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Nutrients. 2019 Apr 26;11(5). pii: E958. doi: 10.3390/nu11050958.

Dietary Diversity and Nutritional Adequacy among an Older Spanish Population with Metabolic Syndrome in the PREDIMED-Plus Study: A Cross-Sectional Analysis.

Author information

1
Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain. ncaiba@ugr.es.
2
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. ncaiba@ugr.es.
3
Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain. ncaiba@ugr.es.
4
University of Navarre, Department of Preventive Medicine and Public Health, Medical School, 31008 Pamplona, Spain. ageas@unav.es.
5
Navarra institute for health research (IdisNa), 31008 Pamplona, Spain. ageas@unav.es.
6
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. ageas@unav.es.
7
University of Navarre, Department of Preventive Medicine and Public Health, Medical School, 31008 Pamplona, Spain. mamartinez@unav.es.
8
Navarra institute for health research (IdisNa), 31008 Pamplona, Spain. mamartinez@unav.es.
9
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. mamartinez@unav.es.
10
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA. mamartinez@unav.es.
11
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. jordi.salas@urv.cat.
12
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43002 Reus, Spain. jordi.salas@urv.cat.
13
Institut d'Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain. jordi.salas@urv.cat.
14
University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain. jordi.salas@urv.cat.
15
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. dolores.corella@uv.es.
16
Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain. dolores.corella@uv.es.
17
Unit of Cardiovascular Risk and Nutrition, Institut Mar d´Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain. mariadoloreszf@blanquerna.edu.
18
Human Nutrition Unit, Blanquerna-Ramon Llull University, 08001 Barcelona, Spain. mariadoloreszf@blanquerna.edu.
19
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. doraromaguera@yahoo.es.
20
Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain. doraromaguera@yahoo.es.
21
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. vioque@umh.es.
22
Nutritional Epidemiology Unit, Miguel Hernández University, ISABIAL-FISABIO, 03202 Alicante, Spain. vioque@umh.es.
23
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. luisfernando.aros@ehu.eus.
24
Department of Cardiology, OSI ARABA, University Hospital Araba, University of the Basque Country UPV/EHU, 48940 Vitoria-Gasteiz, Spain. luisfernando.aros@ehu.eus.
25
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. jwarnberg@uma.es.
26
Department of Nursing, School of Health Sciences. University of Malaga- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain. jwarnberg@uma.es.
27
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. jalfmtz@unav.es.
28
Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain. jalfmtz@unav.es.
29
Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain. jalfmtz@unav.es.
30
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. lluis.serra@ulpgc.es.
31
Research Institute of Biomedical and Health Sciences. University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain. lluis.serra@ulpgc.es.
32
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. restruch@clinic.ub.es.
33
Department of Internal Medicine, Institut d´Investigacion Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain. restruch@clinic.ub.es.
34
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. fjtinahones@hotmail.com.
35
Virgen de la Victoria Hospital, Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29016 Málaga, Spain. fjtinahones@hotmail.com.
36
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. jlapetra@ono.com.
37
Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain. jlapetra@ono.com.
38
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. xpinto@bellvitgehospital.cat.
39
Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain. xpinto@bellvitgehospital.cat.
40
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. pep.tur@uib.es.
41
Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain. pep.tur@uib.es.
42
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. angarios2004@yahoo.es.
43
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. angarios2004@yahoo.es.
44
Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain. blanca.riquel@gmail.com.
45
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. mdelgado@ujaen.es.
46
Department of Health Sciences, University of Jaen, 23071 Jaen, Spain. mdelgado@ujaen.es.
47
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. pilar.matia@gmail.com.
48
Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain. pilar.matia@gmail.com.
49
Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM + CSIC, 28049 Madrid, Spain. lidia.daimiel@imdea.org.
50
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. vicente.martin@unileon.es.
51
Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain. vicente.martin@unileon.es.
52
Department of Endocrinology, Institut d' Investigacions Biomédiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain. jovidal@clinic.cat.
53
CIBER Diabetes y enfermedades metabólicas (CIBERDEM), ISCIII, 28029 Madrid, Spain. jovidal@clinic.cat.
54
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. clotilde.vazquez@fjd.es.
55
Department of Endocrinology, Fundación Jiménez-Díaz, 28040 Madrid, Spain. clotilde.vazquez@fjd.es.
56
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. eros@clinic.ub.es.
57
Lipid Clinic, Department of Endocrinology and Nutrition, IDIBAPS, Hospital Clinic, 08036 Barcelona, Spain. eros@clinic.ub.es.
58
University of Navarre, Department of Preventive Medicine and Public Health, Medical School, 31008 Pamplona, Spain. pilarbuilc@gmail.com.
59
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. pilarbuilc@gmail.com.
60
Primary Care, Health Service of Navarra-Osasunbidea, 31002 Pamplona, Spain. pilarbuilc@gmail.com.
61
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. andres.diaz@urv.cat.
62
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43002 Reus, Spain. andres.diaz@urv.cat.
63
Institut d'Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain. andres.diaz@urv.cat.
64
University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain. andres.diaz@urv.cat.
65
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. rebeca.fernandez@uv.es.
66
Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain. rebeca.fernandez@uv.es.
67
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. mfito@imim.es.
68
Unit of Cardiovascular Risk and Nutrition, Institut Mar d´Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain. mfito@imim.es.
69
Human Nutrition Unit, Blanquerna-Ramon Llull University, 08001 Barcelona, Spain. mfito@imim.es.
70
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. jadzia.konieczna@gmail.com.
71
Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain. jadzia.konieczna@gmail.com.
72
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. lnotario@umh.es.
73
Nutritional Epidemiology Unit, Miguel Hernández University, ISABIAL-FISABIO, 03202 Alicante, Spain. lnotario@umh.es.
74
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. angelmago13@gmail.com.
75
Department of Cardiology, OSI ARABA, University Hospital Araba, University of the Basque Country UPV/EHU, 48940 Vitoria-Gasteiz, Spain. angelmago13@gmail.com.
76
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. eugenio.contreras.sspa@juntadeandalucia.es.
77
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. iabetego@unav.es.
78
Department of Nutrition, Food Sciences, and Physiology, Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain. iabetego@unav.es.
79
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. almudena.sanchez@ulpgc.es.
80
Research Institute of Biomedical and Health Sciences. University of Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain. almudena.sanchez@ulpgc.es.
81
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. rcasas1@clinic.cat.
82
Department of Internal Medicine, Institut d´Investigacion Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain. rcasas1@clinic.cat.
83
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. araceli.munoz.garach.sspa@juntadeandalucia.es.
84
Virgen de la Victoria Hospital, Department of Endocrinology, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, 29016 Málaga, Spain. araceli.munoz.garach.sspa@juntadeandalucia.es.
85
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. josemanuel.santos@ono.com.
86
Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, 41013 Sevilla, Spain. josemanuel.santos@ono.com.
87
Department of Medicine. University of Sevilla, 41004 Sevilla, Spain. josemanuel.santos@ono.com.
88
Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, 07122 Palma de Mallorca, Spain. laura.gallardo@uib.es.
89
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. jbasora.tarte.ics@gencat.cat.
90
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43002 Reus, Spain. jbasora.tarte.ics@gencat.cat.
91
Institut d'Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain. jbasora.tarte.ics@gencat.cat.
92
University Hospital of Sant Joan de Reus, Nutrition Unit, 43204 Reus, Spain. jbasora.tarte.ics@gencat.cat.
93
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. Olga.portoles@uv.es.
94
Department of Preventive Medicine, University of Valencia, 46010 Valencia, Spain. Olga.portoles@uv.es.
95
Primary Care Division of Barcelona, Institut Català de la Salud-IDIAP Jordi Gol, 08007 Barcelona, Spain. mamunoz.bcn.ics@gencat.cat.
96
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. mmonyino@gmail.com.
97
Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain. mmonyino@gmail.com.
98
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. sjmirallesgis@gmail.com.
99
Nutritional Epidemiology Unit, Miguel Hernández University, ISABIAL-FISABIO, 03202 Alicante, Spain. sjmirallesgis@gmail.com.
100
Department of Cardiology, OSI ARABA, University Hospital Araba, University of the Basque Country UPV/EHU, 48940 Vitoria-Gasteiz, Spain. anai.m.rodriguez@gmail.com.
101
University of Navarre, Department of Preventive Medicine and Public Health, Medical School, 31008 Pamplona, Spain. mcanela@unav.es.
102
Navarra institute for health research (IdisNa), 31008 Pamplona, Spain. mcanela@unav.es.
103
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. mcanela@unav.es.
104
CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. apalau@grupsagessa.com.
105
Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, 43002 Reus, Spain. apalau@grupsagessa.com.
106
Institut d'Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain. apalau@grupsagessa.com.
107
ABS Reus V. Centre d'Assistència Primària Marià Fortuny, SAGESSA, 43203 Reus, Spain. apalau@grupsagessa.com.
108
Unit of Cardiovascular Risk and Nutrition, Institut Mar d´Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain. kperez@imim.es.
109
Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain. abueno@ugr.es.
110
CIBER Epidemiología y Salud Pública (CIBERESP). Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain. abueno@ugr.es.
111
Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain. abueno@ugr.es.

Abstract

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.

KEYWORDS:

PREDIMED-Plus study; aging; dietary diversity; metabolic syndrome; nutrient adequacy

PMID:
31035497
DOI:
10.3390/nu11050958
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