assigned score 1. To classify the degree of adherence to the Mediterranean pattern the more generalized scale was used: scores less than 4 indicate “low adherence,” scores ranging from 4 to 6 indicate “intermediate adherence” and scores more than 6 indicate “high adherence” (Azzini et al., 2011; ENIDE, 2012). Statistical analysis was performed with IBM SPSS 19 (SPSS Inc, Chicago, IL, USA). Means and standard deviations were used as descriptive statistics for quantitative variables. Proportions were used to describe statistical qualitative variable. The two-sample
Student’s t test (with previous Levene’s test for equality of variances) was used to compare two means. One way ANOVA and post hoc Bonferroni and Games-Howell tests were used to compare three or more means. The normality of the distributions was verified by the Kolmogorov–Smirnov test. Level of significance was established as a P-value 5 cigarettes per day
Women (n = 160)
Men (n = 124)
Total (n = 284)
56.3 21.1 ± 5.3 58.5 ± 8.0 165.5 ± 5.7 22.2 ± 3.2 6.9 76.9 13.7 2.5
43.7 21.5 ± 6.5 75.4 ± 12.0 178.1 ± 7.2 22.8 ± 3.5 10.5 67.0 17.7 4.8
100 21.3 ± 5.8 65.9 ± 13.0 170.0 ± 9.0 22.4 ± 3.3 8.5 72.5 15.5 3.5
26.9 48.1 19.4 5.6
15.3 46.0 21.8 16.9
21.8 47.2 20.4 10.6
51.3 8.7 5.0 15.6 19.4
48.4 7.3 19.4 12.8 12.1
50.0 8.1 11.3 14.4 16.2
3.7 18.1 3.1 1.8
6.5 14.5 6.5 2.4
5.0 16.5 4.6 2.3
98.1 288.0 ± 140.6 15.5 ± 7.6
98.4 343.6 ± 187.9 16.2 ± 8.9
98.2 312.3 ± 165.9 15.8 ± 8.4
71.9 156.8 ± 148.7 8.4 ± 8.0
76.6 153.6 ± 167.9 7.3 ± 7.9
73.9 155.4 ± 157.4 7.9 ± 8.0
100 686.1 ± 219.7 36.9 ± 11.8
100 746.2 ± 242.8 35.2 ± 11.5
100 712.3 ± 232.0 36.1 ± 11.2
85.0 185.6 ± 160.7 10.0 ± 8.6
75.8 203.8 ± 203.8 9.6 ± 9.6
81.0 193.5 ± 181.0 9.8 ± 9.2
99.4 496.0 ± 193.2 26.6 ± 10.4
99.2 592.4 ± 248.5 28.0 ± 11.7
99.3 538.1 ± 224.2 27.3 ± 11.4
32.5 37.5 ± 68.4 2.0 ± 3.7
38.7 73.6 ± 140.1 3.5 ± 6.6
35.2 53.3 ± 107.4 2.7 ± 5.4
8.8 11.5 ± 47.4 0.6 ± 2.5
4.8 4.5 ± 35.8 0.2 ± 1.7
7.0 8.4 ± 42.3 0.4 ± 2.2
85.6 8.8 5.6
83.8 7.3 8.9
84.9 8.1 7.0
M.J. García-Meseguer et al./Appetite 78 (2014) 156–164
Table 2 Daily macronutrients and energy intake (mean ± SD).
Energy kcal/day Proteins g/day % energy Carbohydrates g/day % energy Sugars g/day % energy Total fat g/day % energy SFA g/day % energy MUFA g/day % energy PUFA g/day % energy Alcohol g/day % energy Cholesterol mg/day Fiber g/day a b
GDAb
Women
Men
P-value
2000
1860.8 ± 459.4
2116.7 ± 551.7
Contents lists available at ScienceDirect
Appetite j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / a p p e t
Research report
Adherence to Mediterranean diet in a Spanish university population ☆ María José García-Meseguer a,*, Faustino Cervera Burriel b, Cruz Vico García c, Ramón Serrano-Urrea d a b c d
Faculty of Nursing, University of Castilla-La Mancha, Av España s/n, Campus Universitario, 02071 Albacete, Spain Ministry of Health and Social Affairs of Castilla-La Mancha, Ctra Campillo de Altobuey s/n, 16200 Motilla del Palancar, Cuenca, Spain Primary Health Care Center, Health Service of Castilla-La Mancha, Albacete, Spain Faculty of Computer Science Engineering, University of Castilla-La Mancha, Av España s/n, Campus Universitario, 02071 Albacete, Spain
A R T I C L E
I N F O
Article history: Received 18 September 2013 Received in revised form 17 March 2014 Accepted 19 March 2014 Available online 26 March 2014 Keywords: Food habits University students Mediterranean diet 24 hour recall Healthy Eating Index Mediterranean Diet Score
A B S T R A C T
The aim of this work was to characterize food habits of Spanish University students and to assess the quality of their diet and some possible determinant factors according to Mediterranean food pattern among other indices. Two hundred eighty-four enrolled students during the academic year 2012–2013 participated in this survey. For each individual a questionnaire involving anthropometric measurements, types of housing, smoking habits and levels of physical activity were self-reported. Food consumption was gathered by two nonconsecutive 24 hour recalls including one weekend day. BMI within the normal range was showed by 72.5% of students and 75% of the sample reflected a sedentary lifestyle or low physical activity. The percentage of total energy from each macronutrient was approximately 17% proteins, 40% carbohydrates and 40% lipids. The ratio of polyunsaturated to monounsaturated fat only reached 0.32. Cholesterol consumption in men exceeded the intake in women by 70 mg/day but nutritional objectives were exceeded in both genders. The main source of protein had an animal origin from meat (38.1%), followed by cereals (19.4%) and dairy products (15.6%). The assessment of diet quality conducted by Healthy Eating Index (HEI) and Mediterranean Diet Score (MDS) revealed a low–intermediate score in both (51.2 ± 12.8 and 4.0 ± 1.5, respectively). The main deviations from Mediterranean pattern were a low intake of vegetables and fruit and a high consumption of meat and dairy products. According to HEI classification, 96.1% of subjects scored “poor” or “needs improvement” about the quality of their diet and only 5.3% of students achieved a high adherence to Mediterranean diet. It is necessary to foster changes toward a healthier diet pattern according to cultural context in this population for preventing cardiovascular diseases, type 2 diabetes and insulin resistance. © 2014 Elsevier Ltd. All rights reserved.
Introduction The Mediterranean diet (MD) style eating pattern, a nutritional model inspired by the traditional food regimes of countries bordering the Mediterranean Sea, was declared an Intangible Cultural Heritage of Humanity by UNESCO in 2010. There is no single Mediterranean diet. Each region across Europe – from Spain and North Africa to the Middle East – personalizes the basic diet to take advantage of food availability and cultural preferences, but all of them have common characteristics. The principal aspects of this dietary pattern include high consumption of fruit and vegetables, olive oil as a source of fat, low consumption of meat and dairy products and
☆
Acknowledgments: The authors are very grateful to the professors of University of Castilla-La Mancha (campus of Albacete) who collaborated in the recruitment of students as well as the students who agreed to participate in the research. * Corresponding author. E-mail address: [email protected] (M.J. García-Meseguer). http://dx.doi.org/10.1016/j.appet.2014.03.020 0195-6663/© 2014 Elsevier Ltd. All rights reserved.
moderate consumption of wine. The traditional MD has been associated with a reduced risk of several nontransmittable chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease, and with prolonged survival. Hence, the MD has been promoted as a model for healthy eating (Mendez et al., 2008; Trichopoulou, Costacou, Barnia, & Trichopoulos, 2003).Generally young adults, especially university students, present an important challenge, due to the coincidence of a series of emotional, physiological and environmental changes. They select their food, being very receptive to fashion influence such as following slimming diets, skipping meals or consuming snacks, soft drinks and other new products. Young people usually do not acquire sufficient aptitude and experience to make appropriate decisions and they tend to develop unhealthy eating habits (Papadaki, Hondros, Scott, & Kapsokefalou, 2007; Rakicioglu & Yildiz, 2011; Shimbo et al., 2004). The food pattern is determined by these factors, which will stay for a lifetime in many cases (Alcacera et al., 2008; Arroyo Izaga et al., 2006; Wardle, Haase, & Steptoe, 2006). University students are an important target group among the adult population for the promotion of healthy
M.J. García-Meseguer et al./Appetite 78 (2014) 156–164
lifestyles (Chourdakis, Tzellos, Papazisis, Toulis, & Kouvelas, 2010). Students are normally part of the youth group ages 18–24 years old. They differ from adults in that bone mass peak has not been reached yet which is attained after 25 years of age (Vázquez Martínez, 2007). A 24 hour recall is a retrospective method of dietary assessment where an individual is interviewed about his/her food and beverage consumption during a defined period of time, typically the previous day or the preceding 24 hours. Traditionally the 24 hour recall is undertaken in chronological order of consumption. A more recent development has been the multiple pass recall. The use of this protocol is increasing in Spanish and international studies (ENIDE, 2012; Holmes, Dick, & Nelson, 2008; Jackson, Byrne, Magarey, & Hills, 2008). The administration of at least two nonconsecutive recalls is necessary to assess usual intakes (Strauss & Mir, 2001). Dietary quality indices are composite tools aiming to measure and quantify a variety of clinical conditions, behaviors, attitudes and beliefs that are difficult to be measured quantitatively and accurately regarding food intake. All indices, based on guidelines and recommendations, are combined measures of individual variables. Most of them allow the assessment for young and adult population (Kourlaba & Panagiotakos, 2009). Although some surveys have been conducted on food habits in Spain, most of them have been directed to children and few of them to young adult populations. In many cases, food habits and the quality of the diet in university students are far from the Mediterranean pattern guideline (Durá & Castroviejo, 2011; García Segovia & Martínez-Monzó, 2002). Although they are in optimal weight and they follow a low energy diet (Montero Bravo, Úbeda Martín, & García González, 2006), the omission of breakfast, abuse of snacks and soft drinks and the poor variety of food intake are the main features of the food patterns in this population group, which leads to micronutrient deficiencies (Baldini, Pasqui, Bordoni, & Maranesi, 2009; Bollat & Durá, 2008; Oliveras López et al., 2006). The aim of this work was to characterize food habits of students at the University of Castilla-La Mancha (campus of Albacete, Spain) and to assess the quality of their diet and some possible determinant socio-demographic and lifestyle factors. Material and methods Study design A cross sectional survey was conducted on students enrolled at the University of Castilla-La Mancha during the academic year 2012– 2013. All procedures were in accordance with the Declaration of Helsinki on the human trial performance and informed consent was provided by the participants. The study protocol was approved by the Ethics Committee at University Hospital Complex of Albacete (Spain). Study participants The subjects involved in the sample were recruited, including stratification, according to enrolled students in each degree in the campus of Albacete. Students voluntarily participated in the study. It was established an exclusion limit criterion following the recommended intakes. Men whose daily energy intake was higher than 4000 kcal/day and lower than 800 kcal/day were excluded and women whose daily energy intake was higher than 3500 kcal/day and lower than 500 kcal/day were also excluded (Willet, 1998). The second exclusion criterion was the presence of acute diseases (which affect the diet) present when the surveys were administered. The final sample consisted of 284 students, after cleaning up data and removing individuals fulfilling the exclusion criteria (15 and five individuals were removed from the data base for these reasons, respectively).
157
General data For each enrolled volunteer a self-reported questionnaire including the following items was used: (1) demographic data: gender, age; (2) anthropometric measurements: weight, height; (3) type of housing: family dwelling, university residence, shared apartment cooking for themselves, shared apartment having meals from their family, shared apartment with both, cooking for themselves and having meals from their family; (4) special features of the diet: weight loss diet, consumption of added noncaloric sweeteners, taking vitamins or mineral supplements; (5) diseases: diabetes, gluten intolerance, hypercholesterolemia, others; (6) lifestyle smoking habit: yes/no, ≤5 cigarettes or higher; (7) number of meals per day: breakfast, second breakfast, lunch, afternoon snack, dinner, supper, others and (8) level of physical activity. The level of physical activity (PAL) was classified as the ratio of total to basal daily energy expenditure as: sedentary (1.0 ≤ PAL < 1.4), low active (1.4 ≤ PAL < 1.6), active (1.6 ≤ PAL < 1.9) and very active (1.9 ≤ PAL < 2.5) (Institute of Medicine [IoM], 2005a). The body mass index (BMI) (kg/m2) was calculated from anthropometric data and individuals were classified into four categories: underweight (BMI < 18.5), normal range (18.5 ≤ BMI ≤ 24.9), overweight (25 ≤ BMI ≤ 29.9) and obese (BMI ≥ 30) (World Health Organization [WHO], 2000). Food consumption assessment Food consumption was gathered by two nonconsecutive 24 hour recalls including one weekend day (previously, a pilot study was carried out in a sample of university students of this campus) (Cervera Burriel, Serrano Urrea, Vico Garcia, Milla Tobarra, & Garcia Meseguer, 2013). Well trained dietitian nurses explained to the participants how to fill out the surveys administered to them and checked the registration. Students who agreed to participate filled out the first recall and the general questions in a first appointment. All the consumed food and beverages were registered by the recruited individuals. The students who filled out the surveys in the first appointment picked up the second 24 hour recall, which was back it in a second appointment. To help estimate the portion sizes, images of household measures and a Visual Guide were shown (Gómez, Loria, & Lourenco, 2007). The Dial program 2.12 (Alceingenieria, Madrid, Spain) was used to determine energy and nutrients. The evaluation was carried out using the following references: Consensus of Spanish Community Nutrition Society, Spanish Food Composition Tables and Dietary references of Institute of Medicine (IoM, 2005b; Moreiras, Carbajal, Cabrera & Cuadrado, 2011; Spanish Society of Community Nutrition [SENC], 2001) To determine the whole quality of the diet HEI (Kennedy, Ohls, Carlso, & Fleming, 1995) was used. In addition, the adherence to MD was assessed using the Mediterranean Diet Score (MDS) and the “Greek food pattern” (Trichopoulou et al., 2003). HEI involves 10 components, five of them correspond to the major food group (milk, grains, meat, fruit, vegetables) and four components correspond to total fat, saturated fat, cholesterol and sodium. Each component correlates with nutritional goals. The variety in a person’s diet is the component number 10. Scores range from 0 to 10 for each component. HEI scores higher than 80 imply a “good” diet, HEI scores ranging from 51 to 80 imply the diet “needs improvement” and HEI scores less than 51 imply a “poor” diet. MDS consists of nine components from weekly/daily diet. Total score ranges from 0 (minimum adherence) to 9 (maximum adherence) and each component scores 1 or 0. Score 1 (i.e. healthy food group) was assigned when the consumption of a component which is presumed close to the Mediterranean diet pattern is higher than the statistical median (legumes, cereals, fruit, vegetables, fish, high ratio MUFA/SFA). Score 1 is also assigned for consumption that is less than the statistical median of
158
M.J. García-Meseguer et al./Appetite 78 (2014) 156–164
a component which is presumed to be not close to Mediterranean diet pattern (dairy and meat). Sex-specific median was used. For the alcohol, men who consumed 10–50 g/day and women who consumed 5–25 g/day were assigned score 1. To classify the degree of adherence to the Mediterranean pattern the more generalized scale was used: scores less than 4 indicate “low adherence,” scores ranging from 4 to 6 indicate “intermediate adherence” and scores more than 6 indicate “high adherence” (Azzini et al., 2011; ENIDE, 2012). Statistical analysis was performed with IBM SPSS 19 (SPSS Inc, Chicago, IL, USA). Means and standard deviations were used as descriptive statistics for quantitative variables. Proportions were used to describe statistical qualitative variable. The two-sample
Student’s t test (with previous Levene’s test for equality of variances) was used to compare two means. One way ANOVA and post hoc Bonferroni and Games-Howell tests were used to compare three or more means. The normality of the distributions was verified by the Kolmogorov–Smirnov test. Level of significance was established as a P-value 5 cigarettes per day
Women (n = 160)
Men (n = 124)
Total (n = 284)
56.3 21.1 ± 5.3 58.5 ± 8.0 165.5 ± 5.7 22.2 ± 3.2 6.9 76.9 13.7 2.5
43.7 21.5 ± 6.5 75.4 ± 12.0 178.1 ± 7.2 22.8 ± 3.5 10.5 67.0 17.7 4.8
100 21.3 ± 5.8 65.9 ± 13.0 170.0 ± 9.0 22.4 ± 3.3 8.5 72.5 15.5 3.5
26.9 48.1 19.4 5.6
15.3 46.0 21.8 16.9
21.8 47.2 20.4 10.6
51.3 8.7 5.0 15.6 19.4
48.4 7.3 19.4 12.8 12.1
50.0 8.1 11.3 14.4 16.2
3.7 18.1 3.1 1.8
6.5 14.5 6.5 2.4
5.0 16.5 4.6 2.3
98.1 288.0 ± 140.6 15.5 ± 7.6
98.4 343.6 ± 187.9 16.2 ± 8.9
98.2 312.3 ± 165.9 15.8 ± 8.4
71.9 156.8 ± 148.7 8.4 ± 8.0
76.6 153.6 ± 167.9 7.3 ± 7.9
73.9 155.4 ± 157.4 7.9 ± 8.0
100 686.1 ± 219.7 36.9 ± 11.8
100 746.2 ± 242.8 35.2 ± 11.5
100 712.3 ± 232.0 36.1 ± 11.2
85.0 185.6 ± 160.7 10.0 ± 8.6
75.8 203.8 ± 203.8 9.6 ± 9.6
81.0 193.5 ± 181.0 9.8 ± 9.2
99.4 496.0 ± 193.2 26.6 ± 10.4
99.2 592.4 ± 248.5 28.0 ± 11.7
99.3 538.1 ± 224.2 27.3 ± 11.4
32.5 37.5 ± 68.4 2.0 ± 3.7
38.7 73.6 ± 140.1 3.5 ± 6.6
35.2 53.3 ± 107.4 2.7 ± 5.4
8.8 11.5 ± 47.4 0.6 ± 2.5
4.8 4.5 ± 35.8 0.2 ± 1.7
7.0 8.4 ± 42.3 0.4 ± 2.2
85.6 8.8 5.6
83.8 7.3 8.9
84.9 8.1 7.0
M.J. García-Meseguer et al./Appetite 78 (2014) 156–164
Table 2 Daily macronutrients and energy intake (mean ± SD).
Energy kcal/day Proteins g/day % energy Carbohydrates g/day % energy Sugars g/day % energy Total fat g/day % energy SFA g/day % energy MUFA g/day % energy PUFA g/day % energy Alcohol g/day % energy Cholesterol mg/day Fiber g/day a b
GDAb
Women
Men
P-value
2000
1860.8 ± 459.4
2116.7 ± 551.7
![[A lower adherence to Mediterranean diet is associated with a poorer self-rated health in university population].](/assets/img/hold.png)
