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ENALIA 2 Survey. National Food Survey on adults, the elderly and pregnant women.







The ENALIA 2 project (National Food Survey on adults, the elderly and pregnant women) continues on from the ENALIA survey conducted on infants and adolescents. ENALIA 2 is a dietary survey which this time includes the adult population aged between 18 and 75 years from all the Regional Communities and a group of pregnant women. This is an individual survey that provides precise information about the types and quantities of food consumed, which is essential for assessing nutrient intake and for scientific research into exposure to other chemical substances through food.

The ENALIA 2 project, which started in Spring 2014 and ended in the first half of 2015, was developed by the Spanish Agency for Consumer Affairs, Food Safety and Nutrition, within the European framework, and was co-financed by the European Food Safety Authority (EFSA).

In this survey, as with the ENALIA survey, right from the moment of design, is conducted in accordance with a harmonised methodology agreed throughout Europe, listed in the guide “General principles for the collection of national food consumption data in the view of a pan-European dietary survey”, published by the EFSA in 2009 ( It was also included in the European EU Menu project. This project, coordinated by the EFSA, aims to harmonise data collection on food consumption across Europe, so that the data obtained in the surveys in different countries can be compared and processed globally for risk assessments and decision-making on food safety in the European Community.

At national level, ENALIA 2 is an opportunity to obtain useful, up-to-date and quality data, obtaining important information for the analysis of dietary risk and for nutritional studies. In this case, the collection of representative national data for adults and specifically for a sample of pregnant women may be used to make dietary recommendations for these population groups.  

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The subjects of study in the ENALIA2 survey are Spanish residents aged between 18 and 74 years. They were selected using random multistage sampling carried out in the 17 Regional Communities on the general population for this age group.

The sampling frame for obtaining the sample of the adult and elderly population was the general population living at home, whereas, given the difficulty in finding a suitable number of pregnant women living at home, the sample frame for obtaining the sample of pregnant women was the midwives employed at Health Centres. The oversampling of pregnant women was also carried out randomly, using a list of health centres which employ this type of health professional available from the Ministry of Health, Social Services and Equality. The European methodological recommendations contained in the afore-mentioned guide were observed at all times.

Lastly, of the 1498 adults and elderly people who were contacted for the survey, a sample of 933 participants was obtained (initial response rate 62.3%), 623 individuals aged 18 to 64 and 310 aged 65 to 74 years. In the case of pregnant women, of the 166 women contacted a sample of 157 pregnant women was obtained (initial response rate 94.6%).

The information was collected using a food survey. The same survey was used to collect information in the adult and elderly population as in the population of pregnant women. The survey mainly includes dietary information of two types: firstly, regarding the daily diet, that is, specifying the type of food and quantities eaten (g/day) in one day and secondly regarding the frequency of consumption of certain foods and food supplements. Information was also collected on general characteristics, physical activity, and the anthropometric measurements of weight, height and waist of the participants were collected.

The dietary information was collected using questionnaires and support material which were designed ad hoc, previously used in the ENALIA survey and following the recommendations contained in the EFSA pilot project, PANEU.

  • To collect the information on the daily diet (consumption of food and quantities consumed in grams per day at the different meals of the day) the questionnaire “24 hour recall” was applied on two different non-consecutive days (at least 14 days apart) and this allows the usual consumption to be estimated. In the sample of adults and the elderly, 824 replied to the first reminder (response rate 55.0% with respect to number of people contacted) and 800 replied to the second reminder (response rate 53.0%). In the sample of pregnant women, 144 replied to the first reminder (response rate 91.7%) and 133 also replied to the second reminder (response rate 80.1%).

The quantities consumed were referred by the participants and calculated using a photographic food atlas designed ad hoc and already used in the previous ENALIA survey, together with conversion tables for homemade measurements.

  • To collect the information on the frequency of consumption of food and dietary supplements the “Questionnaire on frequency of consumption” was used. This questionnaire includes 50 questions on groups of food and 14 questions on food supplements, selected based on the recommendations of the PANEU and experts in nutrition and food safety (AECOSAN): large groups of food consumed by the majority of the general population and food consumed occasionally but which has been identified as a major source of potentially hazardous agents and/or nutrients.

Field work was carried out by specially trained interviewers with experience in this type of survey. The interviews were computer-assisted face-to-face interviews using software previously used and designed for ENALIA (ENIA-soft). For the classification and coding of the food, the FoodEx2 system proposed by the EFSA for monitoring was used.

Once the results had been processed, all the individual consumer data was included in the European Food Consumption Database.

A detailed description of the methodology of this survey is published in the document available in this section Spanish National dietary survey in adults, elderly and pregnant women

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The principal results obtained regarding the type and quantities of food consumption in grams/day of the daily diet, are presented below, using the following explanatory tables. The results are classified by age group and the results for the sample of pregnant women are treated in isolation. Two data types are given in each table:

  • the first part contains the data referred to the whole population included in the sample by age group (whether or not they ate this food): Mean (to three decimal places), standard deviation (SD), and 95th percentile.
  • The second part contains the data referred to the participants who consumed the food or group of foods (consumers) in each age group, for which the legend is:
    • N: number of times that the consumption of this food is mentioned among the consumers (number of consumptions). Taking into account that the survey was conducted on two different days, some of those surveyed consumed a food on both days and may have eaten it at different times (Br-mid morning-Lu-Tea-Su-before bed). Therefore, there may be more than one consumption per individual.
    • %: percentage of consumers: estimated percentage of individuals (taking as a base the reference population of each age group) which consumes a food or group of foods.
  • The mean (to three decimal places), the standard deviation (SD) and the 50th, 75th and 95th percentiles of the quantities consumed among the consumers is also given.
  1. 18 to 39 year old age group
  2. 40 to 64 year old age group
  3. 65 to 74 year old age group
  4. 18 to 74 year old age group
  5. Pregnant women

The results referred to the frequency of consumption of food, drinks and food supplements and the nutritional study of this population group are currently being prepared and will be presented following the analysis of the same in forthcoming months.

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1. ENALIA2 photographic atlas

The atlas contains 53 series of photographs of different foods and each series contains between 4 and 6 photographs showing different portion sizes

The majority of the photos can be used to help calculate not only the size of the food in the photos, but also of other food that looks similar after cooking, and for which the weight has also been established. This circumstance is indicated for each series of food photos together with various foods by way of example.

2. - Spanish National dietary survey in adults, elderly and pregnant women