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1 Health *wf7sos9o0y4a5fk*

2 ** Genetic predisposition study This report details the results obtained in the analysis (genotyping) of genetic variants, called polymorphisms, which are found in your DNA. It also includes a series of recommendations proposed by specialists in each area of interest. The human genome includes a multitude of polymorphisms of your genes. The genotype is the genetic information present in each person, or in other words, the information contained in their chromosomes. The genotype and the environmental factors that have an impact on DNA determine the individual characteristics of each person, namely, their phenotype. Genotyping analysis is used to determine the specific variations that exist in each person. This study is designed to select the most relevant polymorphisms for you based on many scientific publications. is not a diagnostic tool; however, it does offer information about your genetic predisposition to certain diseases or conditions. Professionals (working in medicine, nutrition, sport, etc.) can use the results obtained to help you to change certain lifestyle habits to improve your health or to attain certain objectives. The information in the report does not replace in any way medical advice or advice from other specialists. Page 3

3 ** Genes analysed and summary of the results obtained A list of the genes analysed and the genotype found in your DNA is displayed below. Your genotype is represented by two letters, corresponding to the alleles obtained for genetic variant analysed. You have inherited one of these alleles from your father and the other from your mother. Gene Your genotype Gene Your genotype WFS1 (1) GG ADRB2 (1) CG CYP2R1 (1) AG CDKN2B (1) TT GNPDA2 (1) GG LEPR (1) GG LOC (1) TT MC4R (1) GG SLC30A8 (1) CT FTO (1) CC MAF (1) CC CASR (1) AA FADS1 (1) CT MC4R (2) TT F2 (1) GG NOS3 (1) TT CYP11B2 (1) AA TNF (1) GG MTHFR (1) GG PPARG (1) CC CASR (2) GG MCM6 (1) CC HLA-DQB1 (1) CC MC4R (3) CC HLA-DQA1 (1) TT GABRA2 (1) TT DGAT2 (1) TT LPL (1) CC SLC23A1 (1) CC APOE (1) TT IGF2BP2 (1) TT HNF1B (1) GA HLA-DQB1 (2) AG HLA-DQA1 (2) TT ADD1 (1) GT MCM6 (2) GG ADRB3 (1) AA HHEX (1) CT AGTR1 (1) AA KCNJ11 (1) CT GNB3 (1) CT F5 (1) CC BCO1 (1) TT UCP2 (1) TT APOA5 (1) AA CETP (1) AG APOE (2) CC HLA-DQB1 (3) TT CYP1A2 (1) CA ETV5 (1) CT CDKAL1 (1) AG HLA-DQA1 (3) TT TCF7L2 (1) CT TCF7L2 (2) CT FTO (2) AA PPARGC1A (1) CT TMPRSS6 (1) AG RSPO3 (1) CC FTO (3) GG FTO (4) AA Page 4

4 ** Summary of the genetic results and conclusions The conclusions obtained from the results of your genetic analysis are summarised below: Study Weight gain Type 2 diabetes Type 2 diabetes and obesity Insulin resistance and its link to obesity Glucose homoeostasis High blood pressure High blood pressure and microalbuminuria are associated with diabetes. HDL cholesterol Triglycerides Obesity and cardiovascular risk Ischaemic heart disease, cardiac ischaemia or coronary disease Myocardial infarction Cardiovascular accident (stroke) Venous thrombosis Oxidative stress Pharmacogenetics - Thiazides Pharmacogenetics - Hydrochlorothiazide Pharmacogenetics - Statins Pharmacogenetics - Simvastatin Pharmacogenetics - Sulfonylureas Pharmacogenetics - Metformin + Glibenclamide Pharmacogenetics - Triptans Exercise and weight control Aerobic capacity Ability for endurance sports Appetite regulation Increased food intake Sensation of satiety Predilection for fatty foods Page 5

5 ** Study Gluten intolerance Lactose intolerance Lipids Saturated fatty acids Monounsaturated fatty acids Polyunsaturated fatty acids Omega-3 and omega-6 fatty acids Metabolism of carbohydrates Vitamin B2 (riboflavin) Vitamin B3 (niacin or nicotinic acid) Vitamin B9 (folic acid or folate) Vitamin C (ascorbic acid) Beta-carotene (provitamin A) Vitamin D (calciferol) Iron Calcium Phosphorus Magnesium Sodium Metabolism of antioxidant substances Metabolism of caffeine Alcohol dependency Interpretation of results and recommendations The following sections describe the various aspects studied, as well as the risk/benefit results stemming from the analysis of genetic variants presented in this study. These results should always be considered with respect to averages for the general population, although this inherently presents certain risks/benefits. Page 6

6 ** Obesity According to the World Health Organization (WHO), overweight and obesity are defined as an abnormal accumulation of fat that poses a risk to health, mainly due to an energy imbalance between the calories consumed and those expended. An imbalance resulting from the increased consumption of food with a high calorie content and a decrease in physical activity. Body mass index (BMI) is a simple indicator of weight-for-height that is commonly used to classify overweight and obesity in adults. To calculate it, a person's weight (in kg) is divided by the square height (in m), using the following formula: BMI = kg/m². If overweight, the BMI is a value equal to or greater than 25 and, in case of obesity, is equal to or greater than 30. Obesity may also be caused by some genetic syndromes, certain endocrine disorders (such as hypothyroidism) and certain medications (anti-psychotics, antidepressants, hypoglycaemic drugs, etc.). Overweight and obesity are risk factors for diseases such as diabetes, cardiovascular diseases, metabolic syndromes, some types of cancer, musculoskeletal disorders (such as osteoarthritis), sleep disorders, among others. This risk will increase with weight gain. Weight gain People become overweight and obese due to an increase in the size and number of fat cells (adipocytes) in the body due to an imbalance between the calories consumed and those expended. Healthcare professionals use, among other tools, a body mass index (BMI) calculation and the measurement of waist circumference to detect and diagnose overweight and obesity. Some of the most relevant factors causing weight gain, with the resulting risk of becoming overweight or obese are: unhealthy eating habits (such as eating too many calories, too much saturated-fat and trans-fat, or foods with a high-sugar content), lack of exercise, lack of sleep, high stress levels, age, gender, genetics and family history. No increased risk of weight gain. Page 7

7 ** Diabetes It is a disease in which the body is unable to regulate blood glucose levels. It occurs when the pancreas is unable to produce sufficient quantities of insulin or when the body cannot use insulin effectively. It is a chronic and serious disease. There are three main types of diabetes: type 1, type 2 and gestational diabetes. This study only analyses the genetic predisposition to type 2 diabetes. To summarise, it can be said that: Type 1 diabetes (also called insulin-dependent) diabetes is an autoimmune disease in which the body s defence system attacks insulin-producing cells, so they are unable to produce the hormone or produce it in insufficient quantities. It can occur at any stage of life, but it is more common in children and young people. People affected will need to take periodic injections of insulin for life. Type 2 diabetes (is detailed in the next section). Gestational diabetes develops in pregnant women and can cause complications for both the mother and the foetus. It usually disappears after birth; however, both the mother and the baby will have an increased risk of developing type 2 diabetes at any time during their lives. Type 2 diabetes It is the most common form of diabetes, accounting for approximately 90% of cases of the disease. It is characterised by the development of insulin resistance and by a relative deficiency of insulin (both situations may occur simultaneously or separately), which triggers hyperglycaemia (increased levels of blood glucose). Type 2 diabetes can develop at any age; however, it is most common in adulthood. Eating processed foods (which often are high in fat or refined carbohydrates and sugary drinks), having a sedentary lifestyle and low levels of physical activity, increase the risk of being overweight or obese and, consequently, of developing type 2 diabetes. Patients may have no symptoms for several years. Some of the symptoms include: increased need to pass urine (polyuria), increased thirst (polydipsia), increased hunger (polyphagia), unexplained weight loss, numbness in the extremities, foot pain, blurred vision, infections, among others. Some of the risk factors associated with this type of diabetes are: unhealthy diet, overweight or obesity, lack of physical activity, high blood pressure, blood cholesterol levels outside the normal range, elderly age and history of gestational diabetes. It is a complex disorder caused by mutations in multiple genes and environmental factors. Some of the complications associated with type 2 diabetes are cardiovascular diseases, eye and nerve damage, kidney failure, etc. Page 8

8 ** Moderate risk of developing type 2 diabetes. Recommendations It is important to pay attention to possible symptoms of hyperglycaemia and have regular check-ups. To prevent this disease, it is advisable to do regular physical exercise, eat a healthy diet, check your blood pressure and lipid profile (cholesterol, triglycerides, etc.) and refrain from smoking. The ideal is to promote a correct lifestyle from childhood - the age when eating and physical exercise habits are formed - and correctly regulate the energy balance, as achieving such a balance will reduce the risk of developing type 2 diabetes in later life. When medication is required, it must be prescribed and supervised by a doctor. Type 2 diabetes and obesity Type 2 diabetes mostly affects people who are obese (especially those with abdominal obesity). The level of obesity proportionally increases the risk of developing type 2 diabetes. Moderate risk of developing type 2 diabetes in people with obesity. Recommendations It is important to maintain a healthy body weight in relation to your height and age to reduce the risk of developing type 2 diabetes. It is important to follow a healthy diet and do regular physical activity. Insulin resistance and its link to obesity Resistance to insulin (also called insulin resistance) is characterised by a decrease in the ability of this hormone to perform its normal physiological functions. It tends to precede the development of type 2 diabetes and is associated with being overweight or obese. In the beginning, insulin resistance is compensated thanks to an increase in the secretion of insulin to maintain glucose levels in the blood, so it is difficult to detect it. Type 2 diabetes is associated with obesity, low levels of physical activity and a poor diet. It almost always includes insulin resistance. Page 9

9 ** No increased risk of having insulin resistance associated with obesity. Glucose homoeostasis Glucose homoeostasis maintains blood glucose levels within an appropriate range. It depends on two processes: firstly, the body's ability to transport glucose (after ingesting food) from the blood to tissues to produce energy or for storage purposes (insulin-dependent process); and, secondly, the body s ability to access these glucose stores (in the liver, muscle and fat) and transport it back to the bloodstream (during fasting periods). Similar ability to that of the general population to improve glucose homoeostasis when doing regular physical exercise. High blood pressure and microalbuminuria are associated with diabetes. Microalbuminuria means an increased rate of albumin excreted in the urine. Microalbuminuria in diabetics is an early indicator of kidney disease and an increased risk of cardiovascular complications. Several factors can influence the levels of albumin excreted in the urine. Some of these include: a diet rich in protein, physical exercise, urinary tract infections and high blood pressure. Risk of high blood pressure and microalbuminuria in diabetics similar to the general population. Page 10

10 ** Cardiovascular risk Cardiovascular diseases are one of the most important causes of disability and premature death worldwide. Atherosclerosis is the most common cause for these diseases; it develops over years and symptoms usually appear in middle age. Coronary episodes (such as myocardial infarction) and cerebrovascular events occur suddenly. It is possible to reduce the risk of such episodes (and therefore premature death) by modifying the risk factors. The main risk factors include: age, gender (the risk is higher in men than in women), a family history of such diseases, being overweight or obese, having high blood pressure, hyperlipidaemia, type 2 diabetes, an unhealthy diet, lack of physical activity and consumption of tobacco and alcohol. High blood pressure Blood circulates throughout the body through the blood vessels. Blood pressure results from the force exerted by blood against the walls of the arteries as it is pumped by the heart. It is measured in millimetres of mercury (mm Hg) and is recorded using two numbers separated by a slash. The first number is the systolic arterial pressure, which occurs when the heart contracts and is, therefore, the higher figure. The second number, the diastolic pressure, is produced when the heart relaxes after each beat and is, therefore, lower. High blood pressure is a condition that means the blood vessels are continuously subjected to high pressure. High blood pressure is considered as systolic pressure equal to or greater than 140 mm Hg and diastolic blood pressure equal to or greater than 90 mm Hg. Maintaining normal blood pressure levels is important for the proper functioning of the heart, brain and kidneys. The higher the blood pressure, the greater the effort required by the heart to pump blood. Uncontrolled high blood pressure may cause myocardial infarction, ventricular hypertrophy and heart failure. High pressure in the blood vessels can cause dilation (called aneurysms) and areas of weakness in the vessel wall that increase the probability of blockage and rupture. Blood can also leak into the brain, causing strokes. In addition, high blood pressure can also cause kidney failure, blindness and cognitive impairment. Some habits can contribute to developing high blood pressure such as: eating foods with a high fat and salt content, low intake of fruits and vegetables, sedentary lifestyle and physical inactivity, abuse of alcohol, smoking and stress. Certain metabolic factors, such as diabetes, hypercholesterolemia and being overweight or obese, increase the risk of diseases associated with high blood pressure. A family history of high blood pressure is also a major risk factor to consider. Most people with high blood pressure do not have any symptoms. Sometimes, hypertension can cause headaches, breathing difficulties, dizziness, chest pain, palpitations or nosebleeds. Although such symptoms cannot always be interpreted as indicative of high blood pressure, it is important not to ignore them. Page 11

11 ** Lower risk of suffering from high blood pressure. HDL cholesterol Cholesterol is a type of lipid found in cells that circulates in the bloodstream. It plays an important role in helping the body to function properly, as it is required for the formation of cell membranes and hormones. Cholesterol can be synthesised by the body or supplied through the diet. Cholesterol is transported in the blood by lipoproteins, which can be low density (LDL) or high density (HDL). LDL lipoproteins transport cholesterol from the liver back to the body's cells; HDL lipoproteins recover the unused cholesterol and return it to the liver for storage or elimination. Therefore, HDL cholesterol (also known as good cholesterol) reduces the risk of cardiovascular disease. No increased risk of a decrease in HDL cholesterol levels in blood. Triglycerides Triglycerides are the most common type of fat in the body. Adequate levels will vary according to the age and gender. Individuals with diabetes or heart disease are more likely to have elevated triglyceride levels. Elevated triglyceride levels combined with high levels of LDL cholesterol (also known as bad cholesterol) increases the risk of developing atherosclerosis and, therefore, having an infarct or heart attack. No increased risk of having raised triglyceride levels in the blood. Page 12

12 ** Obesity and cardiovascular risk A person who is overweight or obese has a greater probability of developing high blood pressure, atherosclerosis and diabetes. These diseases increase your risk of cardiovascular disease. Recent studies have shown that fat, especially fat located in the abdominal area, has a significant impact on the metabolism. This fat affects blood pressure, blood lipid levels (cholesterol, triglycerides, etc.) and interferes with the body's ability to use insulin properly (which increases the risk of developing diabetes). Lower risk of presenting abdominal obesity. Ischaemic heart disease, cardiac ischaemia or coronary disease It is caused by arteriosclerosis of the coronary arteries, which supply blood to the myocardium (heart muscle). Coronary arteriosclerosis is a slow process resulting in the formation of collagen and the accumulation of lipids and lymphocytes (inflammatory cells) that cause a narrowing (stenosis) of these arteries. This process begins in the early stages of life, but no symptoms appear until the stenosis reaches such a point that it prevents an adequate supply of oxygen to the heart muscle. Cardiac ischaemia will then occur (stable angina) or a sudden blockage caused by a thrombus (blood clot), which can result in an acute coronary syndrome (unstable angina and acute myocardial infarction) due to a lack of oxygenation of the heart muscle. The main factors of this disease are: age, gender (more common in men than in women, although the rate balances out after the menopause), a family history of disease, high blood pressure, type 2 diabetes, elevated total cholesterol and LDL (bad) cholesterol and low HDL (good), and physical inactivity. In addition, people who have previously had angina or a heart attack are at increased risk. High risk of suffering from cardiac ischaemia. Recommendations To prevent or delay the disease, it is essential to follow a healthy diet, exercise regularly and stop smoking. Taking periodic blood pressure readings and undergoing regular clinical tests prescribed by a healthcare professional are recommended to determine Page 13

13 ** and control lipid and glucose levels in the blood. If you have previously suffered from angina or myocardial infarction, it is important to receive closer medical monitoring. Myocardial infarction The lack of oxygen and nutrients that occurs when blood flow to the heart is interrupted by the blockage of a coronary artery can cause it permanent damage. If the interruption occurs suddenly it is called myocardial infarction (also called a heart attack or coronary thrombosis). Blockage of the arteries that causes myocardial infarction is due to an accumulation of fatty deposits along the inner walls of these arteries (to which an unhealthy diet, physical inactivity and smoking contribute), causing them to become narrower and less flexible (known as atherosclerosis). As the blood vessels constrict, it increases the probability of having clots that can block the vessels preventing them from bringing blood to the heart. People who are overweight or obese have a higher risk of suffering a myocardial infarction, especially if they have abdominal obesity (also called central obesity). Moderate risk factor of having a myocardial infarction. Recommendations To minimise the risk of suffering a myocardial infarction, it is very important to follow a healthy diet, exercise regularly and stop smoking. It is advisable to take periodic blood pressure readings and undergo clinical tests prescribed by a healthcare professional to determine and control blood lipid and glucose levels, as a high concentration of lipids (hyperlipidaemia) and elevated glucose levels (diabetes) are risk factors for having a myocardial infarction. Some oral contraceptives and hormone treatments can increase the risk of this condition, so it is worthwhile seeing your doctor for more information. It is also important to avoid stress. Cardiovascular accident (stroke) It is caused by an interruption of blood flow to the brain, meaning the supply of oxygen and nutrients is lost, resulting in brain tissue damage. When the cardiovascular accident (stroke) is severe, it is called a cerebral effusion (or haemorrhage), or cerebral thrombosis. People who are overweight or obese have a higher risk of stroke, especially if they have abdominal obesity (also called central obesity). Another cause of stroke may be a rupture of a blood vessel in the brain, causing blood to pour into it and triggering a brain haemorrhage. High blood pressure is an important risk factor for this type of condition. Page 14

14 ** On the other hand, if the heart rate of a person is weak or irregular, blood clots can form in the heart which can then break off and travel through the blood vessels to the brain thereby obstructing a cerebral artery and preventing blood from reaching certain areas of the brain. No increased risk of having a stroke. Venous thrombosis Deep vein thrombosis occurs when a blood clot forms in a deep vein. They usually develop in the legs or pelvis, but they can also occur in the arms. This condition can lead to serious illness, disability or even be fatal. It is a frequently undiagnosed condition; however, it can be prevented and treated, when it is picked up at an early stage. The most serious complication of deep vein thrombosis occurs when part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called a pulmonary embolism. Anyone can have a deep vein thrombosis. Some risk factors are: injury to a vein (caused by a fracture, muscle injuries, surgery, etc.), slow blood flow (caused by lying down in bed for long periods after an illness or surgery, limited movement due to injury, sitting for a long time, especially with crossed legs or paralysis), increased oestrogen levels (during pregnancy or due to oral contraceptives, hormone replacement therapy after menopause, etc.) or some chronic conditions (such as heart disease, lung disease, cancer and its treatment or inflammatory bowel disease, among others). In addition to the above, other risk factors to consider are a previous episode of venous thrombosis, a family history of the condition, age, obesity or inherited clotting disorders. The risk increases in someone who has more than one of these factors at the same time. Many people who have a deep vein thrombosis do not have any symptoms. Symptoms that occur in the affected part of the body are: swelling, tenderness to touch, pain or redness of the skin. No increased risk of thrombosis. Oxidative stress Oxidative stress is defined as an imbalance between the production of reactive oxygen species and antioxidant substances in the body, due to an increase in the former or a decrease in the latter. These reactive oxygen species are produced by the cellular metabolism and environmental factors (such as pollution, tobacco smoke, ionizing radiation, or heavy metals, among other). They are molecules that react with many types of biological Page 15

15 ** macromolecules present in cells (such as nucleic acids, lipids, carbohydrates, proteins, etc.) altering their function. They can also modify the expression of certain genes. Humans possess antioxidant systems that are usually very effective in limiting the damaging effects of reactive oxygen species. These systems can be either endogenous or exogenous. Endogenous systems are enzymes whose function is to metabolise the reactive oxygen species to neutralise and remove them; exogenous systems include vitamins C and E and beta-carotene (precursor of vitamin A). When faced with pathological conditions, these systems can become saturated, which lessens their antioxidant capacity. Oxidative stress contributes to the development of various diseases some of which are related to cardiovascular risk (high blood pressure, atherosclerosis, ischaemia, etc.), diabetes, asthma, chronic obstructive pulmonary disease, neurological disorders or cancer, all of which are related to premature cell ageing. No increased risk of suffering from oxidative stress. Page 16

16 ** Pharmacogenetics Pharmacogenetics uses genetic information to explain differences in drug metabolism between individuals, and their physiological response to drugs. This means that it is possible to identify whether a person will respond to a drug action and predict its efficacy and/or toxicity. Pharmacogenetics aims to improve the likelihood of achieving positive results and reducing the risk of serious adverse reactions to develop personalised pharmacological therapies. It is important to take into account that factors such as age, diet, environment, lifestyle and health status can influence a person's response to a given drug. Similarly, possessing information on the genetic make-up of an individual may be key to helping doctors prescribe the most appropriate drug treatment from the onset, thus avoiding the traditional trial-and-error method. The following table summarises the results obtained for the different drugs analysed in relation to your genetics. Treatment Drug Diuretic Thiazides Reduction of the risk of diabetes Diuretic (high blood pressure) Hydrochlorothiazide Better response to the treatment than the general population. Hypercholesterolemia Statins Treatment more effective than in the general population. Cardiovascular prevention Type 2 diabetes Simvastatin Sulfonylureas Response rate to the treatment similar to that of the general population. Risk of treatment failure similar to that of the general population. Type 2 diabetes Metformin + Glibenclamide Greater risk of treatment failure than the general population. Migraine Triptans Response rate to the treatment greater than that of the general population. Page 17

17 ** Physical Exercise Physical activity is defined, according to the World Health Organization (WHO), as any movement produced by the skeletal muscles, with the corresponding consumption of energy. The intensity of physical activity varies from person to person. Physical exercise is a sub-category of physical activity and refers to planned, structured and repetitive activities that aim to maintain or improve the physical condition of the body. A lack of physical activity is one of the main risk factors for developing obesity, cardiovascular disease, diabetes and even cancer. Moderate regular physical activity (walking, cycling, doing any sport, etc.) has many benefits for health and helps prevent these diseases. Exercise and weight control Regular physical activity is important to maintain or reduce weight. Doing more physical activity increases the quantity of calories expended for energy. If the number of calories consumed is also reduced, this creates a caloric deficit that will result in weight loss. Most weight is lost by consuming fewer calories in the diet. The best way to maintain weight loss is to do regular physical activity. It also reduces the risk of developing cardiovascular disease and diabetes to an even greater extent than weight loss alone. Similar ability to that of the general population to use body fat stores in response to regular physical exercise. Aerobic capacity Aerobic capacity, also known as the maximum volume of oxygen (VO2 max), is the maximum oxygen consumption of the body during a period of maximum intensity. VO2 max is used to determine the limits of the cardiorespiratory system in terms of transporting oxygen from air to the tissues for a certain level of fitness and the availability of oxygen. A decreased aerobic capacity, the lack of exercise and a sedentary lifestyle are risk factors for developing diabetes and cardiovascular diseases, thereby increasing the risk of morbidity and mortality. As a person becomes more active, he or she increases their aerobic capacity, improves their cardiorespiratory system and reduces the risk of disease and premature death. Page 18

18 ** Aerobic capacity similar to that of the general population. Ability for endurance sports Endurance sports involve activity or physical effort carried out over a prolonged period. Such sports include: long-distance running, cycling, swimming, tennis and rowing, among others. Normal ability to do endurance sports. Page 19

19 ** Food behaviour Regulating energy intake is a vitally important process to the organism, as its purpose is to maintain an equilibrium between the amount of energy stored in the form of fat in the body and the use of this fat. The regulation between food intake and the balance of energy is a complex process whose operation and equilibrium are possible thanks to the action of different endocrine signals in the gastrointestinal tract. Any changes to this equilibrium can trigger the development of chronic conditions such as obesity. Appetite regulation Appetite is defined as a need to eat food, and this need is regulated by psychological or social factors associated with pleasure produced by the act of eating. It is a selective need and is influenced by factors such as palatability, taste and aroma of food. Several genes are linked to the synthesis of certain hormones (such as leptin and ghrelin) that are involved in the regulation of appetite. It is important to differentiate appetite from hunger, which is the physiological need to eat and, unlike appetite, it is the response to a physical and non-selective need, which can be satisfied by any type of food. High risk of having poor appetite regulation. Recommendations It is very important to acquire healthy nutritional habits, such as eating high-fibre foods that help to achieve the sensation of feeling full. It is recommended that people should eat five light meals a day, so the stomach does not remain empty for long periods of time, thereby avoiding an excessive increase in appetite. Staying adequately hydrated, sleeping 7 or 8 hours a night, and doing regular physical exercise to maintain the hormone levels that keep the appetite regulated within a suitable range are also important. Page 20

20 ** Increased food intake Intake (hunger/satiety) in the body is regulated through the interaction of complex systems of signals from the gastrointestinal system, energy reserves and the central nervous system (hypothalamus). The ultimate purpose of this regulation is to maintain a balance between energy and the regulation of adiposity and body weight. Under normal conditions, the amount of food ingested depends on the requirement for nutrients, on anticipating the length of time before the next meal and the expected consumption of energy between meals. However, this normal situation is broadly influenced by numerous environmental conditions such as stress or anxiety, meaning there is an increased risk of weight gain associated with a possible increase in food intake - food that is usually high in calories and fat. Moderate risk of an increased food intake. Recommendations It is imperative that a nutritionist should assess the reasons behind the increased intake to be able to put in place measures to prevent unwanted weight gain. It is advisable to increase the consumption of foods rich in fibre, to increase the sensation of feeling full (satiety). Sensation of satiety Satiety is defined as the sensation of feeling full after eating. It is our body s perception that it does not need to eat food immediately. It is a homoeostatic response targeted at restoring equilibrium when the demand for energy and nutrients is satisfied. It is an active process that involves a complex neural commitment which, ultimately, triggers an inhibition of the eating response. High risk of having a poor sensation of satiety. Recommendations To avoid unwanted weight gain, it is important to control the sensation of feeling full. To do this, it is recommended increasing the consumption of foods rich in fibre, with a low-calorie content, low in fat (prioritising unsaturated fat) or increasing the intake of water, among others. Page 21

21 ** Predilection for fatty foods Our genes have been designed to encourage energy savings, as until around 200 years ago humankind had always experienced food shortages. Lower levels of physical activity combined with the consumption of high-calorie food have increased the weight of the population. Fats, in addition to their high caloric content, contribute to the texture, aroma and the other organoleptic properties of a wide range of foods. The palatability and enjoyment of eating such foods increases our preference for them compared to diets based on grains, fruit, vegetables, etc. Our predilection for fatty foods may be based on the association between their sensory attributes and the physical consequences of their ingestion, such as satiety and well-being. Genetic predisposition, metabolic requirements and behavioural or emotional factors can influence the preference for these foods, and it may also be influenced by economic factors and socio-cultural values. Greater risk of having a predilection for food high in fat. Recommendations It is essential to avoid saturated fats, and choose foods rich in unsaturated fats containing fibre, to avoid unwanted weight gain and other health problems. Page 22

22 ** Nutritional genomics: Nutrigenomics and Nutrigenetics Nutrigenomics is the study of how nutrients in the diet influence cellular homoeostasis, and alter gene activity, protein synthesis and/or metabolite production. Nutrigenetics is the study of the different variants of the human genome that influence the body's response to nutrients (increasing or decreasing the risk of nutrition-related conditions). The fundamental aim of nutrigenomics is to gain an understanding of how diet and nutrients affect the way the genome functions and how genetic variation affects individual responses to food. The overall aim is to personalise a person s diet based on their individual needs to sustain optimal health and prevent diseases. Food intolerance In recent decades, the rates of food allergies and intolerances have increased significantly in the population. Food intolerance causes an adverse reaction of the body to a certain type of food, meaning that the person is unable to digest and metabolise the food; however, it never involves an immune defence mechanism. Lactose and gluten (coeliac disease) intolerance are the most common types observed. Gluten intolerance Gluten is a protein found in some grains, such as wheat, rye, barley, spelt and oats. Coeliac disease is a permanent intolerance to this protein (and is, therefore, a chronic illness), as the villi in the small intestine have atrophied meaning that nutrients cannot be absorbed properly. It is a condition that can occur at any age in persons with a genetic predisposition. It is complicated to diagnose, since it may have moderate symptoms or, even, no symptoms. When symptoms appear, the most common include: loss of appetite and weight loss, diarrhoea, bloating, anaemia, mouth ulcers, personality alterations, delayed growth, etc. To repair the intestinal villi and, thereby, ensure the symptoms disappear, a strict gluten-free diet must be followed for life. From that time onwards, it is referred to as a coeliac condition instead of coeliac disease. Page 23

23 ** No increased risk of gluten intolerance. Lactose intolerance Lactose is a sugar found in milk and its derivatives. Lactase is an enzyme required to metabolise lactose. Lactose intolerance means you are unable to digest lactose properly, and feel uncomfortable when eating foods that contain this type of sugar. The reason is that the digestion process is hampered by insufficient levels of the lactase enzyme. This situation can occur at any age, but it is rare in infants and more common in adults. People with northern European ancestry are less likely to develop this intolerance. Damage to the small intestine (due to coeliac disease, Crohn's disease, infections, injuries, surgery, etc.) may mean that lower quantities of lactase are produced, causing lactose intolerance. Symptoms include: colic or abdominal pain, diarrhoea, wind, abdominal bloating or nausea. These symptoms are commonly confused with other conditions. High risk of lactose intolerance. It is important to note that this does not mean that the condition will develop. Recommendations Symptoms of lactose intolerance can be confused with other conditions, so it is important to see a specialist if you experience such symptoms after eating or drinking milk or dairy products. Symptoms can be controlled by making changes to your diet. In some cases, it is not necessary to eliminate milk and dairy products entirely, as some can be tolerated in small amounts. Some products also exist that help digest lactose, as well as lactose-free milk and dairy products and low-lactose products that contain the same nutrients as normal versions. In case you need to reduce your intake of milk and dairy products, which are the most common sources of calcium, you must increase your consumption of other foods that contain significant amounts of this mineral, along with others that contain vitamin D, so you can absorb it properly. Metabolism of lipids The main functions of lipids relate to energy reserves, structure and regulation. They form part of cell membranes, act as an energy source and store and as precursors of certain hormones and vitamins; they also act as a protective physical barrier, maintain the water balance and are vital for heat regulation. Page 24

24 ** Lipids It is an effective way of storing metabolic energy, as they contain much more energy than other substances (such as glycogen) and can be stored in large quantities and in a dried form, occupying a smaller volume. In the body they are stored in fat tissue (adipose tissue). Most of this is located under the skin (subcutaneous fatty tissue). Lipids are needed as a source of fuel for the different types of cells in the body. An excess of lipids in the diet can lead to a series of symptoms and illnesses, such as: being overweight (which can lead to obesity), high levels of cholesterol, cardiovascular disease, etc. High risk of weight gain with high-fat diets. Recommendations To maintain a proper state of health, it is necessary to eat adequate amounts of dietary fat. The recommended daily amounts of lipids vary according to various factors (sex, age, degree of physical activity, etc.) and, for this reason, it is advisable to see a nutritionist. Saturated fatty acids Present mainly in foods of animal origin (meat, bacon, milk and dairy products, eggs, etc.). They also appear in some foods of vegetable origin (coconut, cocoa, palm oil, etc.). At ambient temperature, they are in a solid form. Saturated fat is a very unhealthy type of fat that can raise blood cholesterol levels, thereby increasing cardiovascular risk. High risk of weight gain with diets rich in saturated fatty acids. Recommendations Read the nutrition labels on food to check the amount of saturated and unsaturated fats they contain, to make better choices (higher proportion of the latter than the former) for a healthy diet. It is important to not increase the overall fat intake, as this may lead to unwanted weight gain. For this, replace less healthy fats by healthier ones. Page 25

25 ** Monounsaturated fatty acids These are healthier fatty acids. Mainly present in plant foods, but they are also found in some foods of animal origin. Found in a liquid state at an ambient temperature but harden when they cool down. Eating moderate amounts of these fats instead of saturated and trans-fats can be beneficial for your health, as they help lower LDL levels (thereby reducing the cardiovascular risk), and can help people with type 2 diabetes to control their blood sugar levels, help develop and maintain the body's cells and have a high vitamin E content (necessary for healthy vision and a healthy immune system). No increased risk of weight gain when consuming monounsaturated fatty acids. Polyunsaturated fatty acids Polyunsaturated fatty acids are mainly present in plant foods, but they are also found in some foods of animal origin. They are in a liquid state at an ambient temperature. Eating moderate amounts of polyunsaturated (and monounsaturated fats) instead of saturated and trans-fats can be beneficial for your health, as they help lower LDL levels (thereby reducing your cardiovascular risk). No increased risk of weight gain when consuming polyunsaturated fatty acids. Omega-3 and omega-6 fatty acids Polyunsaturated fats include omega 3 and omega 6 fatty acids. These are essential nutrients that cannot be synthesised by the body. They are key compounds for cellular growth and the correct functioning of the brain. Omega-3 fatty acids are good for the heart, as they help reduce triglyceride levels in the blood, decrease the risk of arrhythmias (irregular heartbeats), slightly lower blood pressure and slow down the build-up of plaque in the arteries. Omega-6 fatty acids can help control sugar levels in the blood and, therefore, reduce the risk of diabetes, as well as lowering blood pressure. Page 26

26 ** High risk of having low levels of omega-3 and omega-6 fatty acids. Recommendations Increasing the consumption of foods high in omega-3 and omega-6 fatty acids is recommended, without increasing the overall consumption of fat to avoid unwanted weight gain. For this reason, we should select products with a high content of this type of fatty acids that are beneficial for cardiovascular health and avoid products with a high proportion of saturated fat. Metabolism of carbohydrates Carbohydrates, also called sugars, are a major component of food. They are responsible for releasing energy so that the body can maintain its vital functions (breathing, body temperature regulation, pumping blood, etc.) They are also essential when doing physical exercise, as they are readily available fuel. When the energy needs of the body are met, a small portion of these carbohydrates is stored in liver and muscles in the form of glycogen. The remainder is stored in the adipose tissue as fat. Carbohydrates also play a role in the regulation of the metabolism of fats and proteins. They form part of nucleic acids (DNA and RNA) and participate in the process of eliminating certain toxic substances. Excess consumption of carbohydrates can cause obesity, gastrointestinal disorders, dental decay and result in a poor assimilation of complex B vitamins; while insufficient consumption can trigger symptoms such as dehydration, fatigue, loss of body protein, ketosis or high urea production. Moderate risk of weight gain with a high-carbohydrate diet. Recommendations Due to the importance of carbohydrates as a source of energy, and as glucose is an essential nutrient for the functioning of the central nervous system (it is the main fuel for the brain), it is advisable to eat the daily recommended amounts in your diet to maintain the body s vital functions. It is also important to avoid an excess consumption of carbohydrates, as this can result in unwanted weight gain, as well as other health problems. Page 27

27 ** Metabolism of vitamins Vitamins are essential compounds found in very small amounts in food. The body is unable to synthesise them, meaning they must be supplied through the diet. However, there are some exceptions, as some vitamins can be produced by intestinal bacteria. They are usually sensitive substances that alter easily due to changes in ph, temperature, etc. They are classified according to whether they are soluble in water (water-soluble) or in fat and organic solvents (fat soluble). Group B and vitamin C are water-soluble vitamins. Fat soluble vitamins are vitamins A, E, K and D. Vitamin B2 (riboflavin) Resistant to heat, but easily destroyed in the presence of light. Essential for cellular respiration and essential to release energy from all the body s cells. It is also involved in the metabolism of iron. No increased risk of having low vitamin B2 levels. Vitamin B3 (niacin or nicotinic acid) Involved in the metabolism of lipids, carbohydrates and proteins. Essential for the maintenance of all the body s cells and in the synthesis of neurotransmitters. It is involved in the production of certain hormones and the removal of toxins from the body. Greater benefit and better response to diets rich in vitamin B3. Vitamin B9 (folic acid or folate) Essential for the formation of haemoglobin and structural proteins, as well as in the synthesis, functioning and repair of DNA. It is required for the metabolism and production of new cells (particularly during periods of rapid cell division and growth during pregnancy and childhood). Page 28

28 ** No increased risk of having low levels of folic acid (vitamin B9). Vitamin C (ascorbic acid) When dissolved, it oxidises rapidly, particularly in the presence of high temperatures. It is involved in various metabolic processes such as collagen synthesis, metabolism of iron and folic acid, the detoxification of histamine and the processing of corticosteroids, among others. It also has a major antioxidant effect. No increased risk of having low vitamin C levels. Beta-carotene (provitamin A) This is one of the most important sources of vitamin A (also called retinol), which is an essential vitamin for sight (as it seems vital to protect the surface of the eye tissue), the immune system, normal growth, reproduction and foetal development, among others. High risk of having low beta-carotene levels. Recommendations An adequate intake is required, as a deficiency causes impaired vision in dim light (night blindness), pathological dry eye (especially in childhood) that may cause xerophthalmia (disease characterised by persistent dry eye and corneal opacity) which, ultimately, can result in blindness. On the other hand, excessive consumption (although rare) can cause headaches, vomiting, hair loss, skin problems, enlarged liver and irregular thickening of some long bones. Page 29

29 ** Vitamin D (calciferol) Its intake in the diet is not required, except when there is a lack of sunlight. There are two forms of vitamin D: D2 (or ergocalciferol) and D3 (or cholecalciferol). Vitamin D2 is synthesised in the skin thanks to the sunlight, and its function is the same as the vitamin D obtained in the diet. Vitamin D3 is present in the fat of certain animal products. Vitamin D is essential for the proper absorption of calcium in the body. High risk of having low vitamin D levels. Recommendations Sun exposure (subject to following the necessary recommendations for avoiding exposure to the sun becoming harmful) and an adequate intake is required, as a deficiency is linked to rickets and osteomalacia, which are caused by an inadequate use of the calcium obtained from the diet. Excessive consumption of this vitamin can raise calcium levels in the body, causing a loss of appetite and weight loss, mental disorientation and, finally, kidney failure. Metabolism of minerals Minerals are essential for the correct functioning and maintenance of the body. They are essential nutrients, as the body cannot synthesise them and they are only found in very low concentrations in food. A balanced diet provides the required amount of minerals. They should not be administered unsupervised, as some can be toxic if consumed in excess. Depending on the quantity required by the body, minerals can be classified into micro-minerals, when the requirement is less than 100 mg/day (iron, copper, iodine, manganese, chromium, cobalt, zinc, fluorine, selenium and molybdenum) and macro-minerals, when the requirement is over 100 mg/day (calcium, phosphorus, magnesium, sulphur, sodium, potassium and chloride). Despite this classification, both groups are equally important and necessary for the body. Iron Iron (Fe) is essential in the synthesis of haemoglobin and the formation of red blood cells, in addition to regulating the activity of certain enzymes. A lack of iron is the most common nutritional deficiency. Iron is distributed throughout the body as functional iron (in the red cells, myoglobins and iron-dependent enzymes) and as storage iron (present in ferritin, haemoglobin and other proteins). Its main functions are: transporting oxygen and depositing it in tissues, metabolism of energy, regulation of processes in the nervous system, synthesis of DNA and an antioxidant effect. Page 30

30 ** Greater risk of having low iron levels. Recommendations An adequate intake is required, since its deficiency due to a poor diet, malabsorption or an increased demand for iron in certain circumstances (such as menstruation) causes anaemia, immune deficiency, incorrect protein synthesis, increased lactic acid levels or an increased risk of cardiopulmonary disease. Excessive consumption does not usually result in toxicity when the excess comes from food, but when the excess is due to pharmacological supplements, it can have toxic effects such as gastrointestinal alterations, diarrhoea, vomiting or nausea. It is advisable to have a prescription for these supplements, where necessary, as iron tends to accumulate in tissues and organs when the regular deposits become saturated, and the body is only able to excrete very small amounts. Calcium Calcium (Ca) is the most common mineral in the body. 99% is found in the bones and teeth (skeletal calcium), where it combines with phosphorus. The remaining 1% is in the blood, extracellular fluids and inside soft tissue cells. Calcium performs functions of various types: structural, in bones and teeth; or metabolic, it plays an important role in cell-membrane transport (it intervenes in muscle contraction), and is involved in nerve transmission and in the regulation of certain enzymes and heartbeat. Moderate risk of having low calcium levels. Recommendations An adequate intake is required, as a deficiency (for long periods of time and since childhood) can cause bone deformities (osteoporosis, rickets, osteomalacia, etc.), muscle spasms (cramps), hypercholesterolemia, high blood pressure or colorectal cancer, among others. High calcium intake combined with high vitamin D levels in the body can cause hypercalcaemia, which triggers excessive calcification of the bones and soft tissues. Vitamin D, acid ph and lactose help the absorption of calcium; while a vitamin D deficiency, a lack of dietary fibre, some medicines and improper absorption of lipids, among other factors, will affect its absorption. Phosphorus Phosphorus (P) is found in nature in the form of phosphate. It is present in each of the body's cells, mainly in bones and teeth, but also in tissues, muscles and in the blood. It performs important functions: structural, in bones and teeth, along with calcium; provides energy, as part of the ATP molecule, which is the main source of energy in various metabolic processes and muscle Page 31

31 ** contraction; and it plays a metabolic role, as a constituent of nucleic acids (DNA and RNA) and regulates the activity of certain proteins. Moderate risk of having low phosphate levels. Recommendations An adequate intake is required, since a deficiency (which is unlikely since phosphorus is present in most foods, especially foods high in protein and calcium) can cause hypophosphataemia (reduced phosphate levels in the blood) and serious long-term complications. On the other hand, excessive intake of phosphorus can cause hyperphosphataemia (high phosphate levels in the blood), especially in individuals with impaired kidney function, causing electrolyte imbalances that can have serious consequences. Magnesium Magnesium (Mg) is essential in many cell reactions and is fundamental for all living cells. This mineral is found, by order of concentration, in bones, muscles, other cells and, to a lesser extent, in the extracellular fluid. It performs a range of functions such as: regulatory, by intervening in the enzymatic metabolic reactions and neuromuscular transmission for the proper functioning of the heart and muscle relaxation; and, structurally, as it is present in the bone matrix. Moderate risk of having low magnesium levels. Recommendations An adequate intake is required. Its deficiency is not usually common in healthy people with a balanced diet (one that includes all the basic food groups), as this mineral is found in very many products. In persons with reduced absorption ability due to surgery, severe burns or as a complication of a disease (endocrine disorder, impaired intestinal absorption of nutrients, and cardiovascular or neuromuscular diseases), a more comprehensive monitoring is required to prevent a deficiency. The body is also able to remove excess magnesium, meaning excess consumption is not usually toxic. Sodium Sodium (Na) is present in all bodily fluids and tissues. It performs control functions, such as balancing and distributing water, ensuring an osmotic equilibrium, maintaining the body s ph and participating in the muscle-contraction process and regulating neuromuscular activity. Page 32

32 ** High risk of sodium-sensitive high blood pressure. Recommendations An adequate intake is required to prevent diseases such as hyponatremia (due to decreased levels of sodium in the blood, causing muscle cramps, nausea, vomiting or apathy) or hypernatremia (caused by high sodium levels in the blood). Metabolism of antioxidant substances Oxidative stress occurs when the body's cells are imbalanced due to an increase in free radicals (substances that react with the body s molecules and damage them) and/or a decrease in antioxidant levels. Over time, it can damage the tissues. Antioxidants are substances that help prevent or delay certain types of cell damage caused by oxidative stress. They are found in a wide range of foods, especially in fruit and vegetables They are also available as dietary supplements. Examples of antioxidants include some vitamins (such as A, C and E), beta-carotene, lutein, lycopene and selenium. No increased risk of suffering from oxidative stress. Metabolism of caffeine Caffeine is a compound that occurs naturally in coffee, tea, cocoa and other foods. Some medicines, foods and beverages can also contain synthetic caffeine Caffeine reaches its maximum level in blood one hour after consumption, but its effects can last for 4 to 6 hours. Some people are more sensitive to its effects than others. Some of the effects produced by the caffeine in the body are: stimulation of the central nervous system (which can give make you feel more awake and have more energy), increased blood pressure and the release of acids in the stomach (which can cause heartburn or stomach-ache). It is a diuretic and can interfere in the absorption of calcium (causing problems with bones and teeth). Excessive caffeine consumption can cause insomnia, headaches, rapid or abnormal heartbeat, anxiety, restlessness, trembling, dizziness, dehydration and even dependency. Page 33

33 ** Slow metabolisation of caffeine, increasing the probability that its effects will be more long-lasting. Recommendations Caffeine should be consumed in moderation. Consumption should be limited or avoided when pregnant, breastfeeding, when suffering from sleep disorders, anxiety, migraines, high blood pressure, rapid or irregular heartbeat, gastroesophageal reflux or stomach ulcer, among others. It is advisable to see a healthcare professional if you are taking medication or supplements, since some can interact with caffeine and produce adverse effects. Children and adolescents should take lower doses than adults, as they can be particularly sensitive to the effects of this substance. Alcohol dependency After consuming alcohol, it rapidly enters the blood and is then metabolised in the liver. Although it is a toxic substance, when it is consumed over lengthy periods, people can adapt and become tolerant to it. In addition, when consuming large amounts, it can damage your liver and cause other health problems. Some of the negative effects of alcohol include: dizziness, disorientation, nausea, vomiting, slurred speech, difficulty walking, reduced concentration levels, etc. The response to consuming alcohol varies from person to person. The response is modulated by genetic variations, the gender of the individual, age and environmental factors, among others. No increased risk of developing an alcohol dependency. Page 34

34 ** Tables of nutrigenetic advice The results transferred to food tables are given below. This will help nutritionists design a personalised diet tailored to individual needs to achieve the desired objective. For the correct interpretation of the information shown in the food tables, the following keys should be read carefully: Key: recommended consumption frequency The recommendation consumption (SS) of each food is indicated by a colour code that is described below: Food that contains potentially beneficial nutrients; it is advisable to consume this food in the diet frequently, respecting the intake levels recommended by the competent bodies. Food that should be consumed following the guidelines established by the competent bodies. Food that contains nutrients which, in excess, can damage health, so occasional consumption is recommended. Food that contains nutrients which, in excess, can damage health substantially, so limited consumption is recommended. Key: warnings A warning icon is displayed next to the food when you need to be careful about certain aspects such as possible food intolerance or excess calories. This information does not affect the recommended consumption (R), as, in the case of intolerance, numerous alternative foods are available on the market that do not contain the implicated substance (such as gluten-free pasta, lactose-free milk, etc.) and, in terms of excessive calories, all that is needed is to reduce the quantities consumed to obtain the potential beneficial effect derived from the nutrients present in the food. Description Food that normally contains lactose High risk of lactose intolerance Avoid the consumption of this food or look for a lactose-free alternative Food with a high calorie content Risk of unwanted weight gain Avoid the excessive consumption of foods with a high calorie content Page 35

35 ** Key: nutrients The shape of the icon indicates the nutrient to which it relates; the colour shows the recommended intake frequency for that particular nutrient. Only the relevant nutrients indicated by the results of genetic analysis are displayed. Description Food with a high fat content High risk of weight gain with high-fat diets Avoid, as far as possible, the consumption of this food Food with a high content of saturated fatty acids High risk of weight gain with diets rich in saturated fatty acids (SFAs) Avoid, as far as possible, the consumption of this food Food with a high content of omega-3 and omega-6 fatty acids High risk of having low levels of omega-3 and omega-6 fatty acids Maximise the consumption of this food Food with a high content of rapidly absorbed carbohydrates Moderate risk of weight gain with carbohydrate-rich diets Moderate the consumption of this food. Increase the consumption of fibre-rich foods Food with a high vitamin B3 content Greater benefit and better response to diets rich in vitamin B3 Maximise the consumption of this food Food with a high beta-carotene content High risk of having low beta-carotene levels Maximise the consumption of this food Food with a high vitamin D content High risk of having low vitamin D levels Maximise the consumption of this food Food with a high iron content High risk of having low iron levels Maximise the consumption of this food Food with a high calcium content High risk of having low calcium levels Maximise the consumption of this food Food with a high phosphate content Moderate risk of having low phosphate levels Maximise the consumption of this food Food with a high magnesium content Moderate risk of having low magnesium levels Maximise the consumption of this food Page 36

36 ** Description Food with a high sodium content High risk of sodium-sensitive high blood pressure Avoid, as far as possible, the consumption of this food Food with a high caffeine content Slow metabolisation of caffeine, extending its effects in the body Avoid, as far as possible, the consumption of this food Page 37

37 ** Milk and dairy products Caramel custard cream, diet 125g Cheese, blue 50g Cheese, Brie 50g fidm) Cheese, Camembert (20-30% 50g fidm) Cheese, Camembert (60% 50g Cheese, Cheddar 50g Cheese, cured 50g Cheese, cured, goat's milk 50g Cheese, Edam 50g Cheese, Emmental 50g Cheese, feta 50g Cheese, fresh 50g Cheese, fresh, goat's milk 50g Cheese, fresh, processed (>60 % fidm) 50g Cheese, goat, uncured 100g Cheese, Gorgonzola 50g Cheese, Gouda 50g Cheese, Gruyere 50g Cheese, manchego 50g Cheese, manchego, in oil 50g Cheese, mozzarella 50g Cheese, Muenster 50g Cheese, parmesan 50g Cheese, Quark (20% fat) 100g Cheese, Quark, fat free 100g Cheese, raclette 50g Cheese, Roquefort 50g Cheese, semi-cured 50g Cheese, spread 60g Cheese, spread, light 60g Cheese, uncured, skimmed, with fruit 100g Chocolate mousse 70g Page 38

38 ** Milk and dairy products Curdled milk 150g Custard, vainilla flavoured 125g Dried skimmed milk 10g Dried whole milk 10g Drinking yogurt, flavoured n/e 125mL Drinking yogurt, plain, sweetened 125mL plain Drinking yogurt, skimmed, 125mL Drinking yogurt, whole milk, with fruits 125mL Egg custard 125g Evaporated milk 30mL Full fat milk yogurt, with flavourings 125g Goat's milk 200mL Ice cream, chocolate 80g Ice cream, cream 80g Ice cream, strawberry 80g Kefir 125g fat) Liquid cooking cream (18% 15mL fat) Liquid cooking cream (35% 15mL Liquid yogurt, whole milk, with cereals 125mL Milk shake, cacao, light 200mL Milk shake, chocolate 200mL Milk shake, strawberry 200mL Milk shake, strawberry, light 200mL Milk, semi-skimmed, pasteurized 200mL Milk, skimmed, condensed, with sugar Milk, whole, condensed, with sugar 20mL Milk, skimmed, pasteurized 200mL 20mL Sheep's milk 200mL Strained yogurt 125g Whipped cream 30g Whole milk 200mL Yoghurt, whole, milk 125g sugar Yoghurt, whole, milk, with 125g Yoghurt, whole, with fruits 125g Page 39

39 ** Milk and dairy products Yogurt mousse, plain 125g Yogurt mousse, with fruits 125g Yogurt, bulgarian-style 125g Yogurt, liquid, whole milk, with fruits 125mL n/e Yogurt, skimmed, flavoured 125g Yogurt, skimmed, plain flavour 125g Yogurt, skimmed, plain flavour, sweetened Yogurt, skimmed, with fruits 125g Yogurt, skimmed, with cereals 125g 125g Fruit and related products Apple 160g Appricot, dry 50g Apricot 100g Avocado 150g Banana 170g Bilberry 120g Blackberry 150g Blackcurrant 200g Cherry 120g Coconut 80g Coconut, dried 20g Custard apple 200g Date 40g Date, dry 22g Fig, dry 50g Figs 90g Flat peach 100g Grapefruit 250g Grapes, white 120g Guava, without skin 120g Kiwi 100g Lemon 50g Page 40

40 ** Fruit and related products Lime 50g Litchi 120g Mango, without skin 150g Medlar, with skin 120g Melon 250g Nectarine 150g Orange 200g Papaya 200g Passion fruit 150g Peach 160g Peach, dried 50g Pear 150g Persimmon 160g Pineapple 170g Pineapple, canned, in juice 120g Plum, dried, without stones 50g Pomegranate 275g Quince 250g Raisin 50g Raspberry 150g Red grape 120g Redcurrant 200g Strawberry 150g Syrup peach 130g Syrup pineapple 120g Tangerine 150g Water chestnut 70g Watermelon 250g Yellow plum, with skin 100g Grains and cereal products Barley 30g Bran, oat 30g Bread white, sliced 70g Bread, barley 70g Bread, burguer 70g Bread, corn 70g Bread, crumbs 40g Bread, milk 70g Page 41

41 ** Grains and cereal products Bread, multigrain 70g Bread, oat 70g Bread, raisin 70g Bread, rye 70g Bread, wheat and rye 70g Bread, white, wheat bran 70g Bread, white, wheat bran, salt-free 70g Bread, whole wheat 70g Bread, whole wheat, sliced 70g Breakfast cereal, corn and wheat 30g Breakfast cereal, corn with honey 30g Breakfast cereal, corn with sugar 30g Breakfast cereal, corn, wheat and oat 30g Breakfast cereal, granola 30g Breakfast cereal, rice with chocolate 30g Breakfast cereal, rice with honey 30g Breakfast cereal, rice, wheat and fruit 30g Breakfast cereal, wheat and fruit 30g Breakfast cereal, wheat and honey 30g Breakfast cereal, wheat and rice 30g Breakfast cereal, wheat with sugar 30g Breakfast cereal, wheat, oat, corn and honey 30g Breakfast cereal, wheat, oat, corn, honey and nuts 30g Breakfast cereals, wheat and chocolate 30g Butter cookie 42g Cereal bar, with chocolate 50g Cereal bar, with corn and wheat Cereal bar, with wheat and chocolate Cookie, digestive type, with chocolate 50g Cereal bar, with fruit 50g 50g Cookie, digestive type 42g 42g Cookie, with chocolate 45g Corn starch 25g Corn, shelled, canned 70g Page 42

42 ** Grains and cereal products Crackers 42g Crispbread 10g Croissant 90g Croissant with chocolate 90g Doughnut 50g Doughnut, with chocolate 50g Flaky pastry, filled with chocolate cream 100g Flour, barley 20g Flour, corn 20g Flour, oat 20g Flour, rye 20g Flour, wheat 20g Flour, wheat, whole 20g Granola 40g Ground wheat 30g Maria crackers 42g Millet 30g Muffin 42g Oat 30g Pasta 70g Pasta, whole 70g Pasta, with egg 70g Pearl barley 30g Puff pastry, raw 50g Quinoa 60g Rice 70g Rice starch 25g Rice, brown 70g Rye 30g Seitan 120g Wheat germ 20g Wheat starch 25g Wheat, bran 30g Wheat, whole 30g Page 43

43 ** Vegetables Broad bean, dried 70g Broad bean, fresh 70g Caper 10g Chickpea, canned 180g Chickpea, dried 70g Flour, carob 20g Flour, soy 20g Garden peas, pods 60g Lentil sprouts 50g Lentil, canned 180g Lentil, dried 70g Lupin 80g Mungbean, mature seeds, dried 70g Pea, canned 150g Pea, dried 70g Pea, fresh 70g Pinto bean 70g Sausage, vegetable 40g Soybean, dry 50g Soybean, fresh 70g Soybean, sprouts, canned 70g Tempeh 120g Tofu 120g White bean 70g White beans, tinned 150g Page 44

44 ** Meat and meat products Bacon, with separable fat 75g Beef, sirloin 150g Blood sausage 70g Bologna 50g Brain, lamb 70g Butifarra sausage 90g Chicken, lean only 150g Chicken, leg, with skin 150g Chicken, whole, with skin 150g Chicken, wing, with skin 150g Common quail 150g Cooked ham, category n/e 80g Couring beef 90g Cured ham 50g Deer, piece n/e, with separable fat 150g Duck, whole 150g Farm rabbit, meat 150g Foie gras 30g Ham, roasted 50g Hare, whole 150g Hen, whole 150g Horse, meat 150g Kid, part n/e, with separable fat 150g Kidney, lamb 70g Kidney, veal 70g Lamb, cutlet 150g Lamb, gizzard 90g Lamb, leg and shoulder 225g Lamb, rib 150g Liver, beef 125g Liver, chicken 125g Liver, pork 125g Liver, veal 125g Ostrich, sirloin 150g Ostrich, steak 150g Oxtail 190g Partridge 150g Pork liver pâté (30% fat) 30g Page 45

45 ** Meat and meat products Pork liver pâté (42% fat) 30g Pork, chop 150g Pork, leg, with separable fat 150g Pork, loin 150g Pork, rib 200g Pork, sirloin 125g Salami 50g Sausage, chicken, fresh 100g Sausage, pork, fresh 100g Sausage, Frankfurt type 70g Sausage, Vienna type 70g Shoulder cured ham / lacon 80g Tongue, veal, roasted 125g Tripe, veal 90g Turkey 150g Turkey luncheon meat 80g fat Turkey luncheon meat, low 80g Turkey, lean only 150g Turkey, leg, with skin 150g Veal, chop 150g Veal, loin, with separable fat 125g Veal, rib, with separable fat 200g Veal, sirloin, with separable fat 150g Page 46

46 ** Alcohol beverages Aguardiente 35mL Anisette, dry 35mL Apricot liqueur 35mL Beer 200mL Beer, low alcohol 200mL Beer, stout, mL Benedictine liqueur 35mL Bitters (16% vol) 90mL Champagne (14% vol) 100mL Coffee liqueur 35mL Cognac 50mL Cream liqueur 15-17% volume 35mL Curaçao liqueur 35mL Fine wines (Sherry, Manzanilla, etc.) (15-18% vol) 75mL Fruits liqueur 35mL Gin 50mL Non-alcoholic beer 200mL Red wine 90mL Rum 50mL Sidra 160mL Sparkling wine, cava type 160mL Sweet wines (from Malaga, Porto, Muscatel) (19-22% vol) 75mL Tequila 35mL Vermuth, n/e 90mL Vodka 50mL Whisky 50mL White wine 90mL Wine, rose 90mL Alcohol-free beverages Almond milk 200mL Carbonated drink, lemon 200mL Coffee, brewed 60mL Coffee, brewed, decaffeinated 60mL Page 47

47 ** Alcohol-free beverages Cola drink, carbonated, decaffeinated 200mL Cola drink, light, carbonated, decaffeinated 200mL Drink, oat 200mL Drink, rice 200mL Drink, soya 200mL Energy drink 200mL Infusion 100mL Juice, apple commercial 200mL Juice, black currant, commercial 200mL Juice, carrot, fresh 200mL Juice, grape and peach, commercial 200mL Juice, grape commercial 200mL Juice, grapefruit, commercial 200mL Juice, lime, commercial 200mL Juice, mango, commercial 200mL Juice, orange, commercial 200mL Juice, orange, fresh 200mL Juice, peach, commercial 200mL Juice, pineapple and grape, commercial 200mL Juice, pineapple, commercial 200mL Juice, red currant, commercial 200mL Juice, tomato, fresh 200mL Lemon juice, fresh 200mL Nectar, apricot 200mL Nectar, grapefruit 200mL Nectar, mango 200mL Nectar, orange 200mL Nectar, passion fruit 200mL Nectar, peach 200mL Nectar, pear 200mL Nectar, pineapple 200mL Nectar, plum 200mL Nectar, tropical fruit 200mL Non-alcoholic bitters 200mL Soft drink, carbonated, orange flavoured 200mL Soft drink, cola flavoured 200mL Soft drink, cola flavoured, light 200mL Soft drink, orange flavoured, no carbonated 200mL Soft drink, soda type 200mL Soft drink, tonic water type 200mL Soluble coffee, powder 10g Soya shake 200mL Sport drink 200mL Tea soft drink 200mL Page 48

48 ** Alcohol-free beverages Tea soft drink light 200mL Tea, infusion (without sugar) 100mL Green vegetables and fresh produce Artichoke, canned 150g Artichoke, frozen 250g Arugula 60g Asparagus, green 150g Asparagus, white, canned 150g Aubergine 200g Bamboo shoots 50g Beetroot 100g beetroot, canned 80g Borage 150g Broccoli 250g Brussels sprout, frozen 250g Cabbage 200g Cabbage, white 200g Cardoon 200g Cardoon, stalk, canned 150g Carrot 100g Cawliflower 240g Celery 150g Chard 250g Chayote 100g Chinese cabbage 200g Corn, on the cob 100g Courgette 200g Cucumber 150g Dehydrated onion 20g Endive 80g Escarole 200g Flour, tapioca 20g Garlic 5g Garlic, powder 5g Green bean, canned 120g Page 49

49 ** Green vegetables and fresh produce Green been 150g Lamb's lettuce 60g Leek 125g Lettuce 100g Lombard 200g Mung bean, sprouts 150g Mushroom 150g Onion 150g Pepper, green 100g Pepper, red 100g Potato 150g Potato starch 5g Pumpkin 200g Radish 80g Savoy cabbage 200g Shallot 75g Spinach 250g Spinach, canned 200g Spring onion 50g Sweet potato 150g Swiss chard, canned 200g Tomato 150g Tomato, ripe, peeled and ground, canned 70g Truffle 5g Turnip, peeled 125g Watercress 60g Dry fruit and seeds Almond 30g Almond, fried, salted 25g Almond, toast 30g Cashew nut 30g Chestnut 30g Chestnut, roasted 30g Coriander, seeds 15g Flax, seeds 15g Page 50

50 ** Dry fruit and seeds Hazelnut 30g Jackfruit, seeds 60g Macadamia nut 30g Peanut, toasted, salted 25g Peanut, without shell 30g Pine nut 30g Pistachio nut 60g Pumpkin, seeds 30g Sesame loose change 15g Sesame, seed 15g Sunflower seeds, peeled, with salt Walnut 25g Sunflower, seeds 30g 30g Fish and seafood Albacore 160g Albacore, canned in oil, drained 56g Anchovy in vegetable oil 30g Anchovy, fresh 200g Baby clam 370g Baby squid 200g Canned clams 65g Caviar 16g Clams 370g Cockles 370g Cockles, canned 65g Cod, raw 200g Page 51

51 ** Fish and seafood Cod, salted 125g Cod, salted, steeped 200g Cod, smoked 80g Conger 200g Crab 340g Crayfish 340g Cuttlefish 200g Derbio 200g Elver 75g European eel 200g Flying fish 200g Fourspotted megrim 200g Frog legs 160g Gilt-head bream 200g Grouper 200g Hake 200g Halibut 200g Herring, salted 80g Herring, smoked 80g Lobster 750g Mackarel 200g Mackerel, canned in oil, drained 80g Monkfish 200g Mullet 200g Mussel 350g Mussel, canned in brine 120g Octopus 200g Oyster 250g Perch 200g Pickled tuna 80g Prawn 150g Ray 200g Red rockfish 200g Red shrimp, frozen, peeled 150g Rice, wild 70g Roe, fish 10g Page 52

52 ** Fish and seafood Salmon 150g Sardine 200g Scallop 250g Scampi 200g Sea bream 200g Seabass 200g Shrimp 150g Smoked salmon 80g Snail 100g Sole 200g Squid 200g Squid, canned 125g Swordfish 150g Thicklip grey mullet 200g Trout 200g Tuna 160g Tuna in olive oil 80g Tuna in vegetable oil 80g Tuna, canned in water 80g Turbot 200g Velvet crab 340g Whiting 200g Wide-eyed flounder 200g Eggs and egg products Egg, chicken, white 38g Egg, chicken, whole 65g Egg, chicken, yolk 18g Egg, duck, whole, raw 70g Page 53

53 ** Eggs and egg products Egg, quail 10g Egg, turkey, whole, raw 79g Seasoning, condiments and spices Apple vinegar 5mL Baking, powder 4g Balsamic vinegar 5mL Basil 2g bay, leaf 2g Black pepper 1g Cardamom, seeds 1g Cinnamon, powder 1g Cloves 1g Cumin 1g Curry 1g Dill, dried 1g Fennel 10g Fresh baker's yeast 25g Ginger 10g Ketchup 15g Lemongrass 10g Mayonnaise light 15g Mayonnaise, olive oil, home-prepared 15g Mayonnaise, soybean oil 15g Mayonnaise, sunflower oil 15g Mint, fresh 10g Miso 30g Mustard 10g Nutmeg 2g oregano, dried 2g Paprika, powder 1g Parsley, fresh 5g Peppers, hot chili, all var.,fresh 5g Rosemary 10g Saffron 1g Sauce, barbecue 20g Sauce, bechamel 20g Sauce, bolognese 20g Page 54

54 ** Seasoning, condiments and spices Sauce, caesar salad dressing 20g Sauce, carbonara 20g Sauce, cheese 20g Sauce, curry 20g Sauce, garlic mayonnaise 15g Sauce, napolitana 20g Sauce, pink salad dressing 20g Sauce, roquefort 20g Sauce, sicilian sauce, hot 20g Sauce, soy 20g Sauce, sweet and sour 20g Sauce, tabasco 1mL Sauce, tahini 20g Sauce, tartar, commercial 20g Sauce, vinaigrette, with olive oil 20g Sea salt 2g Thyme, dried 1g Turmeric 1g Vanilla 1g white pepper 1g Wine vinegar 5mL Aperitifs Chips 50g Cookie, salted 30g Olive, black, with bone 40g Olive, green, with bone 40g Pickled aubergine 100g Pickled gherkin 100g Potato crips, low calorie 50g Page 55

55 ** Sugars, honey and confectionery products Candy 15g Chewing gum, sugarfree 2g Chewing gum, with sugar 2g Chocolate bitter, with sugar 30g nuts Chocolate with macadamian 30g Chocolate with milk and almonds 30g Chocolate with milk and rice 30g Chocolate, bitter 30g Chocolate, bitter, with almonds 30g Coconut cream 30g Custard 30g Custard, vanilla caramel 125g English custard 30g Fructose 5g Gelatin 20g Honey 10g Jam 15g Jam, low calorie 15g Liquorice 30g Milk chocolate 30g Quince jam 32g Royal jelly 13g Soluble cocoa, with sugar, powder 10g Soluble cocoa, with sugar, powder, light 10g Sugar, brown 10g Sugar, white 10g White chocolate 30g Fats and oils Butter 15g Butter, light 15g Coconut oil 10mL Cod liver oil 10mL Page 56