Déficits de nutrientes en pacientes con síndrome metabólico. Diferencias regionales e influencia del nivel socioeconómico y cultural

Abstract

This Doctoral Thesis is devoted to the study of the nutritional intake in Spanish older adults with overweight/obesity and metabolic syndrome, both nutrition-related non-communicable diseases that have increased in the last few decades and that are the main causes of mortality and disability in older adults in Spain. Although some studies have analysed the dietary intake of the Spanish population, the study of the influence of socioeconomic, demographic and other variables related to dietary intake over the dietary quality have not been extensively studied in our country before. Using the data obtained at the PREDIMED-Plus study, a large primary cardiovascular prevention trial conducted in Spanish healthy participants with overweight/obesity and Metabolic Syndrome, we aimed: 1. To assess the adequacy of basal dietary intake according to the European and International dietary reference intakes, as well as to investigate the influence of socioeconomic and lifestyle factors on nutrient inadequate intake and nutrient density. 2. To describe the food intake and nutrient profiles according to the geographical area of residence, and to analyse the influence of this variable over inadequate nutrient intake. 3. To estimate the relationship between dietary diversity and nutrient adequacy and identify which socioeconomic, demographic or lifestyles variables are associated with dietary diversity. 4. To assess the effect of improving Mediterranean Diet adherence on nutrient density after one year of follow-up at the PREDIMED-Plus trial. To obtain the proper results, we used different statistical strategies (i.e. logistic regression, linear regression, etc.). After that, several facts can be concluded. Despite, the patients analysed are subjects with Metabolic Syndrome and overweight/obese, they exhibited suboptimal nutrient intake, particularly for dietary fiber, vitamins A, D, E and B9, calcium and magnesium. Lower nutrient density and higher inadequate nutrient intake was related to sex (higher for men), poor lifestyles (lower physical activity and Mediterranean Diet adherence and smoking status). The dietary pattern of Spain slightly differ among geographical areas (inhabitants in the North area consumed lower amounts of vegetables and fish but more sugar and alcohol). Furthermore, even within the same country, geographical area was significantly associated with inadequate nutrient intake, the higher rates of inadequate nutrient intake was observed for people in the North area. On the other hand, lower levels of dietary diversity are related to men, smokers, lower levels of Mediterranean Diet adherence and not being married, being the influence of dietary diversity notorious over the inadequateness, since as dietary diversity increased, risk of inadequate nutrients intake decreased. Finally, we have also noted that when Mediterranean Diet adherence increases the nutrient density also does. Thus, the PREDIMED-Plus dietary intervention is a feasible strategy to improve nutrient density in Spanish population at high risk of cardiovascular disease with overweight or obesity. The knowledge generated by this Thesis may contribute to the application of different nutritional interventions aimed to reduce the nutritional deficiencies in vulnerable groups of population as older adults in order to prevent or mitigate the progression of non-communicable diseases. The nutritional approach could contribute to decrease the costs in health care derived from these diseases.