Irena Keser

Diet quality in Croatian university students: Energy, macronutrient and micronutrient intakes according to gender

The aim of the study was to evaluate diet quality and nutrient intakes in Croatian university students, which are missing for the past 15 years, and also to report the prevalence of overweight/obesity and underweight. The subjects were 663 students (average age 22 years), representing 0.6% of all Croatian university students. The Quantified Food Frequency Questionnaire, checked for reproducibility and validity, was used for dietary assessment. Students on average had an adequate number of daily meals and snacks, but consumption of breakfast was irregular, particularly for men. The average energy intake was 130.1% of the dietary reference intake and the protein intake was more than double the dietary reference intake in 64.3% students. Dietary fiber, iron (in females), calcium, zinc, folate, and vitamins C, A and E intake were below recommendations in both genders. Only 3.8% of females and 21.9% of males were overweight/obese (body mass index >25 kg/m2). Nutrient intakes significantly differed according to gender and better macronutrient but not micronutrient intakes were observed in females.

Folic acid and vitamin B12 supplementation lowers plasma homocysteine but has no effect on serum bone turnover markers in elderly women: a randomized, double-blind, placebo-controlled trial

An elevated homocysteine level is a newly recognized risk factor for osteoporosis. Older individuals may have elevated homocysteine levels due to inadequate folate intake and/or lower absorption of vitamin B(12). The aim of this study was to determine whether there is an impact of folic acid and vitamin B(12) supplementation on homocysteine levels and, subsequently, on bone turnover markers in older women with mildly to moderately elevated homocysteine levels. It is hypothesized that supplementation with folic acid and vitamin B(12) will improve homocysteine levels and, in turn, positively modify bone turnover markers in this population. This randomized, double-blind, placebo-controlled trial included 31 women (65 to 93 years) with homocysteine levels greater than 10 μmol/L. Participants were randomly assigned to receive either a daily folic acid (800 μg) and vitamin B(12) (1000 μg) (n = 17) or a matching placebo (n = 14) for 4 months. The results showed significantly lower homocysteine concentrations in the vitamin group compared to the placebo group (10.6 vs 18.5 μmol/L, P = .007). No significant difference in serum alkaline phosphatase or C-terminal cross-linking telopeptide of type I collagen was found between the vitamin and placebo groups before or after supplementation. The use of folic acid and vitamin B(12) as a dietary supplement to improve homocysteine levels could be beneficial for older women, but additional research must be conducted in a larger population and for a longer period to determine if there is an impact of supplementation on bone turnover markers or other indicators of bone health.

Validation of the folate food frequency questionnaire with serum and erythrocyte folate and plasma homocysteine

The aim of the present study was to develop and validate a folate food frequency questionnaire (FFQ) designed to measure dietary folate equivalents. The self-administered FFQ containing 39 items and a reference period of 1 month (i.e. the previous month), was validated against three biomarkers: serum and erythrocyte (RBC) folate, and plasma homocysteine (Hcy). Subjects were women (n=99) between the ages of 21 and 87 years. The Pearson correlation coefficients for folate intake and biomarkers were 0.36, 0.34 and −0.25 for serum and RBC folate, and plasma Hcy, respectively. A principal component factor analysis was performed on the three biomarkers to calculate the folate status factor. The Pearson correlation for the folate status factor and folate intake was 0.39. The FFQ described in this study is a valid tool for measuring folate intake expressed as dietary folate equivalents in adult women and is suitable for future investigations about the relationship between folate and disease, or as an educational tool.

Evaluation of diet quality with the mediterranean dietary quality index in university students

Data on diet quality in Croatian university students have been missing for more than 15 years. A food approach rather than a nutrient approach appears more appropriate to present knowledge on diet and health. The aim of the present study was to evaluate diet quality in Croatian university students (n=663) with the Mediterranean Dietary Quality Index (M-DQI) in continental and Mediterranean regions. The M-DQI was determined with a Quantified Food Frequency Questionnaire. The minimum score for the M-DQI is 0 and the maximum score is 14. A higher score indicates a less healthy diet. The score for the M-DQI was the same in both regions (9.6) and did not differ significantly. In the category for scores 8–14 were 84.0% and 84.6% of students in the continental and Mediterranean regions, respectively. Higher correlation for the M-DQI was observed with macronutrient intakes than with micronutrient intakes. The M-DQI did not correlate with trans-fatty acid intake. A significant correlation (negative) with lycopene was observed in the Mediterranean region only. The body mass index did not correlate with the M-DQI. Students from both regions, continental and Mediterranean, had a lower diet quality evaluated with the M-DQI, with no significant difference according to region.

Peak Bone Density in Croatian Women: Variations at Different Skeletal Sites

It is known that different skeletal sites have different peak bone mass at different times and lose bone at different rates. The purpose of the study was to assess bone mineral density (BMD) in healthy female student population (N=220), aged 18-25 yr and to analyze whether young women of that age have already started to lose the bone mass at the trabecular and cortical parts of skeleton. The influence of dietary intake and physical activity on their bone mass was also assessed. BMD was measured, using dual-energy X-ray absorptiometry technique, in spine, proximal femur, and distal third of the radius and in total body. Significant negative correlation between age and bone mass was found in all skeletal regions (p<0.05 spine; p<0.0001 total femur; and p<0.01 total body) except in cortical part of the radius. Peak bone mass in young Croatian women was achieved before the age of 20, but later in the long-bone cortical skeleton, where BMD continued to increase after mid-20s. The BMD values are comparable with those from National Health and Nutrition Examination Survey study, except for the cortical part of the radius, where it is significantly lower. Body weight and physical activity were the most significant positive predictors of bone density in all measured sites.

Influence of nutrition and lifestyle on bone mineral density in children from adoptive and biological families

Background The precise contributions of hereditary and environmental factors to bone density are not known. We compared lifestyle predictors of bone density among adopted and biological children. Methods The study comprised 18 adopted children (mean [SD] age, 14.0 [4.1] years) with their non-biological parents and 17 children with their biological parents. Bone mineral density (BMD; g/cm2) was measured at the lumbar spine, total femur, and distal radius. Nutritional intake was assessed by food frequency questionnaire. Information on smoking and physical activity was obtained by questionnaire. Results Intakes of all nutrients, corrected for energy intake, and all lifestyle characteristics except sleep duration were similar in biological children and their parents. As compared with their parents, adopted children had significantly different energy, protein, and calcium intakes and physical activity levels. In a regression model, BMD z scores of adopted children and their parents were significantly inversely associated at the spine and total femur, whereas BMD z scores of biological children and their parents were significantly positively associated at all measurement sites. The greatest proportion of total variance in BMD was accounted for by calcium intake among adopted children and by parental BMD among biological children. Conclusions For some lifestyle characteristics and nutrient intakes, the differences between parents and children were more obvious among adoptive families than among biological families. The most important lifestyle predictor of bone density was calcium intake.

Nutritional quality of meals in nursing homes and meals on wheels for elderly persons in Croatia.

The aim of the study was to evaluate the adequacy of meals provided for elderly residents and non-residents of nursing homes in Croatia. Menus of 44 all-day meals provided for residents from 4 nursing homes and 34 meals on wheels provided for non-residents of low socioeconomic status were selected by random sampling. A questionnaire was used to determine socioeconomic status and attitude of residents (n = 89) and non-residents (n = 80) regarding meals offered. An average energy value of all-day meals and meals on wheels was 96.7 and 39.8% RDA respectively. All-day meals provide adequate amounts of the micronutrients examined (phosphorus, iron, thiamine, riboflavin, niacin and vitamin C) with exception of calcium. Fat provided 35% and 36% of energy for all-day meals and meals on wheels respectively. The body mass index (BMI) under 18.5 kg/m2 had 1.7% residents and 4.0% non-residents. BMI higher than 24.9 kg/m2 were observed in 50% and 47% of residents and non-residents respectively. Gender differences were observed for meal preferences offered to both residents and non-residents. The meals provided adequate amounts of energy and the micronutrients examined. However, a decrease in the energy fraction of fat and decrease in protein content would be advisable.

Homocysteine Levels Show Significant Differences among Mediterranean Dietary Quality Index Variables Compared to Folate and Vitamin B12 Status in Women

Results of epidemiologic studies and clinical trials have shown that subjects following the Mediterranean diet had lower inflammatory markers such as homocysteine (Hcy). Therefore, the aim of this cross-sectional study was to assess female diet quality with the Mediterranean diet quality index (MDQI) and to determine the correlation between MDQI, homocysteine, folate and vitamin B12 levels in the blood. The study participants were 237 apparently healthy women (96 of reproductive age and 141 postmenopausal) between 25 and 93 years. For each participant, 24-hour dietary recalls for 3 days were collected, MDQI was calculated, and plasma Hcy, serum and erythrocyte folate and vitamin B12 levels were analysed. Total MDQI ranged from 8 to 10 points, which represented a medium-poor diet for the subjects. The strength of correlation using biomarkers, regardless of group type, age, gender and other measured parameters, was ranked from best (0.11) to worst (0.52) for olive oil, fish, fruits and vegetables, grains, and meat, in this order. Hcy levels showed the best response among all markers across all groups and food types. Our study shows significant differences between variables of the MDQI and Hcy levels compared to levels of folate and vitamin B12 in participants with medium-poor diet quality, as evaluated according to MDQI scores.