Mia Bellemans

Breakfast habits affect overall nutrient profiles in adolescents

OBJECTIVE To describe breakfast consumption patterns, on a nutrient and food item level, in Belgian adolescents. DESIGN A 7-day estimated food record was administered in a cross-sectional survey. SETTING Secondary schools in Ghent, Belgium. SUBJECTS A total of 341 adolescents (13-18 years old), multistage clustered sampling. RESULTS The energy contribution of breakfast to daily energy intake was on average 15.7% in boys and 14.9% in girls. Significantly more overweight girls and significantly more girls following vocational training were categorised as eating a low-quality breakfast. In boys, the energy contribution of polysaccharides was significantly higher in consumers of good-quality breakfasts. The intake of all selected micronutrients was significantly higher in consumers of good-quality breakfasts. In girls, the total energy intake and the proportional intake of proteins and polysaccharides were significantly higher in consumers of good-quality breakfasts, while the proportional contribution of total fat, monounsaturated and polyunsaturated fatty acids was significantly lower in these girls. The intake of all micronutrients was significantly higher in girls consuming a good-quality breakfast. In all adolescents, consumers of a good-quality breakfast had significantly higher intakes of bread, fruit, vegetables, milk and milk products, and fruit juice, while intake of soft drinks was significantly lower than in consumers of low-quality breakfasts. CONCLUSIONS Consumers of a good-quality breakfast had a better overall dietary pattern - on a nutrient and food group level - than consumers of a low-quality breakfast. A daily breakfast, including whole-grain products, fruit and (semi-) skimmed milk products or an alternative source of calcium, is recommended.

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.

Assessment of mycotoxin exposure in the Belgian population using biomarkers: aim, design and methods of the BIOMYCO study

Mycotoxins are harmful food contaminants. Currently, human exposure assessment to these toxins is often based on calculations combining mycotoxin occurrence data in food with population data on food consumption. Because of limitations inherent to that approach, biomarkers have been proposed as a suitable alternative whereby a more accurate assessment of exposure at the individual level can be performed. The BIOMYCO study is designed to assess human mycotoxin exposure using urinary biomarkers of exposure. Over the different seasons of 2013 and 2014, morning urine is gathered in a representative part of the Belgian population according to a designed study protocol, whereby 140 children (3–12 years old) and 278 adults (19–65 years old) are selected based on random cluster sampling stratified for sex, age and geographical areas. Every participant completes a food frequency questionnaire to assess the consumption of relevant foodstuffs (n = 43) of both the day before the urine collection and the previous month. Validated multi-toxin LC-MS/MS methods are used to analyse aflatoxins, fumonisins, ochratoxin A, trichothecenes, zearalenone and their metabolites in morning urine. The study protocol is approved by the ethical committee of the Ghent University Hospital. Within this paper, study design and methods are described. The BIOMYCO study is the first study whereby a multi-toxin approach is applied for mycotoxin exposure assessment in adults and children on a large scale. Moreover, it is the first study that will describe the exposure to an elaborated set of mycotoxins in the Belgian population. In first instance, descriptive analysis will be performed, describing the exposure to mycotoxins for the child and adult group. Exposure of different subgroups will be compared. Furthermore, correlations between the mycotoxin concentrations measured and the food consumption reported will be estimated to explore whether the mycotoxin exposure could be explained by the consumption of certain foods.

Iron intake and dietary sources of iron in Flemish adolescents

Objective:To investigate the dietary iron intake and food sources of iron in Flemish adolescents.Design:Cross-sectional survey; dietary assessment method: a 7-day estimated food record.Setting:Private and public secondary schools in Ghent, a city in the Dutch-speaking part of Belgium.Subjects:A total of 341 adolescents (129 boys and 212 girls), 13–18 y, randomly selected by a multistage clustered sampling technique.Results:The mean total iron intake (s.d.) for boys was 13.4 (±2.91) mg/day and for girls 10.1 (±2.79) mg/day. A proportion of 38.8% of the boys and 99.5% of the girls had a mean total iron intake below the Belgian Recommended Dietary Allowance and 3.1% of the boys and 71.2% of the girls below the British Estimated Average Requirement. When bioavailable iron intake is considered, 84.5% of the boys and only 16.5% of the girls met the age-specific requirement. The food groups with the highest mean proportional contribution to total iron intake in both males and females were bread, meat and meat products, cereals and potatoes. A comparison of adolescents from the highest tertile of iron intake (mg/day) with adolescents from the lowest tertile showed a significantly higher energy-adjusted intake of brown bread and a significantly lower intake of soft drinks in the former group in both boys and girls. A significantly higher energy-adjusted intake of breakfast cereals in adolescents of the highest tertile than those of the lowest tertile was seen in girls only. Analyses in consumers only did not change this overall picture.Conclusions:One can conclude that the mean iron intake of Flemish girls is considerably lower than the current recommendations. An increased iron intake in this subgroup of the population is therefore advisable.Sponsorship:This work was financially supported by the National Fund for Scientific Research (fund no. 31557898), the Kelloggs Benelux Company, Unilever Belgium and the Belgian Nutrition Information Center.

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire designed for assessing the intake of dioxin-like contaminants

OBJECTIVE The aim of this study was to assess the reproducibility and relative validity of a food frequency questionnaire (FFQ) designed to estimate the intake of dioxin-like contaminants. METHOD In total, 180 adults (50-65 years) completed the FFQ twice and 157 of them kept four times a 2-day estimated dietary record (EDR) spread over a year. RESULTS Spearman rank correlation coefficients varied between 0.58 and 0.67 for reproducibility, versus between 0.28 and 0.46 for validity for the different food groups under study. Exact agreement within quartiles was between 34% and 39%, only between 3% and 9% was grossly misclassified. The weighed kappa statistics indicated fair agreement between the two methods (0.29 for the total diet). The correction factors used had a relevant influence on the absolute estimated intake. CONCLUSION The FFQ presented here is a valuable tool for ranking individuals in the study population on the basis of estimated intake of dioxin-like contaminants. However, absolute intakes should be estimated without correction factors and interpreted with caution.

Food sources and correlates of sodium and potassium intakes in Flemish pre-school children.

OBJECTIVE The aim of the present study was to investigate dietary sources of Na and K intakes among Flemish pre-school children using multiple linear regression analyses. DESIGN Three-day estimated diet records were used to assess dietary intakes. The contribution to Na and K intakes of fifty-seven food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake for all individuals. SETTING A random cluster sampling design at the level of schools, stratified by province and age, was used. SUBJECTS A representative sample of 696 Flemish pre-school children aged 2·5-6·5 years was recruited. RESULTS Mean Na intake was above and mean K intake was largely below the recommendation for children. Bread (22 %) and soup (13 %) were main contributors to Na intake followed by cold meat cuts and other meat products (12 % and 11 %, respectively). Sugared milk drinks, fried potatoes, milk and fruit juices were the main K sources (13 %, 12 %, 11 % and 11 %, respectively). Although Na and K intakes were positively correlated, several food categories showed Na:K intake ratio well above one (water, cheeses, soup, butter/margarine, fast foods and light beverages) whereas others presented a ratio well below one (oil & fat, fruits & juices, potatoes, vegetables and hot beverages). CONCLUSIONS Flemish pre-school children had too high Na and too low K intakes. The finding that main dietary sources of Na and K are clearly different indicates the feasibility of simultaneously decreasing Na and increasing K intake among children.

A semi-probabilistic modelling approach for the estimation of dietary exposure to phthalates in the Belgian adult population

In this study, a semi-probabilistic modelling approach was applied for the estimation of the long-term human dietary exposure to phthalates--one of worlds most used families of plasticisers. Four phthalate compounds were considered: diethyl phthalate (DEP), di-n-butyl phthalate (DnBP), benzylbutyl phthalate (BBP) and di(2-ethylhexyl) phthalate (DEHP). Intake estimates were calculated for the Belgian adult population and several subgroups of this population for two considered scenarios using an extended version of the EN-forc model. The highest intake rates were found for DEHP, followed by DnBP, BBP and DEP. In the Belgian adult population, men and young adults generally had the highest dietary phthalate intake estimates. Nevertheless, predicted dietary intake rates for all four investigated phthalates were far below the corresponding tolerable daily intake (TDI) values (i.e. P99 intake values were 6.4% of the TDI at most), which is reassuring because adults are also exposed to phthalates via other contamination pathways (e.g. dust ingestion and inhalation). The food groups contributing most to the dietary exposure were grains and grain-based products for DEP, milk and dairy products for DnBP, meat and meat products or grains and grain-based products (depending on the scenario) for BBP and meat and meat products for DEHP. Comparison of the predicted intake results based on modelled phthalate concentrations in food products with intake estimates from other surveys (mostly based on measured concentrations) showed that the extended version of the EN-forc model is a suitable semi-probabilistic tool for the estimation and evaluation of the long-term dietary intake of phthalates in humans.

Dietary exposure of the Belgian population to emulsifiers E481 (sodium stearoyl-2-lactylate) and E482 (calcium stearoyl-2-lactylate)

ABSTRACT A dietary exposure assessment of food emulsifiers E481 (sodium stearoyl-2-lactylate) and E482 (calcium stearoyl-2-lactylate) in the Belgian population was performed. Nationally representative food consumption data from the Belgian National Food Consumption Surveys 2004 (BNFCS2004) and 2014 (BNFCS2014) were used for calculations. A conservative approach (combining individual food consumption data with the maximum permitted level (MPL) of foods (tier 2), was compared with more refined estimates (combining individual food consumption data with actual concentrations measured in food products available on the Belgian market (tier 3)). Estimated daily intakes were compared to the acceptable daily intake (ADI) of the stearoyl-2-lactylates. The results of tier 2 demonstrated that 92% of the children (3–9 years), 53% of the adolescents (10–17 years), 15% of the adults (18–64 years) and 26% of the elderly (64–98 years) had a potential intake higher than the ADI. When replacing the MPL with maximum analysed concentration levels in foods, daily intake estimates decreased dramatically. The estimated daily intake of the food emulsifiers was below the ADI for all age groups, except for a small percentage of children (1.9%) for which the intake exceeded the ADI. The main contributors to the exposure of E481 and E482 were bread, rolls and fine bakery wares.