Concetta Montagnese

European food-based dietary guidelines: A comparison and update

OBJECTIVES The aim of this study was to review and update information about food-based dietary guidelines (FBDGs) used by European countries. METHODS FBDGs from 34 European countries were collected and their pictorial representations, food groupings, and associated messages of healthy eating and behavior were compared. RESULTS FBDGs from 34 European countries were collected, representing 64% (34 of 53) of all European countries; 74% (28 of 34) are European Union members. Of these FBDGs, 67% (23 of 34) adopt the pyramid as a food guide illustration, and classify foods into five or six groups. The main food groups are grains, vegetables, fruits, and vegetables and fruits as a unified group. Some differences include the modality of food classification. Despite dietary pattern results from geographic conditions and cultural (ethnic) heritages, most nutritional key points are similar among the different European FBDGs: In particular, the basic message is to consume adequate amounts of grains, vegetables, and fruits with moderate intake of fats, sugars, meats, caloric beverages, and salt. Other healthy behaviors are frequently but not always indicated. CONCLUSIONS FBDGs still seem insufficient as far as ethnic peculiarities, agreement on how to group foods, and subgroup population nutritional requirements.

Prognostic significance of bioelectrical impedance phase angle in advanced cancer: preliminary observations.

Bioelectrical impedance-derived phase angle is a potentially sensible indicator of protein-energy malnutrition and of fat-free mass loss, frequent in patients with advanced cancer. We evaluated in 13 patients with advanced cancer some biochemical (serum albumin, lymphocyte count, cholesterol, cholinesterase) and clinical (Karnofsky index, Subjective Global Assessment, dietary inquiry) parameters and bioelectrical impedance analysis was performed. In addition to albumin, cholinesterase, and the Karnofsky index, phase angle (R(2)=0.384, P=0.024) was found to be strictly related to survival time and can be therefore considered a prognostic tool in patients with advanced cancer.

Sugar consumption and global prevalence of obesity and hypertension: an ecological analysis

OBJECTIVE The nutrition transition model provides an integrated approach to analyse global changes in food consumption and lifestyle patterns. Whether variability in food availability for consumption, lifestyle and sociodemographic factors is associated with the worldwide prevalence distribution of overweight, obesity and hypertension is unclear. DESIGN Ecological analysis. SETTING Country-specific prevalence estimates of overweight, obesity and hypertension were obtained. Prevalence estimates were then matched to year- and country-specific food and energy availability for consumption of cereals, sugar, sweeteners and honey, vegetable oils, fruits, starchy roots, pulses, total vegetables, alcoholic beverages, total meat, animal fat, eggs, milk, and fish and seafood. The per capita Gross Domestic Product (GDP), urbanization rates and prevalence of physical inactivity for each country were also obtained. SUBJECTS The overweight, obesity and hypertension databases included information from 128, 123 and seventy-nine countries, respectively. RESULTS Consumption of sugar and animal products were directly associated with GDP and urbanization rates. In a multivariate regression model, physical inactivity (B = 0·01, se = 0·005, P = 0·003), cereal consumption (B = -0·02, se = 0·006, P < 0·001) and sugar consumption (B = 0·03, se = 0·01, P = 0·03) were significant predictors of obesity prevalence. Midpoint age (B = 0·21, se = 0·10, P = 0·02), prevalence of overweight (B = 0·18, se = 0·08, P = 0·02) and consumption of cereals (B = -0·22, se = 0·10, P = 0·02) were significant predictors of hypertension. Women appeared to have a significant obesity excess compared with men. CONCLUSIONS High sugar consumption and sedentary lifestyle are associated with increased obesity prevalence. The non-linear association of sugar consumption with prevalence of obesity suggests that effective strategies to reduce its consumption may have differential effects in countries at different stages of the nutrition transition.

Is a single bioelectrical impedance equation valid for children of wide ranges of age, pubertal status and nutritional status? Evidence from the 4-component model

Background/Objectives:Bioelectrical impedance analysis (BIA) is widely used to predict body composition in paediatric research and clinical practice. Many equations have been published, but provide inconsistent predictions.Aims:To test whether a single equation for lean mass (LM) estimation from BIA is appropriate across wide ranges of age, pubertal status and nutritional status, by testing whether specific groups differ in the slope or intercept of the equation.Subjects/Methods:In 547 healthy individuals aged 4–24 years (240 males), we collected data on body mass (BM) and height (HT), and lean mass (LM) using the 4-component model. Impedance (Z) was measured using TANITA BC418MA instrumentation. LM was regressed on HT2/Z. Multiple regression analysis was conducted to investigate whether groups based on gender, age, pubertal status or nutritional status differed in the association of LM with HT2/Z.Results:BM ranged from 5 to 128 kg. HT2/Z was a strong predictor of LM (r 2=0.953, s.e.e.=2.9 kg). There was little evidence of a sex difference in this relationship, however, children aged 4–7 years and 16–19 years differed significantly from other age groups in regression slopes and intercepts. Similar variability was encountered for pubertal stage, but not for nutritional status.Conclusions:No single BIA equation applies across the age range 4–24 years. At certain ages or pubertal stages, the slope and intercept of the equation relating LM to HT2/Z alters. Failure to address such age effects is likely to result in poor accuracy of BIA (errors of several kg) for longitudinal studies of change in body composition.

Accuracy of Predictive Equations for Estimating Resting Energy Expenditure in Obese Adolescents

OBJECTIVE To compare resting energy expenditure (REE) measured by indirect calorimetry with REE predicted using different equations in obese adolescents. STUDY DESIGN We recruited 264 obese patients (body mass index ranging from 30.0-70.0 kg/m(2)) between 14 and 18 years of age. Data were obtained comparing measured and predicted REE derived from published equations for normal weight and obese adolescents. The average differences between measured and predicted REE, as well as the accuracy at ± 10% level, were evaluated. RESULTS Evaluating the mean REE in 109 males (1938 ± 271 kcal/d) and 155 females (2569 ± 459 kcal/d), we found that the Lazzer equation in males had the smallest difference between measured and predicted REE; in females the Henry-1, Food and Agriculture Organization/World Health Organization/United Nations University, Schmelze, and Lazzer equations were the most accurate. The prediction accuracy was considered adequate within ± 10%. CONCLUSIONS REE predictive equations developed in obese patients and for specific age groups are more suitable than those for the general population. Inaccuracy of predicted REE could affect dietary prescription appropriateness and, consequently, dietary compliance in this age group.

Body composition, leg length and blood pressure in a rural Italian population: A test of the capacity-load model

BACKGROUND AND AIMS Whereas adult weight or body mass index (BMI) are directly associated with blood pressure (BP), birth weight is inversely associated with BP. The scenario for height is more complex, as both tall and short stature have been associated with higher BP. We used a theoretical model treating sitting height (SH) and tissue masses (fat mass, lean mass) as components of metabolic load, and leg length (LL) as a marker of homeostatic metabolic capacity. We predicted that decreased capacity and increased load would be independently associated with increased BP.. METHODS AND RESULTS Anthropometry, body composition (bio-electrical impedance analysis) and BP were measured in 601 adults (228 male) aged 20-91 years from three hill villages in southern Italy. Multiple regression analysis was used to investigate associations of body composition and anthropometry with BP. Adjusting for age, systolic BP (SBP) was associated with lean mass in males, and with adiposity in females, whereas diastolic BP (DBP) was associated with fat mass in both sexes. Associations of LL and SH with BP were in opposite directions. LL was inversely associated with SBP and DBP in males, with a similar trend evident in females. SH was directly associated with SBP and DBP in females, and with DBP in males. CONCLUSIONS Consistent with our theoretical model, metabolic load is associated with increased BP, though differently between the sexes, whereas metabolic capacity is independently associated with lower BP. Our findings suggest that early growth improves hemodynamic tolerance of high metabolic load in adulthood..

North and South American countries food-based dietary guidelines: A comparison

Food-based dietary guidelines (FBDGs) are regularly updated educational documents that provide scientific information on nutritional needs and food composition to the general population. The aim of this study was to review the FBDGs of countries in the Americas and compare them based on their pictorial representation, food grouping, and associated messages on healthy eating and behavior, considering intercultural differences. FBDGs from 30 countries in the Americas were collected, representing 97% of the entire North and South American population. Of these FBDGs, 93% (28 of 30) have adopted a food guide illustration shape that conveys local traditions and classifies foods into six or seven groups. The main food groups are vegetables, fruits, cereals, starchy vegetables and fruits, legumes, milk and dairy, protein-rich foods, oils and fats, and sugar and sweeteners. Some differences include single food classifications. Despite the dietary pattern resulting from geographic conditions and cultural heritages, the main nutritional keypoints are similar among the different American FBDGs as follows: (1) Consume large amounts of fruits, vegetables, and cereals; and (2) limit intake of fat, simple sugars, and salt. Although there is general agreement on the basic nutritional messages, FBDGs remain insufficient regarding food groups and the identification of subgroup population nutritional requirements, particularly in countries where both excess and deficit malnutrition are present.

Healthy behaviours and abdominal adiposity in adolescents from southern Italy

OBJECTIVE The present study aimed to evaluate the prevalence of meeting health recommendations on diet and physical activity (having breakfast, eating fruit and vegetables, consumption of milk/yoghurt, performing moderate-to-vigorous physical activity, limiting television watching) and to assess junk snack food consumption in adolescents from southern Italy. The association between healthy behaviours and abdominal adiposity was also examined. DESIGN In a cross-sectional protocol, anthropometric data were measured by trained operators while other data were collected through a structured interview. SETTING Three high schools in Naples, Italy. SUBJECTS A sample of 478 students, aged 14-17 years, was studied. RESULTS The proportion of adolescents who met each of the health recommendations varied: 55·4% had breakfast on ≥6 d/week; 2·9% ate ≥5 servings of fruit and vegetables/d; 1·9% had ≥3 servings of milk/yoghurt daily; 13·6% performed moderate-to-vigorous physical activity for ≥60 min/d; and 46·3% watched television for <2 h/d. More than 65% of adolescents consumed ≥1 serving of junk snack foods/d. Only 5% fulfilled at least three recommendations. Healthy habits tended to correlate with each other. As the number of health recommendations met decreased, the percentage of adolescents with high abdominal adiposity (waist-to-height ratio ≥0·5) increased. The trend was not significant when the proportion of overweight/obese adolescents was considered. Logistic regression analysis indicated that male gender and watching television for ≥2 h/d were independently associated with a higher waist-to-height ratio. CONCLUSIONS Most adolescents failed to meet the five health recommendations considered. Male gender and excessive television watching were associated with abdominal adiposity.