Daphne Pannemans

Dietary intake and nutritional status of children and adolescents in Europe

The objective of this project was to collect and evaluate data on nutrient intake and status across Europe and to ascertain whether any trends could be identified. Surveys of dietary intake and status were collected from across Europe by literature search and personal contact with country experts. Surveys that satisfied a defined set of criteria -- published, based on individual intakes, post-1987, adequate information provided to enable its quality to be assessed, small age bands, data for sexes separated above 12 years, sample size over 25 and subjects representative of the population -- were selected for further analysis. In a small number of cases, where no other data for a country were available or where status data were given, exceptions were made. Seventy-nine surveys from 23 countries were included, and from them data on energy, protein, fats, carbohydrates, alcohol, vitamins, minerals and trace elements were collected and tabulated. Data on energy, protein, total fat and carbohydrate were given in a large number of surveys, but information was very limited for some micronutrients. No surveys gave information on fluid intake and insufficient gave data on food patterns to be of value to this project. A variety of collection methods were used, there was no consistency in the ages of children surveyed or the age cut-off points, but most surveys gave data for males and females separately at all ages. Just under half of the surveys were nationally representative and most of the remainder were regional. Only a small number of local surveys could be included. Apart from anthropometric measurements, status data were collected in only seven countries. Males had higher energy intakes than females, energy intake increased with age but levelled off in adolescent girls. Intakes of other nutrients generally related to energy intakes. Some north-south geographical trends were noted in fat and carbohydrate intakes, but these were not apparent for other nutrients. Some other trends between countries were noted, but there were also wide variations within countries. A number of validation studies have shown that misreporting is a major problem in dietary surveys of children and adolescents and so all the dietary data collected for this project should be interpreted and evaluated with caution. In addition, dietary studies rely on food composition tables for the conversion of food intake data to estimated nutrient intakes and each country uses a different set of food composition data which differ in definitions, analytical methods, units and modes of expression. This can make comparisons between countries difficult and inaccurate. Methods of measuring food intake are not standardised across Europe and intake data are generally poor, so there are uncertainties over the true nutrient intakes of children and adolescents across Europe. There are insufficient data on status to be able to be able to draw any conclusions about the nutritional quality of the diets of European children and adolescents.

Energy and nutrient dietary reference values for children in Europe: methodological approaches and current nutritional recommendations.

The Expert Group on the Methodological Approaches and Current Nutritional Recommendations in Children and Adolescents was convened to consider the current situation across Europe with regard to dietary recommendations and reference values for children aged 2-18 years. Information was obtained for twenty-nine of the thirty-nine countries in Europe and a comprehensive compilation was made of the dietary recommendations current up to September 2002. This report presents a review of the concepts of dietary reference values and a comparison of the methodological approaches used in each country. Attention is drawn to the special considerations that are needed for establishing dietary reference values for children and adolescents. Tables are provided of the current dietary reference values for energy and for the macronutrients, vitamins, minerals, trace elements and water. Brief critiques are included to indicate the scientific foundations of the reference values for children and to offer, where possible, an explanation for the wide differences that exist between countries. This compilation demonstrated that there are considerable disparities in the perceived nutritional requirements of European children and adolescents. Although some of this diversity can be attributed to real physiological and environmental differences, most is due to differences in philosophy about the best methodological approach to use and in the way the theoretical approaches are applied. The report highlights the main methodological and technological issues that will need to be resolved before harmonization can be fully considered. Solving these issues may help to improve the quality and consistency of dietary reference values across Europe. However, there are also considerable scientific and political barriers that will need to be overcome and the question of whether harmonization of dietary reference values for children and adolescents is a desirable or achievable goal for Europe requires further consideration.

Calcium excretion, apparent calcium absorption and calcium balance in young and elderly subjects: influence of protein intake.

The present study was conducted to investigate the effect of dietary protein on urinary Ca excretion, apparent Ca absorption and Ca balance in young and elderly subjects. Young adults (n 29) and elderly persons (n 26) consumed diets containing 12% (diet A) and 21% (diet B) of total energy as protein for 3 weeks according to a randomized crossover design. Results showed no differences between the two age groups with respect to the interaction between protein intake and Ca excretion (both in urine and in faeces), apparent Ca absorption and Ca balance. Therefore analyses were done for both age groups separately and also for the whole group. In elderly persons and in the whole group the Ca excretion in faeces (as a percentage of Ca intake) was lower during the higher protein intake (elderly: diet A, 106 (SEM 7)%; diet B, 86 (SEM 7)%; P = 0.018; whole group: diet A, 99 (SEM 4)%; diet B, 84 (SEM 4)%; P = 0.003). In young adults faecal Ca excretion tended to be lower when they consumed diet B (diet A: 94 (SEM 5)%; diet B: 83 (SEM 6)%; P = 0.093). Relative urinary Ca excretion was greater during the higher protein intake in young adults and in the whole group while relative urinary Ca excretion was not different in the elderly (diet A: 15 (SEM 1)%, 14 (SEM 1)%, 15 (SEM 1)%; diet B: 16 (SEM 1)%, 16 (SEM 1)%, 17 (SEM 2)% for the whole group, the young and elderly subjects respectively, P = 0.019; P = 0.016; P = 0.243). The resulting Ca balance was not influenced by the amount of protein in the diet in young adults. Values for the elderly and for the whole group showed that the Ca balance during diet A was significantly more negative compared with Ca balance during diet B, despite the higher urinary Ca excretion during diet B. It can be concluded that increasing the protein intake from 12 to 21% of total energy intake had no negative effect on Ca balance.

Enegy expenditure, physical activity and basal metabolic rate of elderly subjects

Energy expenditure, and therefore energy requirement, generally decreases with advancing age because of a decrease in basal metabolic rate (BMR) and physical activity. The aim of the present study was to measure total energy expenditure (EE) and activity level in a group of healthy elderly (sixteen men aged 71.3 (SD 4.9) years; ten women aged 67.6 (SD 4.1) years) and young adults (nineteen men aged 30.4 (SD 5.0) years; ten women aged 27.2 (SD 3.9) years) by using the doubly-labelled water method in combination with measurements of BMR. Age-related differences in body composition and their relationship to BMR and activity level were studied. EE was lower in elderly compared with young adults, partly due to a significantly lower BMR. The lower BMR was not fully explained by the lower fat-free mass (FFM) in the elderly. Energy expended (MJ/d) on activity was higher for the younger subjects although there was no significant difference in the physical activity index (PAI = EE/BMR) between the two age groups. The effect of physical activity level is twofold: first it has a positive effect on the BMR, and second it has a positive effect on the FFM. Both effects involve an increase in the total EE with an increased level of physical activity. At energy balance this will lead to increased energy and nutrient intake, making especially the elderly less vulnerable to inadequate energy and nutrient intake.