Alicia Garcia-Alvarez

Obesity and overweight trends in Catalonia, Spain (1992-2003): gender and socio-economic determinants

OBJECTIVE To evaluate the trends of overweight and obesity prevalences in the population of Catalonia, Spain, aged 18-75 years, and the influence of socio-economic determinants on these prevalence trends. DESIGN Analysis based on data from two representative population-based cross-sectional surveys. SETTING Data from the two Evaluations of Nutritional Status in Catalonia (ENCAT 1992-93 and ENCAT 2002-03), Spain. Weights and heights were obtained by direct measurement in standardised conditions by trained interviewers. Overweight and obesity were defined using body mass index (BMI) and waist circumference (WC), categorised according to WHO criteria. SUBJECTS In total, 1015 men and 1233 women from ENCAT 1992-93, and 791 men and 924 women from ENCAT 2002-03. RESULTS Mean BMI and mean WC were higher in males in 2002-03 as compared to 1992-93, while for females mean BMI was lower except for the youngest group, and mean WC was higher. In men, overall BMI overweight prevalence remained stable (from 44.1% to 43.7%), while obesity increased (from 9.9% to 16.6%); total WC overweight remained stable (from 21.7 to 23.8%), while WC obesity increased (from 13.1% to 24.4%). In women, overall BMI overweight increased (from 29.1% to 30.1%), whereas BMI obesity remained stable (from 15.0% to 15.2%); total WC overweight decreased (from 21.8% to 17.7%), while WC obesity increased (from 24.5% to 31.1%). The socio-economic and education variables had an influence on BMI and WC overweight and obesity rates mainly on females in both surveys and on the youngest men only in the 1992-93 survey. CONCLUSIONS Ten-year trends indicate that Catalan males are getting bigger overall (BMI) and around the waistline (WC), while Catalan females only have bigger waistlines (WC). BMI male obesity prevalence has overtaken that of females. WC obesity continues to be more prevalent among females than males.

Usage of Plant Food Supplements across Six European Countries: Findings from the PlantLIBRA Consumer Survey

Background The popularity of botanical products is on the rise in Europe, with consumers using them to complement their diets or to maintain health, and products are taken in many different forms (e.g. teas, juices, herbal medicinal products, plant food supplements (PFS)). However there is a scarcity of data on the usage of such products at European level. Objective To provide an overview of the characteristics and usage patterns of PFS consumers in six European countries. Design Data on PFS usage were collected in a cross-sectional, retrospective survey of PFS consumers using a bespoke frequency of PFS usage questionnaire. Subjects/setting A total sample of 2359 adult PFS consumers from Finland, Germany, Italy, Romania, Spain and the United Kingdom. Data analyses Descriptive analyses were conducted, with all data stratified by gender, age, and country. Absolute frequencies, percentages and 95% confidence intervals are reported. Results Overall, an estimated 18.8% of screened survey respondents used at least one PFS. Characteristics of PFS consumers included being older, well-educated, never having smoked and self-reporting health status as “good or very good”. Across countries, 491 different botanicals were identified in the PFS products used, with Ginkgo biloba (Ginkgo), Oenothera biennis (Evening primrose) and Cynara scolymus (Artichoke) being most frequently reported; the most popular dose forms were capsules and pills/tablets. Most consumers used one product and half of all users took single-botanical products. Some results varied across countries. Conclusions The PlantLIBRA consumer survey is unique in reporting on usage patterns of PFS consumers in six European countries. The survey highlights the complexity of measuring the intake of such products, particularly at pan-European level. Incorporating measures of the intake of botanicals in national dietary surveys would provide much-needed data for comprehensive risk and benefit assessments at the European level.

How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review

EURopean micronutrient RECommendations Aligned is a network of excellence funded by the European commission, and established to address the problem of differences between countries in micronutrient recommendations as well as to understand how nutritional information including requirements and adequacy of intake is processed among different population groups. The aims of the present paper were to review the methods used for the adequacy assessment of the intake of six micronutrients of public health concern (vitamin A, folate, vitamin B12, Fe, Zn and iodine) in non-European and European nutrition surveys carried out on the apparently healthy population and to compare in particular the adequacy across surveys for folate intake. A systematic literature review was conducted to identify nutrition surveys that assessed micronutrient intake adequacy. The search yielded 9049 records, out of which 337 were eligible for the selected micronutrients. The majority (83.9 %) of the European surveys compared the adequacy of the nutrient intake against the Recommended Dietary Allowances (RDA); only a few surveys (8.0 %) used the estimated average requirement cut-point method, while none of them used the probability approach. The comparison of folate inadequacy across eight countries revealed that about 25 % of the adult female population had inadequate intakes when judged against the different recommendations used by the respective investigators, but nearly 75 % had inadequate intakes when compared against the estimated average requirement cut-point value of 320 microg/d. The present review showed that different methods were applied across Europe to estimate the adequacy of micronutrient intake, which led to different prevalence estimates of micronutrient inadequacy.

Effects of dietary assessment methods on assessing risk of nutrient intake adequacy at the population level: from theory to practice

The present study evaluated how applying different dietary methods affects risk assessment of inadequate intakes at the population level. A pooled analysis was conducted using data from two Spanish regional representative surveys both applying similar methodology with a total sample of 2615 individuals aged 12-80. Diet was assessed in the entire sample applying data from one 24 h recall (24HR), a mean of two non-consecutive 24HR, both crude and adjusted for intraindividual variability, and a FFQ. Intakes of vitamins A, C, E, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, Fe, Mg, P and Zn were compared to the average nutrient requirement (ANR or estimated average requirement) in the entire sample and also excluding under-reporters applying the ANR cut-point method (and the probability approach for Fe). Higher percentages of intakes below the ANR were seen for 1-24HR and the mean of 2-24HR, except for nutrients with the highest rates of inadequacy (vitamins A, E, folate and Mg). For these micronutrients, higher percentages of inadequacy were obtained by adjusted 24HR data and the lowest with FFQ. For the remaining nutrients, adjusted data gave the lowest inadequacy percentages. The best concordance was seen between 2-24HR and 1-24HR as well as for adjusted 24HR, with the least observed between FFQ and the other methods. Exclusion of under-reporters considerably reduced inadequacy in both daily methods and FFQ. Crude daily data gave higher estimates of inadequate intakes than adjusted data or FFQ. Reproducibility of daily methods was also reasonably good. Results may differ depending on the micronutrient thus impeding reaching conclusions/recommendations common for all micronutrients.

Overview of methods used to evaluate the adequacy of nutrient intakes for individuals and populations

The objective of the present paper is to review the methods of measuring micronutrient intake adequacy for individuals and for populations in order to ascertain best practice. A systematic review was conducted to locate studies on the methodological aspects of measuring nutrient adequacy. The results showed that for individuals, qualitative methods (to find probability of adequacy) and quantitative methods (to find confidence of adequacy) have been proposed for micronutrients where there is enough data to set an average nutrient requirement (ANR). If micronutrients do not have ANR, an adequate intake (AI) is often defined and can be used to assess adequacy, provided the distribution of daily intake over a number of days is known. The probability of an individuals intake being excessive can also be compared with the upper level of safe intake and the confidence of this estimate determined in a similar way. At the population level, adequacy can be judged from the ANR using the probability approach or its short cut - the estimated average requirement cut-point method. If the micronutrient does not have an ANR, adequacy cannot be determined from the average intake and must be expressed differently. The upper level of safe intake can be used for populations in a similar way to that of individuals. All of the methodological studies reviewed were from the American continent and all used the methodology described in the Institute of Medicine publications. The present methodology should now be adapted for use in Europe.

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies.

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

How does the quality of surveys for nutrient intake adequacy assessment compare across Europe? A scoring system to rate the quality of data in such surveys

Research was conducted within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence, to find the best practice in assessing nutrient intakes. Objectives include: to search for and use data on individual nutrient intake adequacy (NIA) assessment collected in twenty-eight European countries and the four European Free Trade Association countries; to design and test innovative tools for data quality analysis. The information was obtained using the method described by Blanquer et al. in the present issue. The best-practice criteria were devised to select the most appropriate survey in each country. Then a survey quality scoring system was developed in consultation with experts and tested on these surveys. Weights were allocated according to a variable priority order agreed by consultation. The thirty-two countries yielded twenty-four national surveys (eight countries excluded). Data collection techniques: eleven countries/surveys used personal interviews only; six used combinations of techniques. Dietary assessment methods: two used repeated 24 h recalls only; eleven used combinations. NIA assessment methods: two used probabilistic approach and sd/Z-scores only; eleven used comparison with estimated average requirements/RDA only. Countries were ranked according to the survey quality scoring, but careful interpretation is needed because of incomplete data from some surveys; bearing this in mind, the information quality is high in 37.5 % countries, medium in 50.0 % and low in 12.5 %. Although there is room for improvement and caution should be taken when drawing conclusions and recommendations from these results, the lessons learned and tools developed at this first attempt form the basis for future work within the EURRECA framework for aligning European micronutrient recommendations.

Intake of selected bioactive compounds from plant food supplements containing fennel (Foeniculum vulgare) among Finnish consumers.

The purpose of this study was to estimate the intake of selected bioactive compounds from fennel-containing plant food supplements (PFS) among Finnish consumers. The estimated average intake of estragole was 0.20mg/d, of trans-anethole 1.15mg/d, of rosmarinic acid 0.09mg/d, of p-coumaric acid 0.0068mg/d, of kaempferol 0.0034mg/d, of luteolin 0.0525μg/d, of quercetin 0.0246mg/d, of matairesinol 0.0066μg/d and of lignans 0.0412μg/d. The intakes of kaempferol, quercetin, luteolin, matairesinol and lignans from PFS were low in comparison with their dietary supply. The intake of estragole was usually moderate, but a heavy consumption of PFS may lead to a high intake of estragole. The intake of trans-anethole did not exceed the acceptable daily intake, but PFS should be taken into account when assessing the total exposure. To our knowledge, this study provided the first intake estimates of trans-anethole, p-coumaric acid and rosmarinic acid in human populations.