I. Huybrechts

Mapping low intake of micronutrients across Europe

Achieving an understanding of the extent of micronutrient adequacy across Europe is a major challenge. The main objective of the present study was to collect and evaluate the prevalence of low micronutrient intakes of different European countries by comparing recent nationally representative dietary survey data from Belgium, Denmark, France, Germany, The Netherlands, Poland, Spain and the United Kingdom. Dietary intake information was evaluated for intakes of Ca, Cu, I, Fe, Mg, K, Se, Zn and the vitamins A, B1, B2, B6, B12, C, D, E and folate. The mean and 5th percentile of the intake distributions were estimated for these countries, for a number of defined sex and age groups. The percentages of those with intakes below the lower reference nutrient intake and the estimated average requirement were calculated. Reference intakes were derived from the UK and Nordic Nutrition Recommendations. The impact of dietary supplement intake as well as inclusion of apparently low energy reporters on the estimates was evaluated. Except for vitamin D, the present study suggests that the current intakes of vitamins from foods lead to low risk of low intakes in all age and sex groups. For current minerals, the study suggests that the risk of low intakes is likely to appear more often in specific age groups. In spite of the limitations of the data, the present study provides valuable new information about micronutrient intakes across Europe and the likelihood of inadequacy country by country.

The standardized computerized 24-h dietary recall method EPIC-Soft adapted for pan-European dietary monitoring

Background/Objectives:The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies.Subjects/Methods:Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc ‘EPIC-Soft specifications questionnaire’ sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs.Results:A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts.Conclusions:EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere.

Energy and macronutrient intakes in Belgium: results from the first National Food Consumption Survey.

Belgium until recently lacked a systematic survey of dietary habits of its inhabitants. The present study evaluated dietary composition in Belgium with respect to energy and macronutrient intakes. Information on food intake was collected using a repeated non-consecutive 24 h recall (2-8 weeks apart) with the validated software package EPIC-SOFT, in combination with a FFQ (self-administered) covering sixty food items. The database of consumed food items was linked to food composition data. Usual macronutrient intake was estimated by the Nusser method. A representative sample of the Belgian population was randomly selected from the national register following a multi-stage procedure. Information on dietary intake was obtained from 3245 subjects aged 15 years and older. Mean energy percentage (E %) of total fat (37.9 E %) and SFA (16.0 E %) was higher than the dietary reference intakes (DRI). Mean E % of total carbohydrates (45.8 E %) was lower than the DRI, while mean E % of mono/disaccharides was 20.3. Total fat and SFA intakes were higher and total carbohydrate and sugar intakes were lower in the older age categories than in the younger age categories. The percentage of energy from SFA intake was lower and that from carbohydrates was higher than that found in an earlier Belgian study. Further efforts are necessary to improve dietary macronutrient intake, taking into account differences in age categories. In addition, it will be important to monitor its changes regularly using trend analyses.

Predicting urinary creatinine excretion and its usefulness to identify incomplete 24h urine collections

Studies using 24 h urine collections need to incorporate ways to validate the completeness of the urine samples. Models to predict urinary creatinine excretion (UCE) have been developed for this purpose; however, information on their usefulness to identify incomplete urine collections is limited. We aimed to develop a model for predicting UCE and to assess the performance of a creatinine index using para-aminobenzoic acid (PABA) as a reference. Data were taken from the European Food Consumption Validation study comprising two non-consecutive 24 h urine collections from 600 subjects in five European countries. Data from one collection were used to build a multiple linear regression model to predict UCE, and data from the other collection were used for performance testing of a creatinine index-based strategy to identify incomplete collections. Multiple linear regression (n 458) of UCE showed a significant positive association for body weight (β = 0·07), the interaction term sex × weight (β = 0·09, reference women) and protein intake (β = 0·02). A significant negative association was found for age (β = -0·09) and sex (β = -3·14, reference women). An index of observed-to-predicted creatinine resulted in a sensitivity to identify incomplete collections of 0·06 (95 % CI 0·01, 0·20) and 0·11 (95 % CI 0·03, 0·22) in men and women, respectively. Specificity was 0·97 (95 % CI 0·97, 0·98) in men and 0·98 (95 % CI 0·98, 0·99) in women. The present study shows that UCE can be predicted from weight, age and sex. However, the results revealed that a creatinine index based on these predictions is not sufficiently sensitive to exclude incomplete 24 h urine collections.

Lipid, lipoprotein and apolipoprotein profiles in European adolescents and its associations with gender, biological maturity and body fat—The HELENA Study

Background/Objectives:To provide a detailed lipid profile of a European adolescent population considering age, gender, biological maturity, body mass index (BMI), fat mass (FM) and percentage body fat (BF).Subjects/Methods:Within Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA), a cross-sectional study was conducted to determine fasting serum concentrations of lipids, lipoproteins and apolipoproteins in 1076 adolescents aged 12.5–17.49 years from ten European centres.Results:All serum lipid concentrations were significantly higher in girls than in boys. In boys, age was negatively correlated with high-density lipoprotein (HDL)-cholesterol and total cholesterol (TC), and positively associated with triacylglycerides (TAG) (P<0.01) whereas no significant associations were observed in girls. Biological maturity was negatively associated with TC, HDL-, low-density lipoprotein (LDL)- and non-HDL cholesterol in boys (all P<0.05) and negatively correlated with HDL-cholesterol in girls (P<0.05). BMI, FM and BF were significantly correlated with HDL-cholesterol, LDL-cholesterol, non-HDL cholesterol, apolipoprotein (apo) A1, apoB and TAG in both boys and girls.Conclusions:The lipid profile in adolescents is strongly determined by gender. Biological maturity, FM and percentage BF contribute to the variance in lipid concentrations and should be considered in future evaluations of lipid status.

Umweltbedingte Einflussfaktoren : Möglichkeiten und Barrieren für ein gesundes Ernährungs- und Bewegungsverhalten von Kindern und Jugendlichen (Leitthema)

ZusammenfassungObwohl der genetische Einfluss eine wichtige Rolle für die Entwicklung von Adipositas spielt, lässt der dramatische Anstieg ihrer Prävalenz in den letzten Jahren vermuten, dass die Lebensumwelt einen ebenso großen Einfluss hat. In der vorliegenden Arbeit werden die Ergebnisse einer Literaturübersicht über Möglichkeiten und Barrieren in der Lebensumwelt für ein gesundes Ernährungs- und Bewegungsverhalten – beides Faktoren, die die Adipositasepidemie unter Kindern und Jugendlichen beeinflussen – aufgezeigt. Obwohl es deutliche Belege für den Einfluss der Lebensumwelt auf den Lebensstil und damit auf die Ausprägung von Adipositas gibt, liegen nur wenige Hinweise über effektive Strategien zur Veränderung dieser obesogenen Umweltbedingungen vor. Interventionsprogramme, die umweltbedingte Einflussfaktoren verändern wollen, um kindlicher Adipositas entgegenzuwirken, könnten auf zusätzliche Angebote von Sporteinrichtungen und gesunden Mahlzeiten in der Schule (zum Beispiel auf ein Obstangebot), auf die Sicherheit und Verfügbarkeit von Fuß- und Fahrradwegen sowie auf mehr Spielflächen zielen oder die gesellschaftliche Wertung von Gewicht, Ernährung oder Bewegung beeinflussen. Um die gewünschten Veränderungen der Lebensumwelt langfristig aufrechtzuerhalten (zum Beispiel das Verbot von Softdrinks an Schulen), ist jedoch ein gewisser Grad an Institutionalisierung unterstützender Einrichtungen erforderlich. Das Design und die Durchführung von Studien zur genauen Bestimmung umweltbedingter Einflussfaktoren auf obesogenes Verhalten müssen verbessert werden, um den Erfolg großflächig angelegter Interventionsprogramme sicherzustellen.AbstractWhile genetic factors play a role in the development of obesity, its dramatic increase in prevalence over the past few years strongly suggests an important environmental role. The results of a review on environmental opportunities and barriers for physical activity and dietary intake influencing the obesity epidemic among children and adolescents are presented. Although evidence clearly shows the impact of the environment on obesity-related lifestyle factors among children, evidence for effective strategies combating this obesogenic environment is scarce. Interventions aiming to change environmental factors to reduce childhood obesity may include providing extra sporting facilities and healthy foods/meals at school (e.g., provision of fruit), efforts to improve safety and accessibility of walking, cycling, and play areas, while at the same time attempting to influence social values attached to weight, food, or physical activity. Some level of institutionalization of systems that support the desired changes is required to sustain long-term environmental changes (e.g., ban of softdrinks at school). Better-designed and -conducted research on the true importance of environmental factors for obesogenic behavioral change is needed to achieve success of large-scale environmental change interventions.While genetic factors play a role in the development of obesity, its dramatic increase in prevalence over the past few years strongly suggests an important environmental role. The results of a review on environmental opportunities and barriers for physical activity and dietary intake influencing the obesity epidemic among children and adolescents are presented. Although evidence clearly shows the impact of the environment on obesity-related lifestyle factors among children, evidence for effective strategies combating this obesogenic environment is scarce. Interventions aiming to change environmental factors to reduce childhood obesity may include providing extra sporting facilities and healthy foods/meals at school (e.g., provision of fruit), efforts to improve safety and accessibility of walking, cycling, and play areas, while at the same time attempting to influence social values attached to weight, food, or physical activity. Some level of institutionalization of systems that support the desired changes is required to sustain long-term environmental changes (e.g., ban of softdrinks at school). Better-designed and -conducted research on the true importance of environmental factors for obesogenic behavioral change is needed to achieve success of large-scale environmental change interventions.

Fruit and vegetables consumption is associated with higher vitamin intake and blood vitamin status among European adolescents

Background/Objectives:Current research in adults indicates that fruit and vegetable (FAV) consumption increases serum levels of vitamins C, E and folate of β-carotene and reduces homocysteine concentrations. The aim of the present study was to examine the association of FAV consumption on vitamin intakes and their impact on blood vitamin concentrations in European adolescents.Subject/Methods:This multi-center cross-sectional study included 702 (53.7% females) adolescents, aged 12.50–17.49 years, from 10 European cities. Two independent self-administered 24 h dietary recalls were used to estimate the adolescent’s diet. The total energy, vitamins and FAV consumption were calculated. Adolescents were categorized into three groups: (i) very low FAV intake (<200 g/day); (ii) low FAV consumption (200–399 g/day) and (iii) adequate FAV consumption (⩾400 g/day). Adolescent’s fasted blood samples were taken for their analysis on vitamin concentrations.Results:The main results showed that those adolescents meeting the FAV recommendation, classified as FAV adequate consumers, presented higher intake of energy and some vitamins as B6, total folic acid, C, E and β-carotene compared with FAV very low consumers (P<0.05). Regarding their blood status, male adolescents who had a very low FAV consumption presented lower plasma folate, RBC folate blood concentrations compared with adequate FAV consumers (P<0.05). Female adequate FAV consumers had higher concentrations of pyridoxal phosphate (PLP), plasma folate, RBC folate, vitamin C, β-carotene and α-tocopherol compared with very low and low consumers (P<0.05).Conclusions:Having a FAV dairy intake above 400 g/day is associated with higher vitamin intake and blood vitamin concentrations, especially for antioxidant and B-vitamins concentrations.

Umweltbedingte Einflussfaktoren@@@Environmental factors: Möglichkeiten und Barrieren für ein gesundes Ernährungs- und Bewegungsverhalten von Kindern und Jugendlichen@@@Opportunities and barriers for physical activity and healthy eating among children and adolescents

ZusammenfassungObwohl der genetische Einfluss eine wichtige Rolle für die Entwicklung von Adipositas spielt, lässt der dramatische Anstieg ihrer Prävalenz in den letzten Jahren vermuten, dass die Lebensumwelt einen ebenso großen Einfluss hat. In der vorliegenden Arbeit werden die Ergebnisse einer Literaturübersicht über Möglichkeiten und Barrieren in der Lebensumwelt für ein gesundes Ernährungs- und Bewegungsverhalten – beides Faktoren, die die Adipositasepidemie unter Kindern und Jugendlichen beeinflussen – aufgezeigt. Obwohl es deutliche Belege für den Einfluss der Lebensumwelt auf den Lebensstil und damit auf die Ausprägung von Adipositas gibt, liegen nur wenige Hinweise über effektive Strategien zur Veränderung dieser obesogenen Umweltbedingungen vor. Interventionsprogramme, die umweltbedingte Einflussfaktoren verändern wollen, um kindlicher Adipositas entgegenzuwirken, könnten auf zusätzliche Angebote von Sporteinrichtungen und gesunden Mahlzeiten in der Schule (zum Beispiel auf ein Obstangebot), auf die Sicherheit und Verfügbarkeit von Fuß- und Fahrradwegen sowie auf mehr Spielflächen zielen oder die gesellschaftliche Wertung von Gewicht, Ernährung oder Bewegung beeinflussen. Um die gewünschten Veränderungen der Lebensumwelt langfristig aufrechtzuerhalten (zum Beispiel das Verbot von Softdrinks an Schulen), ist jedoch ein gewisser Grad an Institutionalisierung unterstützender Einrichtungen erforderlich. Das Design und die Durchführung von Studien zur genauen Bestimmung umweltbedingter Einflussfaktoren auf obesogenes Verhalten müssen verbessert werden, um den Erfolg großflächig angelegter Interventionsprogramme sicherzustellen.AbstractWhile genetic factors play a role in the development of obesity, its dramatic increase in prevalence over the past few years strongly suggests an important environmental role. The results of a review on environmental opportunities and barriers for physical activity and dietary intake influencing the obesity epidemic among children and adolescents are presented. Although evidence clearly shows the impact of the environment on obesity-related lifestyle factors among children, evidence for effective strategies combating this obesogenic environment is scarce. Interventions aiming to change environmental factors to reduce childhood obesity may include providing extra sporting facilities and healthy foods/meals at school (e.g., provision of fruit), efforts to improve safety and accessibility of walking, cycling, and play areas, while at the same time attempting to influence social values attached to weight, food, or physical activity. Some level of institutionalization of systems that support the desired changes is required to sustain long-term environmental changes (e.g., ban of softdrinks at school). Better-designed and -conducted research on the true importance of environmental factors for obesogenic behavioral change is needed to achieve success of large-scale environmental change interventions.While genetic factors play a role in the development of obesity, its dramatic increase in prevalence over the past few years strongly suggests an important environmental role. The results of a review on environmental opportunities and barriers for physical activity and dietary intake influencing the obesity epidemic among children and adolescents are presented. Although evidence clearly shows the impact of the environment on obesity-related lifestyle factors among children, evidence for effective strategies combating this obesogenic environment is scarce. Interventions aiming to change environmental factors to reduce childhood obesity may include providing extra sporting facilities and healthy foods/meals at school (e.g., provision of fruit), efforts to improve safety and accessibility of walking, cycling, and play areas, while at the same time attempting to influence social values attached to weight, food, or physical activity. Some level of institutionalization of systems that support the desired changes is required to sustain long-term environmental changes (e.g., ban of softdrinks at school). Better-designed and -conducted research on the true importance of environmental factors for obesogenic behavioral change is needed to achieve success of large-scale environmental change interventions.