bluuebunny/crossref_metadata_2025 huggingface dataset:
The accuracy of self-reported weight by overweight and obese women in an outpatient setting
Authors: Rossouw Katja , Senekal Marjanne , Stander Ilse
Published: June 2008

Objective:

To investigate the accuracy of self-reported weight of overweight and obese women and characterisation of under-, correct- and over-reporters based on a number of related variables.

Design:

Weight was self-reported before entering the study. At baseline, actual weight was recorded, and demographic, health, nutritional, psychological and physical activity questionnaires were completed.

Setting:

A hospital outpatient department.

Subjects:

Participants were 131 women aged 18–64 years with a body mass index (BMI)≥ 28 attending a Comprehensive Weight Management Programme.

Outcome measures:

The accuracy of self-reported weight was investigated for the total group, and the subjects were then categorised into three groups according to accuracy of self-reported weight (under-, correct- and over-reporters). The relationship between these accuracy groups and demographic, health, nutritional, and psychological variables and physical activity was examined, to characterise the under-, correct- and over-reporters.

Results:

Although not statistically significantly different, the total group of women tended to underestimate their weight by 0.8 (±3.6) kg. Categorisation according to the accuracy groups revealed that 29% underestimated their weight by 2 kg or more, 19% overestimated their weight by 2 kg or more, and only 52% correctly estimated their weight within 2 kg. Some trends and statistically significant differences between the accuracy groups concerning certain variables, e.g. height, age, income, education, contraceptive pill usage, smoking and food choices were evident.

Conclusions:

Self-reported weight of a group of overweight/obese individuals may be a valid and reliable indicator of actual weight, but self-reported weight of an overweight/obese individual can not be interpreted similarly. Further research is necessary to ensure reliable characterisation of under-, over- and correct reporters.
Association between nutrition knowledge and nutritional intake in middle-aged men from Northern France
Authors: Dallongeville J , Marécaux N , Cottel D , Bingham A , Amouyel P
Published: June 2008

Objective:

The way in which nutrition knowledge transforms into dietary behaviour and nutrient intake may vary among populations. Therefore, the goal of the study was to examine whether nutrition knowledge is associated with nutritional intake in middle-aged men who are at major risk of cardiovascular disease.

Design:

Cross-sectional population study aimed at comparing the response to a nutrition quiz with food habits and nutrient intake determined by a 3-day food record.

Setting:

Men of the Urban Community of Lille (France) examined at home.

Subjects:

361 men aged 45–64 y, randomly selected from the electoral rolls.

Results:

Subjects were separated in a high-score (n = 59) and a low-score (n = 41) group according to their responses to the nutrition quiz. Subjects in the high-score group had better educational and higher income levels than those from the low-score group. Multivariate analysis, adjusting on educational and socio-economic levels and other confounding variables – such as age, body mass index, cigarette smoking, physical activity and energy intake underreporting – showed that subjects in the high-score group were more often consumers of olive oil (36 vs. 12%; p = 0.06), cheese (85 vs. 76%; p<0.01) or cereals (27 vs. 15%; p<0.04) and less often consumers of sunflower oil (51 vs. 68%; p<0.02) or dry vegetables (12 vs. 22%; p<0.05) than those in the low-score group. Subjects in the high-score group had lower intakes of fat (89±24 vs. 104±38 g/d; p = 0.04) and especially of monounsaturated fat of animal origin (23±9 vs. 29±13 g/d; p = 0.01) than individuals in the low-score group.

Conclusion:

Nutrition quiz score is associated with specific patterns of food choices and nutrient intake suggesting that nutrition knowledge influences dietary behaviour in middle-aged men from Northern France.
Anaemia among non-pregnant women in rural Bangladesh
Authors: Hyder SM Ziauddin , Persson Lars-Åke , Chowdhury AMR , Ekström Eva-Charlotte
Published: June 2008

Objective:

To estimate the prevalence and severity of anaemia among non-pregnant women in rural Bangladesh and describe its social distribution.

Design:

A cross-sectional study conducted in February–March 1996. Haemoglobin concentration was measured on a capillary blood sample by cyanmethaemoglobin method. The World Health Organization (WHO) classification was used to define anaemia.

Setting:

Twelve randomly selected villages in Fulbaria thana of Mymensingh district, about 110 km northwest of Dhaka city in Bangladesh.

Subjects:

A systematically selected sample of 179 non-pregnant apparently healthy women aged 15–45 years.

Results:

Anaemia was highly prevalent (73%; 95%CI 67–79%). Most of the women had mild (52%) or moderate (20%) anaemia, but a few of them suffered from severe anaemia (1%). Ascaris was common (39%) while hookworm was not (1%). The anaemia prevalence had no statistically significant association with age, parity or Ascaris infestation (P>0.05). Women with less than 1 year of schooling, who were landless or who reported having an economic deficit in the household had significantly higher prevalence of anaemia (P<0.05). There was a significantly increasing trend in anaemia prevalence with decreasing socioeconomic situation (SES). However anaemia was common in all social strata.

Conclusions:

Although the overall anaemia prevalence among non-pregnant rural women is high, only a few women suffer from severe anaemia. Women of all SES groups irrespective of their age and parity are affected by anaemia.
Maternal cured meat consumption during pregnancy and risk of paediatric brain tumour in offspring: potentially harmful levels of intake
Authors: Pogoda Janice M , Preston-Martin Susan
Published: June 2008

Objective

To describe the relationship between specific levels of nitrite intake from cured meat consumption during pregnancy and the relative risk of paediatric brain tumours in the offspring.

Design

Exposure data were previously collected for a population-based case–control study of paediatric brain tumours; data on nitrite content were obtained by a comprehensive literature review of surveys of residual nitrite content in cured meats published in the USA and Canada. The level of nitrite intake for each mother was predicted by year of pregnancy based on survey results. Dose–response was evaluated both categorically and continuously using polynomial and quadratic spline regression.

Setting

The US west coast: Los Angeles County, the San Francisco–Oakland Bay Area and the Seattle–Puget Sound area.

Subjects

There were 540 cases diagnosed between 1984 and 1990 at ages varying from 0 to 19 years, and 801 controls frequency-matched by geographic area, age and birth year.

Results

In general, survey results suggest a trend of decreasing nitrite levels in cured meats over time. We observed a moderate increase in brain tumour risk in the offspring of mothers with relatively low levels of nitrite consumption from cured meats during pregnancy, and a two- to three-fold risk increase in offspring of mothers who consumed 3 mg day−1 nitrite from cured meats (about 125 g day−1 of cured meat consumption throughout the pregnancy).

Conclusions

A substantial risk of paediatric brain tumour appears to be associated with relatively high levels of maternal cured meat consumption during pregnancy. A more scientifically valid approach than a literature review to estimate nitrite intake from cured meats and data from a large group of highly exposed subjects would be useful in determining potentially harmful levels.
Diet profiles in a population sample from Mediterranean southern France
Authors: Scali Jacqueline , Richard Aurélia , Gerber Mariette
Published: June 2008

Objective

A Mediterranean diet quality index (MDQI) was devised to give an overall assessment of dietary habits and to identify groups at risk.

Design

The MDQI was based on scores given for selected levels of consumption of selected nutrients and foods.

Setting

Mediterranean southern France.

Subjects

The sample included 473 men and 491 women in three age classes recruited at random.

Results

Only 9.5% of men, 9.0% of women, 4.7% of 20–34 year old subjects, 6.6% of 35–54 year old subjects and 14.0% of 55–76 year old subjects were shown to have a healthy diet. However, 10.1% of men, 8.6% of women, 19.4% of 20–34 year old subjects, 10.2% of 35–54 year old subjects and 4.6% of 55–76 year old subjects were shown to have a poor diet. There were significantly fewer smokers among subjects with a good diet but the distribution of moderate wine drinkers was comparable between those with a good diet and those with a poor diet. Correspondence analysis associated a healthy diet with 55–76 year old men and women living in rural areas, who had received primary schooling only and who were manual workers. Both men and women with a poor MDQI score tended to be young and smokers. In addition, women with a poor MDQI tended to be heavy drinkers and obese.

Conclusions

This study showed that the Mediterranean model, which is generally recognized as a healthy diet, appears restricted to older people and to rural areas, whereas urbanized young people depart from it. A nutritional prevention policy targeted at young adults is required to encourage them to adhere to the Mediterranean model. Smoking and drinking showed different distribution patterns in the sample under study.
Comparison of two frequency questionnaires for quantifying fruit and vegetable intake
Authors: Amanatidis Soumela , Mackerras Dorothy , Simpson Judy M
Published: June 2008

Objective

The effect on individual rankings and total intakes of nutrients of correcting total fruit and vegetable frequencies from a long food frequency questionnaire (FFQ) using the responses to two summary questions was examined in a group of women.

Methods

The performance of a self-administered FFQ in ranking individual levels of intake and estimating absolute levels of nutrient and energy intake was compared with the performance of the questionnaire when it was corrected for fruit and vegetable intake reported using the Block summary questions.

Subjects

The study population included 123 women, aged between 18 and 54 years, who were recruited from the Family Planning Association Colposcopy Clinic in Sydney.

Results

Substantial and significant differences (P<0.001) were found in fruit and vegetable intakes between the FFQ and the summary questions. Intake frequency by the FFQ was more than double that by the summary questions. When the FFQ was corrected for fruit and vegetable intakes using the summary questions, the intakes of beta-carotene, vitamins A and C, and dietary fibre were more than 20% lower (P<0.001) than the uncorrected results. However, this had little effect on ranking individuals. This study also examined seasonal differences in vegetable intakes and differences in nutrient intakes when either summer or winter vegetable consumption was substituted for seasonal vegetable intake in the FFQ. Although there were seasonal differences for some foods, the substitution had little effect on intake of nutrients.

Conclusion

These results indicate that important differences in intakes are observed when two methods, which appear to yield the same results, are used. Further work is needed to determine which, if either, of the two methods yields intakes that can be compared quantitatively with national references for assessing the adequacy of population intakes.
Is principal components analysis necessary to characterise dietary behaviour in studies of diet and disease?
Authors: McCann Susan E , Weiner John , Graham Saxon , Freudenheim Jo L
Published: June 2008

Objective:

To assess the relative ability of principal components analysis (PCA)-derived dietary patterns to correctly identify cases and controls compared with other methods of characterising food intake.

Subjects:

Participants in this study were 232 endometrial cancer cases and 639 controls from the Western New York Diet Study, 1986–1991, frequency-matched to cases on age and county of residence.

Design:

Usual intake in the year preceding interview of 190 foods and beverages was collected during a personal interview using a detailed food-frequency questionnaire. Principal components analysis identified two major dietary patterns which we labelled ‘healthy’ and ‘high fat’. Classification on disease status was assessed with separate discriminant analyses (DAs) for four different characterisation schemes: stepwise DA of 168 food items to identify the subset of foods that best discriminated between cases and controls; foods associated with each PCA-derived dietary pattern; fruits and vegetables (47 items); and stepwise DA of USDA-defined food groups (fresh fruit, canned/frozen fruit, raw vegetables, cooked vegetables, red meat, poultry, fish and seafood, processed meats, snacks and sweets, grain products, dairy, and fats).

Results:

In general, classification of disease status was somewhat better among cases (54.7% to 67.7%) than controls (54.0% to 63.1%). Correct classification was highest for fruits and vegetables (67.7% and 62.9%, respectively) but comparable to that of the other schemes (49.5% to 66.8%).

Conclusions:

Our results suggest that the use of principal components analysis to characterise dietary behaviour may not provide substantial advantages over more commonly used, less sophisticated methods of characterising diet.
Maternal consumption ofpulque, a traditional central Mexican alcoholic beverage: relationships to infant growth and development
Authors: Backstrand Jeffrey R , Allen Lindsay H , Martinez Eulalia , Pelto Gretel H
Published: June 2008

Objectives:

To document the consumption during pregnancy ofpulque, a traditional central Mexican alcoholic beverage, and its relationship to subsequent infant size, physical growth and performance on the Bayley Scales of Infant Development.

Design:

Prospective cohort study.

Setting:

Six villages in rural, central Mexico in 1984–1985.

Subjects:

Seventy mother–infant pairs.

Results:

Most women (72.9%) consumedpulqueduring pregnancy, and 28.6% consumed more than 150 g ethanol week−1from the beverage. Individuals who consumedpulqueshowed no compensating decrease in energy obtained from other foods.Pulqueconsumption possessed curvilinear relationships with both infant length (at 1 and 6 months) and Bayley mental performance (at 6 months). Heavypulqueintakes were associated with smaller infant size and poorer mental performance. In modest quantities,pulqueconsumption may have been beneficial due to its micronutrient content.

Conclusions:

Intakes of alcohol frompulquewere common among pregnant women in these rural, central Mexican villages. Given current scientific knowledge of the adverse effects of ethanol on foetal development, public health interventions are needed to reduce heavypulqueconsumption during pregnancy in some areas of rural Mexico.
Coronary heart disease: dietary links and pathogenesis
Authors: Renaud Serge , Lanzmann-Petithory Dominique
Published: June 2008

For decades it has been postulated that the main environmental factor for coronary heart disease (CHD) was the intake of saturated fatty acids (SFA). Nevertheless, confirmation of the role of SFA in CHD through intervention trials has been disappointing. It was only when the diet was enriched in n-3 fatty acids that CHD was significantly prevented, especially cardiac death.

In addition to n-3 fatty acids, many other foodstuffs or nutrients such as fibers, antioxidants, folic acid, calcium and even alcohol contribute to prevent CHD. Thus the relationship between diet and CHD morbidity and mortality appears to be much more complex than formerly suspected considering as key factors only SFA, linoleic acid, cholesterol and atherosclerosis. Some of the mechanisms are briefly described, but many additional nutrients (or non nutrients) may also play an important role in the pathogenesis of CHD.

Finally, as a result of the most recent epidemiologic studies the ideal diet may comprise: 8% energy from SFA, 5% from polyunsaturated fatty acids with a ratio 5/1 of linoleic/alpha-linolenic acid+longer chains n-3, oleic acid as desired, large intake of cereals, vegetables, legumes and fruits, fish twice a week, cheese and yogurt as dairy products, rapeseed and olive oils as edible fat. Without side effects, such a diet can be highly palatable, easily enjoyed by many populations and may prevent effectively and rapidly (within a few weeks or months) CHD.
Healthy lifestyles in Europe: prevention of obesity and type II diabetes by diet and physical activity
Authors: Astrup Arne
Published: June 2008

The prevalence of obesity is increasing rapidly in all age groups in most EU-countries and is one of the fastest growing epidemics, now affecting 10–40% of the adult population. Obesity increases the risk of serious co-morbidities such as type 2 diabetes, cardiovascular disease, certain cancers and reduced life expectancy, and these complications may account for 5–10% of all health costs in EU countries. The risk of diabetes is particularly increased by obesity, and 80–95% of the increase in diabetes can be attributed to obesity and overweight with abdominal fat distribution. There is robust evidence from cross-sectional and longitudinal studies to support that an energy-dense, high fat diet and physical inactivity are independent risk factors for weight gain and obesity. Furthermore, interaction between dietary fat and physical fitness determine fat balance, so that the obesity promoting effect of a high fat diet is enhanced in susceptible subjects, particularly in sedentary individuals with a genetic predisposition to obesity.

Ad libitum consumption of diets low in fat and high in protein and complex carbohydrates, with a low glycaemic index, contributes to the prevention of weight gain in normal weight subjects. It also causes a spontaneous weight loss of 3–4 kg in overweight subjects, and has beneficial effects on risk factors for diabetes and CVD. To prevent obesity and diabetes there are grounds for recommending the combination of increasing daily physical activity level to a PAL-value of at least 1.8 and reducing dietary fat content to 20–25 energy-% in sedentary subjects, and to 25–35% in more physically active individuals.
Iron deficiency in Europe
Authors: Hercberg Serge , Preziosi Paul , Galan Pilar
Published: June 2008

In Europe, iron deficiency is considered to be one of the main nutritional deficiency disorders affecting large fractions of the population, particularly such physiological groups as children, menstruating women and pregnant women. Some factors such as type of contraception in women, blood donation or minor pathological blood loss (haemorrhoids, gynaecological bleeding,..) considerably increase the difficulty of covering iron needs. Moreover, women, especially adolescents consuming lowenergy diets, vegetarians and vegans are at high risk of iron deficiency.

Although there is no evidence that an anbsence of iron stores has any adverse consequences, it does indicate that iron nutrition is borderline, since any further reduction in body iron is associated with a decrease in the level of functional compounds such as haemoglobin.

The prevalence of iron-deficient anaemia has slightly decreased in infants and menstruating women. Some positive factors may have contributed to reducing the prevalence of iron-deficiency anaemia in some groups of population: the use of iron-frotified formulas and iron-fortified cereals; the use of oral contraceptives and increased enrichment of iron in several countries; and the use of iron supplements during pregnancy in some European countries.

It is possible to prevent and control iron deficiency by counseling individuals and families about sound iron nutrition during infancy and beyond, and about iron supplementation during pregnancy, by screening persons on the basis of their risk for iron deficiency, and by treating and following up persons with presumptive iron deficiency. This may help to reduce manifestations of iron deficiency and thus improve public health. Evidence linking iron status with risk of cardiovascular disease or cancer is unconvincing and does not justify changes in food fortification or medical practice, particularly because the benefits of assuring adequate iron intake during growth and development are well established. But stronger evidence is needed before rejecting the hypothesis that greater iron stores increase the incidence of CVD or cancer. At present, currently available data do not support radical changes in dietary recommendations. They include all means for increasing the content of dietary factors enhancing iron absorption or reducing the content of factors inhibiting iron absorption. Increased knowledge and increased information about factors may be important tools in the prevention of iron deficiency in Europe.
Fetal programming and adult health
Authors: Godfrey Keith M , Barker David JP
Published: June 2008

Low birthweight is now known to be associated with increased rates of coronary heart disease and the related disorders stroke, hypertension and non-insulin dependent diabetes. These associations have been extensively replicated in studies in different countries and are not the result of confounding variables. They extend across the normal range of birthweight and depend on lower birthweights in relation to the duration of gestation rather than the effects of premature birth. The associations are thought to be consequences of ‘programming’, whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on structure, physiology and metabolism. Programming of the fetus may result from adaptations invoked when the materno-placental nutrient supply fails to match the fetal nutrient demand. Although the influences that impair fetal development and programme adult cardiovascular disease remain to be defined, there are strong pointers to the importance of maternal body composition and dietary balance during pregnancy.
Breastfeeding in countries of the European Union and EFTA: current and proposed recommendations, rationale, prevalence, duration and trends
Authors: Yngve Agneta , Sjöström Michael
Published: June 2008

Recommendations suggestexclusive breastfeedingfor at least the first 4 to 6 months after birth. Paradoxically, an overwhelming proportion of breastfeeding (BF) data in Europe refers toallBF, i.e. not only exclusive but also partial BF (including formula, juices, water, sweetened water etc). This makes it difficult to estimate to what extent the recommendations are met. There is currently strong evidence for recommending exclusive breastfeeding for at least 6 months.

Exclusive BF has progressively gained scientific support. Prevention of infections, allergies and chronic diseases and a favourable cognitive development are highlighted in the recent scientific literature. Further long-term studies on the effects of BF on prevention of chronic disease in the adult are needed.

Great differences exist in BF prevalence and duration both within and between European countries. Trends point towards higher prevalence and duration, with some exceptions. Young mothers breastfeed less than older mothers; single and/or less educated mothers breastfeed less than married mothers with more education. However, inefficient and unreliable monitoring systems prevail, and the data are scarce, not only on exclusive BF but also on demographic, socio-economic, psychosocial and medical determinants of BF patterns. National BF co-ordinators have not been appointed in many countries, and only every second country has promotion of BF incorporated into their national plan of action for nutrition.

Conclusions:

Efficient surveillance systems, comparable across Europe and using common definitions and methodology, need to be developed. These should include determinants of breastfeeding. A European consensus conference should urgently be determinants of breastfeeding. A European consensus conference should urgently be organised, in which strategies for successful promotion of exclusive BF should be particularly considered. There is now strong evidence for a recommendation to breastfeed exclusively for about 6 months, which is more than the duration recommended previously.
A review of ethnicity, health and nutrition-related diseases in relation to migration in the United Kingdom
Authors: Landman J , Cruickshank JK
Published: June 2008

Objectives:

To identify lessons from and gaps in research on diet-disease links among former migrants in the United Kingdom (UK).

Results:

Migrant status and self-identified ethnicity do not match so these terms mask differences in social, nutritional and health status within and between population groups. Some former migrants differ in causes of death from the general population, e.g.: fewer coronary heart disease deaths among Caribbean-born; fewer cancer deaths among Caribbean, South Asian- and East African-born adults. Irish- and Scottish-born have higher mortality from all causes. Experience of risk factors differ also, e.g.: higher prevalences of hypertension and diabetes in Caribbean- and South Asian-born adults than representative samples of the general population; obesity and raised waist-hip circumference ratios in South Asian, African-Caribbean and some Irish-born adults. Former migrants experience long-term disadvantage, associated with more self-defined illness and lower reported physical activity. Nutrient intake data from the few, recent, small-scale studies must be interpreted with caution due to methodological diversity. However, second generation offspring of former migrants appear to adopt British dietary patterns, increasing fat and reducing vegetable, fruit and pulse consumption compared with first generation migrants.

Conclusions:

There is insufficient evidence on why some former migrants but not others experience lower specific mortality than the general population. Dietary intake variations provide important clues particularly when examined by age and migration status. Majority ethnic and younger migrant groups could raise and sustain high fruit and vegetable intakes but lower proportions of fat, by adopting many dietary practices from older migrants. Objective measures of physical activity and longitudinal studies of diets among different ethnic groups are needed to explain diversity in health outcomes and provide for evidence-based action.
Nutrition and health among migrants in the Netherlands
Authors: Brussaard JH , van Erp-Baart MA , Brants HAM , Hulshof KFAM , Löwik MRH
Published: June 2008

Objective:

this paper aims to give a broad overview of published data on nutrition and health among migrants in the Netherlands, as well as data on determinants of health.

Results and conclusions:

Depending on the definition, 9 to 17% of the population belongs to the group ‘migrants’ and this proportion is expected to grow in the coming years. Roughly 2/3 of migrants are of the first generation and on average, they are younger than the Dutch population. Relatively few data concerning the health status of migrants are available. The diet of migrants showed both positive (macronutrients) and negative (micronutrients) differences with the general Dutch diet. The risk of overweight was high among both children and adult women, and the data suggest a higher risk for Turkish and Moroccan groups than for Dutch groups. The importance of health determinants, such as smoking, alcohol use and physical and social environment, was different for migrants than for the Dutch population; however, there were also differences between ethnic groups. The limited data on morbidity for migrants suggest higher risks than for the indigenous population. The same holds for mortality data, especially for the younger age groups. In general, the data that are available suggest that the health status of migrants was less favourable than that of the indigenous population. However, there were also differences between the various groups of migrants. The lower socio-economic position of migrant groups partly explained the differences in health status. Nevertheless, a study among Turkish people indicated that their health status was lower than that of Dutch people of comparable socio–economic status.
Food composition issues – implications for the development of food-based dietary guidelines
Authors: Leclercq Catherine , Valsta Liisa M , Turrini Aida
Published: June 2008

Sound food composition databases that are both comprehensive and representative of available foods are an essential basic tool to develop Food Based Dietary Guidelines (FBDG). The main drawbacks of current food composition databases available in the European Union are: partial coverage of foods and nutrients, variability of analytical data, lack of accuracy in the description of food items, need for harmonisation of the expression of nutrients. An inappropriate use of these databases could lead to gross errors in the assessment of the nutrient intake levels, in the identification of the major sources of a nutrient, in the comparison of data between countries and in the analysis of time trends. Inadequacy of food composition data is, in part, responsible for the failure to understand some relationships between nutrient intakes and health or disease and for difficulties in establishing quantitative dietary guidelines in terms of nutrients. Recommendations are made for the compilation of future food composition databases and tools are proposed to enhance the quality of existing data. A careful study of the food composition databases is always necessary before nutrition recommendations are given and before trends in nutrient intakes are interpreted.
Under-reporting in dietary surveys – implications for development of food-based dietary guidelines
Authors: Becker W , Welten D
Published: June 2008

Objective:

To illustrate issues related to under-reporting in dietary surveys relevant for development of food-based dietary guidelines

Setting:

Food and nutrient intakes in two national dietary surveys are analysed in relation to under-reporting using the concept of cut-off values for the ratio between energy intake and basal metabolic rate as well as biochemical markers of nutritional status.

Results:

Subjects with an implausibly low EI/BMR ratio had dietary patterns more close to recommended levels, e.g. lower fat intake and higher fibre intake, than those with acceptable energy intakes. Intakes of micronutrients were lower. This was due to both general and selective under-reporting of foods. Under-reporting was due to less frequent consumption, larger proportion of non consumers and smaller portion sizes. Low EI/BMR ratios did not influence the characterisation of protein and micronutrient intake of low and high consumers of fruit and vegetable intake.

Conclusions:

Under-reporting can influence the usefulness of dietary data as a tool for developing food-based dietary guidelines, and the extent of under-reporting should be assessed using appropriate methods.
Eating patterns – temporal distribution, converging and diverging foods, meals eaten inside and outside of the home – implications for developing FBDG
Authors: Kearney JM , Hulshof KFAM , Gibney MJ
Published: June 2008

Objective:

A consideration of eating patterns in the general population is necessary when deriving food-based dietary guidelines (FBDG) as promoting the intake of one food may indirectly result in the increased consumption of another, which may not always be desirable. A number of issues that influence meal patterns such as temporal distribution of food intake (using data from the Netherlands), converging and diverging foods (using data from Ireland) and meals eaten inside and outside of the home (using data from the UK) are examined and discussed in the context of developing FBDG.

Setting:

Food intake databases from three EU countries: The Netherlands, Ireland and the UK.

Results:

The hot meal (dinner) was found to be the main contributor to the intake of energy and macro-nutrients in the Dutch population. It was also the main contributor to the intake of all micro-nutrients with the exception of calcium where the bread meal contributed a similar proportion as the hot meal to the intake of this micronutrient. Furthermore, fruit intake showed a very different temporal distribution to vegetable intake. Exploring the convergence of certain foods in the Irish population also revealed differences between fruit and vegetables. A low correlation was shown for consumers of fruit and vegetables indicating that being a high fruit consumer did not suggest being also a high vegetable consumer. An examination of where meals were consumed among British adults showed that 71% of all meals were consumed inside the home while 29% were consumed outside. 27% of food energy and 45% of alcohol energy was consumed out of home by the total population. In addition, those eating less of their foods out of home obtained a lower proportion of their food energy from fat and protein and a higher proportion from carbohydrate. A different demographic profile was associated with eating out compared to eating in, comprising more males and younger individuals.

Conclusions:

Information on patterns of food intake and food habits, specifically temporal distribution, the convergence and divergence of foods and foods consumed inside and outside of the home, give a culturally specific picture of food consumption practices within a population. This should enable the development of more culturally acceptable and realistic FBDG.
MTHFR gene polymorphism, homocysteine and cardiovascular disease
Authors: Cortese Claudio , Motti Corradino
Published: June 2008

Homocysteine is an emerging new risk factor for cardiovascular disease. It is a thiol compound derived from methionine and involved in two main metabolic pathways: the cycle of activated methyl groups, requiring folate and vitamin B12 as cofactors, and the transsulfuration pathway to cystathionine and cysteine requiring vitamin B6 as cofactor. The homocysteine metabolism represents an interesting model of gene-environment interaction. Elevations in homocysteine may be caused by genetic defects in enzymes involved in its metabolism or by deficiencies in cofactor levels. A common polymorphism in the gene coding for the 5, 10-methylene tetrahydrofolate reductase (MTHFR) (C677T, Ala → Val) is associated with a decreased activity of the enzyme due to thermolability. In case of homozygosity for the Val allele, a relative deficiency in the remethylation process of homocysteine into methionine leads to a mild-to-moderate hyperhomocysteinemia, a condition recognized as an independent risk factor for atherosclerosis. The genetic influence of the MTHFR polymorphism on homocysteine levels is attenuated in females in premenopausal age and is not significant in subjects who exhibit serum levels of folate and/or vitamin B12 above the 50thpercentile of distribution in the general population. The prevalence of the Val/Val genotype varies among different ethnic groups. It is very low in African populations, whereas in Europe and North America it ranges between 5% and 15%. In Italy an even higher prevalence has been reported in some regions. The question whether the MTHFR polymorphism might beper sean independent contributor to cardiovascular risk is debated. The interaction between this or other genetic factors and environmental/nutritional conditions (i.e. intake of vitamins such as folate) is a key determinant for homocysteine concentrations in healthy conditions as well as in some disease (i.e. in renal disorders). Another example of gene/environment interaction in the field of atherosclerosis is given by the apolipoprotein E polymorphism and its influence in response to diet. The presence of a high prevalence of risk-related allelic variants of such candidate genes within a certain population could serve to locally reinforce the recommendations concerning nutrient intake.
Inequalities in diet and physical activity in Europe
Authors: Dowler Elizabeth
Published: June 2008

The contribution of food, nutrition and physical activity to inequalities in health across Europe is largely unexplored. This paper summarizes cross sectional survey data on food patterns and nutrient intakes, and briefer data on physical activity, by various indicators of socio-economic status for countries across Europe. Factors are examined which underlie the outcome data seen. These include structural and material conditions and circumstances which contribute to excluding sociodemographic groups from participating in mainstream patterns of living. Trends in social and economic conditions, and their implications for nutritional and physical wellbeing are briefly outlined.
Cost effectiveness of cardiovascular disease prevention strategies: a perspective on EU food based dietary guidelines
Authors: Brunner Eric , Cohen David , Toon Lynn
Published: June 2008

For policymakers considering strategy options for the prevention of cardiovascular disease (CVD) the distinction between effectiveness and cost effectiveness is critical. When cost limitations apply, an evaluation of cost effectiveness is essential if a rational decision is to be made. Policy changes and resource reallocation have opportunity costs, and therefore it is necessary to compare the cost of health gains achievable by means of different policies. Here the broad question is: How cost effective are diet change strategies compared to other measures aimed at reducing cardiovascular disease in EU member states?

An overview of published studies of cost effectiveness in the primary and secondary prevention of cardiovascular disease was conducted. Few comprehensive studies were available.

Estimated costs per life year gained were as follows: population-based healthy eating £14–560; smoking cessation £300–790; nurse screening and life style advice £900 (minimum); simvastatin (HMGCoA reductase inhibitor) £6200–11 300. Cost effectiveness is dependent on the underlying level of CVD risk in the target population, and the duration of the achieved alterations in behaviours and risk factors.

The limited evidence from these studies tends to support the view that health protection strategies which promote healthy eating are likely to be more cost-effective than strategies involving modern cholesterol-lowering drugs, screening and advice in primary care, and are comparable to or less expensive per year of life saved than anti-smoking strategies. Given the considerable diversity in food habits, health care and public health systems among current and prospective EU member states, careful appraisal of the policy options within each member state is desirable to ensure that health gain is maximised. EU wide food based dietary guidelines are potentially the basis of large health gains in Europe, and cost-effectiveness studies tend to support their adoption.
The school setting: an opportunity for the implementation of dietary guidelines
Authors: Pérez-Rodrigo Carmen , Klepp Knut-Inge , Yngve Agneta , Sjöström Michael , Stockley Lynn , Aranceta Javier
Published: June 2008

Nutrition, physical activity and health related promotion programmes in schools have developed into a mature field of research over the past decades. A number of success factors have been identified and evidence-based interventions have been performed. However, the school setting as an arena for evidence-based health promotion programmes, is still not used to its full potential. Schools provide an excellent arena for reaching large segments of the population, such as young people, school staff, families and the surrounding community.

There is a need for an overview regarding the current status of nutrition, physical activity, related health as well as support structures in the EU member states. Based upon such an analysis, a consensus report should be written, pointing out the major problems at hand. Self-assessment tools for national as well as for school level should be produced, in order to guide changes, but also to include an element of continuous assessment of change, for evaluation purposes.
Breastfeeding determinants and a suggested framework for action in Europe
Authors: Yngve Agneta , Sjöström Michael
Published: June 2008

This is a background paper for the EURODIET initiative. A number of international initiatives and documents were identified, such as the Baby-Friendly Hospital Initiative, the International Code of Marketing of Breast Milk Substitutes and a number of consensus reports from professional groups, that propose ways forward for breastfeeding promotion. These point at a range of initiatives on different levels. The determinants for successful breastfeeding have to be identified. They can be categorised into five groups; socio-demographic, psycho-social, health care related, community- and policy attributes. A framework for future breastfeeding promoting efforts on European level is suggested, within which these determinants are considered.

A common surveillance system needs to be built in Europe, where determinants of breastfeeding are included. There is also a need for a surveillance system which makes it possible to use the collected data on local level, not only on national and supranational level. Combined with a thorough review of the effectiveness of already existing breastfeeding promotion programmes, a co-ordinated EU – EFTA action plan on breastfeeding should be formulated and implemented within a few years. Urgent action could take place in parallel, especially targeting young, low-income, less educated mothers.
Analysis of patterns of food intake in nutritional epidemiology: food classification in principal components analysis and the subsequent impact on estimates for endometrial cancer
Authors: McCann Susan E , Marshall James R , Brasure John R , Graham Saxon , Freudenheim Jo L
Published: June 2008

Objective:

To assess the effect of different methods of classifying food use on principal components analysis (PCA)-derived dietary patterns, and the subsequent impact on estimation of cancer risk associated with the different patterns.

Methods:

Dietary data were obtained from 232 endometrial cancer cases and 639 controls (Western New York Diet Study) using a 190-item semi-quantitative food-frequency questionnaire. Dietary patterns were generated using PCA and three methods of classifying food use: 168 single foods and beverages; 56 detailed food groups, foods and beverages; and 36 less-detailed groups and single food items.

Results:

Classification method affected neither the number nor character of the patterns identified. However, total variance explained in food use increased as the detail included in the PCA decreased (~8%, 168 items to ~17%, 36 items). Conversely, reduced detail in PCA tended to attenuate the odds ratio (OR) associated with the healthy patterns (OR 0.55, 95% confidence interval (CI) 0.35–0.84 and OR 0.77, 95% CI 0.49–1.20, 168 and 36 items, respectively) but not the high-fat patterns (OR 0.95, 95% CI 0.57–1.58 and OR 0.85, 0.51–1.40, 168 and 36 items, respectively).

Conclusions:

Greater detail in food-use information may be desirable in determination of dietary patterns for more precise estimates of disease risk.
Estimation and validation of mercury intake associated with fish consumption in an EPIC cohort of Spain
Authors: Sanzo JM , Dorronsoro M , Amiano P , Amurrio A , Aguinagalde FX , Azpiri MA ,   EPIC Group of Spain
Published: June 2008

Objective:

To estimate mercury intake due to fish consumption among the individuals from Gipuzkoa participating in the European Prospective Investigation into Cancer (EPIC), and to validate the estimation of mercury exposure through diet, by measuring blood mercury level.

Design and setting:

The population for the EPIC Gipuzkoa cohort was recruited from 1992 to 1995. Each individual's diet was assessed regarding habitual intake over the previous year, using the diet history method. Blood samples were taken at the time of the interview. The mercury content of the fish species consumed was supplied by the Food Chemical Surveillance Programme in the Basque Country.

Subjects:

For the estimation, 8417 volunteers, men and women, aged 35–65 years, of the EPIC cohort; for the validation, a random sample of 120 individuals stratified by fish intake was taken.

Results:

The validation study confirmed the relationship between fish consumption and mercury intake, as well as between fish consumption and mercury in erythrocytes. 99.9% of individuals have intakes below 75% of the Provisional Tolerable Weekly Intake (PTWI) of mercury established by the World Health Organization. But the limit dosage recommended by the United States Environmental Protection Agency, measured by the average risk index, would be exceeded often.

Conclusions:

No individual from the cohort would exceed the PTWI of mercury. Nevertheless, owing to the amount of fish consumed, certain individuals would have mercury intakes approaching the recommended limits. With a view to the future, we believe mercury in fish must continue to be monitored closely in order to assess the risks for the population.
The use of supermarket till receipts to determine the fat and energy intake in a UK population
Authors: Ransley Joan K , Donnelly Judith K , Khara Tanya N , Botham Helen , Arnot Heidy , Greenwood Darren C , Cade Janet E
Published: June 2008

Objectives:

To validate the use of supermarket receipts as an index of fat and energy intake in a population that buys most of its food from supermarkets.

Design:

Cross-sectional, prospective dietary survey – feasibility study.

Setting:

Households situated within a 20-mile radius of a large (Tesco) supermarket in Leeds.

Subjects:

Two hundred and fourteen households who spend ≥=60% of their food purse in (Tesco and other) supermarkets.

Results:

Mean daily household purchase of fat, energy and percentage energy from fat contained in food from supermarkets were 185 g, 19.2 MJ and 35.9%. Mean daily household intakes of fat and energy were 190 g and 20.7 MJ, and 35% of energy was derived from fat. Mean household size was 2.4 persons. The association between the amount of fat and energy purchased from supermarkets and the amount of fat and energy consumed by households was strong. 0.90 MJ (95% confidence interval (CI): 0.8–1.0) of energy were consumed for every 1 MJ purchased from supermarkets and 0.76 g (95% CI: 0.64–0.87) of fat were consumed for every 1 g of fat purchased.

Conclusions:

The results show a strong association between estimates of the intakes of fat and energy and percentage energy from fat using 4-day food diaries and 28 days of receipts, in populations who buy most of their food from supermarkets. They also show that the fat content of total food purchases from supermarkets is 35.9% energy from fat compared with 33% energy from fat recommended by the Department of Health. This preliminary research indicates the feasibility of and potential for utilising large quantities of readily available data generated from supermarket checkouts in dietary surveys.