Jóhanna Haraldsdóttir

Fruit and vegetable intake in a sample of 11-year-old children in 9 European countries: The pro children cross-sectional survey

Background/Aims: An adequate fruit and vegetable intake provides essential nutrients and nutritive compounds and is considered an important part of a healthy lifestyle. No simple instrument has been available for the assessment of fruit and vegetable intake as well as its determinants in school-aged children applicable in different European countries. Within the Pro Children Project, such an instrument has been developed. This paper describes the cross-sectional survey in 11-year-olds in 9 countries. Methods: The cross-sectional survey used nationally, and in 2 countries regionally, representative samples of schools and classes. The questionnaires, including a precoded 24-hour recall component and a food frequency part, were completed in the classroom. Data were treated using common syntax files for portion sizes and for merging of vegetable types into four subgroups. Results: The results show that the fruit and vegetable intake in amounts and choice were highly diverse in the 9 participating countries. Vegetable intake was in general lower than fruit intake, boys consumed less fruit and vegetables than girls did. The highest total intake according to the 24-hour recall was found in Austria and Portugal, the lowest in Spain and Iceland. Conclusion: The fruit and vegetable intake in 11-year-old children was in all countries far from reaching population goals and food-based dietary guidelines on national and international levels.

Promoting Fruit and Vegetable Consumption among European Schoolchildren: Rationale, Conceptualization and Design of the Pro Children Project

Background/Aims: The Pro Children Project was designed to assess fruit and vegetable consumption in European schoolchildren and their parents, as well as determinants of the children’s consumption patterns. A second objective was to develop and test strategies, applicable across Europe, for promoting consumption of fruits and vegetables among schoolchildren and their parents. In this paper, the rationale, theoretical background, overall design and implementation of the project is presented. Methods: Surveys of national, representative samples of 11-year-old schoolchildren and their parents were conducted in 9 countries, i.e. in Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden. Comprehensive school-based educational programmes have been developed and tested in three settings, i.e. in Spain, the Netherlands and in Norway. A precoded 24-hour recall form combined with a set of food frequency questions assessing regular intake were used to assess fruit and vegetable consumption. Determinants were assessed employing a comprehensive theoretical framework including personal, social and environmental factors related to fruit and vegetable consumption. The intervention programmes have been tested employing a group-randomized trial design where schools have been randomly allocated to an intervention arm and a delayed intervention arm. Surveys among all participating children and their parents were conducted prior to the initiation of the intervention, immediately after the end of the intervention and at the end of the subsequent school year. Conclusion: The project is expected to provide new information of great importance for improving our understanding of consumption patterns of fruits and vegetables and for guiding future efforts to promote increased consumption patterns across Europe.

Validity and Reproducibility of a Precoded Questionnaire to Assess Fruit and Vegetable Intake in European 11- to 12-Year-Old Schoolchildren

Background/Aims: Validity and reproducibility were evaluated of a new questionnaire to assess fruit and vegetable intakes in 11- to 12-year-old children. Methods: The precoded teacher-assisted self-administered questionnaire included two sections: a 24-hour recall part and a food frequency part. Validity was tested in 4 countries (Denmark, Iceland, Norway, Portugal; n = 43–60 per country) using a 1-day weighed food record and 7-day food records as reference methods. Test-retest (7–12 days apart) reproducibility was assessed in 6 countries (Belgium, Denmark, Iceland, Norway, Portugal, Spain; n = 60–74 per country). Results: Spearman rank correlations for fruit and vegetable intake according to the frequency part and the 7-day food record ranged between r = 0.40–0.53. Between 25–50% were classified into the same quartile and 70–88% into the same or adjacent quartile. Test-retest Spearman rank correlations for the food frequency part were r = 0.47–0.84. Three countries showed no significant difference between fruit intake as assessed with the 24-hour recall part and the 1-day weighed food record, and 2 countries showed no significant difference for vegetables. In the other countries, the 24-hour recall part resulted in substantially higher mean intake levels. Conclusion: Validity and reproducibility as to ranking of subjects were regarded to be satisfactory in all countries. Group mean intake, based on the original 24-hour part, was valid for fruit in 3 countries and for vegetables in 2 countries, and this part was subsequently adjusted to avoid overestimation, before the questionnaire was used in the Pro Children study.

Green tea extract only affects markers of oxidative status postprandially: lasting antioxidant effect of flavonoid-free diet

Epidemiological studies suggest that foods rich in flavonoids might reduce the risk of cardiovascular disease and cancer. The objective of the present study was to investigate the effect of green tea extract (GTE) used as a food antioxidant on markers of oxidative status after dietary depletion of flavonoids and catechins. The study was designed as a 2 x 3 weeks blinded human cross-over intervention study (eight smokers, eight non-smokers) with GTE corresponding to a daily intake of 18.6 mg catechins/d. The GTE was incorporated into meat patties and consumed with a strictly controlled diet otherwise low in flavonoids. GTE intervention increased plasma antioxidant capacity from 1.35 to 1.56 (P<0.02) in postprandially collected plasma, most prominently in smokers. The intervention did not significantly affect markers in fasting blood samples, including plasma or haemoglobin protein oxidation, plasma oxidation lagtime, or activities of the erythrocyte superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase. Neither were fasting plasma triacylglycerol, cholesterol, alpha-tocopherol, retinol, beta-carotene, or ascorbic acid affected by intervention. Urinary 8-oxo-deoxyguanosine excretion was also unaffected. Catechins from the extract were excreted into urine with a half-life of less than 2 h in accordance with the short-term effects on plasma antioxidant capacity. Since no long-term effects of GTE were observed, the study essentially served as a fruit and vegetables depletion study. The overall effect of the 10-week period without dietary fruits and vegetables was a decrease in oxidative damage to DNA, blood proteins, and plasma lipids, concomitantly with marked changes in antioxidative defence.

Sociodemographic differences in dietary habits described by food frequency questions — results from Denmark

Objectives: To investigate whether a modest number of food frequency questions are sufficient to describe sociodemographic differences in dietary habits, and to identify sociodemographic characteristics of subjects adhering to food-based dietary guidelines operationalised in a ‘healthy-diet index’.Design: Cross-sectional population survey.Subjects: A total of 480 men, 515 women, aged 15–90 y. Random sample of private telephone numbers drawn from regional telephone records, geographically stratified. Participation rate 62%.Methods: Computer-assisted telephone interviews, including six food frequency questions, a question on type of fat spreads used on bread, questions on seven sociodemographic variables.Results: The summary of the healthy-diet index showed that the subjects who adhered to food-based dietary guidelines (top quintile) compared to those who did not (bottom quintile) were most often women (odds ratio (OR)=6.07; confidence interval (CI): 3.91–9.43, women vs men), of older age (OR=9.72; CI: 3.02–31.31, old age vs young), highly educated (OR=3.69; CI: 1.53–8.92, high education vs low) and living in multiperson households including children (OR=4.66; CI: 2.47–8.80, multiperson household vs single household). The results also showed that gender difference in dietary habits is associated with other sociodemographic variables.Conclusions: The selected food frequency questions proved sufficient to describe sociodemographic differences in dietary habits, and this method may be a valuable supplement to traditional quantitative dietary surveys in monitoring sociodemographic changes in eating patterns. The results also underline the influence of sociodemographic status on dietary habits.Sponsorship: The Danish Nutrition Council funded the study.

Effect of a fruit and vegetable subscription in Danish schools

OBJECTIVE To measure the effect of a school fruit and vegetable subscription on childrens intake of fruit and vegetables after 5 weeks of intervention. SETTING Seven primary schools in Denmark. DESIGN AND METHODS Intervention schools (n=4) were offered a fruit and vegetable subscription comprising one piece per day. Control schools situated in another municipality were not offered the subscription. Intake of fruit and vegetables was measured at baseline and 5 weeks after the start of the subscription. Two methods were used for dietary assessment: a pre-coded 24-hour recall form including total food intake and a food-frequency questionnaire (FFQ) including only fruit and vegetables. SUBJECTS Children aged 6-10 years (n=804 from intervention schools and n=689 from control schools). Response rate in the dietary assessment was 31%. RESULTS At intervention schools 45% of the children enrolled in the subscription. After 5 weeks of intervention, both subscribers and non-subscribers had increased their intake of fruit by 0.4 (P=0.019) and 0.3 (P=0.008) pieces per school day, respectively, but no change was observed in vegetable intake. Total intake increased only for non-subscribers by 0.4 piece/school day (P=0.008) mainly due to the consistent increase in fruit intake. No change in intake was measured at control schools. Only the 24-hour recall questionnaire was sensitive enough to pick up the changes of the subscription, whereas the FFQ was not. CONCLUSION Five weeks with the subscription affected both subscribers and non-subscribers to increase intake of fruit. This may indicate that the subscription had an additional effect of stimulating parents of non-subscribers to supply their children with fruit. The results stress the importance of evaluating the effect of this type of programme, and the carefulness needed in designing the evaluation study.

Validity of a questionnaire to assess fruit and vegetable intake in adults

Objective:To validate a method for assessing fruit and vegetable intake among adults in a population of low intake. The method assesses mean intake and ranks individuals by their usual intake.Design:A precoded fruit and vegetable Questionnaire included a 24-h recall and a food frequency. The participants filled in the Questionnaire, a week later they started a 7-day food record, 1-day weighed record and 6 days using household measures.Subjects:Following advertisements 40 participants were recruited, 36 returned food records(mean age=37 years).Results:No difference was observed between the average intake yielded by the 24-h recall and that from the 1-day weighed food record of fruits or vegetables. Correlation coefficients between results from the food frequency questionnaire and the 7-day food records were 0.45 (P=0.007) for vegetables, 0.63 (P<0.001) for fruits and 0.73 (P<0.001) for fruits and vegetables combined. Cross-classification into quartiles showed that the proportion of participants in the same or the adjacent quartile of the intake distribution were 94% for fruit intake and 80% for vegetable intake. Registered intake of fruits and vegetables was higher the first 4 days of the record than the last 3 days (P=0.002). The 4-day food record correlated with the food frequency questionnaire in similar manner as the 7-day record.Conclusion:The present study indicates that the precoded 24-h recall may be valuable tool for measuring average intake of fruits and vegetables among adults in a population of low intake. Moreover, the food frequency questionnaire was valid for ranking individuals according to their usual intake. A 4-day food record might be sufficient when validating food frequency questionnaires for fruits and vegetables.

Fruit and Vegetable Intake of Mothers of 11-Year-Old Children in Nine European Countries: The Pro Children Cross-Sectional Survey

Objective: To describe and compare fruit and vegetable intakes of mothers of 11-year-old children across Europe. Methods: Cross-sectional surveys were carried out in 9 European countries in October/November 2003. Self-administered questionnaires assessing fruit and vegetable consumption were used for data collection. The current paper presents dietary intake data obtained by a precoded 24-hour recall and a food frequency questionnaire. Results: The consumption levels of fruit and vegetables (without fruit juice) were in line with World Health Organization recommendations of ≧400 g/day for only 27% of all participating mothers. Based on both instruments, the Pro Children results showed comparatively high average fruit intake levels in Portugal, Denmark and Sweden (211, 203 and 194 g/day) and the lowest intake in Iceland (97 g/day). High vegetable intake levels were found in Portugal and Belgium (169 and 150 g/day), the lowest in Spain (88 g/day). A south-north gradient could not be observed in the Pro Children study. Conclusion: Fruit and vegetable intakes are low in mothers of 11-year-olds across Europe. Especially vegetable consumption can be regarded as marginal in most of the studied European countries. A high percentage of mothers indicated to eat fruit and vegetables less than once a day. The results have shown that national and international interventions are necessary to promote fruit and especially vegetable consumption in the European population of mothers.

Iodine. Do We Need an Enrichment Program in Denmark

A working group was established to evaluate the need for iodine enrichment in Denmark. Judged from studies of urinary iodine excretion and one dietary survey the intake of iodine in Denmark is low compared with recommended intakes. The occurrence of non-toxic goitre is relatively high; between 9 and 13% in elderly women. Furthermore, a high occurrence of toxic goitre has been seen in the western part of Denmark. On the other hand, an increased or a high intake of iodine may lead to hyperthyroidism and thyroiditis. The working group concluded that an increase in iodine intake in the Danish population is needed and the best way to achieve this is to iodize all salt. To avoid side effects of a sudden large increase in iodine intake the initial amount of iodine in salt will only be 2 ppm.

Relative bioavailability of the flavonoids quercetin, hesperetin and naringenin given simultaneously through diet

The bioavailability and urinary excretion of three dietary flavonoids, quercetin, hesperetin and naringenin, were investigated. Ten healthy men were asked to consume a ‘juice mix’ containing equal amounts of the three flavonoids, and their urine and plasma samples were collected. The resulting mean plasma area under the curve (AUC)0−48h and Cmax values for quercetin and hesperetin were similar, whereas the AUC0−48h of naringenin and, thus, the relative bioavailability were higher after consumption of the same dose. The study consolidates a significantly lower urinary excretion of quercetin (1.5±1%) compared with hesperetin (14.2±9.1%) and naringenin (22.6±11.5%) and shows that this is not due to a lower bioavailability of quercetin, but rather reflects different clearance mechanisms.