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The World Health Organization has proposed that health be promoted and protected through the development of an environment that enables sustainable actions at individual, community, national and global levels. Indeed, food-based dietary guidelines, i.e., food pyramids, have been developed in numerous countries to disseminate nutritional information to the general population. However, wider recommendations are needed, with information on an active, healthy lifestyle, not just healthy eating. The objective of the present work is to propose a three-dimensional pyramid as a new strategy for promoting adequate nutrition and active healthy lifestyles in a sustainable way. Indeed, the Iberomerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles has been designed as a tetrahedron, its three lateral faces corresponding to the binomials food and nutrition, physical activity and rest, and education and hygiene. Each lateral face is divided into two triangles. These faces show the following: 1. food-based guidelines and healthy eating habits as related to a sustainable environment; 2. recommendations for rest and physical activity and educational, social and cultural issues; 3. selected hygiene and educational guidelines that, in conjunction with the other two faces, would contribute to better health and provide measures to promote environmental sustainability. The new FINUT pyramid is addressed to the general population of all ages and should serve as a guide for living a healthy lifestyle within a defined social and cultural context. It includes an environmental and sustainability dimension providing measures that should contribute to the prevention of non-communicable chronic diseases. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Content may be subject to copyright.
Proceedings of the IUNS 20th Congress of Nutrition
The FINUT Healthy Lifestyles Guide: Beyond
the Food Pyramid
Angel Gil,
* Maria Dolores Ruiz-Lopez,
Miguel Fernandez-Gonzalez,
and Emilio Martinez de Victoria
Departments of
Biochemistry and Molecular Biology II,
Nutrition and Food Science, and
Physiology, Institute of Nutrition and Food Technology,
Center of Biomedical Research, University of Granada, Granada, Spain; and
Iberomerican Nutrition Foundation (FINUT), Granada, Spain
The WHO has proposed that health be promoted and protected through the development of an environment that enables sustainable actions at
individual, community, national, and global levels. Indeed, food-based dietary guidelines, i.e., food pyramids, have been developed in numerous
countries to disseminate nutritional information to the general population. However, wider recommendations are needed, with information on
an active healthy lifestyle, not just healthy eating. The objective of the present work is to propose a three-dimensional pyramid as a new strategy
for promoting adequate nutrition and active healthy lifestyles in a sustainable way. Indeed, the Iberoamerican Nutrition Foundation (FINUT)
pyramid of healthy lifestyles has been designed as a tetrahedron, with its 3 lateral faces corresponding to the facets of food and nutrition,
physical activity and rest, and education and hygiene. Each lateral face is divided into 2 triangles. These faces show the following: 1) food-based
guidelines and healthy eating habits as related to a sustainable environment; 2) recommendations for rest and physical activity and educational,
social, and cultural issues; and 3) selected hygiene and educational guidelines that, in conjunction with the other 2 faces, would contribute to
better health for people in a sustainable planet. The new FINUT pyramid is addressed to the general population of all ages and should serve as a
guide for living a healthy lifestyle within a defined social and cultural context. It includes an environmental and sustainability dimension
providing measures that should contribute to the prevention of noncommunicable chronic diseases. Adv. Nutr. 5: 358S367S, 2014.
In recent years, the denition of health has been under de-
bate (1). The most commonly quoted denition of health
was published by the WHO in the 1940s: a complete state
of physical, mental and social well-being, and not merely the
absence of disease or infirmity(2). At the end of the 20th
century, Saracci (3) included the consideration of human
rights, basic and universal, in the definition of health. In
the present century, Bircher (4) related the term health
to age, culture, and personal responsibility. Others consider
the social, emotional, and spiritual wellness of the whole
community in addition to the wellness of the individual (5).
In the Global Strategy on Diet, Physical Activity, and
Health (6), the WHO has proposed developing an environ-
ment that enables sustainable actions at the individual, com-
munity, national, and global levels to promote and protect
health and to reduce disease and death rates related to un-
healthy diet and physical inactivity. Within this context,
the FAO has established links between agriculture, health,
and the environment and food industries in the document
Sustainable Diets and Biodiversity(7). This document in-
cludes the concept of sustainable diets and their contribu-
tion to nutrition security and a healthy life for present and
future generations. In addition, it proposes the double pyramid
of healthy food for people and sustainable food for the planet
model, which preserves both agriculture and health. Moreover,
it also promotes the idea that biodiversity and traditional food
systems can ensure food security in developing countries.
Published in a supplement to Advances in Nutrition. Presented at the International Union of
Nutritional Sciences (IUNS) 20th International Congress of Nutrition (ICN) held in Granada,
Spain, September 15–20, 2013. The IUNS and the 20th ICN wish to thank the California
Walnut Commission and Mead Johnson Nutrition for generously providing educational
grants to support the publication and distribution of proceedings from the 20th ICN. The
contents of this supplement are solely the responsibility of the authors and do not
necessarily represent the official views of the IUNS. The supplement coordinators were
Angel Gil, Ibrahim Elmadfa, and Alfredo Martinez. The supplement coordinators had no
conflicts of interest to disclose.
This article has been funded by Consejería de Innovacio
´n, Ciencia y Empresa,
Secretaría General de Universidades, Investigacio
´n y Tecnología, Junta de Andalucia,
Spain (grant re. no. 441.49). This is a free access article, distributed under terms
( that permit
unrestricted noncommercial use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Author disclosures: A. Gil, M. D. Ruiz-Lopez, M. Fernandez-Gonzalez, and E. Martinez de
Victoria, no conflicts of interest.
* To whom correspondence should be addressed. E-mail:
358S ã2014 American Society for Nutrition. Adv. Nutr. 5: 358S–367S, 2014; doi:10.3945/an.113.005637.
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In addition to the WHO Global Recommendations on
Physical activity and Health (8) and the position statement
of the American College of Sports Medicine about tness in
healthy adults (9), the United Nations Educational, Scientic,
and Cultural Organization (UNESCO) has emphasized sus-
tainable active living as a way to better integrate sustainable
development with physical education and sport (sustainable
active living) and how they are related to a healthy society (10).
Since 1992, when the International Conference on Nu-
trition established the need for the development of food-
based dietary guidelines as a new strategy to disseminate
nutritional information to the general population, many
countries have developed their own food guidelines. These
guides promote sustainable foods and diversication of the
diet through the production and consumption of foods that
are rich in micronutrients (1114). Several pictorial represen-
tations, mainly in the form of food pyramids, have been de-
veloped in a number of countries; the first one was proposed
by the Food and Nutrition Board of the National Academy of
Sciences (12,13). The European Food Information Council
has reviewed the European food guidelines; most of these
guidelines include recommendations on food consumption
using a triangle,usually referred as to food pyramid,al-
though others adopted other forms, such as circles mimick-
ing a dish or truly three-dimensional figures (14). On the
basis of the USDA Report of the Dietary Guidelines Advisory
Committee on the Dietary Guidelines for Americans 2010 (15),
the MyPlate pictorial was created; later, the Healthy Eating
Plate was designed by nutrition experts at the Harvard School
of Public Health and editors at Harvard Health Publications
to address deficiencies in the USDAs MyPlate (16).
Despite the nutritional recommendations and food
guidelines, the pandemic of noncommunicable chronic dis-
eases (NCCDs)
continues in both developed and develop-
ing countries (17). Therefore, wider recommendations are
needed, with information on an active healthy lifestyle, not
just on food. Thus, the recently revised Mediterranean pyr-
amid includes some lifestyle recommendations, such as reg-
ular physical activity, eating with others, cooking at home,
etc. (1820). However, these recommendations do not ap-
pear to be enough to help the citizens worldwide reach an
optimum health status. In addition to appropriate food
guidelines, global health recommendations should promote
physical activity and exercise, personal and food hygiene, ed-
ucation and other aspects associated with a sustainable envi-
ronment, and human rights.
The Iberoamerican Nutrition Foundation (FINUT) is a
nonprot organization; its trustees are the International
Union of Nutritional Sciences (IUNS), the Spanish Society
of Nutrition (SEÑ), and the Latin American Federation of
Nutrition Societies (SLAN). In consideration of all of the pre-
viously mentioned factors, FINUT has developed a new three-
dimensional pyramid of food and active healthy lifestyles in a
sustainable environment. The goal is to decrease the burden
of NCCDs around the world and particularly in Latin Amer-
ica, where the double burden of malnutrition and obesity
coexists with chronic diseases. The FINUT proposed this
new pyramid at the recent 21st International Congress of Nu-
trition held in Granada, Spain.
The pyramid was developed from 2011 to 2013 as the central message of
the exhibition Nutrition, Source of Life,which was open to the public at Par-
que de las Ciencias de Granada, Spain, on the occasion of the celebration of
the IUNS 20th International Congress of Nutrition in September 2013.
To develop the FINUT pyramid concept, in addition to the information
obtained through specic PubMed searches as described below, 3 different
focus groups were organized in conjunction with a communication com-
pany (Ogilvy Action, Madrid, Spain) with the participation of people of dif-
ferent ages and socioeconomic status. A mixed scientic committee formed
by members of the Parque de las Ciencias de Granada, 2 community mem-
bers from secondary schools, and 3 full professors from the University of
Granada, Spain (A.G., M.D.R.-L., and E.M.d.V.) were involved in the eval-
uation of focus group results.
At the request of the FINUT, the authors of the present article con-
ducted a literature search and review on the food guidelines and healthy
lifestyles. Reviewers, working independently, were to select, quality as-
sess, and extract relevant data where appropriate and possible. Studies
were restricted to those with human participants only and included pro-
spective studies. We conducted the literature search by using the PubMed
databases for articles cited through September 2013. Searches were con-
ducted by using Medical Subject Headings (MeSH) combined with key-
word searches to capture all indexed studies. Bibliographic searches were
also conducted to ensure inclusion of all relevant studies. Initially, we
performed a prospective and qualitative review by using combinations
of the following selected MeSH terms, among others: diet/standards,
environment,”“environmental health,”“exercise,”“feeding behavior,
food .habits,”“food guidelines,”“guidelines as topic,”“food pyra-
mid,”“practice guidelines as topic,”“physical fitness,”“public health,
sanitation,”“social conditions,and social environment.Later, we
performed a systematic review, and the search strategy retrieved 899 pri-
mary articles. The abstracts were reviewed and studies were included if
they were related to food guidelines and recommendations for healthy
lifestyles. Full-text copies of the articles meeting those criteria were
then screened for their suitability for inclusion, and those meeting the
inclusion criteria were manually cross-referenced. A total of 198 articles
met the initial search criteria.
The following equations for specic searches were used to nd and eval-
uate relevant literature related to food pyramid and healthy lifestyles: Diet
Pyramid;(food habitsOR diet) AND (environmentOR conserva-
tion of natural resourcesOR agriculture)AND (guidelines as topicOR
practice guidelines as topic); diet/standardsAND (guidelines as topic
OR practice guidelines as topic); Eating" AND Pyramid;(exercise)
AND (environment) AND (guidelines as topicOR practice guidelines
as topic); exercise" OR Motor activity" OR physical fitness" AND Pyr-
amid;(feeding behaviorOR nutrition policyOR food habits) AND
(environmentOR conservation of natural resourcesOR agriculture)
AND (guidelines as topic); Food Pyramid;(hygieneOR sanitation)
AND (environmentOR conservation of natural resourcesOR agricul-
ture) AND (guidelines as topic); hygiene" AND Pyramid;(motor ac-
tivity) AND (environment) AND (guidelines as topicOR practice
guidelines as topic); and (physical activityOR physical fitness) AND
(environment) AND (guidelines as topicOR practice guidelines as
topic) . In addition, review bibliographies of books and review articles,
and references from retrieved articles were explored.
On the basis of the title of publication and the abstract identied from the
trial search, irrelevant citations were discarded by the reviewers (A.G., M.D.R.-L.,
and E.M.d.V.). If there was any possibility that the article could be relevant,
the full-text article was retrieved for further assessment. Two reviewers (A.G.
and E.M.d.V.) independently decided which trials met the inclusion criteria.
Any disagreement was resolved by discussion between the reviewers, with
Abbreviations used: FINUT, Iberoamerican Nutrition Foundation; IUNS, International Union
of Nutritional Sciences; NCCD, noncommunicable chronic disease.
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referral to a third reviewer (M.D.R.-L.) to adjudicate any persisting
On the basis of that review, we developed a new three-dimensional life-
style pyramid (The FINUT pyramid) addressed to the general population,
which included selected recommendations on the following 3 main facets
of active healthy lifestyles: 1) food and nutrition, 2) physical exercise and
rest, and 3) education and hygiene. Each of these facets occupies one-half
of the 3 lateral faces of a tetrahedron. The other half of each face is paired
with a number of practices and recommendations to increase environmen-
tal sustainability and to improve the local educational, social, and cultural
surroundings. Hence, each lateral face of the tetrahedron is divided into
2 triangles. The right halves are structured recommendations as follows:
1) food consumption, arranged in ascending order on the basis of relative
intake frequency; 2) adequate patterns of rest, physical activity, and exercise,
also arranged by recommended frequency, with less frequent activities at the
summit; and 3) appropriate measures and patterns of education and hy-
giene. The present FINUT pyramid of active healthy lifestyles has been de-
signed as a simple and intuitive tool so that it does not need any additional
information to be easily interpreted. The base of the FINUT pyramid makes
the claim for healthy lifestyles in a sustainable planet. Citations for all of the
claims included in a pyramid graphic are not feasible in this supplement ar-
ticle. However, to trace the scientific basis of the various claims for the
FINUT pyramid, we have identified the major documents we considered
in building up the evidence base of our pictorial (68,15,17,2024).
Figures 13depict the 3 facets corresponding to food and nu-
trition, physical activity and rest, and education and hygiene
that constitute the FINUT pyramid. Figure 4 corresponds to
lifestyles for people within the context of a sustainable planet.
Food and nutrition
On this face of the tetrahedron, we show food-based guidelines
and healthy eating habits as related to a sustainable environ-
ment (Fig. 1) (6,15,2022).
Right half of triangle. In this triangle, guidelines for a var-
ied, balanced, healthy diet, including daily, weekly, and
occasional consumption of foods, are provided. The recom-
mended frequency for intakes of the most important groups
of foods is illustrated in ascending order from the most to
the least frequent. These recommendations are in agreement
with those recently proposed in the Mediterranean diet pyra-
mid (1820). Water and liquid foods are located at the base,
FIGURE 1 Food and nutrition face of the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles. The images of the
FINUT pyramid were previously registered as a trademark by the FINUT.
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promoting body hydration; 1.52 L/d of water is recommen-
ded. Water from different sources, namely tap or spring water,
together with the water in infusions, teas, soups, fruit juices,
and other low-sugar drinks, is represented.
On the next step, cereals and their main derivatives
(bread, pasta, etc.) are shown. This contributes to a signi-
cant portion of the energy provided by the diet along with
potatoes, which are frequently used in side dishes in the
Mediterranean diet (1820). From 4 to 6 portions daily of
those foods (1 portion = 6068 g of pasta or rice or 4060 g
of bread), with at least one-half of these from whole-grain
cereals, are recommended.
Fruits, vegetables, and related products occupy the next
level. This is a diverse food group, including plant roots, bulbs,
stems, leaves, owers, and fruits, which are rich in dietary ber
and micronutrients, as well as bioactive compounds (1820).
At least 5 portions (1 portion = 150200 g), with a minimum
of 2 fresh portions, are recommended.
The fourth level contains milk (i.e., low-fat milk) and
dairy products, particularly fermented milks and cheese,
which provide protein of a very high quality, as well as cal-
cium and other minerals and vitamins (15,20); the recom-
mended intake for this type of food is 23 portions daily
(1 portion = 200250 mL of milk, 200250 g of yogurt, or
80 g of fresh cheese).
At the next level, virgin olive oil, a major food in the
Mediterranean diet (1820), as well as other healthy unsat-
urated oils, namely rapeseed or colza, including canola, sun-
flower, and soybean oils, are considered as the dietary fat of
preference not only as part of salad dressing but also for food
cooking and frying (15). This group includes olives, which
are also rich in bioactive compounds and fiber. Daily
consumption of 3 to 5 portions (1 portion = 10 mL) is
On the sixth level, the consumption of 23 portions daily
of protein-rich foods of animal origin (range: 60150 g), in-
cluding poultry and other white meats, eggs and fish, as well
as plant-based protein-rich foods, namely legumes and nuts,
is recommended (15,1820). These foods, which provide
not only protein but also many micronutrients and a
FIGURE 2 Physical activity and rest face of the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles. The images
of the FINUT pyramid were previously registered as a trademark by the FINUT.
The FINUT pyramid of healthy lifestyles 361S
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number of PUFAs (22), should be consumed by alternating
them in main dishes during the week. Up to 4 portions of
poultry and white meats (1 portion = 100125 g), 4 eggs (1
portion = 6080 g), 23 fish portions (1 portion = 125150 g),
and 2 servings of legumes (1 serving = 6080 g) per week are
recommended. In addition, 2 portions (1 portion = 2030 g)
of nuts should be consumed. At the vertex of the triangle, red
meats, high-fat products, sweets, and other sugar-enriched
products are grouped in the consume occasionallybracket
Wine in moderation plays a role in most Mediterranean
countries, and it is widely accepted that ~1 glass/d of red
wine (150200 mL) might be beneficial mainly due to its
relatively high amounts of polyphenols (20). However,
the consumption of wine by North African and Asiatic
Mediterranean countries is almost negligible. Because the
FINUT pyramid constitutes a global healthy lifestyle guide
and is intended not only for adults but also for teenagers
we did not include the consumption of wine, even in
Even though salt has been used for years in the Mediterra-
nean basin for food preservation, namely sh, the Mediter-
ranean diet is intrinsically a relatively low-salt diet (20). In
addition to the relative high consumption of fruits and vege-
tables, the wide use of spices and herbs in the preparation of
meals provides a way to reduce the daily intake of salt.
Left half of triangle. In this portion of the triangle, we tried
to emphasize good food habits and behaviors favoring envi-
ronmental sustainability and healthy living (7,23). The rst
pictogram, related to the familiar environment, states the
importance of breastfeeding to sustain healthy growth and
development (6). Other social messages include eating with
others, particularly with family (i.e., conviviality), as well as
cooking at home, which in turn leads to varied and slow eat-
ing with relatively small portions (20)
With the label sustainable agriculture,we incorporate a
new focus on food production linked to the environment
and more socially centered on the ecologic sustainability
of the production systems (7). Related to this, avoidance
FIGURE 3 Education and hygiene face of the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles. The images
of the FINUT pyramid were previously registered as a trademark by the FINUT.
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of pesticides for pest control is recommended to maintain
the soil quality and healthy agrosystems. Finally, we empha-
size the need to maintain biodiversity as a world heritage for
present and future generations (7,23).
Agricultural policies are needed to support greater avail-
ability. In addition, food distribution policies to facilitate the
acquisition of fruits and vegetables at lower prices by con-
sumers should be considered (24,31,32). Indeed, fair pay
and eating of local and seasonal products and sustainable ag-
riculture and livestock are recommended (Fig. 1,left side).
Physical activity and rest
On this face of the tetrahedron, we illustrate healthy life-
styles related to rest and physical activity (Fig. 2)(810).
Right half of triangle. On this half of the triangle, we in-
clude the recommendations for rest and physical activity,
the latter arranged by their importance in frequency, dura-
tion, and intensity in daily life. On the base of the triangle,
we include the recommendation for sleeping at least 8 h/d,
although this period should be higher in children and lower
with advancing age. A brief daily resting period after lunch is
also recommended (e.g., a siesta).
On the second level, 8 h of professional or daily labor ac-
tivities with a brief resting period of at least 30 min are
included. Small intervals for stretching are highly recom-
mended for those activities associated with postural stress,
such as working for hours in front of a computer (see yellow
boxes in Fig. 2).
In the third level, relatively light activities (cooking,
housekeeping, and quietly walking) are considered. Some
daily time for leisure is also recommended (lectures, watch-
ing television, cinema, etc.).
The fourth level is devoted to mild physical activity, such
as walking, and in the next level, moderate to intense phys-
ical activity is recommended, such as rhythmic walking
(6 km/h), dancing, jogging, and other active play. The last
2 levels, close to the vertex of the triangle, are dedicated to
practicing sports, with aerobic sports in the lower level
and anaerobic sports in the upper level. All types of activities
(light, mild, and moderate-intense) should be carried out on
a daily basis, whereas sports should be played on a weekly
Physical activity should be performed during free time or
during time outside the home, at work, and at home, within
the context of daily familiar and community activities. Rec-
ommendations related to frequency, duration, and intensity
are at least 150 min/wk (ideally, 300 min/wk) of aerobic
moderate physical activity and approximately half of this
value for intense aerobic activities. The former should be
split into 30-min periods of moderate exercise 5 times/wk.
In addition, muscle-strengthening exercises are recommen-
ded at least 2 times/wk.
Left half of triangle. The left half of the triangle includes
all aspects of physical activity and rest related to the environ-
ment and sustainability, as well as educational, social, and
cultural issues (810). Thus, to avoid sedentary behavior,
FIGURE 4 Base of the
Iberoamerican Nutrition
Foundation (FINUT) pyramid,
which makes a claim for
healthy lifestyles for people in
a sustainable planet. The
images of the FINUT pyramid
were previously registered as a
trademark by the FINUT.
The FINUT pyramid of healthy lifestyles 363S
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active leisure and transportation, physical activity at school,
and the promotion of active aging populations are recom-
mended. Similarly, social aspects related to physical activity,
such as sportsmanship, and environmental aspects, such as
adaptation and adequate design of outdoor spaces in towns
for the practice of physical activity and sports, are envisioned.
Education and hygiene
On this face of the tetrahedron, we include the hygiene and ed-
ucational habits that should contribute to healthy lifestyles
(Fig. 3) (6,15,17).
Right half of triangle. On this face, we show the most im-
portant aspects related to education and hygiene that, in
conjunction with the other 2 faces, contribute to better
health. Body hygiene is critical to preventing microbial con-
tamination and avoiding infectious diseases. Similarly, keep-
ing a home clean and well ventilated results in a suitable
environment for domestic tasks, including cooking, playing,
and resting, while preventing parasitic infections. An appro-
priate room design will also decrease the incidence of do-
mestic accidents.
Food hygiene and the appropriate handling of foods, par-
ticularly cooking using safe and sustainable foods and non-
contaminated tools as well as refrigerating and freezing raw
foods and meals, allow people to maintain and preserve the
maximum quality of foods, leading to improved food safety
and disease prevention (15). Similarly, personal contribu-
tion to reducing enviromental pollution is important to
avoiding cross-contamination. In addition, the global pro-
tection of children and the commitment to facilitate their
education and to augment their social interaction appear
to be critical in the acquisition of lifestyle habits that
will result in maintaining health. Moreover, road safety and
preventing work accidents are key to minimizing deaths
worldwide. In addition, providing adequate access to safe
drinking water is a key social commitment in the mainte-
nance of health.
Left half of triangle. The left side of the triangle emphasizes
how we should contribute to the sustainability of the envi-
ronment, particularly by the responsible use and consump-
tion of water and energy, including using sustainable means
of transport, as well as maintaining a clean atmosphere by
keeping the emissions of residues to a minimum and facili-
tating the collection and recycling of wastes (7,23).
Currently, health cannot be considered only the absence of
disease or the presence of positive healthas it was estab-
lished by the WHOs 1948 definition (32). In the 20th cen-
tury, the WHO suggested that health conditions and
contextual factors in the form of personal and environmen-
tal variables interact to influence two distinct components of
health: 1) body functions and structures; and 2) activities
and participation (33). Because an individuals functioning
and disability occur within specific contexts, the International
Classification of Functioning, Disability and Health also in-
cluded a list of environmental factors (33).
Considering those aspects of health related to healthy
lifestyles in a sustainable environment (68,15,17,20
24,34,35), the FINUT has designed a novel three-dimensional
pyramid, as a tetrahedron, that is addressed to the general
population of all ages to serve as a guide to healthy lifestyles
within a defined social and cultural context and with an en-
vironmental and sustainability dimension.
This guide is novel in that it reaches far beyond the cur-
rent recommendations proposed in the current published
and available guides of healthy lifestyles. Most current guides
deal exclusively with food habits and physical activity, along
with some recommendations related to alcohol abuse and
tobacco consumption (1214,1820,3645).
A three-dimensional, truncated, and staggered healthy
lifestyle pyramid exclusively addressed to children and ado-
lescents has also been developed (46). On this pyramid, 2
faces are formulated around achieving daily food intake
(face 1) and daily activities (face 2). The third face is an ad-
aptation of the traditional food guide pyramid, adapted to
childrens energy, nutritional, and hydration needs; and
the fourth face addresses both daily and life-long habits.
However, this pyramid does not include any aspect related
to interactions between the environment and food habits,
physical activity, and education and hygiene.
The most recent Mediterranean pyramid is a food guide
represented as a triangle. Its recommendations include basic
information on active living. It mentions social aspects related
to conviviality and cultural and environmental aspects, such
as home and traditional cooking using local and seasonal pro-
ducts and agricultural sustainability (1820). However, the
guide does not consider any specific recommendations for
physical activity and rest or other aspects related to health,
namely educational and hygiene aspects, and their interac-
tion with the environment.
One of the most important differences in the present
FINUT healthy lifestyles pyramid is that in each of the 3 faces
related to health, we devote 1 area to aspects related to fre-
quency of consumption of different foods (Fig. 1), patterns
of physical activity and rest (Fig. 2), and individual and com-
munity commitments and behaviors related to hygiene in a
larger sense (Fig. 3). We devote another area to social, cul-
tural, and environmental aspects as they relate to sustainable
development within each of the 3 pyramid faces (Figs. 13).
On the face dedicated to food and nutrition, we have used
the Mediterranean diet pattern with minimal differences,
which has been repeatedly reported both in epidemiologic
and intervention studies to have a role in the prevention
of NCCDs with high mortality and morbidity, namely cardi-
ovascular disease, cancer, diabetes, and depression (4751).
A number of authoritative reviews provided evidence that
consumption of red meat, due to its high content of satu-
rated fat, should be limited (2530). Hence, in this context
we adopted a similar recommendation to that of the Har-
vard School of Public Healths Healthy Eating Plate and pyr-
amid for Americans (16).
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For the food and nutrition face, we emphasized the im-
portance of breastfeeding not only to support adequate
growth and development of infants but also to prevent
NCCDs later in life. In fact, current scientic evidence re-
lated to early programming suggests that exclusive breast-
feeding during the rst months of life contributes to the
prevention of obesity and associated chronic diseases (52).
Many countries have included the promotion of breastfeed-
ing in their nutritional goals because of its preventative as-
pects. In some of these countries, the average duration of
breastfeeding has decreased to <2 mo in recent decades,
which is much shorter than the WHO and UNICEF recom-
mendations to maintain exclusive breastfeeding for at least
the first 6 mo of life (52).
Similar to the Mediterranean diet pyramid, we recom-
mend the consumption of seasonal and local products. Local
food systems should not be designed to completely isolate
themselves from trade but rather aim to adapt local food
production and markets to suit the environmental and
health priorities of a community (24). Eating locally con-
tributes to the utilization and preservation of species and
varieties, which has a clear impact on biodiversity (7), de-
creases CO
emissions, and improves the price of basic
foods, promoting a fair market. Current research indicates
that local food systems may offer social, environmental,
and health benefits, although the links between use of local
food systems and better eating habits and reductions
in chronic diseases need to be more clearly established
(7,24,31,32). We also recommend regulating food produc-
tion, monitoring food quality and safety, and responding
to nutritional and safety issues that arise through sustainable
agriculture and the protection of biodiversity, as emphasized
by the present FINUT pyramid (7,15).
With regard to the physical activity and rest face, our goal
was to illustrate a daily or weekly routine, providing easy
recommendations in terms of the frequency, duration, in-
tensity, type, and total amount of physical activity needed
to prevent NCCDs (810,34). Similarly, we emphasize how
important it is to promote an appropriate environment for
physical activity in all ages, especially at schools and for the
elderly, creating spaces, particularly in urban areas, for exer-
cising and sports. It is well known that physical inactivity is
the fourth risk factor for mortality in the world. It consider-
ably influences the prevalence of NCCDs and the health of the
general population, and international recommendations on
physical activity have been developed to prevent NCCDs
(6). In addition, inadequate sleep and rest are associated
with obesity and other chronic diseases (53). Hence, the FI-
NUT pyramid can serve as a useful tool to promote physical
activity and good resting habits, contributing to the preven-
tion of NCCDs.
Body hygiene and food safety are essential factors in
maintaining good health. Major sources of food poisoning
in heavily populated and industrialized countries include
pathogenic microorganisms, toxic agents, parasites and other
organisms entering the food supply, and chemical contamina-
tion, including additives and contamination of the food
supply by toxic industrial waste (54,55). Moreover, climate
change can affect global food production with uncertain con-
sequences for human health, particularly in developed coun-
tries (56). Similarly, adequate water supply and sanitation are
critical for the prevention of many diseases. In fact, vast num-
bers of people are without improved sanitation (57), and too
much wastewater still remains untreated (58). The FINUT
pyramid emphasizes personal commitment to maintaining
good personal hygiene habits and safely producing food while
maintaining a clean home and environment. It also empha-
sizes a personal contribution to environmental hygiene and
a social commitment to protecting children and providing
safe sources of water. We recommend promoting the respon-
sible use and consumption of water while keeping emissions
of residues to a minimum and strengthening existing struc-
tures and policies to facilitate the collection and recycling of
waste, as described in the current FINUT pyramid.
In conclusion, the FINUT healthy lifestyles pyramid,
which is based on the 3 facets of food and nutrition, physical
activity and rest, and education and hygiene, and their inter-
actions with environmental sustainability, is a novel approach
that provides healthy lifestyle guidelines in a holistic frame-
work for populations of all ages. It provides individuals
with the information needed to recognize and put into prac-
tice individual and social behaviors that promote better in-
dividual and community health and the health of future
A.G. had primary responsibility for the FINUT Pyramid
design, development, nal content and contributed to the
systematic review of the literature. M.D.R. and E.M.V. were
involved in the design, data interpretation, and manuscript
preparation; and M.F.-G. was in charge of the pictorials. All
authors read and approved the nal manuscript.
Literature Cited
1. Niyi A. Re-defining health. Comment on the article: Üstün & Jakob
2005;83:802. World Health Organization Bulletin [cited 2013 Dec
15]. Available from:
2. WHO. Preamble to the constitution of the World Health Organization
Proceedings and final Acts of the International Health Conference held
in New York in June of 1946. Official Records of the World Health Or-
ganization, no. 2, p. 100. United Nations WHO, New York, 1948.
3. Saracci R. The World Health Organisation needs to reconsider its def-
inition of health. BMJ. 1997;314:140910.
4. Bircher J. Towards a dynamic definition of health and disease. Med
Health Care Philos. 2005;8:33541.
5. National Health and Medical Research Council. Promoting the health
of indigenous Australians. A review of infrastructure support for Ab-
original and Torres Strait Islander health advancement: final report
and recommendations. Part 2:4. Canberra (Australia): National Health
and Medical Research Council; 1996.
6. WHO. Global strategy on diet, physical activity and health. 2004 [cited
2013 Dec 15]. Available from:
7. FAO. Sustainable diets and biodiversity: directions and solutions for
policy, research and action. In: Burglingame B, Dernini S, editors. Pro-
ceedings of the International Scientific Symposium Biodiversity and
Sustainable Diets United Against Hunger, 35 November 2010,
The FINUT pyramid of healthy lifestyles 365S
at HOSPITAL REAL on May 15, 2014advances.nutrition.orgDownloaded from
Rome, 2012 [cited 2013 Dec 15]. Available from:
8. WHO. Global recommendations on physical activity for health. 2010
[cited 2013 Dec 15]. Available from:
9. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee
IM, Nieman DC, Swain DP; American College of Sports Medicine
(ACSM). Position stand: quantity and quality of exercise for developing
and maintaining cardiorespiratory, musculoskeletal, and neuromotor
fitness in apparently healthy adults: guidance for prescribing exercise.
Med Sci Sports Exerc. 2011;43:133459.
10. UNESCO. Sports and sustainable development [cited 2013 Dec 15].
Available from:
11. FAO/WHO. Preparation and use of food-based dietary guidelines. Re-
port of a joint FAO/WHO consultation. Nicosia (Cyprus): WHO; 1996
[cited 2013 Dec 15]. Available from:
12. Welsh S, Davis C, Shaw A. Development of the Food Guide Pyramid.
Nutr Today. 1992;6:1223.
13. Food Guide Pyramid. A guide to daily food choices. Washington:
USDA, Human Nutrition Information Service; 1992. Home and Gar-
den Bulletin No. 232.
14. European Food Information Council. Food-based dietary guidelines in
Europe. 2009 [cited 2013 Dec 15]. Available from: http://www.eufic.
15. USDA. USDA report of the Dietary Guidelines Advisory Committee on
the Dietary Guidelines for Americans 2010 [cited 2014 Mar 3]. Avail-
able from:
16. Harvard Medical School. Healthy Eating Plate dishes out sound diet ad-
vice: more specific than MyPlate, it pinpoints the healthiest food
choices. Harv Heart Lett. 2011;22:6.
17. WHO. Diet, nutrition and the prevention of chronic diseases. Report of
the joint WHO/FAO expert consultation. World Health Organ Tech
Rep Ser 2003;Report no. 916, WHO, Geneva.
18. Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A,
Helsing E, Trichopoulou D. Mediterranean diet pyramid: a cultural
model for healthy eating. Am J Clin Nutr. 1995;61 Suppl:1402S6S.
19. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini
S, Medina FX, Battino M, Belahsen R, Miranda G, et al. Mediterranean
Diet Foundation Expert Group. Mediterranean diet pyramid today: sci-
ence and cultural updates. Public Health Nutr. 2011;14:227484.
20. International Centre for Advanced Mediterranean Agronomic Studies.
Mediterra 2012 [cited 2014 Mar 3]. Available from: http://www.ciheam.
21. WHO. Protein and amino acid requirements in human nutrition. Re-
port of a Joint WHO/FAO/UNU Expert Consultation. World Health
Organ Tech Rep Ser 2007;935 [cited 2014 Mar 3]. Available from:
22. FAO. Fats and fatty acids in human nutrition. Report of an expert con-
sultation. Rome: FAO; 2010. FAO Food and Nutrition Paper 91 [cited
2014 Mar 3]. Available from:
23. Johns T, Eyzaguirre PB. Linking biodiversity, diet and health in policy
and practice. Proc Nutr Soc. 2006;65:1829.
24. OKane G. What is the real cost of our food? Implications for the en-
vironment, society and public health nutrition. Public Health Nutr.
25. Karanja NM, Obarzanek E, Lin PH, McCullough ML, Phillips KM,
Swain JF, Champagne CM, Hoben KP. Descriptive characteristics of
the dietary patterns used in the Dietary Approaches to Stop Hyperten-
sion Trial. DASH Collaborative Research Group. J Am Diet Assoc. 1999;
99(8 Suppl):S1927.
26. Steffen LM, Kroenke CH, Yu X, Pereira MA, Slattery ML, Van Horn L,
Gross MD, Jacobs DR Jr. Associations of plant food, dairy product, and
meat intakes with 15-y incidence of elevated blood pressure in young
black and white adults: the Coronary Artery Risk Development in
Young Adults (CARDIA) Study. Am J Clin Nutr. 2005;82:116977.
27. Wang L, Manson JE, Buring JE, Sesso HD. Meat intake and the risk of
hypertension in middle-aged and older women. J Hypertens. 2008;26:
28. Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat in-
take and mortality: a prospective study of over half a million people.
Arch Intern Med. 2009;169:56271.
29. Núñez-Córdoba JM, Valencia-Serrano F, Toledo E, Alonso A, Martínez-
González MA. The Mediterranean diet and incidence of hypertension:
the Seguimiento Universidad de Navarra (SUN) Study. Am J Epide-
miol. 2009;169:33946.
30. World Cancer Research Fund/American Institute for Cancer Research.
Food, nutrition, physical activity, and the prevention of cancer: a global
perspective. Washington: AICR; 2007.
31. French SA. Pricing effects on food choices. J Nutr. 2003;133 Suppl:
32. Locker D, Gibson B. The concept of positive health: a review and com-
mentary on its application in oral health research. Community Dent
Oral Epidemiol. 2006;34:161.
33. WHO. International classification of functioning, disability and health.
Geneva: WHO; 2001.
34. U.S. Department of Health and Human Services. Physical activity and
health: a report of the Surgeon General. Atlanta (GA): U.S. Department
of Health and Human Services, Centers for Disease Control and Pre-
vention, National Center for Chronic Disease Prevention and Health
Promotion; 1996.
35. Patrick R, Capetola T, Noy S. Health promotion and sustainability:
transitioning toward healthy and sustainable future. Report prepared
by Deakin University, School of Health and Social Development,
Melbourne Campus, Deakin University for Sustainability Victoria
(Australia); 2011.
36. WHO. Preventing chronic diseases: a vital investment. Geneva: WHO.
[cited 2014 Mar 27]. Available from:
37. Painter J, Rah JH, Lee YK. Comparison of international food guide pic-
torial representations. J Am Diet Assoc. 2002;102:4839.
38. Cronin FJ. Reflections on food guides and guidance systems. Nutr To-
day. 1998;33:1868.
39. Hunt P, Rayner M, Gatenby S. A national food guide for the UK:
background and development. J Hum Nutr Diet. 1995;8:31522.
40. Health Canada. Canadas Food Guide to Healthy Eating for People
Four Years Olds and Over. Ottawa (Canada): Minister of Public
Works and Government Services Canada; 1992. Catalog H39-
41. Health Canada. Eating well with Canadas food guide [cited 2013 Dec
15]. Available from:
42. Australian guide to healthy eating. Canberra (Australia): Common-
wealth Department of Health and Aged Care; 1998. A052465.
43. Australian Department of Health & Aging. Australian guide to healthy
eating [cited 2013 Dec 15]. Available from: http://www.eatforhealth.
44. The Chinese Nutrition Society. Dietary guidelines and the Food Guide
Pagoda. J Am Diet Assoc. 2000;100:8867.
45. Aranceta J, Serra-Majem L; Working Party for the Development of
Food-Based Dietary Guidelines for the Spanish Population. Dietary
guidelines for the Spanish population. Public Health Nutr. 2001;4:
46. González-Gross M, Gómez-Lorente JJ, Valtueña J, Ortiz JC, Meléndez
A. The "Healthy lifestyle guide pyramid" for children and adolescents.
Nutr Hosp. 2008;23:15968.
47. Couto E, Boffetta P, Lagiou P, Ferrari P, Buckland G, Overvad K, Dahm
CC, Tjønneland A, Olsen A, Clavel-Chapelon F, et al. Mediterranean
dietary pattern and cancer risk in the EPIC cohort. Br J Cancer.
48. Sofi F, Abbate R, Gensini GF, Casini A, Trichopoulou A, Bamia C. Iden-
tification of change-points in the relationship between food groups in
366S Supplement
at HOSPITAL REAL on May 15, 2014advances.nutrition.orgDownloaded from
the Mediterranean diet and overall mortality: an a posterioriap-
proach. Eur J Nutr. 2012;51:16772.
49. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-
Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, et al; PREDIMED Study
Investigators. Primary prevention of cardiovascular disease with a Med-
iterranean diet. N Engl J Med. 2013;368:127990.
50. Ajala O, English P, Pinkney J. Systematic review and meta-analysis of
different dietary approaches to the management of type 2 diabetes.
Am J Clin Nutr. 2013;97:50516.
51. Sánchez-Villegas A, Martínez-González MA, Estruch R, Salas-Salvadó J,
Corella D, Covas MI, Arós F, Romaguera D, Gómez-Gracia E, Lapetra J,
et al. Mediterranean dietary pattern and depression: the PREDIMED
randomized trial. BMC Med. 2013;11:208.
52. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeed-
ing. Cochrane Database Syst Rev. 2012;8:CD003517.
53. von Ruesten A, Weikert C, Fietze I, Boeing H. Association of sleep du-
ration with chronic diseases in the European Prospective Investigation
into Cancer and Nutrition (EPIC)-Potsdam study. PLoS ONE. 2012;7:
54. Prakash V. Global aspects of nutrition and health and ways to improve
diet quality. Int J Vitam Nutr Res. 2012;82:18791.
55. Lam HM, Remais J, Fung MC, Xu L, Sun SS. Food supply and food
safety issues in China. Lancet. 2013;381:204453.
56. Lake IR, Hooper L, Abdelhamid A, Bentham G, Boxall AB, Draper A,
Fairweather-Tait S, Hulme M, Hunter PR, Nichols G, et al. Climate
change and food security: health impacts in developed countries. Envi-
ron Health Perspect. 2012;120:15206.
57. WHO/UNICEF. Progress on sanitation and drinking-water: 2012 op-
date. Geneva: WHO; 2012.
58. Mara D. Pits, pipes, pondsand me. Water Res. 2013;47:210517.
The FINUT pyramid of healthy lifestyles 367S
at HOSPITAL REAL on May 15, 2014advances.nutrition.orgDownloaded from
... Gaya hidup sehat merupakan faktor penting dalam kesehatan. Gaya hidup sehat tidak hanya berbicara mengenai makanan sehat saja tetapi juga mengenai physical activity dan istirahat, sesuai dengan piramida FINUT yang bertujuan sebagai pedoman gaya hidup sehat (Gil et al., 2014). ...
... Physical activity penting untuk memperkuat sistem kekebalan tubuh, dengan berolahraga minimal 150 menit/minggu. Selain itu, berdasarkan piramida FINUT, dianjurkan untuk melakukan aktivitas relatif ringan, aktivitas ringan, aktivitas relatif sedang hingga intens setiap hari serta aerobik dan anaerobik yang dapat dilakukan setiap minggu (Gil et al., 2014). ...
... Kualitas tidur yang buruk dapat menimbulkan berbagai masalah seperti gangguan kognitif dan psikomotorik, masalah keuangan, hingga kematian (Hillman & Lack, 2013). Penelitian yang dilakukan oleh Gil et al., (2014) menganjurkan manusia untuk tidur setidaknya 8 jam/hari dan diperlukan setidaknya 30 menit untuk beristirahat dan melakukan peregangan akibat bekerja berjam-jam di depan komputer. ...
Pandemi COVID-19 membuat masyarakat menerapkan gaya hidup sehat agar dapat menguatkan sistem imun sehingga tubuh tidak mudah terkena virus. Penelitian ini dilakukan dengan tujuan untuk mengetahui penerapan gaya hidup sehat, yaitu aktivitas fisik, istirahat, dan makanan gizi seimbang, yang dilakukan oleh generasi Z di Surabaya berdasarkan AIO (Activity, Interest, Opinion) serta mengetahui perbedaan antara laki-laki dan perempuan dalam penerapannya. Penelitian ini dilakukan pada 332 responden dengan menggunakan Independent Sample T-Test dan uji Mann-Whitney. Hasil yang didapatkan dari menerapkan aktivitas, generasi Z rutin mengonsumsi makanan gizi seimbang dan melakukan aktivitas fisik. Generasi Z minat menerapkan aktivitas fisik, istirahat, dan mengonsumsi makanan gizi seimbang. Berdasarkan opini, generasi Z setuju bahwa istirahat dan mengonsumsi gizi seimbang penting untuk tubuh. Hasil penelitian juga menunjukkan tidak ada perbedaan yang signifikan antara laki-laki dan perempuan terhadap makanan gizi seimbang dan aktivitas fisik, tetapi penerapan istirahat menunjukkan adanya perbedaan yang signifikan antara laki-laki dan perempuan.
... In view of this scenario, the need for recommendations that address the issue of current production and consumption is evident, encompassing the relationship between diet, health, environment, and society [8,22,23]. Feeding is a complex phenomenon, not having the sole purpose of providing nutrients [3]. Incorporating sustainability issues into the recommendations for healthy eating has been identified as a key to nutrition policies [8,22]. ...
... Feeding is a complex phenomenon, not having the sole purpose of providing nutrients [3]. Incorporating sustainability issues into the recommendations for healthy eating has been identified as a key to nutrition policies [8,22]. Sustainability has different dimensions, with the environmental, social, and economic dimensions being known as the sustainability tripod [24]. ...
... Thus, it is observed that other aspects still do not seem to be well incorporated in the dietary recommendations [22]. The importance of nutritional content is recognized for the assessment and promotion of healthy eating practices, especially in view of the history of increased Chronic Noncommunicable Diseases (NCD) [32]. ...
Full-text available
Objective Was analyzed the contents of the main messages of food-based dietary guidelines to promote healthy eating, identifying nutritional, symbolic, and sustainable recommendations. Methods Food-based dietary guidelines from 90 different countries were analyzed. These guidelines were selected from the United Nations Food and Agriculture Organization database. For data extraction, all messages were exported to the Nvivo software and, after repeated readings, were grouped into predefined categories and corresponding dimensions based on the literature. The categories were created according to the mixed model, that is, they were created before data analysis was performed, but modified if necessary. Results Was identified 1,982 messages grouped into the following dimensions: nutritional (n=73.9%); sustainable (3.2%); symbolic (3.3%), and others (19.7%). All food-based dietary guidelines addressed nutritional aspects, and the most frequent recommendation was regarding the consumption of fats, followed by the consumption of salt and vegetables and fruits, cited by at least 75 food-based dietary guidelines. Less than half (n=40) of the food-based dietary guidelines addressed sustainable or symbolic aspects of food and 13 of the food-based dietary guidelines addressed both aspects. However, these messages represented only 6.5% of the total messages in the documents. Conclusions The recommendations for healthy eating in the food-based dietary guidelines are incipient in terms of sustainable and symbolic issues. Recommendations for adopting healthy diets need to consider the completeness of the food and its various combinations, dietary patterns, and the factors associated with their consumption, as well as the individual’s relations with food, environment, and society.
... Therefore, our data should be considered with caution and more research would be needed to evaluate the impact of the different aspects of this category on BM. The importance of including these dimensions in the nutrition has been established by the Iberoamerican Nutrition Foundation, which developed a new 3D pyramid of food and active healthy lifestyles in a sustainable environment, including: (1) food and nutrition, (2) physical activity and rest, and (3) education and hygiene [53]. Our data support the importance of further exploring other aspects of healthy habits, in addition to one's diet, since they could affect the fatty acid levels, as well as other components of BM. ...
Full-text available
In lactating women, breast milk (BM) fatty acids may come from the diet or stored adipose tissue. Our objective was to evaluate the influence of the adherence to the healthy food pyramid (HFP), the dietary pattern in the Mediterranean region, and the maternal body composition on the BM fatty acids pattern. Fifty breastfeeding women answered a socioeconomic survey and the adherence to the HFP questionnaire (AP-Q). In addition, they provided a BM sample at 7 ± 1, 14 ± 1, and 28 ± 1 days postpartum. The body’s composition was analyzed at days 7 and 28 by bioimpedance. The BM fatty acids were analyzed by gas chromatography–mass spectroscopy. We found a negative association between the consumption of olive oil and the BM palmitic acid levels (β = −3.19 ± 1.40; p = 0.030), and the intake of cereals and legumes was positively associated with the BM saturated fatty acids (β = 11.48 ± 3.87; p = 0.005). The intake of proteins and vegetables was positively associated with the omega-3 fatty acids and negatively with the omega-6:omega-3 ratio in BM. A negative association between the maternal age (β = −0.43 ± 0.11; p = 0.001) and the α-linolenic acid (ALA) levels was observed, being overall AP-Q positively associated with the ALA levels (β = 0.39 ± 0.15; p = 0.016). Physical activity reduced both the omega-3 and omega-6 fatty acids in BM. Diet had a larger influence than the maternal body’s composition on BM fatty acids during the first month of lactation, demonstrating a better adherence to the HFP and positively impacting on the omega-3 content in BM, a fact that is modulated by one’s maternal age.
... 5 It is widely known that the combination of foods consumed, known as dietary patterns, and their potential synergistic effects are important in the prevention of chronic diseases (such as type 2 diabetes and cardiovascular disease) rather than the impact of individual nutrients. [6][7][8] This has led to the development of methods that can be used to describe these dietary patterns. ...
Full-text available
Background Several diet quality scores have been developed to evaluate the health benefits of individual diets such as Healthy Eating Index (HEI), Dietary Approach to Stop Hypertension (DASH), and Mediterranean diet score (Med). This study aims to determine the relationship between dominant dietary health scores with the risk of atherosclerosis in Iranian adults. Methods This case-control study was conducted on 323 patients with atherosclerosis and 334 individuals without atherosclerosis as control group. Food Frequency Questionnaire was used for obtaining dietary intakes; then HEI, DASH score, and Med score was calculated. Logistic regression models were used to calculate Odds Ratios (OR) and 95% Confidence intervals (CI) between quartiles of the HEI, DASH and Med and atherosclerosis risk. Results The results showed that total scores for HEI, DASH, and Med in control group was higher than the atherosclerosis group. The results also indicated that higher adherence to HEI (OR: 0.43; CI: [0.24, 0.76], P-trend = .006), DASH (OR: 0.48; CI: [0.3, 0.78], P-trend = .003), and Mediterranean pattern (OR: 0.4; CI: [0.21, 0.76]) decreased odds ratio of atherosclerosis. Conclusion Our findings suggest that adherence to HEI, DASH, and Mediterranean diet might be associated with a lower risk of Atherosclerosis and can have a positive effect on general health and prevention of chronic diseases in people.
... The Iberoamerican Nutrition Foundation (FINUT) has designed a 3D pyramid as a new strategy to sustain and promote a healthy, active lifestyle. The three faces include (1) food-based guidelines and healthy eating habits that are environmentally sustainable; (2) recommendations for physical activity (PA), rest, education, and social and cultural issues; and (3) guidelines for education and hygiene chosen, which are intended for the general population of all ages and which serve as a guide for living an active, healthy lifestyle (Gil et al., 2014). ...
Full-text available
Objective: This study aims to determine the role of the family in promoting an active and healthy lifestyle for children aged 3-12 years during the COVID-19 pandemic in the Qassim region in light of Saudi Arabia's Vision 2030 program. Background: This study is important in defining the role of the family in promoting an active lifestyle for children during the COVID-19 pandemic because the family is primarily responsible for promoting a healthy lifestyle for children. Method: We evaluated responses of 320 parents completing an online survey about their children's physical health during the pandemic. Results: The results showed a low level of children's physical activity and excessive use of electronic devices. Late bedtimes were evident and defined as midnight or later. As well, however, families knew the necessary information about COVID-19 and maintained the children's preventive measures. The families were aware of the child's consumption of a healthy diet. They helped the child complete studies through distance education. The families supported the child's psychological well-being and helped them develop some entertainment plans. Conclusions: Although the family plays an important role in promoting the active and healthy lifestyle of the child, there is still a need for more awareness regarding the child's practice of physical activity, healthy sleep habits, and correct use of electronic devices. Implications: Programs should be established to increase family awareness of the guidelines of the World Health Organization and the Saudi Ministry of Health regarding the child's physical activity, sleep habits, and the use of electronic devices.
... ttività motoria e nutrizione (14), due pilastri dell'evoluzione dell'essere umano, non sono usati con consapevolezza, come veri e propri farmaci naturali, ma sono diventati, sorprendentemente, un potenziale nemico dell'uomo. L'uomo moderno vive in un ambiente che ha esplicitamente progettato e disegnato per eliminare il lavoro fisico quanto più possibile. ...
Full-text available
Over the past three centuries, the effects of humans on the global environment have increased. It seems appropriate to assign the term “Anthropocene” to the current geological epoch, which is in many ways dominated by humans. The Anthropocene can be said to have begun in the latter part of the 18th century, when analyses of air trapped in polar ice showed the beginning of the rise in global concentrations of carbon dioxide and methane. This date also coincides with the design of the steam engine by James Watt in 1784. In particular, the 21st century witnessed an unforeseen but predictable resurgence of infectious diseases, not least the COVID-19 pandemic, which had a devastating impact on lives and livelihoods worldwide. The 2003 severe acute respiratory syndrome coronavirus outbreak, the 2009 swine flu pandemic, the 2012 Middle East respiratory syndrome coronavirus outbreak, and the 2013-2016 Ebola virus outbreak in West Africa all caused significant morbidity and mortality as they spread through the global village across borders to infect people in multiple countries. In the last 70 years, the speed at which human habits have changed through technological, demographic and climatic changes is unprecedented: airline flights have doubled since 2000, more people live in urban than rural areas since 2007, climate change poses a growing threat to society, and humans have stopped following the high road shown by nature with proper nutrition and regular exercise. In this review, we consider the extent to which these recent global changes have increased the risk of infectious disease outbreaks, even though improved sanitation and access to health care have led to significant progress worldwide.
... I contenuti nutritivi della nostra alimentazione determinano la composizione delle nostre cellule, dei nostri tessuti, dei nostri organi e sono addirittura in grado di influenzare il nostro comportamento ed il nostro genoma. 1,2 Anche il cibo, come l'essere umano, ha subito modifiche nel tempo; tuttavia, negli ultimi 60-70 anni più che di evoluzione dobbiamo parlare di una vera e propria trasformazione. 3 L'avvento dell'industrializzazione nel campo alimentare ha portato modifiche molto profonde, mai verificatesi prima, con la creazione, per motivi di business, di alimenti trasformati, fatti cioè con ingredienti molto lontani dal prodotto naturale. ...
Full-text available
Our physical and mental well-being are directly linked to what we eat and drink. The nutritional content of what we eat determines the composition of our cell membranes, bone marrow, blood, hormones, tissues, organs, skin, and hair. Lifestyle and nutrition of the humankind has undergone substantial changes during the last century. Additives and processed food have become the basis of our nutrition. Ingredients such as salt, sugar and fat are sometimes added to processed foods to make their flavour more appealing and to extend their shelf life. When the processed food industry discovered that these ingredients could be formulated to produce a state of satiety, pleasure, and sensory hedonia in those who consumed them, it extended their use to the “bliss point”, the point where the levels of saltiness, sweetness, and richness were perceived by the consumer as just right. Such modified foods can dysregulate the brain’s food reward system by increasing dopamine production, thus making the foods addictive. It is not easy to avoid these foods: the only way is to eat mainly fresh or only lightly processed foods (such as canned tomatoes and frozen vegetables). It is helpful to know which foods are healthy and what you can do to ensure you eat the healthiest diet you can. Combining a variety of foods, eating regular meals, including wholegrains, fibres, fruit, vegetables and “healthy fats”, and limiting the amount of sugar, salt and fat you eat are all recommended for good nutrition. (Healthy_habits)
... According to recommendations by the Pyramid of Healthy Nutrition and Physical Activity (Gil et al., 2014), grains and grain-based products are most frequently recommended and consumed immediately after fruit and vegetables. They not only enrich food with indispensable, energy providing nutrients, but also with vitamins, minerals, fiber and native antioxidants, as well as other health promoting substances (Ragaee et al., 2012). ...
Background. One of the requirements for proper nutrition and maintenance of good health is to supply the body, through diet, with an appropriately increased quantity of bioactive compounds. With this in mind, modern milling and baking industries keep introducing new types of products. The use of such additives as wholegrain flours and bran in baked products provided the basis for research in this paper. Materials and methods. The aim of the study was to conduct a qualitative and quantitative evaluation of marketable wheat, barley and oat grain, used as raw materials to produce dehulled kernels, ground grain, wholemeal flour and wheat flour type 550 (all-purpose or plain flour), as well as wheat bran. Additionally, analyses were performed to determine the chemical composition and contents of nutrients, selected bioactive compounds and antioxidant activity. Results. The studied raw materials in commercial cereal differ in their chemical composition. Dehulling of wheat, barley and oat grains significantly contributed to the reduction of minerals, protein and total dietary fiber (TDF) contents, except for the amount of protein in dehulled wheat and oat grains. Oat bran, in contrast to other oat products, was characterized by the highest contents of minerals, protein, TDF, and the smallest amounts of saccharides and total starch. The lowest content of minerals was recorded in wheat flour type 550. Thermal processes affect the concentration of tocochromanols in the grain, with tocotrienols being more resistant to hydrothermal treatment than tocopherols. Grain dehulling also significantly decreased the total amount of tocochromanols in relation to the original grains. Conclusion. Wheat products differ in the contents of their individual components. They are characterized by high contents of tocochromanols, phenolic compounds and water-extractable arabinoxylans, with the exception of white refined wheat flour, which is mainly a source of saccharides. In the case of barley and oat products, the analysis showed no differences between these product groups. It was also shown that dehulling of barley and oat grain causes statistically significant differences in the contents of nutrients and natural antioxidants.
El cumplimento de las Guías Alimentarias Basadas en Alimentos (GABA) vigentes en Chile, asegura una alimentación suficiente y equilibrada. Objetivo: Determinar el cumplimiento de 5 recomendaciones de las GABA y su asociación con variables antropométricas, de estilo de vida y metabólicas, en adolescentes que participaron en la Encuesta Nacional de Salud 2016-2017. Sujetos y Método: Estudio transversal que incluyó 355 adolescentes entre 15 a 19 años. Los participantes se dividieron en 4 grupos (cumple ninguna, 1, 2 o ≥ 3 recomendaciones) utilizando 5 mensajes de las GABA (consumo de leguminosas, pescado, lácteos, frutas y verduras y agua). Las asociaciones entre GABA y las variables de salida: peso corporal, índice de masa corporal, perímetro de cintura, actividad física, horas de sueño, variables metabólicas, fueron investigados utilizando análisis de regresión lineal ajustado por variables sociodemográficas. Resultados: El 5,6% de adolescentes cumplían con tres o más recomendaciones GABA. De las recomendaciones medidas, presentaron un mayor cumplimiento el consumo de agua (85%) y legumbres (78,7%), reconociendo diferencias entre mujeres y hombres para el consumo de legumbres (58,6% vs. 86,4%), agua (69,6% vs. 91%) y lácteos (92,9% vs. 39,1%). Los adolescentes con mayor cumplimiento de las GABA, presentaban una menor glicemia (p = 0,025). No se identificaron otras asociaciones significativas en estilos de vida y mediciones antropométricas. Conclusiones: Los adolescentes participantes en este estudio presentaron dificultades en la adhesión a recomendaciones de las GABA.
Food-based dietary guidelines (FBDGs) have been developed to promote healthy diets and prevent chronic diseases. However, the methodological quality of Spanish FBDGs has not been systematically assessed yet. The objective of this review is to identify and assess the methodological quality of Spanish FBDGs, as well as to describe their food guides and key recommendations. We conducted a systematic search to identify Spanish FBDGs targeted at the general population using multiple sources. Two authors independently screened the references, extracted data, and assessed the quality of the FBDGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Recommendation Excellence (AGREE-REX) instruments. We performed a descriptive analysis of the FBDGs. We included 19 FBDGs, published between 2007 and 2019. The median scores for each AGREE II domain were: “scope and purpose” 44% (Q1–Q3: 33–61%); “Stakeholder involvement” 31% (11–44%), “rigor of development” 3% (1–14%); “clarity of presentation” 42% (33–47%), “applicability” 0% (0–6%); and “editorial independence” 0% (0–8%). Six FBDGs (32%; 6/19) were categorized as “recommended with modifications”, and the rest (68%; 13/19) as “not recommended”. None of the FBDGs scored ≥60% in three or more domains, including the “rigor of development” domain. FBDGs indexed in literature databases scored significantly higher in overall rating than those not indexed (P = 0.023). The majority of FBDGs (74%; 14/19) used the pyramid as a food guide representation with a larger number of food levels (3–7 levels). The majority of FBDGs recommended a daily intake of cereals and grains, vegetables, fruits, olive oil and dairy products; a weekly intake of vegetable and animal proteins; and the occasional and limited intake of other food groups (e.g., ultraprocessed foods). Overall, the methodological quality of FBDGs is poor showing that only 32% of FBDGs are “recommended for use with modifications”. Our results highlight the need to revise, systematize and improve FBDG development processes in Spain.
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A few observational studies have found an inverse association between adherence to a Mediterranean diet and the risk of depression. Randomized trials with an intervention based on this dietary pattern could provide the most definitive answer to the findings reported by observational studies. The aim of this study was to compare in a randomized trial the effects of two Mediterranean diets versus a low-fat diet on depression risk after at least 3 years of intervention. This was a multicenter, randomized, primary prevention field trial of cardiovascular disease (Prevención con Dieta Mediterránea (PREDIMED Study)) based on community-dwelling men aged 55 to 80 years and women aged 60 to 80 years at high risk of cardiovascular disease (51% of them had type 2 diabetes; DM2) attending primary care centers affiliated with 11 Spanish teaching hospitals. Primary analyses were performed on an intention-to-treat basis. Cox regression models were used to assess the relationship between the nutritional intervention groups and the incidence of depression. We identified 224 new cases of depression during follow-up. There was an inverse association with depression for participants assigned to a Mediterranean diet supplemented with nuts (multivariate hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.55 to 1.10) compared with participants assigned to the control group, although this was not significant. However, when the analysis was restricted to participants with DM2, the magnitude of the effect of the intervention with the Mediterranean diet supplemented with nuts did reach statistical significance (multivariate HR = 0.59; 95% CI 0.36 to 0.98). The result suggest that a Mediterranean diet supplemented with nuts could exert a beneficial effect on the risk of depression in patients with DM2. This trial has been registered in the Current Controlled Trials with the number ISRCTN 35739639.
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My life in low-cost sanitation and low-cost wastewater treatment and the use of treated wastewater in agriculture and aquaculture really has been ‘pits, pipes and ponds’ – ‘pits’ are low-cost sanitation technologies (LCST) such as VIP latrines and pour-flush toilets; ‘pipes’ are low-cost sewerage, principally condominial (simplified) sewerage; and ‘ponds’ are low-cost wastewater treatment systems, especially waste stabilization ponds, and the use of treated wastewater in agriculture and aquaculture. ‘Pits’ were mainly working on World Bank LCST research projects, with fieldwork principally in Zimbabwe, ‘pipes’ were working on condominial sewerage projects in Brazil and disseminating this LCST to a wider global audience, and ‘ponds’ were waste stabilization ponds, with fieldwork mainly in Brazil, Colombia, Portugal and the United Kingdom, the development of aerated rock filters to polish facultative-pond effluents, and the human-health aspects of treated wastewater use in agriculture and aquaculture, with fieldwork in Brazil and the UK, and the application of quantitative microbial risk analysis. The paper provides a professional perspective and lessons from historical developments and gives recommended future directions based on my career working on low-cost sanitation technologies and treated wastewater use in agriculture and aquaculture.
WHO developed the Global Recommendations on Physical Activity for Health with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of NCDs. The recommendations set out in this document address three age groups: 5-17 years old; 18-64 years old; and 65 years old and above. The section below includes the recommendations for each age group. For further information click below and download the complete document or click on the individual age groups for specific recommendations.
The Dietary Approaches to Stop Hypertension trial was a randomized, multicenter, controlled feeding study to compare the effect on blood pressure of 3 dietary patterns: control, fruits and vegetables, and combination diets. The patterns differed in selected nutrients hypothesized to alter blood pressure. This article examines the food-group structure and nutrient composition of the study diets and reports participant nutrient consumption during intervention. Participants consumed the control dietary pattern during a 3-week run-in period. They were then randomized either to continue on the control diet or to change to the fruits and vegetables or the combination diet for 8 weeks. Sodium intake and body weight were constant during the entire feeding period. Analysis of variance models compared the nutrient content of the 3 diets. Targeting a few nutrients thought to influence blood pressure resulted in diets that were profoundly different in their food-group and nutrient composition. The control and fruits and vegetables diets contained more oils, table fats, salad dressings, and red meats and were higher in saturated fat, total fat, and cholesterol than was the combination diet. The fruits and vegetables and combination diets contained relatively more servings of fruits, juices, vegetables, and nuts/seeds, and were higher in magnesium, potassium, and fiber than was the control diet. Both the fruits and vegetables and combination diets were low in sweets and sugar-containing drinks. The combination diet contained a greater variety of fruits, and its high calcium content was obtained by increasing low-fat dairy products. In addition, the distinct food grouping pattern across the 3 diets resulted in substantial differences in the levels of vitamins A, C, E, folate, B-6, and zinc. J Am Diet Assoc. 1999;99(suppl):S19–S27.