Dietary total antioxidant capacity is inversely related to central adiposity as well as to metabolic and oxidative stress markers in healthy young adults
Nutrition & Metabolism
Dietary total antioxidant capacity is inversely related to central adiposity as well as to metabolic and oxidative stress markers in healthy young adults
Helen Hermana M Hermsdorff 0
Blanca Puchau 0
Ana Carolina P Volp 2
Kiriaque BF Barbosa 1
Josefina Bressan 3
M ngeles Zulet 0
J Alfredo Martnez 0
0 Department of Nutrition, Food Science, Physiology and Toxicology, University of Navarra. Pamplona , Spain
1 Nutrition Center, Federal University of Sergipe , Aracaju , Brazil
2 Department of Clinical and Social Nutrition, Federal University of Ouro Preto , Ouro Preto , Brazil
3 Department of Nutrition and Health, Federal University of Vicosa. Vicosa , Brazil
Background: Dietary total antioxidant capacity (TAC) has been assumed as a useful tool to assess the relationship between the cumulative antioxidant food capacity and several chronic disorders. The aim of this cross-sectional study was to investigate the potential relationships of dietary TAC with adiposity, metabolic and oxidative stress markers in healthy young adults. Methods: This study enrolled 266 healthy subjects (105 men/ 161 women; 22 3 years-old; 22.0 2.7 kg/m2). Dietary intake, anthropometry, blood pressure, lifestyle features, and biochemical data were assessed with validated procedures. Results: In linear regression analyses, dietary TAC values were inversely associated with glycemia, total cholesterol: HDL-c ratio, triglycerides and oxidized-LDL concentrations, and positively associated with HDL-c concentrations, independently of gender, age, smoking status, physical activity, vitamin use supplement, waist circumference, energy intake, fatty acid intake. In addition, plasma TAC was negatively correlated with ox-LDL concentrations (r= -0.20, P = 0.003), independently of the assessed confounding variables. Finally, dietary TAC values were inversely related to waist circumference values (r= -0.17, P = 0.005) as well as to lower mild central obesity occurrence (waist circumference 80/ 94 cm for women/ men, respectively). Conclusion: Dietary TAC values are inversely associated with glucose and lipid biomarkers as well as with central adiposity measurements in healthy young adults, indicating dietary TAC as a useful tool to assess the health benefits of cumulative antioxidant capacity from food intake. In addition, the independent and inverse relationships of ox-LDL concentrations with dietary and plasma TAC respectively suggest a putative role of antioxidant rich-diet in the link between redox state and atherogenesis at early stage.
Antioxidants; Central obesity; ox-LDL; Oxidative stress; Arteriosclerosis
Dyslipidemias and insulin resistance constitute major
risk factors of cardiovascular diseases (CVD) and
related-features . Furthermore, oxidative stress
impairment or altered antioxidant status have been
suggested as pivotal keys in the onset of certain chronic
diseases such as metabolic syndrome (MS), type 2
diabetes and CVD [2,3]. In this sense, oxidized low-density
lipoprotein (ox-LDL), a recognized oxidative stress
marker, has been positively associated with central obesity
, metabolic syndrome manifestations  and
subclinical atherosclerosis .
In turn, dietary total antioxidant capacity (TAC) has
been assessed in order to altogether capture synergic
antioxidant/redox activities of single antioxidant
compounds from diet . Despite some authors have
debated about the applicability of the extrapolation of
dietary TAC data to its antioxidant contribution in vivo
[8,9], this dietary index has been a relevant tool in
epidemiological studies [10,11]. In this sense, increased
dietary TAC has been associated with higher diet quality
scores  as well as with improved values concerning
glucose metabolism  and inflammatory status
[14,15] in middle-aged people. In addition, dietary TAC
has been recently associated with a lower risk for
ischemic stroke in Italian cohort . However, the
relationship of dietary TAC with biomarkers has been only
modestly investigated in young adult people [17,18],
which is of great interest to provide new light for early
an association of overall antioxidant intake with
metabolic and oxidative biomarkers in vivo. Indeed, the
association between this dietary TAC and ox-LDL
concentrations has not been apparently reported.
Overall, the present study assessed the potential
association of dietary TAC with adiposity as well as with
metabolic and oxidative stress markers in healthy young
adults with emphasis on plasma ox-LDL concentrations,
as a relevant oxidative stress marker and an
Subjects and Methods
Participants of the current research were involved in a
study of Interuniversity Cooperation between the
Federal University of Viosa (Brazil, CAPES-MECD-DGU
109/06) and the University of Navarra (Spain,
PHB2005-0119-PC). Thus, a group of 266 subjects from
Brazil (57 men and 66 women) and Spain (48 men and 95
women), with a mean age of 22 3 years-old (range:
18-35 years) and a mean body mass index (BMI) of 22.0
2.7 (range: 18.5-34.9 kg/m2), were enrolled in this
The volunteers were recruited through magazines,
radio, web page, and intranet tools at both Universities.
In the enrollement message, the age range (18-35 years
old) was mentioned as well as relevant clinical
information for those interested in participating in this
crosssectional nutritional study. Exclusion criteria were any
diagnosed organic underlying disease (gastrointestinal,
kidney, liver, respiratory or heart disease), cancer,
infectious and inflammatory disorders, diabetes (fasting
glucose level > 126 mg/dl), hypertension (systolic and
diastolic blood pressure values 140 and 90 mmHg,
respectively), pregnancy, disorders affecting body
composition (e.g. lipodystrophy and Cushing syndrome) or
blood lipid-lowering treatments. Other exclusion criteria
were recent follow up of diets designed for weight loss
or unstable weight in the past 3 months. The present
study was conducted according to the guidelines laid
down in the Declaration of Helsinki and all procedures
involving human subjects/patients were approved by the
appropriate human research review boards at each
location: Ethics Committee in Human Research of the
Federal University of Viosa (ref. n 009/2006) and
Investigation Ethics Committee of the Clnica
Universidad de Navarra (ref. n 79/2005). Written informed
consent was obtained from all the subjects/patients.
Dietary intake assessment
In the Brazilian sample, dietary intake information was
obtained by a 3 day-record. Daily food consumption was
estimated as a 3d-mean of portion size for each
consumed food item, considering in addition to preparation
(crude or cooked), and edible portions. Nutrient intake
was estimated using the Diet Pro 5i software (AS Siste
mas, Viosa, Brazil), adapted with the latest available
information from the food composition tables for Brazil
[19,20]. In the Spanish sample, dietary intake
information was obtained by a semi-quantitative food frequency
questionnaire with 136 food-items, which is validated
for Spanish people [21,22]. Daily food consumption was
estimated as frequency portion size for each
consumed food item. Nutrient intake was estimated using
an ad hoc computer program specifically developed for
this aim, which displays the latest available information
included in the food composition tables for Spain
Furthermore, dietary TAC from dietary intake
information, expressed as mmol (of Trolox equivalent)/d,
was calculated by a proxy estimation previously
validated to the 3 day-record as well as for the
food-frequency questionnaire .
Clinical and biochemical assessments
Anthropometric determinations were taken using
standard measurement procedures, in accordance to
previously described protocols  as agreed by both
universities participating in the study. Thus, BMI was
calculated by the ratio between weight (kg) and the
squared height (m2), which was applied to categorize
normal-weight (18.5-24.9 kg/m2), overweight (25-29.9
kg/m2), and obese (BMI 30 kg/m2) subjects, according
to the World Health Organization criteria . Waist
circumference was used as a central adiposity indicator,
considering values higher than 80 and 94 cm for women
and men, respectively, as an indicator of mild central
obesity. Systolic and diastolic blood pressures were
measured following World Health Organization guidelines
Venous blood samples were drawn after a 12 h
overnight fast by venipuncture. The EDTA-plasma and
serum samples were separated from whole blood by
centrifugation (2,205 g 15 min at 4C) and were frozen
immediately at -80C until assay. Serum concentrations
of triglycerides, total cholesterol (TC), high density
lipoprotein-cholesterol (HDL-c), glucose and insulin were
measured by standard methods as previously described
[17,25]. Serum low-density lipoprotein-cholesterol
(LDLc) and insulin resistance as HOMA-IR were calculated
as described by Friedewald et al.  and Matthews et
al.  equations, respectively. TC:HDL-c and LDL-c:
HDL-c ratios also were calculated, since they are
independent predictors of the risk for CVD [30,31].
Hypercholesterolaemia was considered as a total
cholesterol concentration 200 mg/dl . Plasma ox-LDL was
measured using ELISA kits from Mercodia (Uppsala,
Sweden), based on the mouse monoclonal antibody 4E6,
which is directed against a conformational epitope in
oxidized ApoB-100 [32,33]. Finally, plasma TAC was
determined using a commercial colorimetric kit
(Cayman Chemical Corporation, Ann Arbor, USA), based on
the inhibition the oxidation of ABTS
(2,2-Azino-di-[3ethylbenzthiazoline sulphonate]) to ABTS+, which is
subsequently quantified as mmol Trolox equivalent
Other variable assessment
For lifestyle variables, the participants were asked about
their smoking status (never, former, or current smokers)
and about vitamin supplement use (Yes/No). With
respect to physical activity, the participants declared
whether they took regular physical activity (Yes/No),
and if so, the type and the volume of activity (h/week).
To quantify the volume of activity, a metabolic
equivalent (MET) index was also computed by assigning a
multiple of resting metabolic rate (MET score) to each
activity , followed by the sum over all activities to
obtain a value of overall weekly MET/h as described
Results are shown as mean standard deviations (SD)
or median (interquartile interval), depending on the
variable distribution as determined by the Shapiro-Wilk
test. Non-normally distributed variables were
log-transformed before statistical analyses. Dietary intakes were
adjusted for the daily energy intake, while biochemical
variables, when considered outcomes, were adjusted for
study center, both by the residuals method, applying
separate models among women and men . To assess
the associations of dietary TAC values with
anthropometric, clinical and lifestyle characteristics of the
participants, we categorized the participants by tertiles of this
specific dietary index. Linear trends were assessed by
assigning the median value to each tertile of dietary
TAC and modeling these values as a continuous
variable. Comparisons between three groups were
performed by chi-square tests (categorical variables) or by
one-factor ANOVA tests (continuous variables), while
the post hoc Bonferroni test was used to correct the
impact of multiple comparisons.
Moreover, b-coefficients and 95% confidence intervals
(CIs) were calculated in multivariate linear regression
models to assess the association of dietary TAC values
(independent continuous variable) with the investigated
glucose and lipid biomarkers (dependent variables).
Linear regression models were controlled by gender, age
(years), waist circumference (cm), daily energy intake
(kcal/d), physical activity during leisure time
(METshour per week), smoking status (never, former and
current smokers), vitamin supplement use (Yes/ No), and
monounsaturated (MUFA): saturated fatty acid (SFA)
ratio intake, since these variables were considered
potential confounding factors. In addition, partial
correlations were established to evaluate the potential
relations between dietary TAC, plasma TAC and ox-LDL
concentrations as well as potential links between dietary
TAC and waist circumference as a central adiposity
Furthermore, we used stepwise multiple regressions
 to identify the variability impact of the consumed
food-items concerning dietary TAC values of the
participants of this study. Statistical analyses were performed
with SPSS 15.0 software (SPSS Inc., Chicago, IL, USA)
for Windows XP (Microsoft, USA). A P-value < 0.05
was considered as statistically significant.
Anthropometric, clinical and lifestyle characteristics
were examined by tertiles of dietary TAC values
(Table 1). Thus, those subjects included in the highest
tertile were older subjects, had lower values for diastolic
blood pressure and higher values for physical activity
counts (METs), while reported higher vitamin
supplement use as compared with those of the lowest tertile
(P < 0.05). In addition, the participants included in the
last tertile of dietary TAC consumption had significantly
lower waist circumference values as well as lower
occurrence of mild central obesity (as waist circumference
80 and 94 cm for women and men, respectively).
Indeed, dietary TAC values were negatively and
significantly correlated (r = -0.17, P < 0.05) with waist
circumference values in the partial correlation adjusted for
gender (Figure 1).
Moreover, those participants who were included in the
third tertile of dietary TAC presented higher
consumption of olive oil, fruits, vegetables, fruit juices, fish, coffee
and red wine as well as higher intake values of protein,
lipids, monounsaturated fatty acid (MUFA), and dietary
fiber, while lower intake values for saturated fatty acid
(SFA) were found as compared with subjects in the
lowest tertile (Table 2). In addition, the food-groups
32 (18;59)e 40 (20; 85)
consumed by the participants with higher contribution
to dietary TAC values were vegetables, fruits and fruit
juices (R2 = 0.69). Other important contributing food
items, such as olive oil, coffee, fish, and legumes,
explained altogether 22% of total variability in dietary
TAC. Fruits and vegetables remained as the highest
contributors to dietary TAC when the analysis was
performed by study center (data not shown).
Regarding the association between dietary TAC and
glucose profile, dietary TAC values were inversely
associated with glycemia and HOMA-IR (P < 0.05),
independently of gender, age, waist circumference, smoking
habit, physical activity counts, vitamin supplement use
(Table 3). Furthermore, higher dietary TAC values were
statistically associated with lower values to TC
concentrations, TC:HDL-c ratio, ox-LDL and triglycerides
Figure 1 Association between dietary TAC and waist
circumference values. P-value from partial correlation, adjusted for
gender (n = 266).
concentrations as well as with higher values to HDL-c
concentrations, independently of the same covariates
(Table 3). Interestingly, similar outcomes are found
when waist circumference (cm) was substituted by BMI
Table 2 Food and nutrients consumption, according to
tertiles (T) of energy-adjusted dietary TAC (n = 266)
Energy-adj. dietary TAC (mmol/d)
T1 (< 1.6) T2 (1.6-5.9) T3 ( 5.9) P-valuea
Participants (n) 86 90 90
Energy intake (kcal) 2758 699 2540 922 2785 855 0.108
Carbohydrate (% EI) 50.5 7.9b,c 47.3 8.4 d 44.5 8.0 < 0.001
Protein (%EI) 15.0 2.5 b,c 16.5 2.7 d 17.5 2.6 < 0.001
Lipids (%EI) 33.3 6.0 b,c 36.1 6.1 36.9 6.0 0.002
MUFA (%EI) 6.3 4.2b,c 12.4 6.2d 15.7 4.5 0.001
PUFA (%EI) 4.6 2.1c 5.5 2.7 5.4 1.9 0.017
SFA (%EI) 12.2 3.6 b,c 10.6 4.0d 9.1 3.8 0.003
Dietary fiber (g/d) 24.2 13.2 b 25.3 15.0 29.6 12.7 0.023
Olive oil (ml/d) 4 16 b,c 19 27 d 39 33 < 0.001
Fruits (g/d) 154 120 b,c 245 190d 393 300 < 0.001
Vegetables (g/d) 94 68 b,c 253 211d 572 395 < 0.001
Fruit juice (ml/d) 67 95b 91 122 169 233 < 0.001
Cereals (g/d) 145 114 167 104 177 83 0.103
Legumes (g/d) 29 20 28 31 20 13 0.127
Red meats (g/d) 99 67 96 54 84 61 0.214
Fish (g/d) 16 43 b,c 41 52 d 93 63 < 0.001
Nuts (g/d) 8 10 7 8 15 32 0.281
Coffee (ml/d) 38 63b 59 82 68 84 0.028
Beer (ml/d) 31 62 31 49 58 107 0.069
Red wine (ml/d) 6 5b 7 4d 50 18 0.009
aP-value from one-factor ANOVA test.
bP < 0.05, T1 vs. T3; cP < 0.05, T1 vs. T2; dP < 0.05, T2 vs. T3, from the post hoc
Bonferroni test for multiple comparisons.
dietary TAC, dietary total antioxidant capacity; EI, energy intake; MUFA, monounsaturated
fatty acid; PUFA, polyunsaturated fatty acid; SFA, saturated fatty acid.
Table 3 Association of dietary TAC values (as independent variable) and glucose and lipid profile (as dependent
variables) in the participants of the study (n = 266)
Energy-adj. dietary TAC (mmol/d) as independent variable
Model 1b Model 2b
aNon-normally distributed variables were log-transformed before regression analyses and, adjusted for study center by residual method.
bModel 1: multivariate linear regression adjusted for gender, age (years), waist circumference (cm), daily energy intake (kcal/d), smoking habit (never or smoker/
former), METs (h/week), and vitamin supplement use (Yes/ No). Model 2: multivariate linear regression adjusted for as model 1 plus MUFA: SFA ratio intake.
cData are b-coefficient (95% Confidence Interval). Bold style to significant associations.
dn = 224, for this variable.
TAC, total antioxidant capacity; HOMA-IR, insulin resistance index; TC, total cholesterol; HDL-c, high density lipoprotein-cholesterol; LDL-c, low density
lipoproteincholesterol; ox-LDL, oxidized low density protein cholesterol; TG, triglycerides.
(kg/m2) or by mild central obesity occurrence, as
categorical covariate (data not shown).
Since dietary fatty acids have been related to
atherogenesis and CVD, linear regression models were also
adjusted for MUFA:SFA ratio. In this case, the
associations of dietary TAC values with glycemia, TC:HDL-c
ratio, HDL-c, ox-LDL and triglycerides concentrations
maintained the trend and the statistical significance,
while its associations with insulin, HOMA-IR, and TC
lost the statistical significance (Table 3). For this reason,
the interaction between dietary TAC and MUFA:SFA
ratio was tested, but any statistical interplay was found
(P > 0.05).
Finally, dietary TAC values were positively related with
plasma TAC concentrations in the participants of the
study, although statistical significance was not identified
(r = 0.11, P = 0.131) in the partial correlation, adjusted
for study center, gender, age, and energy intake.
Interestingly, plasma TAC was inversely correlated with ox-LDL
concentrations (r= -0.20, P = 0.003), independently of the
study center, gender, age, energy intake, waist
circumference and LDL-c concentrations (Figure 2).
The first relevant finding of this study was the lower
occurrence of mild central obesity in those individuals
included in the last tertile of dietary TAC, while dietary
TAC values were inversely correlated to waist
circumference values in a young population. Other studies
have reported an inverse association of the dietary TAC
and dietary antioxidants with obesity indicators, while
abdominal obesity has been associated with decreased
serum antioxidants concentrations in other age groups
[10,39-41]. Thus, in the line with existing literature, data
from our study indicate a relationship between dietary
antioxidant consumption, body fat distribution and
antioxidant status in healthy young people.
In this study, the dietary TAC was also inversely
associated with glucose biomarkers. This finding is in
agreement with other studies that have reported an inverse
relationship between dietary TAC and glucose
biomarkers in young and middle-aged subjects [13,18],
reinforcing the hypothesis of an interactive influence between
Figure 2 Association between log plasma TAC and log ox-LDL.
P-value from partial correlation, adjusted for study center, gender,
age, energy intake, waist circumference and LDL-c concentrations (n
oxidative stress, pro-inflammation and insulin resistance
In turn, the association of a higher dietary TAC with
lower values of some specific lipid biomarkers appears to
be reported apparently for the first time in the present
study. In fact, an increased consumption of
antioxidantrich foods, such as fruits, vegetables, olive oil, nuts, red
wine, seafood and legumes, has resulted in an
improvement in the lipid profile, with increased HDL-c and
decreased LDL-c and triglycerides concentrations in some
intervention trial studies [43-46]. Likewise, polyphenols
and carotenoids have the ability to reduce cholesterol
absorption, to increase cholesterol and fecal bile excretion,
to inhibit cholesterol synthesis and to stimulate the
expression and activity of the LDL receptors . Since
these compounds might contribute to dietary TAC values,
they could be related to potential hypocholesterolemic
mechanisms involving the dietary healthy index. In this
context, our findings suggest that dietary TAC is a reliable
indicator to assess the relationship of antioxidant-food
items altogether with glucose and lipid biomarkers, despite
other studies could contribute to establish molecular and
cellular mechanisms as well as its potential application in
the treatment of chronic disorders in vivo.
Other relevant outcome of this cross-sectional study,
which is also apparently reported for the first time, was
the inverse and independent association of dietary TAC
values with ox-LDL, a recognized oxidative stress
marker and independent risk factor for MS and CVD [5,6].
In fact, a high consumption of antioxidant-rich foods
might decrease oxidation in the low-density lipoprotein.
On one hand, by scavenging free radicals and by sparing
lipophilic antioxidant content of lipoproteins and, on
the other hand by increasing the plasma TAC
availability [47-50]. In this sense, the independent correlation
between plasma TAC and ox-LDL concentrations
observed in this study might explain, at least in part, the
potential effect of dietary TAC on this oxidative stress
marker. In fact, lipid-soluble antioxidants (e.g.
carotenoids) are carried in LDL; therefore, an increase in the
antioxidant-substrate could be reflected in higher LDL
resistance to oxidation .
Moreover, we had previously reported an inverse
association between dietary TAC values, plasma C-reactive
protein and gene expression of the nuclear
factorkappa-B, interleukin-1 receptor-1, interleukin-6 and
tumor necrosis factor-alpha . Since ox-LDL is able
to induce a pro-inflammatory status by the activation of
the nuclear factor-kappa-B, a redox-sensitive and
proinflammatory transcriptional factor [42,52], our previous
and current findings suggest jointly a putative role of
antioxidant rich-foods, expressed by dietary TAC values,
in the link between oxidative stress and inflammation in
which TAC and ox-LDL are likely interacting.
In turn, when MUFA:SFA ratio was included in the
linear regression models, the prediction power of dietary
TAC on glucose and lipid biomarkers was attenuated or
lost in some cases (HOMA-IR, TC and triglycerides).
This finding suggests potential synergistic actions of the
subtype of fat intake and dietary antioxidant content in
the glucose and lipid metabolism, since the replacement
of SFA to MUFA resulted in an improvement in the
lipid profile and glycemic control in other intervention
trials [43,53-55]. Likewise, since dietary TAC values
were inversely correlated to waist circumference values
in this study and, body adiposity has been positively
associated with pro-inflammatory and oxidative stress
markers [4,10,56,57], the inverse relationships of dietary
TAC values with some of the investigated biomarkers
could be biased by a lower central obesity among those
participants with higher dietary TAC values. However,
the associations between dietary TAC and the studied
markers maintained the trend and the statistical
significance regardless of the waist circumference, suggesting
that the effects of dietary TAC on glucose and lipid
profile in this study were independently from body fat
distribution. In addition, our sample presented higher
number of women (60%). The hormone estrogen
(17bestradiol in particular) has been noted to have
antioxidant and antilipidemic properties , which might
influence in the association of dietary intake with the
studied biomarkers, depending on menstrual cycle
status. However, we adjusted dietary total antioxidant by
energy in separated models for women and men and we
assessed the association of dietary TAC values with the
investigated glucose and lipid biomarkers in multivariate
linear regression models controlled by gender. Thus, our
main study outcomes should be independent from
gender and sex-hormonal effect. Moreover, estradiol
concentrations have not been able to modify the oxidative
and inflammation status in young women, regardless
menstrual cycle phase .
Our study had certain limitations. First, since the
nature of this study is cross-sectional, we cannot prove that
the reported associations are causal, although we
controlled for several potential covariates. Second, the use
of different dietary assessment methods (food-frequency
questionnaire and 3 day-record) by the study centers
could provide differences in the information concerning
dietary intake. However, both dietary assessment
methods were validated to assess dietary TAC with a strong
correlation between them . At the same time, both
dietary questionnaires have been successfully used to
assess the relationship of dietary TAC values from
habitual diet with biomarkers [13,14,17,18]. In addition,
major outcomes of this study maintained the statistical
significance after adjusting for study center. Finally,
although the sample size is adequate from the
standpoint of an initial association discovery, further
replication in independent and larger samples would be
convenient for a future translational application at a
In this cross-sectional study, dietary TAC values are
inversely associated with glucose and lipid biomarkers as
well as with central adiposity in healthy young adults,
indicating dietary TAC as a useful epidemiological tool
to assess to health benefits of a cumulative antioxidant
capacity from food intake. In addition, the independent
and inverse relationships of ox-LDL concentrations with
dietary and plasma TAC suggest a putative role of an
antioxidant rich-diet in the link between redox state and
atherogenesis at early stage.
BMI: body mass index; CVD: cardiovascular disease; HDL-c: high density
lipoprotein-cholesterol; MET: metabolic equivalent index; MUFA:
monounsaturated fatty acid; MS: metabolic syndrome; LDL-c: low density
lipoprotein-cholesterol; ox-LDL: oxidized low density lipoprotein; SFA:
saturated fatty acid; TAC: total antioxidant capacity; TC: total cholesterol.
We wish to thank the physician Blanca E. Martnez de Morentn, the nurse
Salom Prez, and the technician Vernica Ciaurriz as well as to the nursing
assistant Elisngela Lessa for excellent technical assistance in the University
of Navarra and Federal University of Viosa, respectively. We also thank to
The Capes Foundation - Ministry of Education of Brazil as well as to the
Ministry of Education of Spain for the supporting the interuniversity
cooperation between the Federal University of Viosa (CAPES-MECD-DGU
109/06) and the University of Navarra (PHB-2005-0119-PC). Finally, this work
was supported by the Health Department of the Government of Navarra
(22/2007), the Lnea Especial about Nutrition, Obesity and Health (University
of Navarra LE/97), and by the Foundation for Research Support of the State
of Minas Gerais (FAPEMIG- CDS 303/06).
HHMH: Design, field work, data collection, analysis, and writing of the
manuscript. BP, ACPV, and KBFB: Design, field work, and data collection. JB:
project leader in Brazil, design, financial management. MZ: project co-leader
in Spain, design, financial management. JAM: project leader in Spain, general
coordination, design, financial management, data interpretation. All authors
assisted in editing the manuscript as well as they read and approved the
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