Alejandra Carretero-Krug

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.

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.

Background/Objectives: Aeronautical military personnel operate under intense physical and mental stress, requiring high psychophysical aptitude. Adequate nutrition is essential to sustain operational readiness and mitigate the risk of chronic diseases and other health issues. This study aims to evaluate the nutritional status of aeronautical military personnel group in Spain through dietary parameters. Methods: A total of 390 male aeronautical military personnel, who attended the Centro de Instrucción de Medicina Aeroespacial (Madrid, Spain), were evaluated. Energy and nutrient intakes were estimated by three non-consecutive 24-h dietary recalls (DIAL^® program). Results: The median energy intake was 2134 kcal/day, with significant variations across professional groups, highest in parachutists (2347 kcal/day). Protein intake was 18.2% TE, while carbohydrate intake was 37.6% TE, below standards, with 83.8% of participants not meeting the EFSA guidelines. However, a high intake of added sugars was observed (10% TE). Fat intake (38.3% TE) and saturated fats (11.7% TE) exceeded recommendations. Micronutrient deficiencies were notable for vitamin D (98% below recommendations), folate (56.4%), vitamin C (40.2%), calcium (50.3%), iodine (76.6%), and zinc (59%). Elevated cholesterol intake (352 mg/day) and inadequate fiber intake (18.5 g/day) were also observed. Conclusions: This study highlights imbalanced dietary patterns among Spanish aeronautical military personnel, with high protein, fat, cholesterol and added sugar consumption, low carbohydrate, and inadequate intake of critical micronutrients and fiber. These findings emphasize the need for targeted dietary interventions, nutritional monitoring protocols, and specific guidelines to enhance health and performance in this specialized group.

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.

Growing evidence confirms choline as a critical perinatal nutrient. However, intake levels of choline and betaine among the Spanish fertile population remain unknown. Given their role in one-carbon metabolism with potential epigenetic effects, the aim of the present study was to evaluate the dietary intakes, their adequacy to existing guidelines and the main food sources together with other micronutrients involved in the methylation-methionine cycle (vitamin B₆, folates and vitamin B₁₂) in women of childbearing age. The ANIBES study, a cross-sectional study of a representative sample of women of childbearing age (18–45 years, n = 641) resident in Spain, was used. The sample was divided into younger women (18–30 years, n = 251) and older women (31–45 years, n = 390). Dietary intake was assessed by a three-day dietary record by using a tablet device. Total median intakes for the total sample were 303.9 mg/d for choline; 122.6 mg/d for betaine; 1.3 mg/d for vitamin B₆; 140.8 μg/d for folates, and 3.8 μg/d for vitamin B₁₂. The older subgroup showed significantly higher choline (p < 0.05), betaine (p < 0.001) and folates (p < 0.05) intakes than younger women. Main food sources for the whole sample were meat and meat products for choline (28.3%), vitamin B₆ (25.7%) and vitamin B₁₂ (22.8%); cereals and derivatives (79.9%) for betaine; vegetables (20.0%) for folates. Overall intake adequacy was only observed for vitamin B₁₂, with a very limited number of participants showing adequate intakes for all the other micronutrients. These results illustrate there is a relevant need to raise awareness about optimizing the status of the methionine cycle-related vitamins and cofactors in this potentially vulnerable population.

Moving towards sustainable food systems and food consumption are proposed as strategies to reduce environmental impact. However, these strategies require joint action between different stakeholders, including the general population’s knowledge and perception, as final consumers. To assess the knowledge and awareness on food sustainability and environmental impact concepts in a representative sample of Spanish adult population, we conducted a cross-sectional, nationally representative telephone survey. After random selection, 2052 respondents aged ≥18 years (57% woman and 43% men) participated. A questionnaire was specifically designed for the research. Participants showed a good attitude towards sustainable diets, which were described as healthy by 40% of the population. Most of the responders (>70%), did not well understand ecological and carbon footprints, and green and blue water concepts. Men declared a higher understanding of sustainability concepts, as compared to women. More than 50% of the population misunderstood the impact of meat and derivatives production on sustainability, and 70% perceived the same for fish and dairy products. Women were more prone to pay more money to afford a sustainable diet than men were. In conclusion, although consumers show a positive attitude towards sustainability, important misconceptions remain, and thus require intervention through education, information, and motivation.

Background: An adequate hydration status is critical to ensure efficiency during mental and physical activities. Our goal was to assess the hydration status of a Spanish group of aeronautical military men and to determine the association of hydration status with body composition and anxiety.Methods: 188 men were evaluated through a validated hydration questionnaire, anthropometric and biochemical parameters, and an anxiety questionnaire. According to that, criteria of hydration was established.Results: 81% of the total sample met hydration criteria (urine color = Well hydrated, Water Balance ≥ 0 mL, and total water intake/weight ≥35 mL/kg) and 19% did not meet hydration criteria (urine color = Not enough hydrated or Dehydrated, Water Balance < 0 mL, and total water intake/weight < 35 mL/kg). Subjects not meeting the hydration criteria had lower urine pH, negative water balance, and lower water intake. The latter also had higher anxiety status (score= 4 vs 3, p=0.026), weight (84.7 ± 10.5 vs 80.5 ± 10.2 Kg), Body Mass Index (26.3 ± 3.1 vs 25.2 ± 2.8 kg/m2), body fat (22.3 ± 5.6 vs 18.3 ± 6.5 %), urine specific gravity and urine color. The Hydration Status, in a logistic binary regression model was related significantly with the percentage of body fat (p=0.004), but no relation was found with age, comorbidity and medication. Furthermore, total water intake/weight was positively correlated with percentage of body water (rho=0.357, p=0.000) and negatively with body fat (kg) (rho= -0.427, p=0.000), percentage of body fat (rho= -0.405, p=0.000) and waist/hip ratio (rho= -0.223, p=0.002). The total water intake/weight, in a linear regression model was related significantly with the percentages of body fat (p=0.019) and body water (p= 0,035). No relation was found, however, with waist/hip ratio, age, comorbidity and medication.Conclusion: All these findings suggest a relationship between hydration status and body composition, but also set the bases for future studies that relate hydration status and anxiety status. These results can be used to improve the hydration status and body composition of military personnel.