Carmen Morais-Moreno

Despite the growing discourse on sustainable diets, a critical gap persists in the integrated assessment of nutritional quality and environmental impact. While most analyses treat these dimensions in isolation, few provide a unified framework for their simultaneous evaluation. This study develops and applies a scalable framework for jointly assessing nutrient density and environmental impact using 119 commonly consumed foods and beverages in Spain. Nutrient density was measured with the Nutrient Rich Factor (NRF11.3) index, while environmental impact was quantified as kg CO2e/kg food based on Life Cycle Assessment. To evaluate how various analytical frameworks influence sustainability assessments, results were compared across three classification systems: food origin, a conventional food group classification, and the WHO-Nutrient-Profile-Model. The integrated analysis reveals nutritional-environmental patterns often overlooked in environmental assessments. Beyond the well-documented high impact of red meat, several sweet, highly processed products, such as chocolate, cookies, and confectionery, show CO2 emissions comparable to animal-based foods while providing very low nutrient density. In contrast, plant-based and minimally processed foods consistently combine high nutrient density with lower environmental impact across classification systems. By demonstrating how sustainability outcomes vary depending on nutritional, environmental, and food classification frameworks, this study underscores the value of integrated assessments for evidence-based dietary sustainability evaluations. Although Spain serves as the case study, this framework is globally transferable. It provides actionable insights for dietary guidelines, reformulation targets, labeling systems, and procurement policies designed to align public health with environmental targets, ultimately fostering more evidence-based food policy.

Fasting may be effective for reducing weight and improving health. We analysed the effect of a Mediterranean diet intervention, with a 5-day semi-fast, on inflammation, blood lipids and carbohydrate metabolism in overweight type II (BMI>27-30) or obesity (BMI>30-40). Glucose, total cholesterol, triglycerides, HDL-/LDL-cholesterol, albumin, AST-GOT, ALT-SGTP, C-reactive protein, insulin, IGF-1, T3, T4 and TSH were monitored, during a 6-week period, in 42 subjects with overweight type-II/obesity, between the ages of 30-65. Glucose, triglycerides, insulin, AST, IGF-1 and T3 values were not significantly decreased (p>0.05) during fasting and non-fasting diets, while albumin and T4 increased in both groups. C-reactive protein decreased significantly when fasting but increased when not. Total cholesterol, HDL, LDL and ALT (p0.05) were found for total cholesterol, HDL, LDL and TSH in the Control group. Fasting resulted in greater insulin sensitivity and reduced levels of body fat, IGF-I, insulin, glucose, atherogenic lipids and inflammation.

Background/Objectives: Childhood obesity and nutritional inequalities remain major public health challenges, particularly in socioeconomically disadvantaged settings. In Spain, these disparities are reflected in unequal access to healthy food and differing health outcomes among the young population. This study aimed to explore how social vulnerability influences dietary patterns, body composition, and food insecurity among children and adolescents, with a particular focus on sex differences. Methods: A descriptive cross-sectional study was conducted with 280 participants aged 6 to 15 years old, recruited from urban areas across Spain. Two groups were evaluated, a socioeconomically vulnerable group (VG) (n = 175) and a non-vulnerable group (NVG) (n = 105), classified according to socioeconomic and social established criteria. Validated tools were used to assess diet quality, adherence to the Mediterranean Diet (MD), consumption of ultra-processed foods (UPF), and household food insecurity. Anthropometric measurements were also collected, and body mass index (BMI) was calculated using both national and international reference standards. Results: Vulnerable children and adolescents showed higher prevalence of food insecurity, less favorable body composition indicators, and lower global dietary quality, characterized by lower adherence to the MD and higher consumption of UPF. Multivariate analysis confirmed that socioeconomic vulnerability was significantly associated with female sex, higher BMI, lower adherence to the MD, and greater consumption of UPF. Conclusions: Our findings highlight a concerning pattern of health and nutritional inequality among children and adolescents based on socioeconomic status. There is a clear and urgent need for effective public health strategies with an equity focus that promote healthy and affordable eating habits from early life, especially in the most disadvantaged environments and targeted by gender.

Purpose Hearing loss (HL) represents a major health problem worldwide, and increasingly so due to population ageing and new leisure activities, such as video gaming or virtual reality experiences. HL has a multifactorial origin including both genetic and environmental issues with nutrition status emerging as a new contributing factor. In fact, certain micronutrient deficiencies, along with excessive consumption of specific macronutrients, have been related to HL This study aimed to examine the association of HL with dietary fat intake, nutritional status biomarkers, and serum metabolic signature in aviation pilots and controls. Methods A cohort of aviation pilots, chronically exposed to noise pollution at work, was compared to a cohort of non-exposed university workers (controls). Hearing function was determined by tonal audiometry and dietary fat intake was assessed by three 24-h recalls. In addition, lipoprotein profiles as well as serum homocysteine (Hcy), folate, vitamins B₁₂ and D were analysed. Two multiple linear regression models adjusted for age were constructed to explain HL variability. Results HL prevalence was similar and elevated in both cohorts (controls: 64% vs. noise-exposed: 65%), when compared to the American Speech-Language-Hearing Association (ASHA) classification. When comparing both cohorts, although no significant differences were found in Hcy and folate levels, controls had significantly lower vitamins B₁₂ and D concentrations and, conversely, higher serum lipids and lipoprotein values (triglycerides, total cholesterol, HDL-cholesterol and LDL-cholesterol subfractions), suggesting the possible involvement of CV risk in HL in the control cohort. In the noise-exposed cohort, HL was associated with flight hours, Hcy, and folate (r² = 0.439), while in controls, HL was associated with Hcy and vitamin D (r² = 0.474). After adjusting for CV profile, the positive association between HL and Hcy was maintained (β = 0.444; p < 0.001), evidencing the strong involvement of this metabolite not only in CV risk, but also in HL. Conclusion Folate insufficiency together with hyperhomocysteinemia increased susceptibility to noise-induced HL. However, the role of Hcy in HL without noise exposure at work seems to be partially masked by an altered CV profile.

Background: Folic acid (FA), which in its chemical form is pteroylglutamic acid, is the fully oxidised, water-soluble, monoglutamic form of vitamin B9. This compound is part of the folate group but with higher bioavailability, and it is found in vitamin supplements and fortified foods and drugs. Folate metabolism is complex and associated with various metabolic pathways, all of which confer protection on the cell and allow its survival. Methods: We conducted a non-systematic search of articles published in English and Spanish including controlled trials, cohort studies, systematic re-views, and meta-analyses were included, as well as key studies in animal models related to pharmacokinetic studies. Search terms encompassed: “folic acid”, “folates”, “5-metyltetrahydrofolate”, “5-MTHF”, “neural tube defects”, “supplementation”, “fortification”, AND “homocysteine” Results: A crucial role demonstrated for FA is to help prevent neural tube defects (NTDs). However, more studies are definitely still needed to establish 5-MTHF as a safe and effective therapeutic approach comparable with FA. Moreover, there is a lack of clinical studies that evaluate the efficacy of 5-MTHF supplementation in the prevention of NTDs. The present evidence-based narrative review discusses differences between FA and 5-MTHF in terms of structure, metabolism, bioavailability, clinical efficacy, and safety. Conclusions: Despite the potential value of 5-MTHF as an alternative to FA, clinical studies would be urgently needed to support the efficacy, dosage, timing, and/or safety of its use as a supplement.

Hydration status plays a key role in healthy ageing, and it is potentially affected by several factors, including drug consumption. However, research on this issue to date is scarce, especially in highly vulnerable groups, such as the elderly. We aimed to study the relationship linking hydration status, analysed by means of a validated questionnaire, 24 h urine analysis, body composition assessment, and drug consumption in a sample of old adults. A total of 144 elders were included in the study. Cardiovascular drug consumption was significantly associated with a lower water intake in men (β = −0.282, p = 0.029). Moreover, urinary analysis revealed that total drug intake as well as the consumption of diuretics and cardiovascular drugs were associated with poorer hydration status, whereas genito-urinary drugs were associated with an opposite effect, and these results were confirmed in terms of body composition. Hence, total drug consumption (β = −0.205), diuretic (β = −0.408), cardiovascular (β = −0.297), and genito-urinary drugs (β = 0.298) were significantly associated (p < 0.05) with total body water. The obtained results confirmed the impact of chronic treatment with certain drugs on hydration status. Nutritional interventions may be of great interest in certain population groups in order to prevent complications due to altered hydration status.

Adequate nutrition during breastfeeding is crucial for ensuring the good health of mothers and babies. Despite the high energy and nutrient demands of breastfeeding, lactating women are often vulnerable from a nutritional perspective. The nutritional focus during breastfeeding tends to be on the newborn, often neglecting the mother’s diet. Therefore, in the present narrative review, nutrient intakes were compared with the dietary reference values (DRVs) proposed by the European Food Safety Authority (EFSA) as well as by the World Health Organization/Food and Agriculture Organization (WHO/FAO). In the diets of lactating mothers, dietary inadequacies were observed in the intake of some vitamins, such as folic acid, vitamin B12, vitamin A, and vitamin D, and in the intake of certain minerals like calcium, iron, and iodine; polyunsaturated omega-3 fatty acid deficiencies, primarily in eicosapentaenoic acid and docosahexaenoic acid, were also observed. On the other hand, the debate on the necessity of supplementation during lactation continues; the need for nutritional supplementation during lactation depends on many factors, such us mothers’ eating habits. There seems to be a positive association between nutritional supplementation of the lactating mother and the concentration of certain nutrients in human milk. The present narrative review provides an update on the nutritional status (fatty acids and micronutrients) of breastfeeding mothers and the impact of diet and dietary supplementation on human milk composition.

Noise-induced hearing loss is the most frequent and preventable occupational disease. Aviation pilots are a vulnerable population, as they spend many hours exposed to noise pollution in their working environment. Different studies suggest that certain dietary compounds may play a key role in the etiology and prevention of this pathology. We aimed to study the relationship linking auditory function, dietary intake, and some serum biomarkers in pilots, exposed to noise in the work environment. A total of 235 pilots, who undergo a periodic medical examination at the Centro de Instrucción de Medicina Aeroespacial (Madrid, SPAIN), were evaluated. Auditory function was assessed by tonal audiometry. Energy and nutrient intakes were estimated by 24 h recall (DIAL^TM program). Serum homocysteine (Hcy) was determined in a Cobas 6000^TM multi-analyzer while folate, vitamin B₁₂, and D were analyzed in a Cobas e411^TM. The prevalence of hearing loss (HL) was 64.3%. HL was significantly related to age (r = 0.588, p ≤ 0.001) and flight hours (r = 0.283, p ≤ 0.001). A multiple linear regression model was used to assess the relationship among HL, flight hours, serum folate, and Hcy serum levels. HL was significantly (p < 0.050) associated with flight hours (β = 0.246), serum folate (β = −0.143), and serum Hcy (β = 0.227). Nutritional interventions would be of great interest to monitor and slow down the HL progression in populations exposed to noise pollution in their workplace.

Age-related hearing loss (ARHL) is a sensory impairment, with a dramatic increase in its incidence, which is caused by genetic and environmental factors such as noise and ototoxic drugs. Recent studies correlated ARHL to elevated plasma homocysteine (Hcy) by folate deficiency, suggesting that reduction of Hcy levels by folate supplementation could potentially ameliorate ARHL. Hyperhomocysteinemia (HHcy), a status that contributes to ARHL, may also arise from malfunction of Hcy remethylation by betaine homocysteine S-methyltransferases (BHMTs) and methionine synthase in the methionine cycle. The expression and/or activity of these enzymes may be altered by ototoxic drugs, including paracetamol (APAP). To determine the effect of APAP in cochlear morphology and function of control and Bhmt-/- mice, and to analyze putative preventive effects of folic acid (FA) supplementation. Two-month-old Bhmt-/- mice (n = 47), with greater dependence on folate metabolism for Hcy remethylation, and Bhmt + / + mice (n = 42) were fed control or FA supplemented diets for 30 days. The last day APAP (250 mg/kg) or placebo were injected intraperitoneally. Hearing was evaluated by recording auditory brainstem responses (ABR) at the beginning of the experiment and after treatments. Picrosirius red staining was used for evaluation of the cochlear lateral wall cytoarchitecture. Plasma and hepatic metabolite levels were determined by HPLC or on Spinlab 100® autoanalyzer. Loss of Bhmt expression induced HHcy, but an impact on hearing acuity was not observed. Acute APAP administration did not induce ABR threshold shifts. However, following ototoxic treatment, changes of 5–17% in the areas of the stria vascularis and spiral ligament were detected between Bhmt-/- mice under different dietary treatments; cochlear structures of Bhmt-/- mice receiving APAP plus FA supplementation resemble those of the control group. APAP increases susceptibility to ototoxic damage in the presence of HHcy. BHMT plays a central role in cochlear methionine metabolism. FA supplementation modulates Hcy levels, contributing to a proper remethylation status that prevents ARHL.

At present, obesity and overweight are major public health concerns. Their classical determinants do not sufficiently explain the current situation and it is urgent to investigate other possible causes. In recent years, it has been suggested that water intake could have important implications for weight management. Thus, the aim of this study was to examine the effect of hydration status on body weight and composition in healthy adolescents from Spain. The study involved 372 subjects, aged 12–18 years. Water intake was assessed through the validated “hydration status questionnaire adolescent young”. Anthropometric measurements were performed according to the recommendations of the International Standards for Anthropometric Assessment (ISAK) and body composition was estimated by bioelectrical impedance analysis. Water intake normalized by body weight was positively correlated with body water content (boys (B): r = 0.316, p = 0.000; girls (G): r = 0.245, p = 0.000) and inversely with body mass index (BMI) (B: r = −0.515, p = 0.000; G: r = −0.385, p =0.000) and fat body mass (B: r = −0.306, p = 0.000; G: r = −0.250, p = 0.001). Moreover, according to BMI, overweight/obese individuals consumed less water than normal weight ones. In conclusion, higher water balance and intake seems to be related with a healthier body composition.