Monique Raats

Problems in identifying predictors and correlates of weight loss and maintenance: Implications for weight control therapies based on behaviour change

Weight management is a dynamic process, with a pre‐treatment phase, a treatment (including process) phase and post‐treatment maintenance, and where relapse is possible during both the treatment and maintenance.

Current micronutrient recommendations in Europe: towards understanding their differences and similarities

BackgroundNowadays most countries in Europe have established their own nutrient recommendations to assess the adequacy of dietary intakes and to plan desirable dietary intakes. As yet there is no standard approach for deriving nutrient recommendations, they may vary from country to country. This results in different national recommendations causing confusion for policy-makers, health professionals, industry, and consumers within Europe. EURRECA (EURopean micronutrient RECommendations Aligned) is a network of excellence funded by the European Commission (EC), and established to identify and address the problem of differences between countries in micronutrient recommendations. The objective of this paper is to give an overview of the available micronutrient recommendations in Europe, and to provide information on their origin, concepts and definitions. Furthermore this paper aims to illustrate the diversity in European recommendations on vitamin A and vitamin D, and to explore differences and commonalities in approaches that could possibly explain variations observed.MethodsA questionnaire was developed to get information on the process of establishing micronutrient recommendations. These questionnaires were sent to key informants in the field of micronutrient recommendations to cover all European countries/regions. Also the latest reports on nutrient recommendations in Europe were collected. Standardisation procedures were defined to enable comparison of the recommendations. Recommendations for vitamin A and vitamin D were compared per sex at the ages 3, 9 months and 5, 10, 15, 25, 50 and 70 years. Information extracted from the questionnaires and reports was compared focusing on: (1) The concept of recommendation (recommended daily allowance (RDA), adequate intake (AI) or acceptable range), (2) The year of publication of the report (proxy for available evidence), (3) Population groups defined, (4) Other methodological issues such as selected criteria of adequacy, the type of evidence used, and assumptions made.ResultsTwenty-two countries, the World Health Organization (WHO)/the Food and Agriculture Organization of the United Nations (FAO) and the EC have their own reports on nutrient recommendations. Thirteen countries based their micronutrient recommendations on those from other countries or organisations. Five countries, WHO/FAO and the EC defined their own recommendations. The DACH-countries (Germany, Austria and Switzerland) as well as the Nordic countries (Norway, Sweden, Finland, Denmark and Iceland) cooperated in setting recommendations. Greece and Portugal use the EC and the WHO/FAO recommendations, respectively and Slovenia adopted the recommendations from the DACH-countries. Rather than by concepts, definitions, and defined population groups, variability appears to emerge from differences in criteria for adequacy, assumptions made and type of evidence used to establish micronutrient recommendations.DiscussionThe large variation in current micronutrient recommendations for population groups as illustrated for vitamin A and vitamin D strengthens the need for guidance on setting evidence based, up-to-date European recommendations. Differences in endpoints, type of evidence used to set recommendations, experts’ opinions and assumptions are all likely to contribute to the identified variation. So far, background information was not sufficient transparent to disentangle the relative contribution of these different aspects.ConclusionEURRECA has an excellent opportunity to develop tools to improve transparency on the approaches used in setting micronutrient recommendations, including the selection of criteria for adequacy, weighing of evidence, and interpretation of data.

A measure of satisfaction with food-related life

A measure of satisfaction with food-related life is developed and tested in three studies in eight European countries. Five items are retained from an original pool of seven; these items exhibit good reliability as measured by Cronbachs alpha, good temporal stability, convergent validity with two related measures, and construct validity as indicated by relationships with other indicators of quality of life, including the Satisfaction With Life and the SF-8 scales. It is concluded that this scale will be useful in studies trying to identify factors contributing to satisfaction with food-related life.

Penetration of nutrition information on food labels across the EU-27 plus Turkey

Objectives:The European Union (EU)-funded project Food Labelling to Advance Better Education for Life (FLABEL) aims to understand how nutrition information on food labels affects consumers’ dietary choices and shopping behaviour. The first phase of this study consisted of assessing the penetration of nutrition labelling and related information on various food products in all 27 EU Member States and Turkey.Methods:In each country, food products were audited in three different types of retailers to cover as many different products as possible within five food and beverage categories: sweet biscuits, breakfast cereals, pre-packed chilled ready meals, carbonated soft drinks and yoghurts.Results:More than 37 000 products were audited in a total of 84 retail stores. On average, 85% of the products contained back-of-pack (BOP) nutrition labelling or related information (from 70% in Slovenia to 97% in Ireland), versus 48% for front-of-pack (FOP) information (from 24% in Turkey to 82% in the UK). The most widespread format was the BOP tabular or linear listing of nutrition content. Guideline daily amounts labelling was the most prevalent form of FOP information, showing an average penetration of 25% across all products audited. Among categories, breakfast cereals showed the highest penetration of nutrition-related information, with 94% BOP penetration and 70% FOP penetration.Conclusions:Nutrition labelling and related information was found on a large majority of products audited. These findings provide the basis for subsequent phases of FLABEL involving attention, reading, liking, understanding and use by consumers of different nutrition labelling formats.

Factors Influencing Eating a Varied Diet in Old Age

OBJECTIVE To investigate the influences of resources and food-related goals on the variety of food choice among older people. DESIGN A questionnaire-based survey in eight European countries: Poland, Portugal, United Kingdom, Germany, Sweden, Denmark, Italy and Spain. SUBJECTS Participants (n 3200) were above 65 years of age and living in their own homes. The samples were quota samples, eight groups of fifty in each country, based on gender, age and living circumstances, reflecting the diversity of each of the national populations based on education, income and urbanization of living environment. RESULTS Hierarchical multiple regression analysis showed that income, health status, access to a car and living arrangement affected the level of dietary variety. The perceived level of different food-related resources impacted the consumption of a varied diet over and above actual resource levels. Food-related goals contributed to variety of food intake that was not accounted for by the amount of material resources possessed or the social and other resources perceived to be possessed. CONCLUSIONS Older peoples variety of food intake depended on material resources (e.g. monthly income, access to a car, living arrangement, physical and mental health). However, in addition to these variables, the way older people perceived other resources, such as their level of appetite, their food knowledge, their perception of the distance to the shops, access to high-quality products, having better kitchen facilities, access to good service providers and support from friends and neighbours, all contributed to how varied a diet they ate.

The effects of information on sensory ratings and preferences: the importance of attitudes

Abstract Eighty subjects rated flavoured milk samples which varied in sweetener (sugar versus aspartame) and fat content (full-versus low-fat milk). Twenty of the subjects were in a control condition and received no information about the samples. The remaining sixty subjects initially rated the samples with no information and then rated them again when given information on the fat and sugar content of the samples. Ratings of sweetness, body, healthiness and calorie content were influenced by the information but liking and likelihood of buying were not affected in the overall group. Dividing subjects on the basis of attitudes towards low- and full-fat flavoured milks, however, showed different effects within the two subgroups. When information was given, both liking and rated likelihood of buying increased for the type of sample towards which subjects had a more generally positive attitude. Those subjects with more positive attitudes towards low-fat flavoured milks showed a clear differentiation in ratings of the healthiness of the samples when information was provided. However, those with more positive attitudes towards full-fat flavoured milks did not differentiate the samples in terms of rated healthiness. Similar effects were found when the subjects were divided on the basis of dietary restraint. Those subjects with higher scores for dietary restraint showed greater differentiation of the samples in terms of calorie content, healthiness and sweetness.

Attitudes and beliefs in food habits

The choice of foods by free-living individuals is an area of concern for many people involved in the production and distribution of foods, but also for those concerned with nutrition and health education. Despite a great deal of knowledge gained on the impacts of diet on health and on specific diseases (Committee on Medical Aspects of Food Policy, 1994), relatively little is known about how and why people choose the foods that make up their diets or about how to influence their choices in an effective way. Given recommendations, for example, to reduce fat in the diet or increase the consumption of fruit and vegetables, it is then necessary to understand what determines people’s choices of foods and what obstacles there might be to such changes. Although official recommendations have been in place in the UK since the report by COMA in 1984 (Committee on Medical Aspects of Food Policy, 1984) for a reduction in the energy in the diet derived from fat there has been relatively little change (Committee on Medical Aspects of Food Policy, 1994).

How do peanut and nut-allergic consumers use information on the packaging to avoid allergens?

To cite this article: Barnett J, Leftwich J, Muncer K, Grimshaw K, Shepherd R, Raats MM, Gowland MH, Lucas JS. How do peanut and nut‐allergic consumers use information on the packaging to avoid allergens? Allergy 2011; 66: 969–978.

How we will produce the evidence-based EURRECA toolkit to support nutrition and food policy

BackgroundThere is considerable variation in the recommended micronutrient intakes used by countries within Europe, partly due to different methodologies and concepts used to determine requirements and different approaches used to express the recommendations. As populations become more mobile and multi-national, and more traditional foods become available internationally, harmonised recommendations based on up to date science are needed. This was recognised by the European Commission’s (EC) Directorate-General (DG) Research in their 2005 call for proposals for a Network of Excellence (NoE) on ’nutrient status and requirements of specific vulnerable population groups’. EURopean micronutrient RECommendations Aligned (EURRECA), which has 34 partners representing 17 European countries, started on its 5-year EC-funded programme in January 2007. The programme of work was developed over 2 years prior to submitting an application to the EC. The Network’s first Integrating Meeting (IM) held in Lisbon in April 2007, and subsequent consultations, has allowed further refinement of the programme.AimThis paper presents the rationale for the EURRECA Network’s roadmap, which starts by establishing the status quo for devising micronutrient recommendations. The Network has the opportunity to identify previous barriers and then explore ’evidence-based’ solutions that have not been available before to the traditional panels of experts. The network aims to produce the EURRECA ’toolkit’ to help address and, in some cases, overcome these barriers so that it can be used by those developing recommendations.ResultsThe status quo has been largely determined by two recent initiatives; the Dietary Reference Intake (DRI) reports from the USA and Canada and suggestions for approaches to international harmonisation of nutrient-based dietary standards from the United Nations University (UNU). In Europe, the European Food Safety Authority (EFSA) has been asked by the EC’s Directorate-General for Health and Consumer Protection to produce values for micronutrient recommendations. Therefore, EURRECA will draw on the uniqueness of its consortium to produce the sustainable EURRECA toolkit, which will help make such a task more effective and efficient. Part of this uniqueness is the involvement in EURRECA of small and medium-sized enterprises (SMEs), consumer organisations, nutrition societies and other stakeholders as well as many scientific experts. The EURRECA toolkit will contain harmonised best practice guidance for a more robust science base for setting micronutrient recommendations. Hence, in the future, the evidence base for deriving nutrient recommendations will have greater breadth and depth and will be more transparent.ConclusionsThe EURRECA Network will contribute to the broader field of food and nutrition policy by encouraging and enabling the alignment of nutrient recommendations. It will do this through the development of a scientific toolkit by its partners and other stakeholders across Europe. This will facilitate and improve the formulation of micronutrient recommendations, based on transparently evaluated and quantified scientific evidence. The Network aims to be sustainable beyond its EC funding period.

Usage of Plant Food Supplements across Six European Countries: Findings from the PlantLIBRA Consumer Survey

Background The popularity of botanical products is on the rise in Europe, with consumers using them to complement their diets or to maintain health, and products are taken in many different forms (e.g. teas, juices, herbal medicinal products, plant food supplements (PFS)). However there is a scarcity of data on the usage of such products at European level. Objective To provide an overview of the characteristics and usage patterns of PFS consumers in six European countries. Design Data on PFS usage were collected in a cross-sectional, retrospective survey of PFS consumers using a bespoke frequency of PFS usage questionnaire. Subjects/setting A total sample of 2359 adult PFS consumers from Finland, Germany, Italy, Romania, Spain and the United Kingdom. Data analyses Descriptive analyses were conducted, with all data stratified by gender, age, and country. Absolute frequencies, percentages and 95% confidence intervals are reported. Results Overall, an estimated 18.8% of screened survey respondents used at least one PFS. Characteristics of PFS consumers included being older, well-educated, never having smoked and self-reporting health status as “good or very good”. Across countries, 491 different botanicals were identified in the PFS products used, with Ginkgo biloba (Ginkgo), Oenothera biennis (Evening primrose) and Cynara scolymus (Artichoke) being most frequently reported; the most popular dose forms were capsules and pills/tablets. Most consumers used one product and half of all users took single-botanical products. Some results varied across countries. Conclusions The PlantLIBRA consumer survey is unique in reporting on usage patterns of PFS consumers in six European countries. The survey highlights the complexity of measuring the intake of such products, particularly at pan-European level. Incorporating measures of the intake of botanicals in national dietary surveys would provide much-needed data for comprehensive risk and benefit assessments at the European level.