Showing papers in "European Journal of Clinical Nutrition in 1998"

Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects

Abstract: Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects

Food variety -- a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali West Africa.

Abstract: Food variety—a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa

The effect of consumption of milk fermented by Lactobacillus casei strain Shirota on the intestinal microflora and immune parameters in humans

Abstract: Objective: To determine the effect of consumption of milk fermented by Lactobacillus casei strain Shirota (L. casei Shirota) on the composition and metabolic activities of the intestinal microflora, and immune parameters in humans. Subjects: Twenty healthy male subjects aged 40-65 years were selected. Design: A placebo-controlled trial was performed in which 10 subjects were randomly assigned to a control and 10 to a treatment group. During the first and last two weeks of the 8-week study the subjects received a strictly controlled diet without fermented products. The same controlled diet was given during the intermediate 4-week test period but then the treatment group received three times daily 100 ml of fermented milk containing 109 CFU L. casei Shirota/ml, whereas the same amount of unfermented milk was given to the subjects in the control group. Results: In comparison to the control group, the consumption of L. casei Shirota-fermented milk resulted in an increase of the Lactobacillus count in the faeces in which the administered L. casei Shirota was predominant at the level of 107 CFU/g wet faeces. This was associated with a significant increase in Bifidobacterium counts (P < 0.05). Some shifts in the other bacterial species were found, such as a decreased number of Clostridium; however the differences were not statistically different between the treatment and the control groups. The β-glucuronidase and β-glucosidase activities per 1010 bacteria decreased significantly (P < 0.05) at the second week of the 4-week test period with the consumption of L. casei Shirota-fermented milk. Furthermore, the consumption of the fermented milk product resulted in a slight but significant increase in the moisture content of the faecal samples (P < 0.05). No treatment effects were observed for any of the immune parameters measured (including natural killer (NK) cell activity, phagocytosis and cytokine production). Conclusions: The results suggest that consumption of L. casei Shirota-fermented milk is able to modulate the composition and metabolic activity of the intestinal flora and indicate that L. casei Shirota-fermented milk does not influence the immune system of healthy immunocompetent males.

Levels and patterns of intrauterine growth retardation in developing countries.

Abstract: The aim of this paper is to quantify the magnitude and describe the geographical distribution of intrauterine growth retardation (IUGR) in developing countries We estimate that at least 137 million infants are born every year at term with low birth weight (LBW), representing 11% of all newborns in developing countries This rate is approximately 6 times higher than in developed countries LBW, defined as 20%) and LBW (> 15%) cut-off levels for triggering public health action, and that population-wide interventions aimed at preventing fetal growth retardation are urgently required

Dietary assessment in the elderly: validation of a semiquantitative food frequency questionnaire

Abstract: Objective: The study was conducted to assess the relative validity of a 170-item semiquantitative food frequency questionnaire (SFFQ) adapted for use in the elderly. Design and subjects: The study was carried out in a sample of 80 men and women aged 55-75 y participating in a community based prospective cohort study in Rotterdam, The Netherlands. The two-step dietary assessment comprised a simple self-administered questionnaire (20 min) followed by a structured interview with trained dietitians (20 min) based on the completed questionnaire. Multiple food records (FR) collected over a one year period served as reference method. 24 h urine urea was used as indirect marker for protein intake. Results: Compared with FR, the SFFQ generally overestimated nutrient intake as reflected by difference in means and the ratio of SFFQ to FR. Energy adjustment reduced the observed overestimation. Pearson's correlation coefficients varied from close to 0.5 to about 0.9 for crude data, and after adjustment for age, sex, total energy intake, and for within-person variability in daily intake for 0.4-0.8. Cross-classification into quintiles resulted in correct classification into the same or adjacent quintile of 75.8% for crude and 76.8% for energy adjusted data. Validation of protein intake estimated by SFFQ with protein excretion from 24 h urine urea indicated overestimation of protein intake by SFFQ. Spearman correlation coefficient between protein intake estimated from urea excretion and SFFQ was 0.67. Conclusions: Adaptation of a SEFQ for use in the elderly resulted in a valid and time-efficient dietary assessment instrument. Its ability to adequately rank study subjects according to their dietary intake support its application in epidemiological studies in the elderly.

By how much does fruit and vegetable consumption reduce the risk of ischaemic heart disease

Abstract: By how much does fruit and vegetable consumption reduce the risk of ischaemic heart disease?

Complementary foods for infant feeding in developing countries: their nutrient adequacy and improvement.

Abstract: Objective: To assess the energy and nutrient adequacy of a variety of complementary foods used in parts of Africa, India, Papua New Guinea, the Philippines and Thailand. Method: The energy, nutrient and anti-nutrient (dietary fibre and phytic acid) content (per 100 g as eaten, per 100 kcal, and per day) of twenty-three plant-based complementary foods consumed in developing countries was calculated from food composition values based on chemical analysis for the trace minerals, non-starch polysaccharide and phytic acid, and the literature. Results were compared with the estimated nutrient needs (per day; per 100 kcal) from complementary foods for infants 9–11 months, assuming a breast milk intake of average volume and composition and three complementary feedings per day, each of 250 g. Results: Complementary foods should provide approximately 25–50% of total daily requirements for protein, riboflavin and copper; 50–75% for thiamin, calcium and manganese; and 75–100% for phosphorus, zinc and iron. Most or all appear to meet the estimated daily nutrient needs (per day; per 100 kcal) from complementary foods for protein, thiamin and copper (per day), but not for calcium, iron, and in some cases zinc, even if moderate bioavailability for iron and zinc is assumed. Some of those based on rice are also inadequate in riboflavin (per day; per 100 kcal). Conclusions: Even if strategies to improve the bioavailability of iron and zinc are employed, they are probably insufficient to overcome the deficits in calcium, iron and zinc. Therefore, research on the feasibility of fortifying plant-based complementary foods in developing countries with calcium, iron and zinc is urgently required. Sponsorship: This study was supported by the Micronutrient Initiative through the Canadian International Development Agency.

Bioavailability of catechins from tea: the effect of milk

Abstract: Objectives: To assess the blood concentration of catechins following green or black tea ingestion and the effect of addition of milk to black tea. Design: Twelve volunteers received a single dose of green tea, black tea and black tea with milk in a randomized cross-over design with one-week intervals. Blood samples were drawn before and up to eight hours after tea consumption. Setting: The study was performed at the Unilever Research Vlaardingen in The Netherlands. Subjects: Twelve healthy adult volunteers (7 females, 5 males) participated in the study. They were recruited among employees of Unilever Research Vlaardingen. Interventions: Green tea, black tea and black tea with semi-skimmed milk (3 g tea solids each). Results: Consumption of green tea (0.9 g total catechins) or black tea (0.3 g total catechins) resulted in a rapid increase of catechin levels in blood with an average maximum change from baseline (CVM) of 0.46 μmol/l (13%) after ingestion of green tea and 0.10 μmol/l (13%) in case of black tea. These maximum changes were reached after (mean (s.e.m.)) t=2.3 h (0.2) and t=; 2.2 h (0.2) for green and black tea respectively. Blood levels rapidly declined with an elimination rate (mean (CVM)) of t½=4.8 h (5%) for green tea and t½=6.9 h (8%) for black tea. Addition of milk to black tea (100 ml in 600 ml) did not significantly affect the blood catechin levels (areas under the curves (mean (CVM) of 0.53 h. μmol/l (11%) vs 0.60 h. μmol/l (9%) for black tea and black tea with milk respectively. Conclusion: Catechins from green tea and black tea are rapidly absorbed and milk does not impair the bioavailability of tea catechins.

Alcohol intake assessment: the sober facts.

Abstract: Recent recommendations in regard to the level of alcohol intake have mainly been based on epidemiologic studies which relied on self-reported amounts of alcohol consumed. Therefore, it is important to be aware of the quality of self-reported measures of alcohol intake. Alcohol intake assessment methods were reviewed with respect to their capacity to rank individuals according to alcohol intake and their ability to explain the variation in the level of intake in population samples. In 33 methodological papers published after 1984, alcohol intake was assessed by five main methods: quantity frequency, extended quantity frequency, retrospective diary, prospective diary, and 24-hour recalls. The mean level of alcohol intake differed by 20% between these methods. It was also found that when researchers asked specifically about intake of beer, wine, and liquor, this resulted in 20% higher estimates of intake. These percentages were similar among populations with low and high mean alcohol consumption (4 vs. 10 drinks per week). It was found that ranking of individuals according to intake was satisfactory, with weighted correlation coefficients between methods ranging from 0.63 to 0.73. The authors conclude that, when there is sufficient evidence that alcohol intake is underestimated in a population, methods that enquire about both the frequency and amount consumed, for beer, wine, and liquor, separately, will yield the most realistic levels of intake.

Effects of intrauterine growth retardation on mortality and morbidity in infants and young children.

Abstract: This review aims to quantify the risks of mortality and morbidity associated with intrauterine growth retardation (IUGR). Twenty-nine data sets with birth-weight-specific mortalities are examined to determine whether consistent patterns of risk emerge when data from different populations are compared. Measures of mortality risk are also made with birth weight as a dichotomous variable. Twelve data sets are presented. From the data available, it is estimated that for term infants weighing 2000-2499 g at birth, the risk of neonatal death is 4 times higher than for infants weighing 2500-2999 g, and 10 times higher than for infants weighing 3000-3499 g. The risk of postneonatal death in term infants weighing 2000-2499 g is estimated to be 2 times higher than for infants 2500-2999 g, and 4 times that of infants weighing 3000-3499 g. Estimates of risk for IUGR infants are less consistent than for preterm infants. This could be due to methodological differences, particularly smaller sample sizes in the studies in developing countries, or may reflect real variation in risk. The latter may be associated with the heterogeneity of IUGR across populations, or to varying risks depending, for example, on which infections predominate or infant age at peak prevalence. IUGR is most prevalent in developing countries and the review therefore focuses on morbidity from diarrhoeal and respiratory infections. Data from nine studies are presented. There is an increased risk of diarrhoea in term infants < 2500 g and an increased risk of pneumonia. The risks of morbidity and mortality appear to differ depending on whether infants are wasted or stunted at birth. Stunted infants of low birth weight have higher neonatal mortality than wasted newborns, but this could be due to inclusion of infants with congenital anomalies who are often stunted. Wasted infants are more prone than stunted infants to neonatal morbidity. No comparative postneonatal data were located.

Delayed gastric emptying rate may explain improved glycaemia in healthy subjects to a starchy meal with added vinegar

Abstract: Objectives: The aim of the study was to evaluate the possible influence of acetic acid (administered as vinegar) on the postprandial glucose and insulin responses, and the potential involvement of a modified gastric emptying rate was studied by use of paracetamol as a marker. Design: The white bread reference meal as well as the corresponding meal supplemented with vinegar had the same content of starch, protein and fat. The meals were served in the morning after an over-night fast and in random order. Capillary blood samples for analysis of glucose, insulin and paracetamol were collected postprandially. Setting: The study was performed at the Department of Applied Nutrition and Food Chemistry, Lund University, Sweden. Subjects: Ten healthy volunteers, seven women and three men, aged 22–51 y, with normal body mass indices were recruited. Results: The presence of acetic acid, given as vinegar, significantly reduced the postprandial glucose (GI=64) and insulin responses (II=65) to a starchy meal. As judged from lowered paracetamol levels after the test meal with vinegar, the mechanism is probably a delayed gastric emptying rate. Conclusions: Fermented foods or food products with added organic acids should preferably be included in the diet in order to reduce glycaemia and insulin demand. Sponsorship: Cerealia Foundation for Research and Development (project no. 232).

Health aspects of fish and n-3 polyunsaturated fatty acids from plant and marine origin

Abstract: Ischemic or coronary heart disease (CHD) is the main cause of deaths in the United States (32% of total deaths in 1994) and other Western countries where it is associated with a high (saturated) fat intake. However, Greenland Eskimos (Inuit) on their traditional diet, which is rich in fat (40% of calories) and cholesterol, did not have such a high incidence of CHD and also much less atherosclerosis (1, 2). This has been ascribed to the high amount of very long chain n-3 polyunsaturated fatty acids (VLC n-3 PUFA; approx 14 g/d) in their diet derived from fish and marine mammals (3). The VLC n-3 PUFA comprise mainly eicosapentaenoic acid (EPA, C20:5 n-3) and docosahexaenoic acid (DHA, C22:6 n-3) (see Fig. 1). Recently, less atherosclerosis and CHD have also been found in native Alaskans whose diet is also rich in marine fish and mammals (4). In addition, certain types of cancer, such as breast cancer, were found to be rare in Eskimos and Alaskan natives (5), which has also been ascribed to VLC n-3 PUFA.

Effects of a milk product, fermented by Lactobacillus acidophilus and with fructo-oligosaccharides added, on blood lipids in male volunteers.

Abstract: Objective: To investigate in adult male volunteers the effect of a new fermented milk product, fermented by Lactobacillus acidophilus and with fructo-oligosaccharides added, on blood lipids. Design: Randomized placebo-controlled double-blind two-way cross over trial with two treatment periods of three weeks, separated by a wash-out period of one week. Setting: the study was performed at the TNO Nutrition and Food Research Institute in Zeist, The Netherlands. Subects: Thirty normal healthy men, aged 33-64 y (mean serum total cholesterol level: 5.23 ± 1.03 (s.d.)), were selected for this study. Normal health was assessed by pre study screening. All subjects were used to an average Dutch food pattern. Interventions: During the treatment periods subjects consumed three times daily a 125 ml of either test or reference product as a part of their habitual diet. The test product was a milk, fermented by yogurt starters and Lactobacillus acidophilus, and contained 2.5% fructo-oligosaccharides, 0.5% vegetable oil and 0.5% milk fat. The reference product was a traditional yogurt (milk fermented only by yogurt strains), containing 1% milk fat. Blood samples for serum lipid analysis and blood glucose measurements were taken before the start of the experiment and at the end of both treatment periods. Results: As compared to the reference product, consumption of the test product resulted in significantly lower values for serum total cholesterol (P < 0.001), LDL-cholesterol (P < 0.005), and the LDL/HDL-ratio (P < 0.05) by 4.4, 5.4 and 5.3% respectively. Levels of serum HDL-cholesterol, triglycerides and blood glucose remained essentially unchanged. The beneficial effects of the test product on serum cholesterol were largely related to an increase of this parameter during the consumption of the reference product. Conclusions: As compared to traditional yogurt, daily consumption of three times 125 ml of test product specifically lowered serum LDL-cholesterol levels in normal healthy male adult subjects with borderline elevated levels of serum total cholesterol within three weeks. Sponsorship: The study was sponsored by Danone, France.

The effect of whisky and wine consumption on total phenol content and antioxidant capacity of plasma from healthy volunteers

Abstract: Objective: To assess whether consumption of 100 ml of whisky or red wine by healthy male subjects increased plasma total phenol content and antioxidant capacity. Design: A Latin square arrangement to eliminate ordering effects whereby, after an overnight fast, nine volunteers consumed 100 ml of red wine, malt whisky or unmatured ‘new make’ spirit. Each volunteer participated on three occasions one week apart, consuming one of the beverages each time. Blood samples were obtained from the anticubital vein at intervals up to 4h after consumption of the beverages when a urine sample was also obtained. Results: Within 30 min of consumption of the wine and whisky, there was a similar and significant increase in plasma total phenol content and antioxidant capacity as determined by the ferric reducing capacity of plasma (FRAP). No changes were observed following consumption of ‘new make’ spirit. Conclusions: Consumption of phenolic-containing alcoholic beverages transiently raises total phenol concentration and enhances the antioxidant capacity of plasma. This is compatible with suggestions that moderate alcohol usage and increased antioxidant intake decrease the risk of coronary heart disease. Sponsorship: Funded by the Scottish Office Agriculture, Environment and Fisheries Department (SOAEFD), the ERASMUS exchange program, the EC-Fair program and the Scotch Whisky Research Institute.

Diet during pregnancy in a population of pregnant women in South West England

Abstract: Objective: To describe the diet of a population of pregnant women. Subjects: Eleven thousand, nine hundred and twenty-three pregnant women resident in the south-west of England. Design: A self-completion unquantified food-frequency questionnaire was sent to the women at 32 weeks gestation. Estimated daily nutrient intakes were calculated from the answers to the questionnaire. Results: On the whole, nutrient intakes of the pregnant women in this survey compared very closely with the reported nutrient intakes for all women aged 16–64 in the last Dietary and Nutritional Survey of British Adults (DNSBA). The exceptions were sugar, calcium, folate and vitamin C where the estimated intakes were somewhat higher, and retinol, where the estimated intake was somewhat lower than the DNSBA. Mean and median estimated nutrient intakes were above the RNIs for the majority of nutrients investigated except for energy, iron, magnesium, potassium and folate. Levels of supplementary vitamin and mineral use were fairly low, the two most commonly taken supplements were iron—taken by 22.5% of the pregnant women before 18 weeks and 43% at 32 weeks, and folate, taken by 9% and 18% of the women, respectively. Conclusions: These results suggest that the diets of pregnant women in this country are likely to contain adequate amounts of most nutrients, the most likely exceptions being iron, magnesium, potassium and folate. The relatively low intakes of folate and small proportion of women taking folate supplements is of concern, because of the association between inadequate amounts of folate in the diet and neural tube defects. Sponsorship: The nutritional aspects of the study have been supported by Northern and Yorkshire region—NHS executive, Cow and Gate Ltd, the Meat & Livestock Commission and Coca-Cola UK.

The Influence of Thermic Effect of Food on Satiety

Abstract: Objectives: To evaluate energy expenditure after three isoenergetic meals of different nutrient composition and to establish the relationship between the thermic effect of food (TEF), subsequent energy intake from a test meal and satiety sensations related to consumption. Design: The study employed a repeated measures design. Ten subjects received, in a randomized order, three meals of 2331±36 kJ (557±9 kcal). About 68% of energy from protein in the high protein meal (HP), 69% from carbohydrate in the high carbohydrate meal (HC) and 70% from fat in the high fat meal (HF). Setting: The experiments were performed at the University of Milan. Subjects: Ten normal body-weight healthy women. Methods: Energy expenditure was measured by indirect calorimetric measurements, using an open-circuit ventilated-hood system; intake was assessed 7 h later by weighing the food consumed from a test meal and satiety sensations were rated by means of a satiety rating questionnaire. Results: TEF was 261±59, 92±67 and 97±71 kJ over 7 h after the HP, HC and HF meals, respectively. The HP meal was the most thermogenic (P<0.001) and it determined the highest sensation of fullness (P=0.002). There were no differences in the sensations and thermic effect between fat and carbohydrate meals. A significant relationship linked TEF to fullness sensation (r=0.41, P=0.025). Energy intake from the test meal was comparable after HP, HC and HF meals. Conclusions: Our results suggest that TEF contributes to the satiating power of foods. Sponsorship: This work was supported by the National Research Council, targeted project ‘Prevention and Control of Disease Factors’, subproject ‘Nutrition’, grant no. 94.00365.PF41.

Relationship between body fat and body mass index: differences between Indonesians and Dutch Caucasians.

Abstract: Objective: To study the relationship between percent body fat and body mass index (BMI) in two different ethnic groups (Indonesians and Caucasians) in order to evaluate the validity of the BMI cut-off points for obesity. Design: Cross-sectional study. Subjects: Not specially selected populations living in southern Sumatra (Palembang, Indonesia) and Caucasian Dutch living in Wageningen. Measurements: Body weight, body height, body fat by deuterium oxide dilution and skinfold thickness. Results: Body fat could be well predicted by body mass index (BMI) and sex in the Indonesians and by BMI, sex and age in the Dutch with a prediction error of 3.6 and 3.3% for the two populations respectively. Although the body mass index in the Indonesian group was about 2 kg/m2 lower compared to the Dutch, the amount of body fat was 3% points higher. Because of small differences between the groups in age, weight and height the differences in body fat were corrected for this (ANOVA). Indonesians having the same weight, height, age and sex have generally 4.8% points more body fat compared to Dutch. Indonesians having the same % BF, age and sex have generally a 2.9 kg/m2 lower BMI compared to the Dutch. Conclusions: The results show that the relationship between % BF and BMI is different between Indonesians and Dutch Caucasians. 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 Indonesia based on the BMI should be 27 kg/m2 instead of 30 kg/m2. Sponsorship: This study was granted in part by DS Medigroup, Milan, Italy.

Fetal growth and adult disease.

Abstract: Current knowledge on associations between variations in fetal growth on the one hand and blood pressure, noninsulin dependent diabetes, coronary heart disease and cancer in adulthood on the other is reviewed and related to more conventional preoccupations of perinatal epidemiology. Commonly used definitions and indicators of impaired fetal growth, possible explanations and mechanisms of the association between fetal growth impairment and later disease, and the concept and operational definitions of programming are discussed. Implications and research priorities that can be derived from this information are presented.

Skinfold thickness measurements are better predictors of body fat percentage than body mass index in male Spanish children and adolescents.

Abstract: Objective: To develop equations, from some simple anthropometric measurements, for the prediction of body density from underwater weighing in male spanish children and adolescents. Subjects: One hundred and seventy-five males, aged 7.0–16.9 y, participated in this study, they were recruited from primary and secondary schools. Measurements: Body weight and height and skinfold thicknesses by anthropometry, body density by underwater weighing. Results: Correlations between body density and body mass index (BMI) were high until 14.0–16.9 y. Correlations between body density and log Σ 4 skinfolds were higher than those with BMI at all ages. Log Σ 4 skinfolds explained between 61% (14.0–16.9 y) and 68% (11.0–13.9 y) of the body density variance. Regression equations for body density from BMI and triceps skinfold thickness explained between 51% (14.0–16.9 y) and 68% (7.0–10.9 y) of the body density variance. Conclusions: The best estimators of body density in the children and adolescents studied were log Σ 4 skinfolds and a combination of BMI and triceps skinfold. Sponsorship: Universidad de Zaragoza

Recommendations for the nutritional management of patients with diabetes mellitus.

Abstract: The quality of life of the individual person must be considered when de®ning nutritional objectives. Health care providers must achieve a balance among the demands of metabolic control, risk factor management, patient well-being and safety. All nutritional programmes should be adapted to the speci®c needs of the individual person within the context of his or her own culture and lifestyle, which may change with time. Over the last twenty years, as part of general moves towards evidence-based medicine, accountability and improved quality of care, diabetes associations have sought to question dietetic principles and practice. Greater emphasis on the scienti®c evidence has led to standardising recommendations on diet composition, and more recently on methods of implementation. In making such recommendations, a logical succession of underpinning questions needs to be answered. Firstly, is any difference required from food eaten in the normal general population? Secondly, are current recommendations for health in the general population applicable to patients with diabetes? Thirdly, are there reasons for recommending special foods for patients with diabetes? Fourthly, is evidence from controlled experiments of diabetic versus control subjects applicable to a free-living population, particularly a population other than that which was used for the speci®c experiment? To answer these questions, the goals of dietary advice for patients with diabetes need to be made explicit: the general goal is maintenance of health and quality of life, for as long as possible, and freedom from vascular complications of diabetes. This will include contributing through diet to avoidance of short-term symptoms from hypoglycaemia (for example, insulin and sulphonamide treated patients) and from hyperglycaemia, and also to avoiding long term complications. Increasingly, evidence suggests that normalisation of blood glucose and lipid pro®les are valid aims. Recommendations will change over time as new data becomes available. The need for recommendations emerges when there is a clearly documented case such that there is cast-iron evidence of bene®t, but importantly also where the evidence is absent or incomplete and there is a need for safe practical guidance pending new information. It is this latter situation, where issues are contentious and any guidelines will be debated, that a professional body most needs to exercise judgement in assessing the evidence, to identify research needs and to take responsibility for recommending changes. Dietary recommendations are therefore derived from evidence in the published literature, but often supported where necessary by consensus, or common sense views. Dietary recommendations are made in terms of nutrients and their biochemical effects, in terms of physiological effects of foods such as glycaemic index, and in terms of the foods themselves. They are used for general patient education materials, but also have to be transformed into advice to individual patients and their families. Considerable interpretation may be involved. Advice to individual patients may be modi®ed through negotiation with the carer and supplemented or rationalised by education from other appropriate sources. Advice may be qualitative or quantitative, but must be in terms of foods, patterns of eating, relation of food and eating to adjunctive therapy, for example, exercise, drug therapy, insulin replacement, and the context of diet in terms of age, lifestyle, cultural setting.

Determining factors in the iron status of adult women in the SU.VI.MAX study

Abstract: The iron status of a national sample of adults living in France and participating in the SU.VI.MAX cohort, was assessed using serum ferritin and hemoglobin concentrations. Complete data were obtained for 6648 women 35-60 y old and for 3283 men 45-60 y old. Assessment of iron dietary intakes was realized on a subsample of 3111 women and 2337 men who reported six 24 h dietary records during a one-year period; 22.7% of menstruating women and 5.3% of post-menopausal women presented a total depletion of iron stores (serum ferritin < 15 microg/l). Iron-deficient anemias were found in, respectively, 4.4% and less than 1% of these women. Three-quarters of the anemias were related to iron deficiency in menstruating women. In men, iron depletion and iron deficiency anemia were very rare. Post-menopausal women had much higher serum ferritin levels than menstruating women. In menstruating women, those using intrauterine devices had significantly lower serum ferritin levels than those without contraception, and much lower than those using oral contraception. The frequency of iron depletion reached 28.1% in women using intrauterine devices, but only 13.6% in those using oral contraceptives. The mean iron intake was 16.7 +/- 5.7 mg/d in men and 12.3 +/- 3.4 mg/d in women. Heme iron represented respectively, 11.1 and 10.4% of iron intake. Ninety-three percent of menstruating women had dietary iron intakes lower than recommended dietary allowances (RDA); 52.6% consumed less than two thirds of these RDA. In post-menopausal women and men, respectively 27.7% and 3.6% had dietary intakes lower than RDA. Serum ferritin was positively correlated with meat, fish and total iron intake, and negatively correlated with dietary products consumption, calcium and fiber intake.

Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil

Abstract: Zinc supplementation, mental development and behaviour in low birth weight term infants in northeast Brazil

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

Abstract: 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.

Socioeconomic determinants of intrauterine growth retardation.

Abstract: This paper reviews the evidence bearing on socioeconomic determinants of intrauterine growth retardation (IUGR). The primary focus is on those factors with a quantitatively important impact from a public health perspective, as indicated by their large etiologic fraction (population attributable risk). In developed countries in which a sizeable proportion of women smoke during pregnancy, cigarette smoking is associated with the largest etiologic fraction (by far), followed by low gestational weight gain (primarily due to low energy intake) and low prepregnancy body mass index (BMI). In developing countries where undernutrition is prevalent and pregnant women do not smoke, low maternal weight gain and BMI assume even greater importance, as does short maternal stature. A major section of the paper concerns the large within-country socioeconomic disparities in IUGR and the possible mechanisms underlying these disparities. In developed countries, differences in cigarette smoking explain a large part of the disparity; low weight gain and short stature may also be important mediators in some settings. Future etiologic studies should assess a wide scope of potential determinants and will require large sample sizes to control for their mutually confounding effects.

Intrauterine growth retardation, body size, body composition and physical performance in adolescence.

Abstract: Studies about effects of IUGR on growth in childhood as well as on body size, body composition and physical performance in adolescence and adulthood are reviewed. The review is based on 12 studies that distinguished IUGR from other types of low birthweight and compared outcomes of IUGR cases with those of non-IUGR controls. This information is complemented by results of a follow-up study of IUGR cases and controls carried out in Guatemalan adolescents and young adults. In Guatemala as well as in other countries, IUGR newborns showed partial catch-up growth during the first one or two years of life, and then maintained their achieved place in the growth distribution. Guatemalan IUGR cases were shorter, lighter and weaker than non-IUGR controls as adolescents and young adults. The differences in adult body size observed in Guatemala between cases and controls are similar to those found in more affluent countries (i.e. about 5 cm in height and 5 kg in weight).

Prevalence of an elevated resting energy expenditure in patients with chronic obstructive pulmonary disease in relation to body composition and lung function

Abstract: Objective: This study describes the prevalence and characteristics of an elevated resting energy expenditure (REE) in patients with chronic obstructive pulmonary disease (COPD). Design and setting: Patients were consecutively admitted to an in-patient pulmonary rehabilitation centre. Subjects: The study group consisted of 172 (123♂) clinically stable patients with COPD, age mean (s.d. ) 64 (10) y). Interventions: REE was assessed by indirect calorimetry (ventilated hood) and adjusted for the influence of fat-free mass (FFM; measured by bioelectrical impedance analysis) using the linear regression equations of REE on FFM generated in 92 healthy age-matched subjects (58♂, age 67 (8) y) for men and women separately. The predicted REE adjusted for FFM (REEFFM) was obtained by using the FFM of each individual patient in the linear regression equation of REE on FFM generated in the healthy control group. Results: 26% of the patients were hypermetabolic (defined as REE >110% REEFFM), characterized by a lower age (60 (10) vs 65 (9) y) and a lower total lung capacity (TLC; 122 (27) vs 139 (28)%pred) compared to normometabolic patients (P 110% REEHB), characterized by a higher age and a lower body mass and FFM (P<0.05). Conclusions: Hypermetabolism commonly occurs in COPD, characterized by less hyperinflation at rest, in contrast to the suggested contribution of an elevated oxygen cost of breathing (OCB) to hypermetabolism in COPD. The higher hyperinflation at rest in FFM-depleted patients independently of hypermetabolism suggests a higher OCB during activities, contributing to the elevated total daily energy expenditure previously reported in COPD. The HB-equations overestimate the prevalence of hypermetabolism and link hypermetabolism incorrectly to aging and depletion.

Comparison of the traditional paper visual analogue scale questionnaire with an Apple Newton electronic appetite rating system (EARS) in free living subjects feeding ad libitum

Abstract: Objective: Assessing the value of a newly developed electronic visual analogue scale questionnaire (Apple Newton Message Pad) with the traditional paper method for appetite rating. Design: In a random, crossover design, subjects completed both electronic and paper questionnaires to compare results obtained by the two methods; individual methods were completed consecutively to assess test-retest reliability; preference was established using a questionnaire. Setting/Subjects: Healthy, free-living adults were studied for comparison of methods (na 12), test-retest reliability (na 8) and preference (na 13). Intervention: Visual analogue scales were completed each waking hour to assess appetite. Preference was assessed after both methods were completed. Results: There was no significant difference in the hourly results obtained by the paper and electronic methods for ‘desire to eat’, ‘how much can you eat now’, ‘urge to eat’ and ‘preoccupation with thoughts of food’. Small differences in ‘hunger’ and ‘fullness’ ratings were noted ( 5% mean difference between methods, P< 0.05), but patterns of change and sensitivity for these and all other parameters remained similar for both methods across the visual analogue scale. Test-retest reliability demonstrated was similar for both methods. Seven (54%) subjects preferred to use the paper questionnaire, five (38%) the electronic method and one (8%) had no preference. Conclusions: The electronic Apple Newton questionnaire is as sensitive and reliable as the paper method, has the advantage that it automatically records the time of data acquisition and data collection and processing are more efficient for the researcher. The two methods should not be used interchangeably. Sponsorship: Medical Research Council. Descriptors: human; appetite; hunger; visual analogue scale

Is macronutrient composition of dietary intake data affected by underreporting? Results from the EPIC-Potsdam study

Abstract: Objective: To investigate whether subjects with low reported relative energy intake differ from those with higher relative energy intake according to characteristics such as obesity, physical activity, and macronutrient composition of the diet. Design: Cross-sectional data from a cohort study employing a semi-quantitative food frequency questionnaire (SFFQ). To determine energy intake relative to BMR the ratio of reported energy intake (EI) to BMR was used and categorized by quintiles. Setting: East German (Potsdam) cohort of the EPIC study (European Prospective Investigation into Cancer and Nutrition) Subjects: 2862 women and 2356 men taking part in the EPIC-Potsdam study from January 1st to December 31st 1995. Results: A significant declining trend could be observed for BMI, percentage of body fat, and body weight from the lowest to the highest quintile of EI/BMR. BMR was slightly decreasing, whereas physical activity was slightly increasing with quintiles of EI/BMR. Absolute macronutrient intake was directly related to EI/BMR. Percent macronutrient intake indicated lower fat intake, and higher carbohydrate and protein intake in low energy reporters. Energy adjusted macronutrient intake by the residual method showed no dependencies on EI/BMR. Conclusions: Underestimation of energy intake is related to obesity and affects the relation of macronutrients in the reported diet. This implies, that the assumption of adequate ranking of subjects by a SFFQ cannot be maintained. Energy adjusted intake values according to the residual method should be employed in diet-disease risk analysis since they were found to be independent of the methodological influence of underreporting. Sponsorship: The Potsdam part of the EPIC study is mainly supported by the Federal Ministry of Technology, Germany Grant No 01 EA 9401. Other funds come from the `Europe against cancer program' of the European Community; Grant No SOC 95 201408 05F02, and from foundations.

Reliability and validity of the Family Eating and Activity Habits Questionnaire.

Abstract: Objective: The purpose of this work was to develop and test an instrument that will identify the factors that facilitate childhood obesity and monitor the environmental changes and family behavior modifications associated with weight loss. Design and methods:The relevant factors that affect obesity and weight loss in children were divided into four scales: activity level, stimulus exposure, eating related to hunger, and eating style. We designed a questionnaire to be completed by the parents of the obese child aged 6 ‐ 11 years. Scores accumulated were calculated separately for each member of the family. Higher numerical scores reflected less appropriate eating patterns. The questionnaire reliability (test ‐ retest), internal consistency and ability to discriminate obese vs normal-weight children’s behaviors was tested using a pilot population of 40 mothers not enrolled in a formal weight loss program. The questionnaire reliability (parents’ report and spouse report) and predictive validity was tested using a selective population: 60 parents of obese children enrolled in a clinical intervention intended to treat childhood obesity with an environmental approach vs a dietary approach. Results: The content validity of the questionnaire was evaluated by a team of ten experts. Cronbach’s a was calculated to test internal consistency. Mean r was 0.83. Pearson’s correlation coefficients were computed between test and retest scores for individual items and for the total score, and ranged from 0.78 to 0.90 (median 0.84) (P< 0.01 for all). Total score test ‐ retest r was 0.85 (P< 0.01). The total family score was also higher in the families with an obese child compared to families with a normal-weight child, P< 0.01. No significant differences were noted between parent report and spouse report scores. The construct validity of the questionnaire was also supported by its high sensitivity to weight loss treatment. Weight loss in the child correlated highly with improvement in questionnaire score. Conclusions: The Family Activity and Eating Habits Questionnaire is reliable and internally consistent, and it is useful as an optional tool for planning an intervention program for childhood obesity. Descriptors: Family Activity and Eating Habits Questionnaire; childhood obesity