Socio-economic differences in cardiometabolic risk markers are mediated by diet and body fatness in 8- to 11-year-old Danish children: a cross-sectional study.

OBJECTIVE: To explore whether socio-economic differences exist in cardiometabolic risk markers in children and whether lifestyle-related factors potentially mediate these differences. DESIGN: Cross-sectional study including measurements of fasting blood lipids, glucose, homeostasis model assessment of insulin resistance (HOMA-IR), blood pressure and heart rate. Potential mediators examined were fat mass index (FMI); intakes of fruit, vegetables, dietary fibre and added sugar; whole-blood n-3 long-chain PUFA (LCPUFA) as a biomarker of fish intake; and physical activity and sedentary time. SETTING: Nine primary schools in Denmark. SUBJECTS: Children aged 8-11 years (n 715). RESULTS: Children of parents with the shortest compared with longest education had higher TAG by 0·12 (95 % CI 0·04, 0·21) mmol/l and HOMA-IR by 0·36 (0·10, 0·62), whereas children of parents with a vocational education had higher total cholesterol by 0·14 (0·02, 0·27) mmol/l and LDL cholesterol by 0·14 (0·03, 0·25) mmol/l compared with children of parents with the longest education; all P<0·05. FMI explained 25 % of the difference in TAG, 64 % of the difference in HOMA-IR and 21-29 % of the differences in cholesterols. FMI and whole-blood n-3 LCPUFA combined explained 42 % of the difference in TAG, whereas FMI, whole-blood n-3 LCPUFA and dietary fibre explained 89 % of the difference in HOMA-IR. CONCLUSIONS: Socio-economic differences were present in blood lipids and insulin resistance among 8- to 11-year-olds and were mediated by body fatness, whole-blood n-3 LCPUFA and dietary fibre. These lifestyle factors may be targets in public initiatives to reduce socio-economic differences. Confirmation in longitudinal studies and trials is warranted.

Relationship between sleep duration and dietary intake in 4- to 14-year-old Danish children.

A negative association between sleep duration and BMI has been observed in children. However, knowledge about the association between sleep duration and diet is limited. The objective was to examine the association between sleep duration and intake of foods and nutrients in children. In the present cross-sectional study, dietary intake and sleep duration were recorded by the parents for seven consecutive days in a food and sleep record in a representative sample of 802 4- to 14-year-old children. No sex differences were found regarding age and sleep duration. Sleep duration was negatively correlated to age (ρ = -0·68; P < 0·001) and BMI (ρ = -0·41; P < 0·001). In multiple linear regression analyses, sleep duration was not associated with energy intake (b = -0·015; P = 0·20), but there was a trend towards a positive association with intake of dietary fibre (b = 0·006; P = 0·05) and vegetables (b = 0·011; P = 0·05), and a negative association with intake of poultry (b = -0·002; P = 0·02), and a trend towards a negative association with intake of liquid 'discretionary calories' (b = -0·01; P = 0·05). Furthermore, in a comparison of dietary intake between age-dependent tertiles of sleep duration, only intake of liquid 'discretionary calories' was significantly lower in long sleepers than in short and medium sleepers (P = 0·03). In conclusion, sleep duration was not associated with energy intake and the proposal that children with short sleep duration have less healthy eating habits than children with longer sleep duration was only weakly supported by the present findings.

Evaluation of dietary intake in Danish adults by means of an index based on food-based dietary guidelines.

BACKGROUND: Data on dietary intake and physical activity has been collected from a representative sample of the Danish population from 2003-2008. OBJECTIVES: The aim of the present study was to describe the habitual diet in Denmark and to evaluate the overall diet quality using a diet quality index based on the National Food-Based Dietary Guidelines (FBDG), which consists of seven guidelines regarding diet and one regarding physical activity. DESIGN: Data from the Danish National Survey of Diet and Physical Activity 2003-2008 (n=3354) were included. The diet quality index was constructed based on five of the seven dietary guidelines. Individuals were categorised according to quartiles of the diet quality index, and food and nutrient intakes were estimated in each of the groups. RESULTS: Macronutrient distribution did not meet recommendations in any of the groups, as energy from total fat and especially saturated fat was too high. A high intake of high-fat milk products, fat on bread and processed meat contributed to a high intake of total fat and saturated fat, and sugar-sweetened soft drinks contributed to a high intake of added sugars in the group below the lowest quartile of the diet quality index. Individuals above in the highest quartile had higher intakes of 'healthy foods' such as fish, fruit and vegetables, rye bread, and also a higher consumption of water and wine. Overall, intakes of micronutrients were sufficient in all groups. CONCLUSIONS: The diet quality index is a useful tool in assessing food and nutrient intake in individuals with high vs. low degree of compliance towards the dietary guidelines, and provides a valuable tool in future studies investigating variations in dietary intakes with respect to lifestyle, demographic and regional differences in Denmark.

Comparison of estimated energy intake from 2×24-hour recalls and a seven-day food record with objective measurements of energy expenditure in children.

OBJECTIVE: The objective of the present study was to evaluate energy intake (EI) estimated from two non-consecutive 24-hour recalls (24-HDRs) and a pre-coded seven-day food record (7-dFR) against objective measurements of energy expenditure (EE) in children. DESIGN: A total of 67 7-8 year-olds and 64 12-13 year-olds completed the 2×24-HDRs, the 7-dFR, and wore ActiReg(®) (PreMed AS, Oslo, Norway), a combined position and motion recording instrument, during the same seven days as the 7-dFR was filled in. RESULTS: In the 7-8 year-olds, EI from the 2×24-HDRs (EI(2×24-HDR)) was overestimated with 3% compared to EE (not significantly different), while EI from the 7-dFR (EI(7-dFR)) was underestimated with 7% compared to EE (P=0.001). In the 12-13 year-olds, the corresponding figures was underestimation by 10% with the 2×24-HDRs (P<0.001) and by 20% with the 7-dFR (P<0.001). For both age groups combined, the 95% limits of agreement were -4·38 and 3.52 MJ/d for the 2×24-HDRs, and -5.90 and 2.94 MJ/d for the 7-dFR. Pearson correlation coefficients between EI and EE were 0.51 for EI(2×24-HDR) and 0.29 for EI(7-dFR), respectively. The proportion classified in the same or adjacent quartiles was 76% for EI(2×24-HDR) and 73% for EI(7-dFR) in the 7-8 year-olds, and 83% for EI(2×24-HDR) and 70% for EI(7-dFR) in the 12-13 year-olds. CONCLUSION: Misreporting of EI seemed modest with both the 2×24-HDRs and the 7-dFR in the 7-8 year-olds when compared to EE measured with ActiReg(®). Under-reporting appeared to be more evident in the 12-13 year-olds, especially with the 7-dFR. Compared to measurements of EE, the 2×24-HDRs seemed to perform slightly better than the 7-dFR in terms of ranking of individuals according to EI.

Validation of the Danish 7-day pre-coded food diary among adults: energy intake v. energy expenditure and recording length.

Under-reporting of energy intake (EI) is a well-known problem when measuring dietary intake in free-living populations. The present study aimed at quantifying misreporting by comparing EI estimated from the Danish pre-coded food diary against energy expenditure (EE) measured with a validated position-and-motion instrument (ActiReg). Further, the influence of recording length on EI:BMR, percentage consumers, the number of meal occasions and recorded food items per meal was examined. A total of 138 Danish volunteers aged 20-59 years wore the ActiReg and recorded their food intake for 7 consecutive days. Data for 2504 participants from the National Dietary Survey 2000-2 were used for comparison of characteristics and recording length. The results showed that EI was underestimated by 12 % on average compared with EE measured by ActiReg (PreMed AS, Oslo, Norway). The 95 % limits of agreement for EI and EE were - 6.29 and 3.09 MJ/d. Of the participants, 73 % were classified as acceptable reporters, 26 % as under-reporters and 1 % as over-reporters. EI:BMR was significantly lower on 1-3 consecutive recording days compared with 4-7 recording days (P < 0.03). Percentage consumers of selected food items increased with number of recording days. When recording length was 7 d, the number of reported food items per meal differed between acceptable reporters and under-reporters. EI:BMR was the same on 4 and 7 consecutive recording days. This was, however, a result of under-reporting in the beginning and the end of the 7 d reporting. Together, the results indicate that EI was underestimated at group level and that a 7 d recording is preferable to a 4 d recording period.

Diet quality: associations with health messages included in the Danish Dietary Guidelines 2005, personal attitudes and social factors.

OBJECTIVE: To study the association between diet quality and the new health messages in the Danish Dietary Guidelines 2005, i.e. 'Eat a varied diet', 'Engage in regular physical activity' and 'Maintain a healthy body weight'. DESIGN/SETTING/SUBJECTS: The study was cross-sectional, comprising a random sample of 3151 Danish adults aged 18-75 years. Dietary intake was estimated using a 7 d pre-coded food diary. Information on social background, leisure-time physical activity, height, body weight and intention to eat healthy was obtained by in-person interviews. Logistic regression models were used to explore the independent effects of energy intake, leisure-time physical activity, food variety, BMI, age, gender, education, household income, location of residence and intention to eat healthy on the likelihood to have high diet quality measured by an index based on the intake of dietary fibre and saturated fat. RESULTS: Greater food variety (OR = 1.32 for women, 1.13 for men), high leisure-time physical activity (OR = 2.20 for women, 1.91 for men), frequent intentions to eat healthy (OR = 8.19 for women, 5.40 for men) and low energy intake (OR=0.78 for women, 0.85 for men) were significantly associated with high diet quality. For women education was positively associated with diet quality. The study did not demonstrate any association between BMI and diet quality. CONCLUSION: The health behaviours 'Eat a varied diet' and 'Engage in regular physical activity' were positively associated with healthy eating. The dietary habits reported were strongly influenced by personal intentions. Thus, the biggest challenge for public health nutritionists will be to reach non-compliers who seldom have intentions to eat healthy.

Comparison of the Danish Physical Activity Questionnaire with a validated position and motion instrument.

OBJECTIVE: To compare the Danish Physical Activity Questionnaire (DPAQ) estimating physical activity energy expenditure (PAEE) and physical activity level (PAL) and the pattern of physical activity (including health-related physical activity) with measurements from a validated position and motion instrument (ActiReg). METHODS: One hundred and thirty-eight healthy Danish volunteers aged 20-59 years participated. Participants filled in the DPAQ at the end of the day every day for seven consecutive days and carried the ActiReg on the same days as the DPAQ were filled in. RESULTS: A small, but statistically significant difference was seen between the DPAQ and the ActiReg for PAEE (mean: -0.32 MJ x d(-1); 95% limits of agreement: ((-2.88)-2.24 MJ x d(-1)); P = 0.003) and PAL (-0.03; ((-0.37)-0.31); P = 0.02) for the whole group and for women (P < 0.008 for PAEE and PAL), but not for men. The correlation between methods was good for PAEE (r = 0.71, P < 0.001) and PAL (r = 0.64, P < 0.001). No difference was observed for time spent in moderate plus vigorous physical activity (MVPA) (P = 0.40). Time reported in MVPA with the DPAQ was positively correlated with time spent in MVPA measured by the ActiReg (p = 0.53, P < 0.001). CONCLUSIONS: Although the volunteer sample may influence the representativeness of the results, the DPAQ provided a close estimate of PAEE, PAL (2-5% underestimation) and health-related physical activity (MVPA) in healthy adults at group level. The results indicate that the questionnaire can be used to rank individuals according to energy expenditure and level of total physical activity and to provide information on health-related physical activity.

The intake of saturated fat and dietary fibre: a possible indicator of diet quality.

The aim of the present study was to assess if a simple dietary quality index (SDQI) is a useful indicator for nutritional quality in the Danish diet. Data from the Danish National Dietary Survey 2000-2 for adults (n 3151; age 18-75 years) were used to construct an SDQI based on the intake of dietary fibre and saturated fat. The SDQI was used to rank the individuals into three subgroups: the 25 % closest in meeting the recommended intakes of saturated fat and dietary fibre (compliers), the 25 % furthest away (non-compliers) and the 50 % in between (intermediates). Significant differences in food and nutrient intake between these subgroups were identified by intakes of food groups and intakes of nutrients followed by non-parametric tests. Compared with the Nordic Nutrition Recommendations 2004 and the Danish Dietary Guidelines 2005, compliers had a significantly better nutrient profile than intermediates and non-compliers, as the diet of compliers contained more whole-grain cereals, fruits, vegetables and fish, and more frequently low-fat dairy products, lean meats and boiled potatoes. The diet of all subgroups, especially non-compliers, had a high content of nutrient-poor, energy-dense foods, for example, salty snacks, confectionery, and beverages, for example, soft drinks and alcohol. The SDQI is a simple and useful tool to characterise the diet quality of Danish adults.

Use of butter and cheese in 10 European countries: a case of contrasting educational differences.

BACKGROUND: This paper aims to analyse socioeconomic variation in the use of cheese and butter in Europe by reviewing existing dietary surveys. It explores whether socioeconomic differences in the intake of these foods follow a similar pattern in all countries. METHODS: An overview of available studies on socioeconomic differences in food habits in Europe over the period 1985-1997 was performed. Twenty studies from 10 countries included information on cheese and butter. A simple directional vote-counting method was used to register the association between educational level and consumption of cheese and butter (animal fat) for each study. FAO's food balance sheets were used to classify the countries according to consumption trends of these foodstuffs. RESULTS: In all countries higher social classes used more cheese than lower classes. The results for butter were less consistent. In the Nordic countries higher social classes used less butter than lower ones. In the other countries an opposite pattern or no differences could be observed. However, in countries where the use of both butter and animal fats could be analysed, animal fats were used more by the lower social classes. CONCLUSIONS: Higher and lower socioeconomic groups have different sources of saturated fats. Higher social classes use more cheese whereas lower social classes use more butter or animal fats. This can be observed especially in countries where the consumption of cheese is increasing and that of butter decreasing. Higher social classes prefer modern foods, lower classes traditional foods.