W.A. van Staveren

Body mass index and percent body fat: a meta analysis among different ethnic groups.

OBJECTIVE: To study the relationship between percent body fat and body mass index (BMI) in different ethnic groups and to evaluate the validity of the BMI cut-off points for obesity.DESIGN: Meta analysis of literature data.SUBJECTS: Populations of American Blacks, Caucasians, Chinese, Ethiopians, Indonesians, Polynesians and Thais.MEASUREMENTS: Mean values of BMI, percent body fat, gender and age were adapted from original papers.RESULTS: The relationship between percent body fat and BMI differs in the ethnic groups studied. For the same level of body fat, age and gender, American Blacks have a 1.3 kg/m2 and Polynesians a 4.5 kg/m2 lower BMI compared to Caucasians. By contrast, in Chinese, Ethiopians, Indonesians and Thais BMIs are 1.9, 4.6, 3.2 and 2.9 kg/m2 lower compared to Caucasians, respectively. Slight differences in the relationship between percent body fat and BMI of American Caucasians and European Caucasians were also found. The differences found in the body fat/BMI relationship in different ethnic groups could be due to differences in energy balance as well as to differences in body build.CONCLUSIONS: The results show that the relationship between percent body fat and BMI is different among different ethnic groups. This should have public health implications for the definitions of BMI cut-off points for obesity, which would need to be population-specific.

Serum vitamin D concentrations among elderly people in Europe

Vitamin D status decreases with age, mainly as a result of restricted sunlight exposure, reduced capacity of the skin to produce vitamin D, and reduced dietary vitamin D intake. We measured wintertime serum 25-hydroxyvitamin D [25(OH)D] concentrations in 824 elderly people from 11 European countries. 36% of men and 47% of women had 25(OH)D concentrations below 30 nmol/L. Users of vitamin D supplements and/or sunlamps had higher 25(OH)D (median 54 nmol/L) than non users (median 31 nmol/L). Surprisingly, lowest mean 25(OH)D concentrations were seen in southern European countries. Low 25(OH)D concentrations could largely be explained by attitudes towards sunlight exposure and factors of physical health status, after exclusion of users of vitamin D supplements or sunlamps. Problems with daily living activities and wearing clothes with long sleeves during periods of sunshine were strong predictors of low wintertime serum 25(OH)D concentrations. These findings show that free-living elderly Europeans, regardless of geographical location, are at substantial risk of inadequate vitamin D status during winter and that dietary enrichment or supplementation with vitamin D should be seriously considered during this season.

The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore

OBJECTIVE: To study the relationship between body fat percentage and body mass index (BMI) in three different ethnic groups in Singapore (Chinese, Malays and Indians) in order to evaluate the validity of the BMI cut-off points for obesity.DESIGN: Cross-sectional study.SUBJECTS: Two-hundred and ninety-one subjects, purposively selected to ensure adequate representation of range of age and BMI of the general adult population, with almost equal numbers from each ethnic and gender group.MEASUREMENTS: Body weight, body height, sitting height, wrist and femoral widths, skinfold thicknesses, total body water by deuterium oxide dilution, densitometry with Bodpod® and bone mineral content with Hologic® QDR-4500. Body fat percentage was calculated using a four-compartment model.RESULTS: Compared with body fat percentage (BF%) obtained using the reference method, BF% for the Singaporean Chinese, Malays and Indians were under-predicted by BMI, sex and age when an equation developed in a Caucasian population was used. The mean prediction error ranged from 2.7% to 5.6% body fat. The BMI/BF% relationship was also different among the three Singaporean groups, with Indians having the highest BF% and Chinese the lowest for the same BMI. These differences could be ascribed to differences in body build. It was also found that for the same amount of body fat as Caucasians who have a body mass index (BMI) of 30 kg/m2 (cut-off for obesity as defined by WHO), the BMI cut-off points for obesity would have to be about 27 kg/m2 for Chinese and Malays and 26 kg/m2 for Indians.CONCLUSIONS: The results show that the relationship between BF% and BMI is different between Singaporeans and Caucasians and also among the three ethnic groups in Singapore. If obesity is regarded as an excess of body fat and not as an excess of weight (increased BMI), the cut-off points for obesity in Singapore based on the BMI would need to be lowered. This would have immense public health implications in terms of policy related to obesity prevention and management.

Standardization of the 24-hour diet recall calibration method used in the european prospective investigation into cancer and nutrition (EPIC): general concepts and preliminary results.

Objectives: Despite increasing interest in the concept of calibration in dietary surveys, there is still little experience in the use and standardization of a common reference dietary method, especially in international studies. In this paper, we present the general theoretical framework and the approaches developed to standardize the computer-assisted 24 h diet recall method (EPIC-SOFT) used to collect about 37 000 24-h dietary recall measurements (24-HDR) from the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). In addition, an analysis of variance was performed to examine the level of standardization of EPIC-SOFT across the 90 interviewers involved in the study.Methods: The analysis of variance used a random effects model in which mean energy intake per interviewer was used as the dependent variable, while age, body mass index (BMI), energy requirement, week day, season, special diet, special day, physical activity and the EPIC-SOFT version were used as independent variables. The analysis was performed separately for men and women.Results: The results show no statistical difference between interviewers in all countries for men and five out of eight countries for women, after adjustment for physical activity and the EPIC-SOFT program version used, and the exclusion of one interviewer in Germany (for men), and one in Denmark (for women). These results showed an interviewer effect in certain countries and a significant difference between gender, suggesting an underlying respondent’s effect due to the higher under-reporting among women that was consistently observed in EPIC. However, the actual difference between interviewer and country mean energy intakes is about 10%. Furthermore, no statistical differences in mean energy intakes were observed across centres from the same country, except in Italy and Germany for men, and France and Spain for women, where the populations were recruited from areas scattered throughout the countries.Conclusion: Despite these encouraging results and the efforts to standardize the 24-HDR interview method, conscious or unconscious behaviour of respondents and/or interviewer bias cannot be prevented entirely. Further evaluation of the reliability of EPIC-SOFT measurements will be conducted through validation against independent biological markers (nitrogen, potassium).European Journal of Clinical Nutrition (2000) 54, 900–917

Effect of fish oil on cognitive performance in older subjects A randomized, controlled trial

Background: High intake of n-3 polyunsaturated fatty acids may protect against age-related cognitive decline. However, results from epidemiologic studies are inconclusive, and results from randomized trials in elderly subjects without dementia are lacking. Objective: To investigate the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation on cognitive performance. Methods: Double-blind, placebo-controlled trial involving 302 cognitively healthy (Mini-Mental State Examination score > 21) individuals aged 65 years or older. Participants were randomly assigned to 1,800 mg/d EPA–DHA, 400 mg/d EPA–DHA, or placebo capsules for 26 weeks. Cognitive performance was assessed using an extensive neuropsychological test battery that included the cognitive domains of attention, sensorimotor speed, memory, and executive function. Results: The mean age of the participants was 70 years, and 55% were male. Plasma concentrations of EPA–DHA increased by 238% in the high-dose and 51% in the low-dose fish oil group compared with placebo, reflecting excellent compliance. Baseline scores on the cognitive tests were comparable in the three groups. Overall, there were no significant differential changes in any of the cognitive domains for either low-dose or high-dose fish oil supplementation compared with placebo. Conclusions: In this randomized, double-blind, placebo-controlled trial, we observed no overall effect of 26 weeks of eicosapentaenoic acid and docosahexaenoic acid supplementation on cognitive performance.

A Meta-Analysis of the Effect of Calcium Intake on Bone Mass in Young and Middle Aged Females and Males

Evidence of a direct relationship between dietary calcium and bone mass in young adults is inconsistent. Therefore, a meta-analysis was performed to evaluate the existing literature concerning this relation in premenopausal women and adult men between the ages of 18 and 50. A computer-aided search of published papers from 1966 through 1994 was conducted. The quality of each study was assessed by examining the study design. The results of the well-designed studies wer combined to obtain quantitative conclusions. A total of 33 eligible studies were identified in the literature, representing 27 cross-sectional studies, two longitudinal and four intervention studies. The results of the cross-sectional studies in permenopausal females showed a significant correlation coefficient (r = 0.13, 95%-confidence interval = 0.09-0.16) as well as partial correlation coefficient (partial r = 0.08, 95%-confidence interval = 0.05-0.12), both weighted by sample size. The intervention studies found that calcium supplementation of approximately 1000 mg/d in premenopausal women can prevent the loss of 1% of bone/y at all bone site except in the ulna. In conclusion, the studies published to date seem to offer overall evidence that calcium intake is positively associated with bone mass in premenopausal females. This association is fairly consistent across the different study designs and is strengthened by the fact that the results are based only on studies with a high methodological quality. In males, too few studies (only three) were published to draw firm conclusions.

Role of social support in lifestyle-focused weight management interventions

Social support is important to achieve beneficial changes in risk factors for disease, such as overweight and obesity. This paper presents the theoretical and practical framework for social support, and the mechanisms by which social support affects body weight. The theoretical and practical framework is supported with a literature review addressing studies involving a social support intervention for weight loss and weight loss maintenance.A major aspect in social support research and practice is the distinction between structural and functional support. Structural support refers to the availability of potential support-givers, while functional support refers to the perception of support. Interventions often affect structural support, for example, through peer groups, yet functional support shows a stronger correlation with health. Although positive correlations between social support and health have been shown, social support may also counteract health behaviour change.Most interventions discussed in this review showed positive health outcomes. Surprisingly, social support was clearly defined on a practical level in hardly any studies, and social support was assessed as an outcome variable in even fewer studies. Future social support intervention research would benefit from clear definitions of social support, a clear description of the intended mechanism of action and the actual intervention, and the inclusion of perceived social support as a study outcome.

Relationships between indices of obesity and its co-morbidities in multi-ethnic Singapore

OBJECTIVE: To investigate the effect of body mass index (BMI) and body fat distribution as measured by waist-to-hip ratio (WHR) on the cardiovascular risk factor profile of the three major ethnic groups in Singapore (Chinese, Malay and Indian people) and to determine if WHO recommended cut-off values for BMI and WHR are appropriate for the different sub-populations in Singapore.DESIGN: Cross-sectional population study.SUBJECTS: A total of 4723 adult subjects (64% Chinese individuals, 21% Malay individuals and 15% Indian individuals) were selected through a multi-staged sampling technique to take part in the National Health Survey in 1998.MEASUREMENTS: Data on socio-economic status (education level, occupation, housing type) and lifestyle habits (smoking and physical activity), body weight, body height, waist and hip circumferences and blood pressure measured using standardised protocols. Fasting venous blood samples were obtained for determination of serum total cholesterol (TC), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), triglycerides (TG). Venous blood samples were taken for 2 h oral glucose tolerance test (2 h glu).RESULTS: Absolute and relative risks for at least one cardiovascular risk factor (elevated TC, elevated TC/HDL ratio, elevated TG, hypertension and diabetes mellitus) were determined for various categories of BMI and WHR. At low categories of BMI (BMI between 22 and 24 kg/m2) and WHR (WHR between 0.80 and 0.85 for women, and between 0.90 and 0.95 for men), the absolute risks are high, ranging from 41 to 81%. At these same categories the relative risks are significantly higher compared to the reference category, ranging from odds ratio of 1.97 to 4.38. These categories of BMI and WHR are all below the cut-off values of BMI and WHR recommended by WHO.CONCLUSIONS: The results show that, at relatively low BMI and WHR, Singaporean adults experience elevated levels of risks (absolute and relative) for cardiovascular risk factors. These findings, in addition to earlier reported high percentage body fat among Singaporeans at low levels of BMI, confirm the need to revise the WHO cut-off values for the various indices of obesity and fat distribution, viz BMI and WHR, in Singapore.

Comparison of three different dietary scores in relation to 10-year mortality in elderly European subjects: the HALE project.

Objective:To investigate and compare the associations between dietary patterns and mortality using different European indexes of overall dietary quality.Design, Setting and Participants:The HALE (Healthy Ageing: a Longitudinal study in Europe) population includes 2068 men and 1049 women, aged between 70 and 90 years of 10 European countries. Subjects were followed for 10 years. This cohort study was conducted between 1988 and 2000.Results:During the follow-up period, 1382 people died. The Mediterranean Diet Score (MDS) (HR: 0.82 with 95% CI: 0.75–0.91), the Mediterranean Adequacy Index (MDI) (HR: 0.83 with 95% CI: 0.75–0.92) and the Healthy Diet Indicator (HDI)(HR: 0.89 with 95% CI: 0.81–0.98) were inversely associated with all-causes mortality. Adjustments were made for age, gender, alcohol consumption, physical activity, smoking, number of years of education, body mass index, chronic diseases at baseline and study centre.Conclusions:The MDS, the MDI and the HDI were significantly inversely related with mortality.Sponsorship:This study is based on data of the HALE project and supported by a grant from the European Union (QLK6-CT-2000–00211) to D Kromhout.

Evaluating the DETERMINE your nutritional health checklist and the mini nutritional assessment as tools to identify nutritional problems in elderly Europeans.

Objective: To evaluate two short questionnaires for assessing the nutritional situation of elderly people, the DETERMINE Your Nutritional Health Checklist of the Nutrition Screening Initiative (NSI checklist) and the Mini Nutritional Assessment (MNA), by comparing equivalent cumulative scores with data on dietary intake, anthropometrics and blood biochemistries.Design: Information similar to the questions of the NSI and MNA lists was collected by SENECA: the Survey in Europe on Nutrition and the Elderly, a Concerted Action.Subjects: Records collected in 1993, could be used from 1161 European elderly men and women born between 1913 and 1918, mostly community dwelling, whose diet, lifestyle and health were studied twice, in 1989 and 1993.Results: The MNA classified 55% of the examinees as well-nourished, 44% as at risk of malnutrition and 1% as malnourished. The NSI categorised the elderly people differently: 11% as good, 41% at moderate nutritional risk, 48% at high nutritional risk. Biochemical, dietary and anthropometric indices did not differ either between NSI categories or between MNA categories. Using serum albumin values (<30 g/l) and lymphocyte counts (<1500/ml) as standards, specificity and sensitivity of both instruments for identifying at-risk groups were below 0.6. Only with body weight loss (≥10%) as criterion variable were higher sensitivities (0.75 (NSI), 0.96 (MNA)) and specificities (0.54 (NSI), 0.60 (MNA)) found.Conclusion: It is concluded that in an apparently healthy elderly population both assessment tools are of limited value.