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nutrients
Article
Macronutrient Distribution and Dietary Sources in
the Spanish Population: Findings from the
ANIBES Study
Emma Ruiz 1, José Manuel Ávila 1, Teresa Valero 1, Susana del Pozo 1, Paula Rodriguez 1,
Javier Aranceta-Bartrina 2, Ángel Gil 3, Marcela González-Gross 4, Rosa M. Ortega 5,
Lluis Serra-Majem 6and Gregorio Varela-Moreiras 1 ,7,*
1Spanish Nutrition Foundation (FEN), C/General Álvarez de Castro 20, 1 pta, Madrid 28010, Spain;
eruiz@fen.org.es (E.R.); jmavila@fen.org.es (J.M.Á.); tvalero@fen.org.es (T.V.);
susanadelpozo@fen.org.es (S.P.); prodriguez@fen.org.es (P.R.)
2Department of Preventive Medicine and Public Health, University of Navarra, C/Irunlarrea 1,
Pamplona 31008, Spain; jaranceta@unav.es or javieraranceta@hotmail.com
3Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Sciences,
University of Granada. Campus de la Salud, Avda. del Conocimiento, Armilla, Granada 18100, Spain;
agil@ugr.es
4
ImFINE Research Group, Department of Health and Human Performance, Technical University of Madrid,
C/Martín Fierro 7, Madrid 28040, Spain; marcela.gonzalez.gross@upm.es
5Department of Nutrition, Faculty of Pharmacy, Complutense University of Madrid,
Plaza Ramón y Cajal s/n, Madrid 28040, Spain; rortega@ucm.es
6Research Institute of Biomedical and Health Sciences, Universidad de Las Palmas de Gran Canaria,
Facultad de Ciencias de la Salud, C/Doctor Pasteur s/n Trasera del Hospital, Las Palmas de Gran Canaria,
Las Palmas 35016, Spain; lluis.serra@ulpgc.es
7Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University,
Urb. Montepríncipe, Crta. Boadilla Km 53, Boadilla del Monte, Madrid 28668, Spain
*Correspondence: gvarela@ceu.es or gvarela@fen.org.es; Tel.: +34-913724726; Fax: +34-913510496
Received: 29 October 2015; Accepted: 15 March 2016; Published: 22 March 2016
Abstract:
Our aim was to analyze dietary macronutrient intake and its main sources according to
sex and age. Results were derived from the ANIBES (“Anthropometry, Intake and Energy Balance
in Spain”) cross-sectional study using a nationally-representative sample of the Spanish population
(9–75 years old). Mean dietary protein intake was 74.5
˘
22.4 g/day, with meat and meat products
as the main sources (33.0%). Mean carbohydrate intake was 185.4
˘
60.9 g/day and was higher in
children and adolescents; grains (49%), mainly bread, were the main contributor. Milk and dairy
products (23%) ranked first for sugar intake. Mean lipid intake was 78.1
˘
26.1 g/day and was higher
in younger age groups; contributions were mainly from oils and fats (32.5%; olive oil 25.6%) and
meat and meat products (22.0%). Lipid profiles showed relatively high monounsaturated fatty acid
intake, of which olive oil contributed 38.8%. Saturated fatty acids were mainly (>70%) combined
from meat and meat products, milk and dairy products and oils and fats. Polyunsaturated fatty acids
were mainly from oils and fats (31.5%). The macronutrient intake and distribution in the Spanish
population is far from population reference intakes and nutritional goals, especially for children
and adolescents.
Keywords:
macronutrient intake; dietary protein; dietary fat; carbohydrate intake; dietary fat quality
sources; ANIBES study
Nutrients 2016,8, 177; doi:10.3390/nu8030177 www.mdpi.com/journal/nutrients
Nutrients 2016,8, 177 2 of 25
1. Introduction
Obesity and other nutrition-related non-communicable diseases represent increasing major health
problems in Mediterranean countries, such as Spain [
1
]. Being overweight and obesity affect more
than 50% of adults and nearly 30% of children in Spain [2].
Undoubtedly, deep social and economic changes occurred in this country in the last few decades,
which also experienced a transition in dietary patterns and life styles [
1
–
3
]. Some have had a potentially
positive impact, such as increasing the variety of foods, access (in fact, a potential overabundance of
energy and nutrients) and food security in the diet. However, globally, these changes are contradictory
with adequate food selection and adherence for a healthy Mediterranean diet [4].
The health-promoting quality of the overall diet is usually associated with energy and nutrient
intake. Populations are encouraged to meet their energy and nutrients needs primarily through
foods [
5
]. National dietary surveillance, while having inherent limitations (misreporting, accurate
updating of food composition tables at the national level, etc.), provides a way to examine eating
patterns and their impact on calorie and nutrient intakes across different populations [6–8].
The use of new available methodologies (e.g., real-time recording of eating and drinking events)
has been urgently claimed to avoid these difficulties [
9
–
11
]. The latter was firmly stated in the
consensus document and conclusions “Obesity and sedentarism in the 21st century: What can be done
and what must be done?” [
4
] and even more recently in the “Methodology of dietary surveys, studies
on nutrition, physical activity and other lifestyles” special review supplement [12].
Different dietary surveys have been previously conducted in Spain [
13
–
16
]. However, no one
has approached up to date energy and macronutrients intake using new, more accurate technologies.
As a consequence
, the ANIBES (“Anthropometry, Intake and Energy Balance in Spain”) study was
recently completed. We have previously reported the ANIBES design and methodology [
17
,
18
] and
energy intake and its dietary sources [19].
This study focuses on macronutrient intake in the Spanish diet, to better characterize also the
macronutrient excess or inadequacy, as well as to analyze food and beverage sources that currently
contribute to the dietary intake of carbohydrates, lipids and proteins. The latter aim is of particular
interest, to provide more detailed and accurate information on how the different food and beverage
groups and subgroups represent the current market in Spain. Moreover, targeting current food and
beverage selections among the Spanish population is key to the design of the dietary guidelines and
public health strategies to improve the diet quality in the future.
2. Materials and Methods
The complete design, protocol and methodology of the ANIBES study have been described in
detail elsewhere [17,18].
2.1. Sample
The initial potential sample consisted of 2634 individuals, and the final sample comprised 2009
individuals (1013 men, 50.4%; 996 women, 49.6%). In addition, for the youngest age groups (9–12, 13–17
and 18–24 years), a boost sample was included to have at least n= 200 per age group (error
˘
6.9%).
Therefore, the random sample plus booster comprised 2285 participants. Sample quotas according
to the following variables were: age groups (9–12, 13–17, 18–64 and 65–75 years); sex (men/women);
geographical distribution (northeast, Levant, south, central, northwest, Barcelona metropolitan area,
Madrid metropolitan area and Balearic and Canary Islands); and locality size: 2000–30,000 inhabitants
(rural), 30,000–200,000 inhabitants (semi-urban) and over 200,000 inhabitants (urban).
The final protocol was approved by the Ethical Committee for Clinical Research of the Region of
Madrid in Spain.
Nutrients 2016,8, 177 3 of 25
2.2. Food and Beverage Records
Study participants were provided with a tablet device (Samsung Galaxy Tab 27.0) to record by
taking photos of all food and drinks consumed during 3 days, both at home and outside. Photos had
to be taken before beginning to eat and drink and again after finishing, so as to record the actual intake.
The ANIBES software was developed to receive information from the field tablets every 2 seconds,
and the database was updated every 30 min. Food, beverages and nutrient intakes were calculated
from food consumption records using software (VD-FEN 2.1), which is based mainly on Spanish food
composition tables [
20
]. Macronutrient reference intakes and distribution objectives for the Spanish
population were used to analyze the overall quality of the diet [21].
2.3. Statistical Analysis
The intake data were grouped into 16 food groups, 38 subgroups and 754 ingredients for in-depth
analysis. Every comparison between groups has been performed by a Student’s t-test for independent
samples with a 95% confidence interval. In addition, the Kolmogorov–Smirnoff normality test was
used to test the normality of the distribution: random sample (2009 participants) and random + booster
sample (2285). The random sample is used to show total sample data and to compare between sexes.
To compare age groups and sex in age groups, a booster sample was included in order to expand those
age groups less represented in the random sample.
3. Results
3.1. Macronutrient Intake and Distribution
Daily intake levels of macronutrients, alcohol, water and their distributions are shown in Table 1.
The mean protein intake was 74.5
˘
22.4 g/day, ranging from 28.2 to 352.5 g/day. Differences were
observed between men and women and also according to the age group (the oldest showed the lowest
intake), as shown in Table 2.
The mean total carbohydrate intake was 185.4
˘
60.9 g/day (37.8 g/day min; 450.3 g/day max)
(Table 1), with differences seen between men and women, as also shown in Table 2. Higher total
carbohydrate consumption was observed in younger age groups as compared to adults and older
adults. Total sugar intake was also quantified: higher in children and adolescents and markedly
lower in adults and older adults. Fiber intake and distribution are also shown in Table 1, with
12.7 ˘5.6 g/day
(2.2 g/day min; 45.1 g/day max), and differences were also found between men and
women; values were also much higher in older adults than in the youngest populations.
Mean lipid intake and distribution are shown in Table 1, with 78.1
˘
26.1 g/day, and ranging
from 21.0 g/day to 201.5 g/day. Results for the different age groups are shown in Table 2. Values were
much higher among younger age groups than older adults. Sex differences were also observed, being
higher in men in all age groups. A decreasing trend in intake with advancing age is observed.
3.2. Contribution of Food and Beverage Groups/Subgroups to Total Macronutrients
Contributions (%) of the various food and beverage categories to daily macronutrient intake is
shown in Figure 1. More detailed information according to different age groups (9–12, 13–17, 18–64
and 65–75 years) is provided in Tables 3–7.
Meat and meat products were the main sources of protein for the whole population (33.1%),
although these contributed much more among younger groups and less so among older adults. Grains
and milk and dairy products ranked second and third, with these groups together contributing over
two-thirds (68%) of the total protein intake (Figure 1). Other protein-rich foods were fish and shellfish,
much higher in older adults. Interestingly, vegetables and pulses contributed only 7% to total daily
protein intake and were especially low in the youngest age groups.
Nutrients 2016,8, 177 4 of 25
Table 1. Daily nutrient intake and distribution in the Spanish ANIBES study population (9–75 years old).
Nutrients Mean Median SD SEM P5 P10 P25 P50 P75 P90 P95 Min Max
Proteins (g) 74.5 71.8 22.4 0.5 43.9 48.2 59.2 71.8 87.0 103.9 112.3 28.2 352.5
Carbohydrates (g) 185.4 177.4 60.9 1.4 99.4 114.2 143.2 177.4 222.1 267.3 294.9 37.8 450.3
Sugar (g) 76.3 71.5 33.9 0.8 30.0 37.3 52.5 71.5 96.2 122.9 136.7 6.7 263.6
Lipids (g) 78.1 75.0 26.1 0.6 41.4 47.3 59.5 75.0 93.0 113.4 126.5 21.0 201.5
SFA (g) 24.0 22.6 9.5 0.2 11.0 12.9 17.3 22.6 29.4 36.2 40.9 5.1 86.6
MUFA (g) 33.7 32.7 11.3 0.3 18.2 20.4 25.3 32.7 40.1 48.5 53.6 8.8 96.7
PUFA (g) 13.4 12.3 6.1 0.1 5.7 6.7 9.0 12.3 16.6 21.2 24.5 2.6 50.6
n-6 (g) 11.1 10.1 5.5 0.1 4.1 5.1 7.0 10.1 14.0 18.4 21.1 1.4 45.1
n-3 (g) 1.3 0.9 11.6 0.3 0.4 0.5 0.6 0.9 1.3 1.9 2.4 0.2 520.7
Cholesterol (mg) 315 298 137 3 136 162 215 298 389 492 557 11 1.584
Fiber (g) 12.7 11.8 5.6 0.1 5.4 6.5 8.7 11.8 15.6 19.7 22.9 2.2 45.1
Alcohol (g) 5.4 0.0 10.6 0.2 0.0 0.0 0.0 0.0 6.8 17.3 26.2 0.0 110.8
Water (mL) 1626 1489 641 14 819 944 1173 1489 1960 2533 2842 368 5683
SD: standard deviation; SEM: standar error; P: Percentil; SFA: saturated fatty acids; MUFA: monounsaturated fatty acids; PUFA: polyunsaturated fatty acids; n-6: omega-6 fatty acids;
n-3: omega-3 fatty acids.
Nutrients 2016,8, 177 5 of 25
Table 2. Total daily nutrient intake by sex and age group in the Spanish ANIBES study population aged 9–75 years.
Total Children 9–12 Years Adolescents 13–17 Years Adults 18–64 Years Elderly 65–75 Years
Total Men Women Total Men Women Total Men Women Total Men Women Total Men Women
n2009 1013 996 213 126 87 211 137 74 1655 798 857 206 99 107
ENERGY (kcal) 1810
(504)
1957
(531)
1660 *
(427)
1960
(431)
2006
(456)
1893 *
(385)
2018
(508)
2124
(515)
1823 *
(436)
1816
(512)
1966
(543)
1675 *
(437)
1618
(448)
1771
(485)
1476 *
(360)
PROTEINS (g) 74.5
(22.4)
80.3
(24.9)
68.5 *
(17.7)
77.6
(18.9)
80.6
(19)
73.3 *
(18.1)
80.0
(21)
85.0
(21)
70.6 *
(17.7)
74.8
(22.9)
81.0
(26)
69.0 *
(17.8)
67.7
(21)
73.5
(23.9)
62.4 *
(16.3)
CARBOHYDRATES (g) 185.4
(60.9)
200.0
(64.9)
170.7 *
(52.7)
214.3
(57.1)
218.2
(61.1)
208.7
(50.7)
224.6
(67.5)
234.5
(70.0)
206.1 *
(58.8)
184.0
(60.4)
198.7
(64.6)
170.3 *
(52.8)
163.7
(53.4)
175.0
(59.7)
153.3 *
(44.7)
SUGAR (g) 76.3
(33.9)
79.5
(36.6)
73.0 *
(30.6)
91.6
(33.3)
93.7
(35.3)
88.4
(30.1)
89.3
(35.1)
90.8
(37.2)
86.6
(31)
74.9
(33.8)
78.4
(36.7)
71.7 *
(30.5)
73.0
(34.0)
74.2
(37.4)
71.8
(30.6)
LIPIDS (g) 78.1
(26.1)
83.7
(27.2)
72.4 *
(23.6)
85.1
(22.1)
87.3
(23.2)
82.1
(20.0)
85.9
(25.8)
90.9
(25.9)
76.7 *
(23.1)
78.7
(26.5)
84.2
(27.8)
73.6 *
(24.2)
67.4
(22.1)
73.2
(23.0)
62.0 *
(19.8)
SFA (g) 24.0
(9.5)
25.8
(10.0)
22.1 *
(8.7)
28.7
(8.7)
29.6
(9.3)
27.5
(7.5)
28.3
(9.6)
30.0
(9.6)
25.2 *
(9.0)
24.0
(9.6)
25.7
(10.1)
22.5 *
(8.8)
19.3
(7.5)
20.8
(7.6)
17.9 *
(7.1)
MUFA (g) 33.7
(11.3)
36.1
(11.9)
31.3 *
(10.2)
34.9
(9.6)
35.8
(10.2)
33.6
(8.6)
35.1
(10.9)
37.3
(11.3)
31.2 *
(8.9)
34.0
(11.6)
36.4
(12.3)
31.8 *
(10.5)
30.6
(9.7)
33.1
(9.6)
28.3 *
(9.2)
PUFA (g) 13.4
(6.1)
14.4
(6.5)
12.5 *
(5.5)
14.1
(5.2)
14.2
(5.1)
14.0
(5.4)
14.7
(6.3)
15.4
(6.3)
13.4 *
(6.2)
13.6
(6.1)
14.6
(6.5)
12.7 *
(5.6)
11.4
(6.5)
12.6
(7.7)
10.3 *
(5)
n-6 (g) 11.1
(5.5)
11.9
(5.8)
10.1 *
(5)
12.0
(4.8)
12.1
(4.6)
11.9
(5.1)
12.6
(5.8)
13.2
(5.8)
11.5 *
(5.7)
11.2
(5.5)
12.1
(5.9)
10.3 *
(5.0)
9.0
(5.3)
9.9
(6.1)
8.3 *
(4.4)
n-3 (g) 1.3
(11.6)
1.6
(16.3)
1.0
(0.7)
0.9
(0.5)
1.0
(0.5)
0.9
(0.5)
1.0
(0.6)
1.0
(0.6)
0.9
(0.5)
1.4
(12.8)
1.8
(18.4)
1.0 *
(0.7)
1.1
(0.9)
1.4
(1.1)
0.9 *
(0.5)
Cholesterol (mg) 315
(137)
345
(146)
284 *
(121)
328
(110)
347
(112)
299 *
(102)
342
(139)
368
(139)
294 *
(128)
316
(137)
347
(144)
287 *
(122)
296
(153)
320
(174)
273 *
(128)
FIBRE (g) 12.7
(5.6)
13.1
(6.1)
12.2 *
(5.2)
11.8
(4.3)
11.5
(4.0)
12.2
(4.6)
11.8
(4.7)
12.1
(4.8)
11.2
(4.6)
12.6
(5.7)
13.1
(6.1)
12.1 *
(5.2)
14.6
(6.8)
15.7
(7.7)
13.6 *
(5.6)
ALCOHOL (g) 5.4
(10.6)
7.3
(12.8)
3.5 *
(7.3)
0.0
(0)
0.0
(0)
0.0
(0)
0.1
(0.6)
0.0
(0.4)
0.1
(0.8)
6.1
(11.1)
8.3
(13.3)
4.0 *
(8.0)
7.0
(12.6)
10.8
(14.8)
3.5 *
(8.7)
WATER (mL) 1626
(641)
1666
(679)
1585 *
(596)
1392
(484)
1432
(514)
1335
(434)
1336
(464)
1391
(511)
1236 *
(345)
1663
(661)
1722
(703)
1608 *
(614)
1583
(539)
1586
(575)
1580
(506)
Results are expressed as the mean
˘
the standard deviation (in brackets); * denotes statistical difference (p
ď
005) by sex; SFA: saturated fatty acids; MUFA: monounsaturated fatty
acids; PUFA: polyunsaturated fatty acids; n-6: omega-6 fatty acids; n-3: omega-3 fatty acids.
Nutrients 2016,8, 177 6 of 25
Table 3. Dietary sources of nutrients (%) from food groups/subgroups in the Spanish ANIBES study population aged 9–75 years (n= 2009).
Total (Aged 9–75 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Grains 7.93 27.40 2.25 17.38 10.35 10.75 7.46 14.68 9.82 5.24 48.97 11.98 39.90 8.60 -
Grains and flours 1.22 4.47 0.17 2.61 0.44 0.30 0.24 1.07 0.71 0.17 8.75 0.25 3.40 - -
Bread 3.90 11.57 1.62 8.35 1.84 1.41 1.20 3.89 2.42 1.36 23.37 2.84 20.72 0.00 -
Breakfast cereals
and cereal bars 0.23 1.00 0.02 0.56 0.23 0.30 - - - - 1.83 1.29 1.57 - -
Pasta 0.98 3.56 0.12 3.09 0.50 0.24 0.17 1.33 0.88 0.41 6.43 0.91 6.21 0.09 -
Bakery and pastry 1.60 6.80 0.32 2.77 7.34 8.49 5.84 8.39 5.81 3.30 8.58 6.69 8.00 8.52 -
Vegetables 8.82 4.02 8.94 3.79 0.59 0.33 0.17 1.55 0.34 1.26 7.66 7.28 23.67 0.01 -
Fruits 7.16 4.75 5.97 1.90 1.86 1.06 1.59 3.13 1.44 1.13 8.21 16.78 17.18 - -
Oils and fats 1.29 12.29 0.05 0.03 32.19 21.39 42.37 33.02 19.48 7.58 0.01 0.02 - 2.45 -
Olive oil 0.91 9.22 0.00 - 24.41 15.01 36.96 18.46 9.84 4.14 - - - - -
Other oils 0.19 1.71 - - 4.41 2.03 3.06 11.49 6.59 0.13 - - - - -
Butter, margarine
and shortening 0.19 1.37 0.05 0.03 3.38 4.35 2.35 3.07 3.06 3.30 0.01 0.02 - 2.45 -
Milk and dairy
products 13.38 11.81 14.95 17.17 13.48 23.67 8.87 2.83 10.00 13.10 9.90 23.26 0.40 14.69 -
Milks 9.10 4.98 10.82 8.05 4.62 7.94 2.99 0.77 4.21 7.34 5.02 12.71 - 5.78 -
Cheeses 0.90 2.99 0.59 5.34 5.34 9.33 3.42 1.25 3.48 3.12 0.21 0.55 - 5.04 -
Yogurt and
fermented milk 2.37 2.37 2.54 2.86 1.77 3.45 1.22 0.36 1.69 2.01 3.09 6.82 0.30 1.41 -
Other dairy
products 1.01 1.47 0.99 0.92 1.76 2.96 1.23 0.45 0.62 0.63 1.58 3.17 0.10 2.46 -
Fish and shellfish 3.03 3.55 2.21 10.63 4.21 3.10 2.94 8.53 9.89 25.88 0.07 0.03 - 12.16 -
Meat and meat
products 7.79 15.16 6.26 33.14 22.52 25.74 22.50 20.33 38.70 38.29 0.30 0.58 - 35.97 -
Meat 5.54 9.25 4.54 21.83 12.74 14.60 12.79 11.29 21.94 25.71 0.00 0.02 - 24.20 -
Sausages and other
meat products 2.16 5.79 1.64 10.95 9.65 10.99 9.63 8.96 16.50 12.32 0.29 0.56 - 11.10 -
Viscera and spoils 0.09 0.11 0.09 0.35 0.13 0.15 0.08 0.07 0.26 0.26 0.01 - - 0.68 -
Nutrients 2016,8, 177 7 of 25
Table 3. Cont.
Total (Aged 9–75 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Eggs 1.53 2.20 1.37 4.68 3.76 3.92 3.09 3.83 2.11 1.70 0.00 0.01 - 20.81 -
Pulses 0.73 2.25 0.23 3.32 0.49 0.12 0.31 1.27 0.55 0.04 3.24 0.57 9.39 - -
Sugars and sweets 0.83 3.34 0.12 0.84 1.40 2.14 1.19 0.90 0.54 0.62 6.52 15.13 0.68 0.25 -
Sugar 0.32 1.37 0.01 0.00 - - - - - - 3.35 8.18 - - -
Chocolates 0.37 1.54 0.06 0.82 1.38 2.13 1.16 0.87 0.52 0.61 2.17 4.74 0.45 0.24 -
Jams and other 0.11 0.33 0.05 0.01 - - - - - - 0.78 1.77 0.19 - -
Other sweets 0.03 0.10 0.01 0.02 0.02 0.01 0.03 0.03 0.01 0.00 0.21 0.44 0.04 0.01 -
Appetizers 0.26 0.79 0.14 0.32 1.11 1.04 1.40 0.88 0.47 0.16 0.74 0.15 1.45 0.08 -
Ready-to-eat meals 3.66 4.21 3.62 4.60 4.48 4.83 4.15 4.41 3.83 3.23 4.28 1.30 4.50 2.77 -
Sauces and
condiments 0.70 1.57 0.64 0.50 3.16 1.70 3.79 3.84 2.83 1.75 0.36 0.70 2.12 1.96 -
Non-alcoholic
beverage 38.40 3.95 47.71 1.18 0.34 0.18 0.17 0.75 - - 8.36 18.57 0.53 - -
Water 24.01 - 30.04 - - - - - - - - - - - -
Coffee and infusions
4.27 0.19 5.46 0.46 0.00 - - - - - 0.35 0.94 - - -
Sugar soft drinks 4.78 2.03 5.74 - - - - - - - 4.62 10.01 - - -
Non-sweetened soft
drinks 1.79 0.02 2.28 0.00 0.05 - - - - - 0.02 0.08 - - -
Sports drinks 0.20 0.07 0.24 - - - - - - - 0.17 0.35 - - -
Energy drinks 0.06 0.04 0.07 - - - - - - - 0.08 0.16 - - -
Juices and nectars 2.59 1.34 3.05 0.31 0.01 - - - - - 2.91 6.55 0.49 - -
Other drinks 0.68 0.26 0.82 0.41 0.28 0.18 0.17 0.75 - - 0.22 0.49 0.05 - -
Alcoholic
beverages 4.47 2.62 5.55 0.36 - - - - - - 1.34 3.60 - - 100.00
Low alcohol content
beverages 4.39 2.39 5.45u 0.36 - - - - - - 1.29 3.51 - - 93.45
High alcohol content
beverages 0.09 0.23 0.10 - - - - - - - 0.04 0.09 - - 6.55
Supplements and
meal replacement 0.01 0.09 - 0.17 0.06 0.04 0.01 0.06 - 0.03 0.05 0.04 0.13 0.03 -
Nutrients 2016,8, 177 8 of 25
Table 4. Dietary sources of nutrients (%) from food groups/subgroups in the Spanish ANIBES study population: children aged 9–12 years (n= 213).
Children (Aged 9–12 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Grains 9.78 29.57 2.65 18.26 12.30 13.29 9.14 16.13 10.54 5.86 48.99 14.82 46.88 10.45 -
Grains and flours 1.30 3.88 0.18 2.27 0.32 0.20 0.17 0.83 0.59 0.16 7.35 0.21 3.11 - -
Bread 4.39 10.99 1.90 8.01 1.93 1.35 1.48 4.04 2.40 1.48 20.50 2.20 20.78 - -
Breakfast cereals
and cereal bars 0.44 1.57 0.04 0.77 0.34 0.58 - - - - 2.82 2.36 2.64 - -
Pasta 1.22 3.96 0.13 3.60 0.51 0.20 0.18 1.49 0.85 0.49 6.85 0.73 7.54 0.09 -
Bakery and pastry 2.42 9.17 0.40 3.61 9.19 10.98 7.31 9.78 6.69 3.72 11.48 9.32 12.82 10.35 -
Vegetables 6.78 2.96 7.04 2.57 0.34 0.18 0.07 0.93 0.25 0.90 5.57 3.61 17.52 0.00 -
Fruits 5.32 2.89 4.54 1.22 1.06 0.56 0.99 2.02 0.94 0.74 4.78 9.80 13.03 - -
Oils and fats 1.31 10.35 0.05 0.02 26.67 15.72 35.80 31.04 17.68 6.89 0.01 0.02 - 2.22 -
Olive oil 0.86 7.09 - - 18.45 9.79 29.86 14.40 7.17 3.44 - - - - -
Other oils 0.24 1.99 - - 5.15 2.14 3.73 13.82 7.80 0.15 - - - - -
Butter, margarine
and shortening 0.21 1.27 0.05 0.02 3.07 3.79 2.21 2.82 2.71 3.31 0.01 0.02 - 2.22 -
Milk and dairy
products 20.66 15.41 23.84 20.77 17.64 28.76 12.06 3.68 11.96 15.63 12.89 29.87 0.52 19.30 -
Milks 13.66 6.71 16.76 10.25 7.20 11.30 4.82 1.28 5.51 9.38 5.74 13.86 - 8.61 -
Cheeses 0.84 2.53 0.53 4.62 4.57 7.38 3.11 1.13 2.57 2.68 0.12 0.32 - 4.48 -
Yogurt and
fermented milk 3.36 3.06 3.65 3.43 2.51 4.61 1.78 0.46 1.87 2.45 3.66 8.70 0.06 1.63 -
Other dairy
products 2.79 3.12 2.90 2.47 3.36 5.46 2.35 0.82 2.01 1.11 3.36 7.00 0.47 4.58 -
Fish and shellfish 2.38 2.13 1.92 7.24 2.22 1.43 1.58 4.68 6.92 20.09 0.02 0.01 - 8.19 -
Meat and meat
products 8.57 14.90 7.09 32.50 22.96 24.28 24.21 21.56 39.81 41.01 0.39 0.67 - 34.24 -
Meat 5.67 7.98 4.83 19.79 11.16 11.92 11.83 9.98 18.96 24.61 0.01 0.02 - 21.42 -
Sausages and other
meat products 2.89 6.89 2.25 12.65 11.77 12.34 12.36 11.57 20.77 16.40 0.38 0.65 - 12.67 -
Viscera and spoils 0.02 0.03 0.02 0.06 0.03 0.02 0.01 0.01 0.08 0.01 0.00 - - 0.15 -
Nutrients 2016,8, 177 9 of 25
Table 4. Cont.
Children (Aged 9–12 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Eggs 1.55 1.90 1.42 4.13 3.21 2.88 2.78 3.45 1.76 1.57 0.00 0.00 - 19.76 -
Pulses 0.72 1.97 0.21 3.02 0.40 0.09 0.26 1.17 0.42 0.02 2.64 0.32 9.02 - -
Sugars and sweets 1.41 5.07 0.25 2.20 3.60 4.57 3.29 3.18 1.85 2.08 7.79 17.18 1.02 0.48 -
Sugar 0.14 0.52 0.00 0.00 - - - - - - 1.19 2.57 - - -
Chocolates 1.10 4.15 0.18 2.17 3.58 4.55 3.27 3.18 1.85 2.08 5.76 12.73 0.91 0.48 -
Jams and other 0.08 0.18 0.03 0.00 - - - - - - 0.41 0.95 0.10 - -
Other sweets 0.09 0.22 0.04 0.02 0.01 0.02 0.01 0.01 - - 0.44 0.93 0.01 - -
Appetizers 0.29 1.08 0.06 0.56 1.32 1.28 1.53 1.35 0.40 0.09 1.06 0.12 2.05 0.09 -
Ready-to-eat meals 4.79 5.53 4.73 6.32 5.80 5.75 5.42 6.44 4.67 3.76 5.22 1.32 6.27 4.05 -
Sauces and
condiments 0.94 1.36 0.96 0.61 2.44 1.21 2.86 4.32 2.80 1.36 0.48 0.82 2.86 1.22 -
Non-alcoholic
beverage 35.49 4.87 45.23 0.57 0.04 0.01 0.01 0.06 - - 10.16 21.44 0.82 - -
Water 22.92 - 29.93 - - - - - - - - - - - -
Coffee and infusions
0.26 0.00 0.35 0.02 - - - - - - 0.01 0.02 - - -
Sugar soft drinks 4.83 1.86 5.89 - - - - - - - 4.09 8.52 - - -
Non-sweetened soft
drinks 0.95 0.01 1.25 0.00 0.01 - - - - - 0.00 0.01 - - -
Sports drinks 0.46 0.15 0.57 - - - - - - - 0.30 0.63 - - -
Energy drinks 0.02 0.00 0.03 - - - - - - - - - - - -
Juices and nectars 5.99 2.83 7.13 0.51 0.01 - - - - - 5.76 12.24 0.82 - -
Other drinks 0.06 0.02 0.07 0.05 0.02 0.01 0.01 0.06 - - 0.00 0.01 - - -
Alcoholic
beverages 0.00 0.00 0.00 - - - - - - - 0.00 0.00 - - 100.00
Low alcohol content
beverages - - - - - - - - - - - - - - -
High alcohol content
beverages 0.00 0.00 0.00 - - - - - - - 0.00 0.00 - - 100.00
Supplements and
meal replacement 0.00 - - - - - - - - - - - - - -
Nutrients 2016,8, 177 10 of 25
Table 5. Dietary sources of nutrients (%) from food groups/subgroups in the Spanish ANIBES study population: adolescents aged 13–17 years (n= 211).
Adolescents (Aged 13–17 Years)
Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Grains 10.82 30.69 3.01 19.07 12.73 13.08 9.31 17.81 10.80 5.94 50.80 14.96 48.84 10.86 -
Grains and flours 1.53 4.61 0.19 2.69 0.39 0.25 0.22 0.93 0.68 0.19 8.57 0.23 3.21 - -
Bread 4.82 11.35 2.12 8.32 1.98 1.43 1.50 4.07 2.34 1.41 21.37 2.59 22.78 - -
Breakfast cereals and
cereal bars 0.57 1.94 0.05 0.84 0.47 0.78 - - - - 3.47 3.13 3.04 - -
Pasta 1.52 4.47 0.19 3.92 0.63 0.26 0.22 1.72 1.02 0.55 7.74 1.17 8.82 0.08 -
Bakery and pastry 2.37 8.32 0.46 3.30 9.26 10.36 7.37 11.08 6.77 3.79 9.65 7.84 10.98 10.77 -
Vegetables 6.82 2.95 7.18 2.61 0.44 0.27 0.19 1.08 0.23 0.91 5.38 3.79 18.31 0.01 -
Fruits 4.25 2.32 3.68 1.02 0.86 0.51 0.81 1.51 0.70 0.68 3.73 7.99 10.11 - -
Oils and fats 1.32 9.75 0.05 0.02 25.39 15.68 33.67 28.80 17.07 6.72 0.01 0.02 - 2.13 -
Olive oil 0.85 6.62 0.00 - 17.43 9.76 27.92 13.42 7.06 3.31 - - - - -
Other oils 0.26 1.91 - - 4.92 2.12 3.54 12.96 7.33 0.15 - - - - -
Butter, margarine and
shortening 0.21 1.22 0.05 0.02 3.04 3.80 2.21 2.42 2.68 3.26 0.01 0.02 - 2.13 -
Milk and dairy products 17.62 12.60 20.68 17.93 15.13 25.09 10.39 3.07 10.55 14.69 9.73 24.03 0.66 16.57 -
Milks 12.37 5.78 15.41 8.91 6.22 9.88 4.30 1.07 5.25 9.05 4.98 13.20 - 7.43 -
Cheeses 1.00 2.87 0.63 5.26 5.21 8.77 3.45 1.21 3.16 3.63 0.13 0.40 - 5.04 -
Yogurt and fermented
milk 2.30 2.00 2.54 2.23 1.60 2.97 1.14 0.27 1.05 1.39 2.47 5.78 0.26 1.20 -
Other dairy products 1.94 1.94 2.10 1.53 2.11 3.46 1.50 0.52 1.08 0.61 2.15 4.64 0.40 2.91 -
Fish and shellfish 2.29 2.09 1.84 6.33 2.59 1.82 1.98 5.12 6.08 17.68 0.02 0.03 - 7.21 -
Meat and meat products 9.49 15.95 7.98 34.62 24.43 26.30 25.30 22.74 41.27 43.00 0.36 0.69 - 36.07 -
Meat 6.54 9.05 5.69 22.06 12.56 13.54 13.07 11.41 20.97 27.23 0.01 0.03 - 23.17 -
Sausages and other meat
products 2.93 6.88 2.26 12.47 11.86 12.74 12.22 11.33 20.22 15.72 0.35 0.66 - 12.75 -
Viscera and spoils 0.02 0.01 0.02 0.08 0.01 0.01 0.01 0.00 0.07 0.05 - - - 0.14 -
Eggs 1.85 2.06 1.86 4.50 3.46 3.26 3.08 3.52 1.82 1.74 0.00 0.02 - 20.16 -
Pulses 0.73 1.95 0.18 2.90 0.42 0.11 0.26 1.07 0.38 0.03 2.77 0.55 8.80 - -
Nutrients 2016,8, 177 11 of 25
Table 5. Cont.
Adolescents (Aged 13–17 Years)
Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Sugars and sweets 1.26 4.36 0.19 1.85 3.03 4.03 2.77 2.41 1.36 1.60 6.82 16.33 0.87 0.31 -
Sugar 0.22 0.70 0.01 0.00 - - - - - - 1.61 3.85 - - -
Chocolates 0.92 3.32 0.15 1.80 2.99 4.01 2.71 2.34 1.35 1.59 4.53 10.85 0.69 0.30 -
Jams and other 0.06 0.14 0.03 0.00 - - - - - - 0.31 0.85 0.08 - -
Other sweets 0.07 0.20 0.01 0.04 0.04 0.01 0.06 0.06 0.01 0.00 0.37 0.78 0.09 0.01 -
Appetizers 0.33 0.99 0.09 0.47 1.17 1.27 1.38 0.95 0.43 0.11 1.06 0.12 1.29 - -
Ready-to-eat meals 5.55 6.51 5.27 7.46 6.87 6.90 6.63 7.17 6.09 4.68 6.21 1.69 7.43 4.42 -
Sauces and condiments 1.02 1.64 1.06 0.57 3.33 1.64 4.12 4.53 3.22 2.23 0.46 1.00 2.75 2.11 -
Non-alcoholic beverage 36.55 6.08 46.81 0.61 0.15 0.06 0.10 0.24 - - 12.60 28.73 0.91 - -
Water 19.98 - 26.18 - - - - - - - - - - - -
Coffee and infusions 0.71 0.02 0.98 0.05 0.00 - - - - - 0.04 0.14 - - -
Sugar soft drinks 8.78 3.37 10.87 - - - - - - - 7.27 16.41 - - -
Non-sweetened soft
drinks 1.19 0.01 1.63 0.00 0.02 - - - - - 0.01 0.03 - - -
Sports drinks 0.11 0.03 0.13 - - - - - - - 0.10 0.17 - - -
Energy drinks 0.17 0.09 0.20 - - - - - - - 0.16 0.37 - - -
Juices and nectars 5.38 2.46 6.51 0.42 0.02 - - - - - 4.96 11.46 0.85 - -
Other drinks 0.24 0.10 0.30 0.13 0.11 0.06 0.10 0.24 - - 0.07 0.14 0.06 - -
Alcoholic beverages 0.10 0.04 0.13 0.01 - - - - - - 0.02 0.05 - - 100.00
Low alcohol content
beverage 0.10 0.04 0.13 0.01 - - - - - - 0.02 0.05 - - 100.00
High alcohol content
beverage - - - - - - - - - - - - - - -
Supplements and meal
replacement 0.01 0.02 - 0.02 0.00 0.00 0.00 0.00 - - 0.03 0.01 0.03 0.01 -
Nutrients 2016,8, 177 12 of 25
Table 6. Dietary sources of nutrients (%) from food groups/subgroups in the Spanish ANIBES study population: adults aged 18–64 years (n= 1655).
Adults (Aged 18–64 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Grains 7.79 27.27 2.22 17.35 10.21 10.56 7.34 14.53 9.72 5.24 49.10 11.92 40.00 8.36 -
Grains and flours 1.21 4.51 0.18 2.64 0.44 0.31 0.24 1.07 0.71 0.18 8.88 0.27 3.46 - -
Bread 3.85 11.57 1.59 8.35 1.85 1.42 1.21 3.87 2.42 1.35 23.47 2.93 21.02 0.00 -
Breakfast cereals
and cereal bars 0.21 0.96 0.02 0.55 0.22 0.25 - - - - 1.75 1.20 1.53 - -
Pasta 0.98 3.60 0.13 3.12 0.52 0.26 0.19 1.32 0.87 0.42 6.55 0.94 6.28 0.11 -
Bakery and pastry 1.54 6.63 0.31 2.70 7.17 8.31 5.70 8.26 5.73 3.29 8.46 6.58 7.71 8.25 -
Vegetables 8.91 4.08 9.01 3.86 0.60 0.33 0.18 1.54 0.35 1.28 7.82 7.60 24.17 0.01 -
Fruits 6.74 4.60 5.59 1.88 1.93 1.09 1.67 3.24 1.51 1.16 7.83 16.18 16.60 - -
Oils and fats 1.28 12.25 0.04 0.03 32.01 21.30 42.03 32.96 19.44 7.51 0.01 0.02 - 2.47 -
Olive oil 0.90 9.12 0.00 - 24.12 14.84 36.57 18.06 9.59 4.06 - - - - -
Other oils 0.20 1.78 - - 4.57 2.13 3.17 11.88 6.81 0.14 - - - - -
Butter, margarine
and shortening 0.18 1.35 0.04 0.03 3.32 4.33 2.30 3.02 3.04 3.31 0.01 0.02 - 2.47 -
Milk and dairy
products 12.68 11.57 14.04 16.85 13.35 23.51 8.80 2.80 9.85 12.99 9.62 22.77 0.39 14.54 -
Milks 8.57 4.74 10.15 7.71 4.34 7.50 2.82 0.72 3.96 7.15 4.88 12.52 - 5.44 -
Cheeses 0.93 3.12 0.61 5.55 5.57 9.77 3.57 1.29 3.66 3.24 0.22 0.58 - 5.29 -
Yogurt and
fermented milk 2.23 2.26 2.38 2.74 1.67 3.26 1.16 0.34 1.65 1.94 2.97 6.60 0.32 1.33 -
Other dairy
products 0.94 1.45 0.90 0.86 1.77 2.98 1.25 0.45 0.59 0.67 1.54 3.06 0.07 2.48 -
Fish and shellfish 3.00 3.58 2.17 10.61 4.30 3.14 3.06 8.72 9.90 25.92 0.08 0.02 - 12.09 -
Meat and meat
products 7.82 15.34 6.28 33.51 22.62 25.96 22.61 20.33 38.92 38.37 0.30 0.59 - 36.39 -
Meat 5.60 9.42 4.58 22.17 12.88 14.78 12.93 11.38 22.16 25.77 0.01 0.02 - 24.58 -
Sausages and other
meat products 2.14 5.80 1.62 10.97 9.60 11.03 9.59 8.87 16.50 12.32 0.29 0.58 - 11.10 -
Viscera and spoils 0.09 0.12 0.09 0.36 0.13 0.15 0.08 0.08 0.27 0.28 0.01 - - 0.71 -
Nutrients 2016,8, 177 13 of 25
Table 6. Cont.
Adults (Aged 18–64 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Eggs 1.50 2.19 1.34 4.65 3.73 3.92 3.07 3.73 2.08 1.70 0.00 0.01 - 20.65 -
Pulses 0.72 2.22 0.24 3.28 0.49 0.12 0.30 1.26 0.53 0.04 3.20 0.59 9.28 - -
Sugars and sweets 0.80 3.28 0.11 0.77 1.27 2.03 1.06 0.76 0.45 0.54 6.55 15.34 0.67 0.23 -
Sugar 0.34 1.48 0.01 0.00 - - - - - - 3.63 8.95 - - -
Chocolates 0.32 1.39 0.05 0.74 1.25 2.02 1.02 0.71 0.43 0.54 1.98 4.28 0.44 0.22 -
Jams and other 0.11 0.31 0.05 0.01 - - - - - - 0.74 1.70 0.18 - -
Other sweets 0.03 0.10 0.00 0.02 0.03 0.01 0.04 0.05 0.02 0.00 0.20 0.41 0.05 0.01 -
Appetizers 0.27 0.81 0.14 0.32 1.16 1.07 1.47 0.90 0.49 0.17 0.76 0.15 1.53 0.08 -
Ready-to-eat meals 3.46 4.22 3.36 4.53 4.48 4.88 4.16 4.25 3.77 3.13 4.38 1.32 4.50 2.76 -
Sauces and
condiments 0.71 1.67 0.63 0.50 3.38 1.82 4.03 4.01 3.01 1.91 0.36 0.72 2.18 2.11 -
Non-alcoholic
beverage 39.32 3.93 48.67 1.26 0.40 0.21 0.20 0.90 - - 8.37 18.62 0.49 - -
Water 24.48 - 30.46 - - - - - - - - - - - -
Coffee and infusions
4.63 0.20 5.91 0.48 0.00 - - - - - 0.37 1.01 - - -
Sugar soft drinks 4.78 2.06 5.70 - - - - - - - 4.72 10.22 - - -
Non-sweetened soft
drinks 2.03 0.03 2.58 0.01 0.06 - - - - - 0.02 0.09 - - -
Sports drinks 0.24 0.09 0.28 - - - - - - - 0.20 0.42 - - -
Energy drinks 0.06 0.04 0.06 - - - - - - - 0.08 0.16 - - -
Juices and nectars 2.36 1.23 2.76 0.30 0.01 - - - - - 2.73 6.17 0.45 - -
Other drinks 0.75 0.30 0.91 0.48 0.33 0.21 0.20 0.90 - - 0.25 0.56 0.04 - -
Alcoholic
beverages 4.99 2.89 6.17 0.42 - - - - - - 1.54 4.10 - - 100.00
Low alcohol content
beverages 4.90 2.63 6.06 0.42 - - - - - - 1.49 3.99 - - 92.95
High alcohol content
beverages 0.10 0.26 0.11 - - - - - - - 0.05 0.11 - - 7.05
Supplements and
meal replacement 0.02 0.10 - 0.19 0.07 0.05 0.01 0.07 - 0.03 0.06 0.05 0.14 0.04 -
Nutrients 2016,8, 177 14 of 25
Table 7. Dietary sources of nutrients (%) from food groups/subgroups in the Spanish ANIBES study population: seniors aged 65–75 years (n= 206).
SENIORS (Aged 65–75 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Grains 6.74 25.59 1.95 16.38 9.24 9.56 6.46 13.69 9.84 4.60 46.89 10.13 31.39 8.23 -
Grains and flours 1.00 3.97 0.13 2.31 0.43 0.31 0.24 1.12 0.76 0.13 7.66 0.19 2.81 - -
Bread 3.67 12.15 1.50 8.87 1.69 1.35 0.87 3.93 2.59 1.27 25.17 2.69 17.32 - -
Breakfast cereals
and cereal bars 0.14 0.75 0.01 0.47 0.14 0.11 - - - - 1.45 0.67 0.86 - -
Pasta 0.57 2.43 0.05 2.08 0.32 0.15 0.08 1.01 0.77 0.26 4.47 0.56 3.70 - -
Bakery and pastry 1.36 6.29 0.26 2.65 6.67 7.64 5.27 7.63 5.73 2.93 8.14 6.02 6.70 8.23 -
Vegetables 10.49 4.86 10.64 4.78 0.72 0.45 0.11 2.16 0.45 1.62 8.89 8.38 25.48 0.01 -
Fruits 13.13 8.53 11.11 3.18 2.90 1.69 2.04 5.18 2.56 1.97 15.32 29.45 28.17 - -
Oils and fats 1.41 14.86 0.06 0.04 39.91 28.31 53.12 35.90 21.12 9.26 0.01 0.03 - 2.86 -
Olive oil 1.10 12.24 - - 33.22 21.64 48.40 25.99 13.93 5.43 - - - - -
Other oils 0.08 0.77 - - 2.09 1.04 1.44 5.45 3.23 0.06 - - - - -
Butter, margarine
and shortening 0.23 1.84 0.06 0.04 4.60 5.64 3.28 4.46 3.96 3.77 0.01 0.03 - 2.86 -
Milk and dairy
products 13.55 11.86 15.19 17.76 12.25 22.55 7.57 2.64 10.72 12.56 11.02 23.97 0.27 13.48 -
Milks 9.50 5.72 11.13 9.44 4.95 9.01 3.01 0.85 5.16 7.27 5.94 13.86 - 6.53 -
Cheeses 0.67 2.25 0.46 4.00 4.04 7.17 2.42 1.02 2.95 2.13 0.20 0.47 - 3.28 -
Yogurt and
fermented milk 2.92 3.07 3.16 3.77 2.40 4.72 1.62 0.55 2.35 2.86 3.86 7.71 0.26 2.18 -
Other dairy
products 0.47 0.82 0.44 0.55 0.87 1.65 0.52 0.22 0.26 0.31 1.02 1.93 0.02 1.49 -
Fish and shellfish 4.02 4.57 2.93 14.32 5.14 4.12 3.23 10.24 12.34 31.36 0.05 0.05 - 17.13 -
Meat and meat
products 6.18 12.83 4.85 28.81 19.44 23.12 18.44 17.93 35.34 33.65 0.16 0.30 - 31.47 -
Meat 4.47 8.30 3.54 19.24 12.01 14.38 11.49 11.00 21.94 24.58 0.00 0.01 - 21.92 -
Sausages and other
meat products 1.55 4.35 1.15 9.02 7.25 8.49 6.81 6.84 13.04 8.82 0.16 0.29 - 8.59 -
Viscera and spoils 0.16 0.18 0.16 0.54 0.18 0.25 0.13 0.09 0.36 0.25 0.01 - - 0.96 -
Nutrients 2016,8, 177 15 of 25
Table 7. Cont.
SENIORS (Aged 65–75 Years)
Total Intake
(Weight) Energy Water Proteins Lipids SFA MUFA PUFA n-6 n-3 Carbohydrates Sugar Fiber Cholesterol Alcohol
% % % % % % % % % % % % % % %
Eggs 1.74 2.69 1.53 5.75 4.70 5.05 3.65 5.26 2.89 2.04 0.00 0.02 - 24.81 -
Pulses 0.82 2.81 0.20 4.21 0.59 0.12 0.36 1.43 0.72 0.03 4.16 0.63 10.64 - -
Sugars and sweets 0.64 2.64 0.13 0.27 0.44 0.81 0.32 0.15 0.08 0.07 5.85 12.97 0.62 0.10 -
Sugar 0.29 1.37 0.01 0.01 - - - - - - 3.25 7.51 - - -
Chocolates 0.11 0.49 0.02 0.24 0.44 0.81 0.32 0.15 0.08 0.07 0.72 1.60 0.19 0.10 -
Jams and other 0.23 0.76 0.10 0.02 - - - - - - 1.83 3.76 0.43 - -
Other sweets 0.01 0.02 0.00 0.00 0.00 - - - - - 0.05 0.09 - - -
Appetizers 0.15 0.32 0.13 0.10 0.60 0.51 0.77 0.46 0.33 0.13 0.19 0.08 0.63 0.08 -
Ready-to-eat meals 3.09 1.79 3.57 1.96 2.00 2.34 1.71 2.21 2.13 2.20 1.74 0.73 1.41 0.74 -
Sauces and
condiments 0.35 0.84 0.31 0.38 1.69 1.13 2.04 1.96 1.49 0.50 0.18 0.21 0.91 0.88 -
Non-alcoholic
beverage 32.51 2.19 40.77 1.51 0.34 0.20 0.18 0.79 - - 4.35 9.64 0.37 - -
Water 22.11 - 27.78 - - - - - - - - - - - -
Coffee and infusions
5.68 0.29 7.28 0.74 0.02 - - - - - 0.51 1.20 - - -
Sugar soft drinks 1.38 0.66 1.64 - - - - - - - 1.56 3.37 - - -
Non-sweetened soft
drinks 0.72 0.01 0.95 0.00 0.02 - - - - - 0.01 0.02 - - -
Sports drinks 0.06 0.02 0.07 - - - - - - - 0.05 0.13 - - -
Energy drinks - - - - - - - - - - - - - - -
Juices and nectars 1.58 0.91 1.83 0.24 0.01 - - - - - 1.99 4.38 0.28 - -
Other drinks 0.99 0.30 1.23 0.53 0.30 0.20 0.18 0.79 - - 0.24 0.54 0.08 - -
Alcoholic
beverages 5.17 3.54 6.62 0.28 - - - - - - 1.15 3.40 - - 100.00
Low alcohol content
beverages 5.05 3.28 6.48 0.28 - - - - - - 1.11 3.28 - - 95.45
High alcohol content
beverages 0.11 0.26 0.15 - - - - - - - 0.04 0.12 - - 4.55
Supplements and
meal replacement 0.02 0.09 - 0.29 0.02 0.03 - - - - 0.03 0.01 0.11 0.06 -
Nutrients 2016,8, 177 16 of 25
Nutrients 2016,8,17717of26
Figure 1. Cont.
Nutrients 2016,8, 177 17 of 25
Nutrients 2016,8,17718of26
Figure1.Nutrientintake(%)byfoodgroupintheSpanishANIBESpopulationaged9–75years.Food
groupsthatcontribute<1%ofthediettothenutrientarenotshown.SFA:saturatedfattyacids;MUFA:
monounsaturatedfattyacids;PUFA:polyunsaturatedfattyacids.
CarbohydrateintakeintheSpanishdietwasmainlyfromgrains,withbreadasthemain
contributor(Figure1).Withinthisgroup,bakedgoodsandpastriesrankednext,andthiscategory
washigherforchildrenthanforadultsandolderadults.Grainswerefollowedtoamuchlesserextent
bymilkanddairyproducts,nonalcoholicbeverages,fruits,vegetables,sugarsandsweetsandwith
muchlowercontributionsfromready‐to‐eatmeals,pulses,alcoholicbeveragesandappetizers
(togetheraccountingfor10%ofthetotal).Olderadultshadabettervarietyofcarbohydratesources
comparedtochildrenandadolescents,mainlyowingtoahigherintakeoffruits,vegetablesand
pulses.Contrarily,theyoungestgroupsshowedamuchhighercontributionfromsugarsandsweets
andnonalcoholicbeverages.Consideringsugarintakebyfoodgroup,milkanddairyproductswere
themaincontributors,followedbyfruits,sugarsandsweets,grainsandmuchlowercontributions
fromvegetablesandalcoholicbeverages;minorcontributorswereready‐to‐eatmeals,saucesand
condiments,meatandmeatproductsandpulses,withroughly1%each.Dietaryfiberinthecurrent
Spanishdietwasfoundindescendingordertobemainlyfromgrains,vegetables,fruitsandpulses.
ContributionsoffoodgroupsandsubgroupstothetotallipidintakearealsoshowninFigure1.
Oilsandfatsrepresentedthemainsource,especiallyfromoliveoil(seeTable3).Meatsandmeat
productsrankedsecond,withcontributionsmainlyfrommeat,butalmostequallyasmuchfrom
sausagesandothermeatproducts.Thenextfoodgroupcontributorwasmilkandmilkproducts,
withcheesesasthemainsubgroup.Grains,mainlybakedgoodsandpastries,werethefourth
contributortolipidintake,whereastheremaininggroupsonlycontributedfrom1%to5%.
Differenceswerefoundaccordingtoagegroup:oliveoilintakewasmuchhigheramongolderadults
(33.2%)thanamongchildrenoradolescents(roughly18%);fishandshellfishintakealsoincreased
withincreasingage.Ready‐to‐eatmealconsumptionwas,however,higheramongtheyoungest
groups.Finally,intakeofsausagesandothermeatproductswashigherinyoungergroups,whereas
childrenandadolescentsaccountedforthelowestconsumptionofmeats.
Anevenmoreimportantissuewasunderstandinghowthedifferentfoodandbeveragegroups
andsubgroupswerecontributingtothequalityofdietaryfat,namely,SFA,MUFAandPUFA,
includingn‐6andn‐3fattyacids(Figure1).
SFAwereobtainedprimarily(>70%)andalmostequallyfrommeatandmeatproducts,milkand
dairyproductsandoilsandfats.Inyoungeragegroups,thegreatestcontributioncamefromthe
sausageandmeatderivativessubgroup,followedbybakeryandpastry.Inadultsandolderadults,
oliveoilandmeatrankedastheprimarycontributors.
AsforMUFAintake,oilsandfatswerethegreatestcontributor,ofwhicholiveoilaccountedfor
36.9%.However,largedifferenceswereobservedacrossthedifferentagegroups,witholiveoil
Figure 1.
Nutrient intake (%) by food group in the Spanish ANIBES population aged 9–75 years. Food
groups that contribute <1% of the diet to the nutrient are not shown. SFA: saturated fatty acids; MUFA:
monounsaturated fatty acids; PUFA: polyunsaturated fatty acids.
Carbohydrate intake in the Spanish diet was mainly from grains, with bread as the main
contributor (Figure 1). Within this group, baked goods and pastries ranked next, and this category
was higher for children than for adults and older adults. Grains were followed to a much lesser
extent by milk and dairy products, nonalcoholic beverages, fruits, vegetables, sugars and sweets and
with much lower contributions from ready-to-eat meals, pulses, alcoholic beverages and appetizers
(together accounting for 10% of the total). Older adults had a better variety of carbohydrate sources
compared to children and adolescents, mainly owing to a higher intake of fruits, vegetables and
pulses. Contrarily, the youngest groups showed a much higher contribution from sugars and sweets
and nonalcoholic beverages. Considering sugar intake by food group, milk and dairy products were
the main contributors, followed by fruits, sugars and sweets, grains and much lower contributions
from vegetables and alcoholic beverages; minor contributors were ready-to-eat meals, sauces and
condiments, meat and meat products and pulses, with roughly 1% each. Dietary fiber in the current
Spanish diet was found in descending order to be mainly from grains, vegetables, fruits and pulses.
Contributions of food groups and subgroups to the total lipid intake are also shown in Figure 1.
Oils and fats represented the main source, especially from olive oil (see Table 3). Meats and meat
products ranked second, with contributions mainly from meat, but almost equally as much from
sausages and other meat products. The next food group contributor was milk and milk products, with
cheeses as the main subgroup. Grains, mainly baked goods and pastries, were the fourth contributor
to lipid intake, whereas the remaining groups only contributed from 1% to 5%. Differences were found
according to age group: olive oil intake was much higher among older adults (33.2%) than among
children or adolescents (roughly 18%); fish and shellfish intake also increased with increasing age.
Ready-to-eat meal consumption was, however, higher among the youngest groups. Finally, intake of
sausages and other meat products was higher in younger groups, whereas children and adolescents
accounted for the lowest consumption of meats.
An even more important issue was understanding how the different food and beverage groups
and subgroups were contributing to the quality of dietary fat, namely, SFA, MUFA and PUFA, including
n-6 and n-3 fatty acids (Figure 1).
SFA were obtained primarily (>70%) and almost equally from meat and meat products, milk
and dairy products and oils and fats. In younger age groups, the greatest contribution came from the
sausage and meat derivatives subgroup, followed by bakery and pastry. In adults and older adults,
olive oil and meat ranked as the primary contributors.
Nutrients 2016,8, 177 18 of 25
As for MUFA intake, oils and fats were the greatest contributor, of which olive oil accounted
for 36.9%. However, large differences were observed across the different age groups, with olive
oil contributing roughly 30% among children and adolescents, but nearly 50% in the older adult
population. Other major contributors were sausages and meat derivatives in children and adolescents
(contributing to a much lesser extent in the adult groups). As for total PUFA, oils and fats were also
the main contributors, followed by meat and meat products and grains, whereas fish and shellfish
accounted for 8.5% (25.9% of the total n-3 fatty acid intake). Olive oil was the highest individual
contributor, from 25.9% for older adults to a much lower intake for children and adolescents (<15%).
Differences were also seen according to age for meat and meat products (higher contributions from
sausages and meat derivatives in the youngest groups) and for fish and shellfish (10.2% in older adults
vs. 4.7% in children). Interestingly, meat ranked first in the older groups for n-6 fatty acid intake,
whereas in the youngest groups, sausages and other meat products ranked first. Fish and shellfish
were the main contributors to n-3 fatty acid intake only in older adults and adults and ranked second
to meat among both children and adolescents.
4. Discussion
Assessing macronutrients’ distribution for the whole Spanish population, but also by sex and
age, is important for health policy makers. Moreover, the detailed information on dietary sources for
macronutrients is critical to better understand the strengths and weaknesses of diet quality. Despite
that secular trends in energy intake remaining stable or even decreasing in many European countries,
including Spain, the partitioning of the macronutrient distribution is worsening and somewhat
moving away from the recommendations and traditional Mediterranean dietary pattern, as shown in
the present ANIBES study. Although the negative changes affect all age groups and either males or
females, those are less pronounced as age increase.
In the ANIBES study, overall protein intake was well above the upper recommended limit (15%
Energy (E)) [
21
]. The dietary reference intake for total protein is about 0.8 g/kg body weight for
adults, representing roughly 12% of energy intake [
21
]. The Spanish National Survey of Dietary
Intake, the Encuesta Nacional de Ingesta Dietética España (ENIDE) study or trends observed in the
Spain Food Consumption Survey (FCS) results were also equivalent [
22
,
23
]. Protein intake, regardless
of sex or age group, was higher when compared to the updated dietary reference intakes for the
Spanish population [
20
] (e.g., 54 g/day in adults and older adult men; 41 g/day in adults and older
adult women) or those previously published by the European Food Safety Authority (EFSA) in 2012
and revised in 2015 [
24
]. In fact, only 10% of the ANIBES population (P10) would be within the
recommended range for dietary protein intake. However, if we refer to the acceptable range proposed
by the Institute of Medicine [
25
] for protein intake (10%–35% E), our results would be within the limits.
The importance of accurately defining the amount and quality of protein required to meet
nutritional needs is well recognized at present, but describing how protein should be distributed (total
and in terms of quality and sustainability) in food ingredients, whole foods or mixed diets is, as well.
EFSA has recently (2015) launched an updated Scientific Opinion on Dietary Reference Values
(DRV) for protein, which includes typical intakes of protein for children and adolescents from
20 countries in Europe and from 24 countries in the case of the adults [
24
]. Differences in methodology
and age classification make comparisons difficult. However, an overview shows that average protein
intake ranges in children from 29 to 63 g/day, increasing to 61–116 g/day in adolescents, being higher
in males in both age groups. In adults, average protein ranges from 67 to 114 g/day in men and from
59 to 102 g/day in women. Our findings from the ANIBES study show a mean intake of 74 g/day, also
much higher in males and increasing with age, except for the elderly [24].
Data from food consumption surveys show that the actual mean protein intakes of adults in
Europe are at, or more often above, the population reference intake (PRI) of 0.83 g/kg body weight
per day [
24
]. In Europe, adult protein intakes at the upper end (90th–97.5th percentile) of the intake
distributions have been reported to be between 17% E and 27% E. It is widely accepted that an excess
of protein may counteract an adequate energy profile and a healthy dietary pattern. However, when
Nutrients 2016,8, 177 19 of 25
consideration has been made to derive an upper level for protein, insufficient available evidence has
been reported. The Institute of Medicine, in fact, reported very high protein intakes (up to 35% E)
without negative effects [
25
]. The latter meaning that approximately an intake of twice the reference
intakes should be considered safe in adults. This, however, must not be considered as adequate to
achieve a healthy diet. In our Spanish ANIBES population, the protein intake distribution shows
an inadequate high amount consumed, except for the elderly women. It should be necessary to keep
in mind that when intakes are usually higher than 45% E, acute adverse outcomes may be expected.
The potential problem in association with long-term excess of protein would be, among others,
how to maintain the nutrient density. On the other hand, it has been also postulated that a high increase
in protein intake may favor a decrease in body weight and adiposity. However, these observations
need to be well proven, since the mentioned effects may be also due to the concomitant modification
of carbohydrate and/or fat intakes [
26
–
28
]. Most of the literature, however, has concluded that there is
strong and consistent evidence that when energy intake is controlled, the macronutrient proportion
of the diet is not directly related to weight loss [
29
]. Other potential adverse effects due to high
protein intake are in relation to insulin sensitivity and glucose tolerance, with somewhat contradictory
results [
30
–
32
]. The dual effect for protein intake may be seen also for its association with calcium
and bone health: it is widely accepted that protein deficiency may increase the risk of bone fragility
and fracture [
33
], whereas an increase in protein intake could also be associated with higher urinary
calcium excretion [
34
]. Finally, and more importantly, intervention studies in humans have not shown
remarkable effects of high protein intake on markers of bone health [35,36].
Although animal sources of proteins, including meat, poultry, seafood, milk and eggs, are the
highest quality proteins, plant proteins may be also an excellent and complimentary source of proteins,
mainly when mixed diets include combinations, such as legumes and grains, as is widely recommended.
As collected by EFSA [
24
], in most European countries, the main contributor to the dietary protein
intake is meat and meat products, followed by grains and grain-based products and milk and dairy
products, contributing all together to about 75% of the protein intake. At that point (2011), meat and
meat products represented a 32% contribution to dietary protein in Spain, much lower when compared
to countries, such as Ireland, Poland or France. The trend seems to be stable in our country, since
our ANIBES data show a similar percentage contribution. A marked and rapid increase for this food
group has been shown in Spain in the last few decades [
16
,
22
], zooming out from the traditional
Mediterranean diet where meat consumption used to be scarce. No significant changes in the last few
years are observed in Spain for grains and grain-based products (by the way, the lowest contribution
within Europe), whereas a decreasing trend in milk and dairy products and in fish and shellfish is
clearly observed in recent years.
In the ENIDE study in Spain [
22
], most protein intake was also of animal origin (80%) and
mainly from meats (31%), although fish (27%) was also a major contributor and much higher than
its contribution in the present ANIBES study. It should be taken into consideration, however, that
a sharp decline in fish consumption has taken place in recent years in Spain, which may compromise
nutritional goals, especially among younger populations [
23
]. As mentioned, the FCS also showed
a high protein intake (twice the PRIs) for the adult Spanish population in the last few years, mainly
from meat and meat products (29.9%), followed by milk and milk products (16.6%), grains (16.5%)
and fish and shellfish (11.3%) [
23
]. In conclusion, more efforts are needed to lower the excessive and
nutritionally unnecessary amount of protein consumed by the Spanish population at present, but also
to redistribute the animal/plant protein ratio.
Total fat intake should be higher than 15% E to provide the intake of the essential fatty acids
and energy and to be able to facilitate the absorption of lipid-soluble vitamins. In general, with
moderate physical activity, a 30% E from fat intake is recommended, and up to 35% in the case of
a high physical activity level [
25
]. We show, however, that total fat intake in Spain is well above
these recommendations and upper limits in some of the most sedentary societies, such as the Spanish
society, nowadays. Interestingly, there is evidence that moderate fat intake (<35% E) is accompanied
by reduced or adequate energy intake, and therefore, body weight control, moderate weight reduction
Nutrients 2016,8, 177 20 of 25
and/or prevention of weight gain may be better achieved. However, EFSA has concluded that there is
insufficient scientific evidence to define a lower threshold intake or tolerable upper intake level for
total fat [
37
]. Presently, at the European level, but also from the World Health Organization (WHO)
and Food Agriculture Organization (FAO), a lower boundary for the reference intake range of 20% E
and an upper boundary of 35% E have been proposed [
38
]. In addition, it is well known that two main
processes contribute to the development of ischemic heart disease: atherosclerosis and thrombosis.
The type of dietary fat may contribute to both. Since some fatty acids have a greater role, consequently,
the evaluation of updated dietary sources of fat may be a helpful tool to advise healthy dietary patterns
to prevent cardiovascular diseases. Fats and oils are also important sources of essential fatty acids and
some bioactive compounds of nutritional interest (e.g., polyphenols from olive oil). However, high-fat
diets may decrease or impair insulin sensitivity and may be also positively associated with increased
higher cardiovascular risk [39,40].
It is also important to understand how the different food and beverage groups and subgroups
contribute to the quality of dietary fat, namely SFA, MUFA and PUFA, including n-6 and n-3 fatty acids,
since dietary fat quality is markedly related to the etiology and/or prevention of different chronic
degenerative diseases.
The intake of SFA has been generally recognized to be deleterious and therefore its determination
is included in most of the diet quality indexes [
41
]. In contrast, higher consumption of MUFA and
PUFA has been reported to be associated with reduced CVD risk. The minimum recommended level
of total PUFA consumption to lower LDL-C and total cholesterol, increasing HDL-C concentrations
in order to decrease the risk of CHD events, is 6% E. Our present data show that this level is easily
achieved by the Spanish population as a whole. In contrast, higher risk of lipid peroxidation may
occur with high (>11% E) PUFA consumption, although this does not seem to represent a risk in our
population findings [25].
For infants in Europe, average intakes of SFA are usually higher than the recommended upper
limit [
37
]. In adults, average SFA intakes according to the last available European Nutrition Health
Report [
13
] vary between less than 9% E and 26% E, with the lowest values mostly observed in southern
European countries. The SFA intake in the ANIBES study was also above the recommendations for
all age groups and both sexes, a negative trend that is being observed in the last two decades [
23
].
However, no dietary reference intakes have been set at present, nor upper levels [37,38]. Even so, the
WHO/FAO have recommended a maximum intake of 10% E for SFA [
38
], which also agrees with
the Spanish Federation of Food, Nutrition and Dietetic Societies (FESNAD) Consensus Document
on Dietary Fats and Oils for the Adult Spanish Population [
41
]. There is also evidence from dietary
intervention studies that decreasing the intake of products rich in SFA and being replaced with
products rich in n-6 PUFA (with no change in total fat intake) were effective in decreasing some
cardiovascular events [
42
–
44
]. In the ANIBES study, >70% of SFA were obtained almost equally from
meat and meat products, milk and dairy products and oils and fats. In children and adolescents, the
highest contribution corresponded to the sausage and meat derivatives subgroup, followed by bakery
and pastry; in adults and older adults, however, olive oil and meat ranked as the primary individual
contributors. These trends, again, add difficulties at present to following the Mediterranean dietary
patterns for the Spanish population, which is mainly of concern in the youngest.
Available combined data for MUFA intakes in Europe range between 8% E and 11% E in infants
and mostly between 10% E and 13% E in children and adolescents [
37
]. In adults, the highest mean
intake has been found in Greece (22%–23% E); in other European countries, average intakes vary
between 11% E and 18% E. As for MUFA intake in the present ANIBES results, oils and fats were
the major contributors, of which olive oil accounted for a high proportion. Undoubtedly, the latter
is still one of the main strengths of the present Spanish diet, and all efforts are made to convince all
age groups about its benefits for a better adherence to the Mediterranean diet. Despite this, large
differences were observed across the different age groups, with olive oil contributing roughly 30% in
children and adolescents, but nearly 50% in the older adult population. In our ANIBES population,
Nutrients 2016,8, 177 21 of 25
MUFA intake was slightly higher in the older adult group and lower among children and adolescents,
once again showing a better adherence to the principles of the traditional Mediterranean diet in
the adult and senior populations. The most recent 2011 goals developed by the Spanish Society of
Community Nutrition (SENC) [21] recommend that MUFA should contribute >20% E of total energy,
whereas the FAO/WHO have recommended a MUFA intake of about 16%–19% E [
38
]. In contrast,
an EFSA panel [
37
] proposed in 2010, however, not setting any dietary reference value for MUFA
based on the following criteria: MUFA are synthesized by the body, with no known specific role in
preventing or promoting diet-related diseases and are therefore not indispensable constituents of the
diet. This assumption by EFSA, however, is rebuttable because MUFA are present in most tissues’ cells
and have roles as key compounds to maintain membrane fluidity and diverse enzymatic activities [
45
].
In addition, MUFA may lower both total and LDL plasma cholesterol levels, potentially lowering
also cardiovascular risk [
46
]. Moreover, in the Prevention with Mediterranean Diet (PREDIMED)
intervention study [
47
], intake of virgin olive oil (MUFA at 22% E) was associated with much lower risk
of CVD events and total mortality. Therefore, according to the PREDIMED findings, a MUFA intake
target of 20%–25% E (with virgin olive oil as a main source) has been proposed. At the population
level, the latter may be quite difficult to achieve.
In spite of the well-known metabolic effects of various dietary PUFA [
43
], EFSA has proposed
not to formulate a dietary reference value for this fatty acid family [
37
]. Other organizations, such
as the WHO/FAO in 2010 [
38
] and SENC (2011) [
21
], have suggested that PUFA should contribute
6%–10% E and 5% E, respectively. In the present ANIBES study, PUFA contributed roughly 6.6%
E, with no sex or age differences, whereas n-3 PUFA intake expressed as the percentage of energy
intake was 0.63% E for the ANIBES study population and increased with age. The WHO/FAO [
38
]
have recommended a minimum intake for adults of 250 mg/day for n-3 long-chain PUFA and up
to
2 g/day
to help prevent CVD. For European children, average cis n-6 PUFA intakes in absolute
amounts vary between approximately 5 g and 17 g per day (in the present ANIBES study, values were
12.0 ˘4.8 g/day
in children and 12.6
˘
5.8 g/day in adolescents), with a much lower contribution for
older adults (9.0 ˘5.3 g/day).
As for total PUFA food sources in the present study, as expected, oils and fats were also the
primary contributors: olive oil was the greatest individual contributor, mainly in adults and seniors
Interestingly, meat ranked first in the older groups for n-6 fatty acid intake, whereas sausages and other
meat products ranked first among the youngest groups. The fish and shellfish food group was the
main contributor to n-3 fatty acids only in older adults (31.4%) and adults (25.9%), but ranked second
to meat and meat products in both children and adolescents. Once again, more efforts are necessary in
children and adolescents to avoid the loss of some key principles of the healthy Mediterranean dietary
pattern as derived from these ANIBES updated results.
WHO/FAO Expert Consultation [
48
–
50
] recommended initially that total carbohydrate (CHO)
in the diet should provide 55%–75% E. Later, the same institutions suggested a new lower limit, 50%
E, whereas EFSA in Europe proposed a range between 45% and 60% E. Finally, in Spain, the SENC
recommend 50%–60% total energy [
21
]. The Spanish population, however, is well below the lower
limit, which is considered a bad indicator of present diet quality.
Mean total carbohydrate intake was 185.4
˘
60.9 g/day (37.8 g/day min; 450.3 g/day max)
and higher in men than in women. Higher total carbohydrate consumption was observed in the
younger groups as compared to adults and older adults. Total sugar intake was also quantified:
76.3 ˘33.9 g/day
(79.5
˘
36.6 g/day in men,
73.0 ˘30.6 g/day
in women). Differences were also seen
according to age group with significantly higher intakes in children and adolescents compared to those
observed in adults and older adults.
In the latest EFSA Scientific Opinion on DRV for CHO and dietary fiber, data were presented for
children and adolescents in 19 countries and for adults in 22 countries in Europe [
50
]. Even though
there is a large diversity in the methodology used and age classification, as stated, the highest mean
intakes were observed in the Czech Republic and Norway, whereas the lowest were found in Greece
and Spain. As for fiber, average dietary intakes varied from 10 to 20 g/day in young children and from
Nutrients 2016,8, 177 22 of 25
15 to 33 g/day in adolescents, whereas in adults, it ranged from 15 to 30 g/day. Finally, for the elderly,
most of the countries showed intakes from 20 to 25 g/day.
It is well known that dietary CHO shows a variety of physical, chemical and important
physiological properties: control of body weight, diabetes, CVD, large bowel cancer, constipation and
resistance to gut infection, caries and a low density of micronutrients, among others. In addition, to
judge the quality of the diet, it is crucial to distinguish the different types of CHO and dietary sources,
as shown in the present study; the latter since the main interest and concern are associated with the
content of sugars (natural or added) and fiber, glycemic index, refined vs. whole-grains, the presence
of fruits and vegetables or solid vs. liquid CHO [49,50].
CHO provide energy and can contribute to weight gain, being overweight and obesity when
consumed in excess. Intervention studies have provided evidence that high fat (>35% E), low
carbohydrate (<50% E) diets are associated with adverse short- and long-term effects on body weight,
although the data are insufficient to define a lower threshold of intake for carbohydrates [
51
,
52
].
It is also known that frequent consumption of sugar-containing foods can increase the risk of dental
caries [
53
]. However, the available data do not allow for setting an upper limit for the intake of added
sugars on the basis of risk reduction for dental caries, which has not yet been proposed. Evidence
relating a high intake of sugars (mainly added sugars) versus starches to weight gain is also inconsistent
and controversial [
54
]. As a consequence, according to EFSA, the available data are insufficient to
set an upper limit for added sugar intake [
50
], even though there is some evidence that high sugar
intake (>20% E) may increase serum triglyceride and cholesterol concentrations and might adversely
affect serum glucose and insulin levels, but this is still insufficient to set an upper limit for added
sugar intake. The latter, however, does not exclude that food-based dietary guidelines and nutrition
goals should take into account potential negative effects under certain conditions and reinforce the
importance to limit sugar consumption. More strongly, a new WHO guideline [
55
] recommends
that adults and children should reduce their daily intake of free sugars to less than 10% of their
total energy intake according to their daily dietary energy reference intakes. A further reduction to
below 5% has been proposed to potentially provide additional health benefits [
55
]. In this sense, the
percentage of energy from sugars in our study was 17.0% E for the total population, significantly
higher in females compared to males, and was more marked among the oldest participants, which
shows that better educational campaigns and advice for the Spanish population is further needed.
Paradoxically, secular trends of CHO intake in Spain show an inverse association with Spanish people
affected by being overweight/obesity at all ages. Importantly, a diet high in fiber is usually considered
also to have relatively low energy density, the promotion of satiety and a lower degree of weight
gain. The percentage contribution of carbohydrates has steadily decreased since the 1960s in Spain.
In that decade, the energy profile was in line with the recommendations [
22
]. It is remarkable also
that when dietary fiber intake in Spain in the 1960s was much higher than the present data from
the ANIBES study, the prevalence of excess weight was also quite lower. The current and increasing
worsening is linked to a decline in the consumption of cereals and derivatives, legumes and pulses
and potatoes. However, as expected, cereals and derivatives represent the highest contribution to total
carbohydrates, followed by milk and derivatives. Whole-grain cereals, vegetables, legumes and fruits
are the most recognized sources for dietary CHO due to their additional high content in fiber and low
energy content. As derived from our present data, whole-grain cereals and legumes are consumed in
lower amounts than recommended.
5. Conclusions
In conclusion, despite that secular trends in energy intake are remaining stable or even decreasing
in many European countries, including Spain, the partitioning of the macronutrient distribution is
worsening and clearly moving away from the recommendations.
The findings of the present ANIBES study are considered key to the future definition and revision
of PRIs, dietary guidelines, nutritional goals in Spain and appropriate and specific targeted public
campaigns. It seems that the new national strategy, including not only those responsible for the
Nutrients 2016,8, 177 23 of 25
health policy, but also education stakeholders and involving gastronomy leaders, that is now being
implemented may help to improve diet quality in Spain.
Acknowledgments:
The authors would like to thank Coca-Cola Iberia for its support and technical advice,
particularly Rafael Urrialde and Isabel de Julián.
Author Contributions:
E.R.M. conceived of the protocol, the methodology used and designed the training
procedures for interviewers and dietician nutritionists. E.R.M. was also responsible for data collection and quality
control and contributed to data analysis and interpretation. J.M.A. conceived of the overall design, protocol and
methodology of the ANIBES study, as well as contributed to the interpretation and discussion of the results. T.V.,
S.P. and P.R. were responsible for the instruments used, training and data cleaning. They also contributed to
data analysis and interpretation. J.A., A.G., M.G.G., R.M.O. and L.S.M. are members of the Scientific Advisory
Board of the ANIBES study. These authors were responsible for the careful review of the study protocol, design
and methodology, providing scientific advice to the study and for the interpretation of the results. They also
critically reviewed the manuscript. G.V.M., the Principal Investigator, was responsible for the design, protocol,
methodology and follow-up/checking of the study. G.V.M. also wrote the paper. All authors approved the final
version of the manuscript.
Conflicts of Interest:
The study was financially supported by a grant from Coca-Cola Iberia through an agreement
with the Spanish Nutrition Foundation (Fundación Española de la Nutrición (FEN)). The funding sponsor had no
role in the design of the study, the collection, analysis nor interpretation of the data, the writing of the manuscript
nor in the decision to publish the results. The authors declare no conflict of interest.
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