Zvonimir Šatalić

Nutritive value of meals, dietary habits and nutritive status in Croatian university students according to gender.

The aim of this study was to evaluate daily menus at students’ restaurants and to report dietary habits and other health-related behaviour of Croatian university students (n=2075) according to gender. A specially designed self- administered questionnaire was used. One hundred and twenty daily menus were chosen by random sampling, and the nutritive value was calculated using food composition tables. Daily menus on average provide an adequate amount of energy, protein and most micro nutrients: 88.2% of daily menus provide a balanced intake of protein, fat and carbohydrates, 22.5% of daily menus provide more than 300 mg of cholesterol, and 58.8% have more than 25 g dietary fibre. On average, students had 2.4 meals and 1.3 snacks per day. Breakfast was the most often skipped meal. Red meat, cereals and fast food were consumed more often by males (P<0.05). Low-fat dairy products, whole grain products and breakfast cereals were consumed more often by females (P<0.05). The most common choice for snacks was fruit. Males exercised more than females (4.4 h/week versus 1.6 h/week; P<0.05). A higher percentage of females (29.8%) than males (17.2%) smoked cigarettes. For alcohol consumption it was vice versa: 88.9 and 84.8% of males and females, respectively. A total of 80.4% of students were well nourished. This study showed that meals offered at students’ restaurants are adequate. Dietary and other health-related behaviour differed according to gender. Clustering of some behaviours was observed.

Diet quality in Croatian university students: Energy, macronutrient and micronutrient intakes according to gender

The aim of the study was to evaluate diet quality and nutrient intakes in Croatian university students, which are missing for the past 15 years, and also to report the prevalence of overweight/obesity and underweight. The subjects were 663 students (average age 22 years), representing 0.6% of all Croatian university students. The Quantified Food Frequency Questionnaire, checked for reproducibility and validity, was used for dietary assessment. Students on average had an adequate number of daily meals and snacks, but consumption of breakfast was irregular, particularly for men. The average energy intake was 130.1% of the dietary reference intake and the protein intake was more than double the dietary reference intake in 64.3% students. Dietary fiber, iron (in females), calcium, zinc, folate, and vitamins C, A and E intake were below recommendations in both genders. Only 3.8% of females and 21.9% of males were overweight/obese (body mass index >25 kg/m2). Nutrient intakes significantly differed according to gender and better macronutrient but not micronutrient intakes were observed in females.

Micronutrient intake and status in Central and Eastern Europe compared with other European countries, results from the EURRECA network

OBJECTIVE To compare micronutrient intakes and status in Central and Eastern Europe (CEE) with those in other European countries and with reference values. DESIGN Review of the micronutrient intake/status data from open access and grey literature sources from CEE. SETTING Micronutrients studied were folate, iodine, Fe, vitamin B12 and Zn (for intake and status) and Ca, Cu, Se, vitamin C and vitamin D (for intake). Intake data were based on validated dietary assessment methods; mean intakes were compared with average nutrient requirements set by the Nordic countries or the US Institute of Medicine. Nutritional status was assessed using the status biomarkers and cut-off levels recommended primarily by the WHO. SUBJECTS For all population groups in CEE, the mean intake and mean/median status levels were compared between countries and regions: CEE, Scandinavia, Western Europe and Mediterranean. RESULTS Mean micronutrient intakes of adults in the CEE region were in the same range as those from other European regions, with exception of Ca (lower in CEE). CEE children and adolescents had poorer iodine status, and intakes of Ca, folate and vitamin D were below the reference values. CONCLUSIONS CEE countries are lacking comparable studies on micronutrient intake/status across all age ranges, especially in children. Available evidence showed no differences in micronutrient intake/status in CEE populations in comparison with other European regions, except for Ca intake in adults and iodine and Fe status in children. The identified knowledge gaps urge further research on micronutrient intake/status of CEE populations to make a basis for evidence-based nutrition policy.

Dietary Intakes among Croatian Schoolchildren and Adolescents

The aim of this study was to evaluate dietary intakes among 575 schoolchildren and adolescents in Croatia because of the lack of data. The completely quantified Food Frequency Questionnaire (FFQ) method was used to identify dietary intakes. Body weight, height and body fat were measured also. Daily energy intake was 95.5 and 83.3% RDA in children and adolescents respectively. Protein intake was very high in both children and adolescents (235.9 vs. 139.6% RDA). Children achieved RDAs for more micronutrients than adolescents did. Children had significantly higher cholesterol (263.7 vs. 231.3 mg) and dietary fiber intake (84.7 vs. 69.2% of the “age + 5” rule). Adolescents consumed significantly more fruit than children (324.8 vs. 204.2 g/day) did. Consumption of vegetables did not differ significantly (269.1 and 255.7 g/day in children and adolescents respectively). In more than 60% of children and adolescents, breakfast provided more than 30% of daily energy intake. Soft drinks and fast food consumption correlated in both children (r = 0.29; P < 0.01) and adolescents (r = 0.43; P < 0.001). No significant correlation was found between BMI and dietetic parameters. Percentage of body fat negatively correlated with fruit intake in children (r = −0.20; P < 0.05) and with intake of cereal products (r = −0.34; p < 0.001) and milk (r = −0.22; P < 0.05) in adolescents.

Validation of the folate food frequency questionnaire with serum and erythrocyte folate and plasma homocysteine

The aim of the present study was to develop and validate a folate food frequency questionnaire (FFQ) designed to measure dietary folate equivalents. The self-administered FFQ containing 39 items and a reference period of 1 month (i.e. the previous month), was validated against three biomarkers: serum and erythrocyte (RBC) folate, and plasma homocysteine (Hcy). Subjects were women (n=99) between the ages of 21 and 87 years. The Pearson correlation coefficients for folate intake and biomarkers were 0.36, 0.34 and −0.25 for serum and RBC folate, and plasma Hcy, respectively. A principal component factor analysis was performed on the three biomarkers to calculate the folate status factor. The Pearson correlation for the folate status factor and folate intake was 0.39. The FFQ described in this study is a valid tool for measuring folate intake expressed as dietary folate equivalents in adult women and is suitable for future investigations about the relationship between folate and disease, or as an educational tool.

Evaluation of diet quality with the mediterranean dietary quality index in university students

Data on diet quality in Croatian university students have been missing for more than 15 years. A food approach rather than a nutrient approach appears more appropriate to present knowledge on diet and health. The aim of the present study was to evaluate diet quality in Croatian university students (n=663) with the Mediterranean Dietary Quality Index (M-DQI) in continental and Mediterranean regions. The M-DQI was determined with a Quantified Food Frequency Questionnaire. The minimum score for the M-DQI is 0 and the maximum score is 14. A higher score indicates a less healthy diet. The score for the M-DQI was the same in both regions (9.6) and did not differ significantly. In the category for scores 8–14 were 84.0% and 84.6% of students in the continental and Mediterranean regions, respectively. Higher correlation for the M-DQI was observed with macronutrient intakes than with micronutrient intakes. The M-DQI did not correlate with trans-fatty acid intake. A significant correlation (negative) with lycopene was observed in the Mediterranean region only. The body mass index did not correlate with the M-DQI. Students from both regions, continental and Mediterranean, had a lower diet quality evaluated with the M-DQI, with no significant difference according to region.

Improving nutrition surveillance and public health research in Central and Eastern Europe/Balkan Countries using the Balkan Food Platform and dietary tools.

The objective of this paper is to share experience and provide updated information on Capacity Development in the Central and Eastern Europe/Balkan Countries (CEE/BC) region relevant to public health nutrition, particularly in creation of food composition databases (FCDBs), applying dietary intake assessment and monitoring tools, and harmonizing methodology for nutrition surveillance. Balkan Food Platform was established by a Memorandum of Understanding among EuroFIR AISBL, Institute for Medical Research, Belgrade, Capacity Development Network in Nutrition in CEE - CAPNUTRA and institutions from nine countries in the region. Inventory on FCDB status identified lack of harmonized and standardized research tools. To strengthen harmonization in CEE/BC in line with European research trends, the Network members collaborated in development of a Regional FCDB, using web-based food composition data base management software following EuroFIR standards. Comprehensive nutrition assessment and planning tool - DIET ASSESS & PLAN could enable synchronization of nutrition surveillance across countries.

Peak Bone Density in Croatian Women: Variations at Different Skeletal Sites

It is known that different skeletal sites have different peak bone mass at different times and lose bone at different rates. The purpose of the study was to assess bone mineral density (BMD) in healthy female student population (N=220), aged 18-25 yr and to analyze whether young women of that age have already started to lose the bone mass at the trabecular and cortical parts of skeleton. The influence of dietary intake and physical activity on their bone mass was also assessed. BMD was measured, using dual-energy X-ray absorptiometry technique, in spine, proximal femur, and distal third of the radius and in total body. Significant negative correlation between age and bone mass was found in all skeletal regions (p<0.05 spine; p<0.0001 total femur; and p<0.01 total body) except in cortical part of the radius. Peak bone mass in young Croatian women was achieved before the age of 20, but later in the long-bone cortical skeleton, where BMD continued to increase after mid-20s. The BMD values are comparable with those from National Health and Nutrition Examination Survey study, except for the cortical part of the radius, where it is significantly lower. Body weight and physical activity were the most significant positive predictors of bone density in all measured sites.

Influence of Heredity and Environment on Peak Bone Density: A Parent-Offspring Study

The aim of the study was to determine the relative influence of heredity and environment on peak bone density and also to estimate the risk of having low peak bone density if the bone density of parents is low. The study comprised 83 families (48 daughters and 35 sons and their parents). The children were at an age when bone density is at its peak at most skeletal sites (22.2+/-1.8 girls; 23.1+/-1.2 boys). Bone mineral density (BMD; g/cm(2)) was determined by dual-energy X-ray absorptiometry. Anthropometric measurements were made, and calcium intake and physical activity were assessed. Heredity accounted for 22-42% of the variation in BMD of the children, depending on the skeletal site. Heritability for cortical BMD of mid-radius was considerably lower than that for spinal trabecular BMD. Children whose parents had low BMDs (T-score< or =-1) were 1.1 times more likely to inherit low BMD. Child BMD depended significantly on parent BMD and also on physical activity. In our study, heredity accounted for the total BMD variation more than the environmental factors. This influence was lower in the cortical than in the trabecular parts of the skeleton. Optimal environmental factors, such as physical activity, may influence the risk of inheriting low BMD.

Eating patterns and fat intake in school children in Croatia

The aim of this study was to assess the quality of childrens daily diet and some nutritional habits with regard to fat, cholesterol and saturated fatty acid (SFA) intake. Food Frequency Questionnaire (FFQ) with weight, height, Body Mass Index (BMI) and body fat as anthropometric parameter was used in children aged 7-10 years. The average energy intake in almost all subgroups was below the Recommended Dietary Allowance (RDA) level while protein intake was double the RDA. The intake of vitamins and minerals correlated with fat intake. Iodine, selenium and vitamin D intake was not sufficient in all the children. In subgroups of children with low fat, cholesterol and SFA intake, the intake of calcium was below RDA. According to BMI, the population was considered as non-obese. The total energy, fat, cholesterol and SFA intake showed no or weakly significant correlation with antropometric factors in all the subgroups. The results showed that high fat intake in childrens diet was not accompanied with dietary patterns that were all considered as unhealthy.