Tue Christensen

Dietary exposure assessments for children in europe (the EXPOCHI project): rationale, methods and design.

Background/purposeThe number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims [1] to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and [2] to use these data to assess the usual intake of lead, chromium, selenium and food colours.MethodsEXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used.ConclusionThe EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.

Evaluation of Web-based Dietary Assessment Software for Children: comparing reported fruit, juice and vegetable intakes with plasma carotenoid concentration and school lunch observations

Web-based Dietary Assessment Software for Children (WebDASC) was developed to estimate dietary intake in a school meal intervention study among 8- to 11-year-old Danish children. The present study validates self-reported fruit, juice and vegetable (FJV) intakes in 8- to 11-year-old children by comparing intake with plasma carotenoid concentration, and by comparing the reported FJV intake to actually eaten FJV, as observed by a photographic method. A total of eighty-one children, assisted by parents, reported their diet for seven consecutive days. For the same five schooldays as they reported their diet, the childrens school lunch was photographed and weighed before and after eating. In the week after the diet reporting, fasting blood samples were taken. Self-reported intake of FJV and estimated intake of carotenoids were compared with plasma carotenoid concentration. Accuracy of self-reported food and FJV consumption at school lunch was measured in terms of matches, intrusion, omission and faults, when compared with images and weights of lunch intake. Self-reported intake of FJV was significantly correlated with the total carotenoid concentration (0·58) (P< 0·01). Fruit and juice consumption showed higher correlations than vegetables with plasma carotenoid concentration (0·38 and 0·42 v. 0·33) (P< 0·01). A total of 82 % of the participants fell into the same or adjacent quartiles when cross-classified by FJV intake and carotenoids biomarkers. WebDASC attained 82 % reporting matches overall and a higher percentage match for reporting fruits compared with beverages. The present study indicated that WebDASC can be used to rank 8- to 11-year-old Danish children according to their intake of FJV overall and at school meals.

Dietary effects of introducing school meals based on the New Nordic Diet - a randomised controlled trial in Danish children. The OPUS School Meal Study.

The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet (NND)) School Meal Study investigated the effects on the intake of foods and nutrients of introducing school meals based on the principles of the NND covering lunch and all snacks during the school day in a cluster-randomised cross-over design. For two 3-month periods, 834 Danish children aged 8-11 years from forty-six school classes at nine schools received NND school meals or their usual packed lunches brought from home (control) in random order. The whole diet of the children was recorded over seven consecutive days using a validated Web-based Dietary Assessment Software for Children. The NND resulted in higher intakes of potatoes (130 %, 95 % CI 2·07, 2·58), fish (48 %, 95 % CI 1·33, 1·65), cheese (25 %, 95 % CI 1·15, 1·36), vegetables (16 %, 95 % CI 1·10, 1·21), eggs (10 %, 95 % CI 1·01, 1·19) and beverages (6 %, 95 % CI 1·02, 1·09), and lower intakes of bread (13 %, 95 % CI 0·84, 0·89) and fats (6 %, 95 % CI 0·90, 0·98) were found among the children during the NND period than in the control period (all, P< 0·05). No difference was found in mean energy intake (P= 0·4), but on average children reported 0·9 % less energy intake from fat and 0·9 % higher energy intake from protein during the NND period than in the control period. For micronutrient intakes, the largest differences were found for vitamin D (42 %, 95 % CI 1·32, 1·53) and iodine (11 %, 95 % CI 1·08, 1·15) due to the higher fish intake. In conclusion, the present study showed that the overall dietary intake at the food and nutrient levels was improved among children aged 8-11 years when their habitual packed lunches were replaced by school meals following the principles of the NND.

Intake of micronutrients among Danish adult users and non-users of dietary supplements

Objectives To evaluate the intake of micronutrients from the diet and from supplements in users and non-users of dietary supplements, respectively, in a representative sample of the Danish adult population. A specific objective was to identify the determinants of supplement use. Design A cross-sectional representative national study of the intake of vitamins and minerals from the diet and from dietary supplements. Method The Danish National Survey of Dietary Habits and Physical Activity, 2000–2004. Participants (n=4,479; 53% females) aged 18–75 years gave information about the use of dietary supplements in a personal interview. The quantification of the micronutrient contribution from supplements was estimated from a generic supplement constructed from data on household purchases. Nutrient intakes from the diet were obtained from a self-administered 7-day pre-coded dietary record. Median intakes of total nutrients from the diets of users and non-users of supplements were analysed using the Wilcoxon rank-sum test. Results Sixty percent of females and 51% of males were users of supplements. With the exception of vitamin D, the intake of micronutrients from the diet was adequate at the group level for all age and gender groups. Among females in the age group 18–49 years, the micronutrient intake from the diet was significantly higher compared with the non-users of dietary supplements. The use of dietary supplements increased with age and with ‘intention to eat healthy.’ Conclusion Intake of micronutrients from the diet alone was considered adequate for both users and non-users of dietary supplements. Younger females who were supplement users had a more micronutrient-dense diet compared to non-users.

Comparison of estimated energy intake using Web-based Dietary Assessment Software with accelerometer-determined energy expenditure in children

Background The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) project carried out a school meal study to assess the impact of a New Nordic Diet (NND). The random controlled trial involved 834 children aged 8–11 in nine local authority schools in Denmark. Dietary assessment was carried out using a program known as WebDASC (Web-based Dietary Assessment Software for Children) to collect data from the children. Objective To compare the energy intake (EI) of schoolchildren aged 8–11 estimated using the WebDASC system against the total energy expenditure (TEE) as derived from accelerometers worn by the children during the same period. A second objective was to evaluate the WebDASCs usability. Design Eighty-one schoolchildren took part in what was the pilot study for the OPUS project, and they recorded their total diet using WebDASC and wore an accelerometer for two periods of seven consecutive days: at baseline, when they ate their usual packed lunches and at intervention when they were served the NND. EI was estimated using WebDASC, and TEE was calculated from accelerometer-derived activity energy expenditure, basal metabolic rate, and diet-induced thermogenesis. WebDASCs usability was assessed using a questionnaire. Parents could help their children record their diet and answer the questionnaire. Results Evaluated against TEE as derived from the accelerometers worn at the same time, the WebDASC performed just as well as other traditional methods of collecting dietary data and proved both effective and acceptable with children aged 8–11, even with perhaps less familiar foods of the NND. Conclusions WebDASC is a useful method that provided a reasonably accurate measure of EI at group level when compared to TEE derived from accelerometer-determined physical activity in children. WebDASC will benefit future research in this area.

Probabilistic assessment of the cumulative dietary acute exposure of the population of Denmark to organophosphorus and carbamate pesticides

Organophosphorus and carbamate pesticides are acetylcholinesterase-inhibiting pesticides and as such have a common mode of action. We assessed the cumulative acute exposure of the population of Denmark to 25 organophosphorus and carbamate pesticide residues from the consumption of fruit, vegetables and cereals. The probabilistic approach was used in the assessments. Residue data obtained from the Danish monitoring programme carried out in the period 2004–2007, which included 6704 samples of fruit, vegetables and cereals, were used in the calculations. Food consumption data were obtained from the nationwide dietary survey conducted in 2000–2002. Contributions from 43 commodities were included in the calculations. We used the relative potency factor (RPF) approach to normalize the toxicity of the various organophosphorus and carbamate pesticides to the two index compounds chlorpyriphos and methamidophos. RPF values derived from the literature were used in the calculations. We calculated the cumulative acute exposure to 1.8% and 0.8% of the acute reference dose (ARfD) of 100 µg kg–1 body weight (bw) day–1 of chlorpyrifos as an index compound at the 99.9th percentile (P99.5) for children and adults, respectively. When we used methamidophos as the index compound, the cumulative acute intakes were calculated to 31.3% and 13.8% of the ARfD of 3 µg kg–1 bw day–1 at P99.9 for children and adults, respectively. With both index compounds, the greatest contributor to the cumulative acute exposure was apple. The results show that there is no cumulative acute risk for Danish consumers to acetylcholinesterase-inhibiting pesticides.

Iodine content in bread and salt in Denmark after iodization and the influence on iodine intake

Objective To measure the iodine content in bread and household salt in Denmark after mandatory iodine fortification was introduced and to estimate the increase in iodine intake due to the fortification. Design The iodine content in rye breads, wheat breads and salt samples was assessed. The increase in iodine intake from fortification of bread and the increase in total iodine intake after fortification were estimated. Subjects Iodine intake before and after fortification was estimated based on dietary intake data from 4,124 randomly selected Danish subjects. Main results Approximately 98% of the rye breads and 90% of the wheat breads were iodized. The median iodine intake from bread increased by 25 (13–43) µg/day and the total median iodine intake increased by 63 (36–104) µg/day. Conclusions The fortification of bread and salt has resulted in a desirable increase in iodine intake, and the current fortification level of salt (13 ppm) seems reasonable.

Dietary intake and main sources of plant lignans in five European countries

Background Dietary intakes of plant lignans have been hypothesized to be inversely associated with the risk of developing cardiovascular disease and cancer. Earlier studies were based on a Finnish lignan database (Fineli®) with two lignan precursors, secoisolariciresinol (SECO) and matairesinol (MAT). More recently, a Dutch database, including SECO and MAT and the newly recognized lignan precursors lariciresinol (LARI) and pinoresinol (PINO), was compiled. The objective was to re-estimate and re-evaluate plant lignan intakes and to identify the main sources of plant lignans in five European countries using the Finnish and Dutch lignan databases, respectively. Methods Forty-two food groups known to contribute to the total lignan intake were selected and attributed a value for SECO and MAT from the Finnish lignan database (Fineli®) or for SECO, MAT, LARI, and PINO from the Dutch database. Total intake of lignans was estimated from food consumption data for adult men and women (19–79 years) from Denmark, Finland, Italy, Sweden, United Kingdom, and the contribution of aggregated food groups calculated using the Dutch lignin database. Results Mean dietary lignan intakes estimated using the Dutch database ranged from 1 to 2 mg/day, which was approximately four-fold higher than the intakes estimated from the Fineli® database. When LARI and PINO were included in the estimation of the total lignan intakes, cereals, grain products, vegetables, fruit and berries were the most important dietary sources of lignans. Conclusion Total lignin intake was approximately four-fold higher in the Dutch lignin database, which includes the lignin precursors LARI and PINO, compared to estimates based on the Finnish database based only on SECO and MAT. The main sources of lignans according to the Dutch database in the five countries studied were cereals and grain products, vegetables, fruit, berries, and beverages.

Dietary exposure assessment of Danish consumers to dithiocarbamate residues in food. A comparison of the deterministic and probabilistic approach

Probabilistic and deterministic estimates of the acute and chronic exposure of the Danish populations to dithiocarbamate residues were performed. The Monte Carlo Risk Assessment programme (MCRA 4.0) was used for the probabilistic risk assessment. Food consumption data were obtained from the nationwide dietary survey conducted in 2000–02. Residue data for 5721 samples from the monitoring programme conducted in the period 1998–2003 were used for dithiocarbamates, which had been determined as carbon disulphide. Contributions from 26 commodities were included in the calculations. Using the probabilistic approach, the daily acute intakes at the 99.9% percentile for adults and children were 11.2 and 28.2 μg kg−1 body weight day−1, representing 5.6% and 14.1% of the ARfD for maneb, respectively. When comparing the point estimate approach with the probabilistic approach, the outcome of the point estimate calculations was generally higher or comparable with the outcome of the probabilistic approach at the 99.9 percentile (consumers only). The chronic exposures for adults and children were 0.35 and 0.76 μg kg−1 body weight day−1 at the 99.9 percentile, representing 0.7% and 1.5%, respectively, of the acceptable daily intake for mancozeb and maneb at 50 μg kg−1 body weight.

Dietary patterns, food and macronutrient intakes among adults in three ethnic groups in rural Kenya.

OBJECTIVE To compare dietary patterns and food and macronutrient intakes among adults in three ethnic groups in rural Kenya. DESIGN In the present cross-sectional study, dietary intake was estimated in adult volunteers using two non-consecutive interactive 24 h recalls. Dietary patterns were assessed from the number of meals and snacks per day and from the food items and major food groups registered, and their contribution to energy intake (EI) was calculated. Anthropometric values were measured and sociodemographic data obtained using a questionnaire. SETTING A cross-sectional study was conducted in the Bondo, Kitui and Transmara districts of rural Kenya. A high prevalence of food insecurity in Kenya underlines the importance of describing the dietary patterns and intakes in different Kenyan ethnic groups. SUBJECTS A total of 1163 (61 % women) adult Luo, Kamba and Maasai, with a mean age of 38·6 (range: 18-68) years, volunteered to participate. RESULTS Dietary patterns and food groups contributing to EI differed significantly among the ethnic groups. Mean EI ranged from 5·8 to 8·6 MJ/d among women and from 7·2 to 10·5 MJ/d among men, with carbohydrates contributing between 55·7 % and 74·2 % and fat contributing between 14·5 % and 30·2 % of total EI. Mean protein intake ranged from 0·72 to 1·3 g/kg per d, and EI:BMR ratio ranged between 1·1 and 1·6 in both sexes, and was highest among the Luo. Prevalence of underweight (BMI < 18·5 kg/m2) was 13·7 %, 20·5 % and 24·2 % in the Luo, Kamba and Maasai, respectively. CONCLUSIONS The degree of food insecurity measured as a degree of undernutrition and as dietary patterns differed considerably among the ethnic groups. The Maasai and Kamba in particular were exposed to food insecurity.