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ABSTRACT Introduction: Folate plays an important role in cell metabolism, but international studies show that intake is currently below recommendations, especially among women. The study objective was to identify folate food sources by food group, gender, and age group, and to identify factors influencing folate intake, based on food consumption data for Swedish adults in the —11 Riksmaten study. Food and nutrient intakes were estimated from self-reported food records during 4 consecutive days. Food consumption was categorized into 26 food groups. Stepwise regression was used to analyze food groups as folate sources for participants.
The present study aimed at researching the potential functionality of a series of low glycemic index products with a moderately high protein content, as possible coadjuvants in the control of type 2-diabetes and weight management within a nutritionally balanced dietary pattern, following a chronologically planned snacking offer morning and afternoon , as well as the influence on biomarkers of the metabolic syndrome and cardiovascular risk manifestations. The full trial protocol can be accessed in Clinical Trials website clinicaltrials.
Recruitment took part during February - March and the study finished in June Written informed consent was given by all the volunteers participating in the intervention. Taking into account the design of the present study as a single group longitudinal intervention, the authors have tried to fulfill the CONSORT guidelines [ 21 ], except for those points where it was considered non-applicable, such as blinding. Study design The present trial was developed at the facilities of the University of Navarra with 17 participants, and followed a longitudinal design, with two consecutive periods of 4 weeks each.
The first period, control phase, was a free living diet and status, where the patients followed their habitual ad libitum dietary pattern following the recommendations of their physician , while the second period consisted on an intervention phase with structured meal replacements, where the volunteers' habitual breakfast, morning snack and afternoon snack, were exchanged by specific products, provided by the researchers, with a moderately high protein content and a controlled low glycemic index, following a scheduled temporal consumption.
Therefore, the measurements and evaluation in the first period are considered as control values in relation to the intervention phase. Blood extractions were performed at recruitment, if the volunteers didn't have a recent blood analysis during the last three months , and on week 0 beginning of the free living period , week 4 end of free-living period and beginning of the intervention period and week 8 end of the intervention period.
Anthropometrical parameters were also measured on weeks 0, 2, 4, 6 and 8 of the trial. The primary outcomes of the current intervention were body-weight and fat mass, while glucose and lipid metabolism, as well as selected cardiovascular risk biomarkers were established as secondary outcomes.
Volunteers were asked to maintain their physical activity throughout the whole intervention. Physical activity was estimated with a 24 h recall at the beginning and the end of the nutritional intervention. There is evidence that serum folate levels are reduced in smokers and alcohol drinkers [ 4 , 5 ], who may therefore need a higher folate intake. Current studies show that the folate intake of adults is below recommendations in several countries [ 6 — 9 ].
Food fortification plays an important role in this regard and is mandatory in many American and African countries [ 10 ]. Folic-acid fortified foods are also found in Europe especially cereals , where this fortification is voluntary [ 11 ]; however, very few food products are fortified with folic acid in Sweden, where the policy is to recommend folic acid supplements to women planning a pregnancy. Among participating countries, the highest intakes were in the UK, Spain, and France, while the lowest were in Sweden and Norway.
The Riksmaten study of the food and nutrient intake in the Swedish population [ 15 ], on which the present article is based, found the intake of this vitamin to be higher than in previous years owing to an increase in fruit and vegetable consumption. The highest intake was among physically active participants, women with the highest income levels, and men with physically demanding work. The lowest intake was among smokers and among individuals in households with more than two people.
Folate bioavailability depends on the food source and appears to be highest from fruit and vegetables, but limited data are available on this aspect [ 16 ]. The food matrix plays a very important role in this regard, and there is incomplete release of cell content from some plant cellular structures [ 17 ].
According to the food composition tables for Sweden, the richest sources of folate include liver, legumes, vegetables mainly green leafy vegetables , fruit, and wholegrain cereals [ 18 ].
The —11 Riksmaten survey provided the opportunity to determine the most important folate food sources in the Swedish population, analyzing patterns of consumption amount, frequency, and food type by subgroup age, gender, educational level, and lifestyle.
The objective of this study was to identify the most important folate food sources for adult participants in the —11 Riksmaten study by gender and age group and to examine the relationship of demographic and lifestyle factors with their folate intake.
The final study sample included participants The Riksmaten study was approved by the Regional Ethical Review Board of Uppsala, and all participants gave oral informed consent before entering the study.
Dietetic and nutritional assessment Food and nutrient intakes were estimated from self-reported food records during 4 consecutive days, described in detail elsewhere [ 19 ]. Household measures, numbers of portions cups, pieces, slices , and grams were used to estimate the amounts consumed [ 20 ].
Natural folate sources were studied by categorizing food consumption into 26 food groups, following Ax et al. Demographic, anthropometric, lifestyle, and food habit covariables Covariables were considered as dichotomized variables.