Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

The principal biological role of α-linolenic acid (αLNA; 18:3n-3) appears to be as a precursor for the synthesis of longer chain n-3 polyunsaturated fatty acids (PUFA). Increasing αLNA intake for a period of weeks to months results in an increase in the proportion of eicosapentaenoic acid (EPA; 20:5n-3) in plasma lipids, in erythrocytes, leukocytes, platelets and in breast milk but there is no increase in docosahexaenoic acid (DHA; 22:6n-3), which may even decline in some pools at high αLNA intakes. Stable isotope tracer studies indicate that conversion of αLNA to EPA occurs but is limited in men and that further transformation to DHA is very low. The fractional conversion of αLNA to the longer chain n-3 PUFA is greater in women which may be due to a regulatory effect of oestrogen. A lower proportion of αLNA is used for β-oxidation in women compared with men. Overall, αLNA appears to be a limited source of longer chain n-3 PUFA in humans. Thus, adequate intakes of preformed long chain n-3 PUFA, in particular DHA, may be important for maintaining optimal tissue function. Capacity to up-regulate αLNA conversion in women may be important for meeting the demands of the fetus and neonate for DHA. n-3 polyunsaturated fatty acids / humans / α-linolenic acid / metabolism

/pdf/conversion-of-alpha-linolenic-acid-to-longer-chain-1vmpit90ub.pdf

Conversion of alpha-linolenic acid to longer-chain polyunsaturated fatty acids in human adults.

https://www.dur-a-avaler.com/wp-content/uploads/2013/02/Red%20meat%20consumption%20An%20overview%20of%20the%20risks%20and%20benefits.pdf

Red meat consumption: an overview of the risks and benefits.

Objectives - To compare the distribution of body mass index (BMI) in a national representative study in The Netherlands in 1996-7 with that from a study in 1980. Methods - Cross sectional data on height, weight, and demographics of 14 500 boys and girls of Dutch origin, aged 0-21 years, were collected from 1996 to 1997. BMI references were derived using the LMS method. The 90th, 50th, and 10th BMI centiles of the 1980 study were used as baseline. Association of demographic variables with BMI-SDS was assessed by ANOVA. Results - BMI age reference charts were constructed. From 3 years of age onwards 14-22% of the children exceeded the 90th centile of 1980, 52-60% the 50th centile, and 92-95% the 10th centile. BMI was related to region, educational level of parents (negatively) and family size (negatively). The - 0.9, +1.1, and +2.3 SD lines in 1996-7 corresponded to the adult cut off points of 20, 25, and 30 kg/m2 recommended by the World Health Organisation/European childhood obesity group. Conclusion - BMI age references have increased in the past 17 years. Therefore, strategies to prevent obesity in childhood should be a priority in child public health.

https://adc.bmj.com/content/archdischild/82/2/107.full.pdf

Body index measurements in 1996–7 compared with 1980

Increasing the concentrations of beneficial polyunsaturated fatty acids in milk produced by dairy cows in high-forage systems

Objective: To assess the intake of trans fatty acids (TFA) and other fatty acids in 14 Western European countries. Design and subjects: A maximum of 100 foods per country were sampled and centrally analysed. Each country calculated the intake of individual trans and other fatty acids, clusters of fatty acids and total fat in adults and/or the total population using the best available national food consumption data set. Results: A wide variation was observed in the intake of total fat and (clusters) of fatty acids in absolute amounts. The variation in proportion of energy derived from total fat and from clusters of fatty acids was less. Only in Finland, Italy, Norway and Portugal total fat did provide on average less than 35% of energy intake. Saturated fatty acids (SFA) provided on average between 10% and 19% of total energy intake, with the lowest contribution in most Mediterranean countries. TFA intake ranged from 0.5% (Greece, Italy) to 2.1% (Iceland) of energy intake among men and from 0.8% (Greece) to 1.9% among women (Iceland) (1.2-6.7 g/d and 1.7-4.1 g/d, respectively). The TFA intake was lowest in Mediterranean countries (0.5 -0.8 en%) but was also below 1% of energy in Finland and Germany. Moderate intakes were seen in Belgium, The Netherlands, Norway and UK and highest intake in Iceland. Trans isomers of C(18:1) were the most TFA in the diet. Monounsaturated fatty acids contributed 9-12% of mean daily energy intake (except for Greece, nearly 18%) and polyunsaturated fatty acids 3-7%. Conclusion: The current intake of TFA in most Western European countries does not appear to be a reason for major concern. In several countries a considerable proportion of energy was derived from SFA. It would therefore be prudent to reduce intake of all cholesterol-raising fatty acids, TFA included. Sponsorship: Commission of the European Communities (AIR 2421); National Funds; European Industries supported the chemical analyses.

Intake of fatty acids in western Europe with emphasis on trans fatty acids: the TRANSFAIR Study.

Objective: This paper aims to give a broad overview of published data on nutrition and health among migrants in the Netherlands, as well as data on determinants of health. Results and conclusions: Depending on the definition, 9 to 17% of the population belongs to the group 'migrants' and this proportion is expected to grow in the coming years. Roughly 2/3 of migrants are of the first generation and on average, they are younger than the Dutch population. Relatively few data concerning the health status of migrants are available. The diet of migrants showed both positive (macronutrients) and negative (micronutrients) differences with the general Dutch diet. The risk of overweight was high among both children and adult women, and the data suggest a higher risk for Turkish and Moroccan groups than for Dutch groups. The importance of health determinants, such as smoking, alcohol use and physical and social environment, was different for migrants than for the Dutch population; however, there were also differences between ethnic groups. The limited data on morbidity for migrants suggest higher risks than for the indigenous population. The same holds for mortality data, especially for the younger age groups. In general, the data that are available suggest that the health status of migrants was less favourable than that of the indigenous population. However, there were also differences between the various groups of migrants. The lower socio-economic position of migrant groups partly explained the differences in health status. Nevertheless, a study among Turkish people indicated that their health status was lower than that of Dutch people of comparable socio-economic status.

/pdf/nutrition-and-health-among-migrants-in-the-netherlands-19ggkuln1i.pdf

Nutrition and health among migrants in The Netherlands.

From April 1987-March 1988, the first Dutch National Food Consumption Survey (DNFCS) was carried out among 2203 households comprising 5898 subjects, aged 1-85. In 1992 (January-December) the second DNFCS was conducted among 6218 subjects, aged 1-92 belonging to 2475 households. In both surveys, among other things, information on individual food intake was obtained using 2-day dietary records. Since changes over time are the most important topic of this study special attention is given to the methodological differences between the surveys. Because the food consumption methods used in both the surveys and the sampling frame were similar for both surveys there was a fair level of standardization of research methods and procedures. However, both surveys differ with regard to non-response, survey starting date, distribution of survey days over the week and the seasons, sample size, Dutch food composition data bank (NEVO) and coding arrangements. The random sample deviated from the Dutch population at large with respect to sex and age distribution. Because sex and age are major determinants of food consumption weighing factors were used in calculations not restricted to specific sex-age categories. The outcome of calculations correcting for variables other than sex and age hardly differed from those in which sex and age were the only variables adjusted for. Therefore, these additional variables were not included in the weighing factor. The results indicate that non-response bias is unlikely to have a strong effect on the survey outcome. In comparing intake figures from the two national surveys, special attention is given to those nutrients of which the mean intake differed most from the Dutch guidelines for a healthy diet or from the Dutch Recommended Dietary Allowances (RDA). The survey in 1987-88 indicated that overweight and obesity was prevalent among the Dutch population, especially among the elderly. The data of that survey suggested that protein intake may be too high for part of the population, especially the elderly. A high (saturated) fat intake was identified as a major nutritional risk in the Dutch diet. Other undesirable characteristics were a low intake of dietary fibre and a low percentage of energy derived from carbohydrates. In 1987-88 the largest difference (below 100%) between mean intake levels of micronutrients and the corresponding RDAs were observed for vitamin B6 (per gram of protein), iron (boys aged 1-3 and 13-18, women aged 1-3 and 10-49) and vitamin A (boys 10-12 years old, girls aged 7-12 and pregnant women). In 1992, the mean intake of energy was lower than 4-5 years before (9.3 vs 9.7 MJ/day), whereas no clear differences were observed regarding mean body weight and mean body mass index. There are no indications that the differences in average energy intake between both surveys can be attributed entirely or partly to differences in reporting behaviour (over- or under-reporting). The average contribution of fat (saturated and monounsaturated fatty acids) to energy intake was lower in 1992 (36.9 energy%) than it was in 1987-1988 (40.0 energy%), whereas in 1992 more energy was obtained from protein and carbohydrates (poly saccharides but not mono- and disaccharides). Both intake of dietary fibre and cholesterol were substantially lower in the second DNFCS. As to micronutrients, the mean intake of retinol equivalents was lower and the intake of thiamin and vitamin B6 was higher in 1992. The above described differences were seen in almost all sex-age groups. Differences in the results of the two surveys can be the result of four broad categories of causes, namely changes in socio-demographic characteristics, methodological differences, food choice and composition of food products. Of the differences observed a major part could be attributed to food choice changes. This indicates the importance of a regular monitoring of the food consumption. The classification into food groups was not identical for both surveys. Generally speaking, these differences will give rise to only minor apparent changes. With respect to the food groups 'fats and oils' and 'mixed dishes', however, differences between the two surveys should be interpreted with caution. Part of the differences result from the updating of the Dutch food composition data bank. Such an update reflects real changes as well as changes in the analytical method. In particular, the differences in the intake of dietary fibre and, to a lesser extent, of vitamin B6 and vitamin A are (partly) due to changes in the method used to analyse the amount in food products. In conclusion, the average Dutch diet still does not fulfil the criteria for a prudent diet and will most likely induce increased risk for some chronic diseases, whereas among some population groups a low intake was prevalent for iron and vitamin A. Marginal vitamin B6 intake is more general although the risk for marginal status is not as clear as in the first survey. Dietary intake among the Dutch population has changed substantially in the period 1987-92, whereas both positive and negative changes were observed regarding the criteria of a healthy diet.

Changes in the diet in the Netherlands: 1987-88 to 1992.

Onderzoek naar de maten en gewichten van groenten

The EC-AIR concerted action Transfair: Trans fatty acid intake and risk factors for cardiovascular disease in Europe had the aim to measure trans fatty acids (TFA) content of representative European food samples to estimate TFA intake in Europe in a uniform way. The scientific conclusions of the project are that a wide range of TFA can be found in European food products, but the current intake of TFA in Europe is lower than previously assumed. In this research paper a detailed description of the study performed in Italy, within the European concerted action, and a discussion on the results obtained, are presented. Fat content and fatty acid composition of each food item, representative of the fat intake in Italy and sampled according to the market share, are reported. The intake of fat and clusters of fatty acids, in absolute amounts and as percentage of total energy, is calculated on the basis of the consumption data referred to Italy (National diet) and to four geographical areas: Nord-West, North-East, Center, South Italy. TFA intake ranges from 1.3g/day (South Italy diet) to 1.9g/day (North-East Italy diet). The main source of TFA in Italy is the group of dairy products. The very low intake of TFA in Italy does not seem to be a reason for concern. However, in the Italian and European diets, a considerable proportion of daily energy is derived from fat, therefore it would be advisable to reduce total fat intake and, in particular, all cholesterol raising fatty acids.

K.F.A.M. Hulshof

Papers

Intake of fatty acids in western Europe with emphasis on trans fatty acids: the TRANSFAIR Study.

Nutrition and health among migrants in The Netherlands.

Changes in the diet in the Netherlands: 1987-88 to 1992.

Onderzoek naar de maten en gewichten van groenten

Livelli di ingestione di lipidi ed acidi grassi in Italia: I risultati dell'azione concertata CE "Transfair"