Environmental intervention in a university canteen with focus on decision guidance: An evaluation study regarding food consumption, nutrient intake, perception, and satisfaction by canteen users.

Background: An environmental intervention with focus on Decision Guidance was implemented in a university canteen. It comprised the offer of a health promoting food option (HPFO), including a health promoting lunch option and health promoting snacks. Design and methods: Possible changes of food consumption and nutrient intake of student canteen users (substudy A), perception of the HPFO by canteen users (substudy B.1), and possible changes of their satisfaction regarding the canteen (substudy B.2) at least 10 weeks after the start of the intervention were examined. Substudy A used a controlled pretest-posttest-design (paired sample). The students were assigned to intervention group (canteen visits ≥ once/week, n = 27) or control group (canteen visits < once/week, n = 39). Substudy B.1 used a cross-sectional design, and substudy B.2 a pretest-posttest-design (paired sample). Only canteen users (≥once/week) were included (substudy B.1 n = 89, substudy B.2 n = 30). Results: Food consumption and nutrient intake did not change (p > 0.05) in the intervention group versus control group (substudy A). In substudy B.1 canteen users were aware of the HPFO, appreciated it highly, and were satisfied with it. In substudy B.2 canteen users were at posttest more satisfied regarding service and health value of offered lunches (p < 0.05). Conclusions: Although the HPFO was positively percepted, no effects on the daily diet were observed. The offered proportion of the HPFO should be increased.

Environmental Intervention in a University Canteen with Focus on Decision Guidance-Effects on Sale and Daily Consumption of Vegetables and Fruit.

The purpose of the study was to evaluate whether an environmental intervention in a university canteen changes the sale and daily consumption of vegetables and fruit among canteen users. The intervention focused on decision guidance, including a positive incentive and nudging. In a pretest-posttest-design, daily sales data of pieces (pcs) of vegetable components and fruit, as well as the sale per main component (pcs/mc), were assessed. Here, 20 opening days were analyzed, each after the intervention (t1) and in the same period of the previous year (t0). Vegetable and fruit consumption were assessed in a controlled pretest-posttest design (3-day-dietary-record, t0 and t1). The intervention group (IG; n = 46) visited the canteen ≥ once/week, and the control group (CG; n = 49) < once/week. At t1, the sale of absolute vegetable components did not change (t0: 132.3 ± 49.7 pcs, p > 0.05), but more per main component were sold at t1 (t0: 0.54 ± 0.09, Δ: 0.09 ± 0.13 pcs/mc, p < 0.05). In addition, the sale of fruit (t0: 17.4 ± 11.6, Δ: 8.3 ± 10.8 pcs, p < 0.05; t0: 0.07 ± 0.03, Δ: 0.05 ± 0.07 pcs/mc, p < 0.001) increased after the intervention. The total consumption of vegetables (IG, t0: 260 ± 170 g/d, CG, t0: 220 ± 156 g/d; p > 0.05) and fruit (IG, t0: 191 ± 109 g/d; CG, t0: 186 ± 141 g/d; p > 0.05), however, did not change. To effectively change daily consumption, the intervention needs to be expanded.

Impact of physical activity, anthropometric, body composition, and dietary factors on bone stiffness in German university students.

BACKGROUND: Bone density in the young-adult life is associated with risk for osteoporosis in later life. Next to genetic factors, lifestyle seems to play an important role for bone health. Aim of the study was to clarify the relationship between various lifestyle factors and bone parameters in university students. METHODS: In 233 women and 52 men (age: 22.7±3.1 vs. 24.0±3.2 years; BMI: 22.2±2.9 vs. 24.2±3.1 kg∙m-2) the following parameters were assessed: calcaneal Stiffness Index ([SI]; quantitative ultrasound), body composition (bioelectrical impedance analysis), actual and past physical activity level ([PAL]; standardized questionnaire), and food/nutrient intake (3-day dietary record). Sex differences (Mann-Whitney-U-tests), relationships between SI and lifestyle factors (Spearman's rank correlation), and the influence of the factors on the variance of SI (multiple linear regression) were tested (α=0.05). RESULTS: 6.9% of the women and 5.8% of the men were classified as osteopenic (-2.5< T score <-1). Significant correlations between SI and BMI, absolute fat mass and fat-free mass, actual PAL, and physical activity during adolescence were found in women (r=0.18-0.24, all P<0.05), but not in men. Food/nutrient parameters did not significantly correlate with bone outcomes (P>0.05). In multiple regression analysis physical activity during adolescence, actual PAL, and BMI explained 8% of the variance of SI (P<0.0001): SI=32.2+3.5∙physical activity during adolescence [1: very low, 2: low, 3: medium, 4: high, 5: very high] +28.5∙PAL+0.8∙BMI [kg∙m-2]. CONCLUSIONS: Parameters of physical activity seem to be more important for bone health than nutrition factors. Therefore, high levels of physical activity during childhood, adolescence, and early-adult life are highly recommended to improve bone parameters.

Association between Body Composition, Physical Activity, Food Intake and Bone Status in German Children and Adolescents.

Achieving a high bone mass during childhood and adolescence is important for the prevention of osteoporosis in later life. Herein, the purpose was to assess the relationship of various lifestyle factors and bone outcomes in school children. In 248 girls (13.4 ± 1.9 years, BMI: 20.2 ± 4.8 kg m-2) and 231 boys (13.6 ± 1.7 years, BMI: 19.3 ± 3.3 kg m-2), bone mass (stiffness index, SI; calcaneal quantitative ultrasonometry), body composition (bioelectrical impedance analysis), food intake (food frequency questionnaire), and physical activity level (PAL; standardized questionnaire) were assessed. The individual food intake of eight food groups was related to the German recommendations (Bone Healthy Eating Index, BoneHEI; 0-100 points). Relationships between SI and lifestyle factors (Spearman´s rank correlation) and the influence of the factors on the variance of SI (multiple linear regression) were tested (α = 0.05). SI correlated with age, BMI, absolute fat-free mass, relative fat mass, PAL, and puberty category score in both girls and boys (r = 0.18-0.56, p < 0.01), but not with BoneHEI (p > 0.05). Age, absolute fat-free mass, sex, and PAL explained 35% of the variance of SI (p < 0.0001): SI = -0.60 + 2.97∙age (years) + 0.65∙fat-free mass (kg) + 6.21∙sex (0 = male, 1 = female) + 17.55∙PAL. Besides age and sex, PAL and fat-free mass are important factors relating to bone health. School children should perform regular physical activity to improve their bone status.

Fluid Intake and Cognitive Performance: Should Schoolchildren Drink During Lessons?

BACKGROUND: Evidence suggests that an insufficient fluid intake impairs cognitive performance. Drinking policies at schools-especially drinking during lessons-is a point of controversy. To provide a scientific base for this debate, more empirical evidence is needed on which aspects of fluid intake are crucial for cognitive performance. This study makes a contribution by investigating associations between quantitative and temporal aspects of fluid intake and cognitive performance in everyday school life. METHODS: The study comprised 125 children (age: mean = 10.98 years, SD = 0.38). Amount of fluid intake and time span between fluid intake and completion of cognitive tests were determined on basis of self-reports. Cognitive performance was assessed by standardized tests. RESULTS: Quantitative and temporal aspects were associated with cognitive performance: The more fluid the children consumed and the shorter the time span between their last fluid intake and test completion, the better they performed. CONCLUSIONS: The amount of fluid intake should be adequate and moreover the time span between intake and cognitive efforts should be as short as possible. Schoolchildren are thus recommended to drink at regular intervals and also during lessons.

Identifying elderly women with osteoporosis by spinal dual X-ray absorptiometry, calcaneal quantitative ultrasound and spinal quantitative computed tomography: a comparative study.

The ability of spinal dual x-ray absorptiometry (DXA), calcaneal quantitative ultrasound (QUS) and spinal quantitative computed tomography (QCT) to identify women with osteoporosis within the GISELA study was evaluated in 43 women, aged 62-87 years. Osteoporosis was defined as a T-score below or equal to -2.5 using DXA (femoral neck). To determine the performance of each method, the sensitivity, specificity and area under the curve (by means of a receiver operating characteristic [ROC] analysis) were calculated. The median T-scores from the measurements differed significantly (p < 0.0001). DXA (spine) identified 75% of women with osteoporosis; QUS and QCT identified 100%. The specificity was 89% for DXA (spine), 66% for QUS and 29% for QCT. ROC analysis showed that all three methods are qualified to identify women with osteoporosis; however, the different sensitivities and specificities of the methods, as well as the thresholds used for diagnosing osteoporosis have to be considered.

Grade of adiposity affects the impact of fat mass on resting energy expenditure in women.

Body fat mass (FM) adds to the variance in resting energy expenditure (REE). However, the nature and extent of this relationship remains unclear. Using a database of 1306 women and a linear regression model, we systematically analysed the contribution of FM to the total variance in REE at different grades of adiposity (ranges of body %FM). After adjusting for age, the relative contribution of FM on REE variance increased from low (10- 30- 40- # 50 %FM) and very high (>50 %FM) grades of adiposity according to the ratio between regression coefficients. These data suggest that the specific metabolic rate of fat tissue is reduced at high adiposity. This should be considered when REE is normalized for FM in obesity.

Eight-year trends in food, energy and macronutrient intake in a sample of elderly German subjects.

Time trends in the food and the corresponding energy and macronutrient intake between 1994 and 2002 are investigated as part of the longitudinal study on nutrition and health status in an ageing population in Giessen, Germany (GISELA study). The dietary intake is assessed via a 3 d estimated dietary record especially developed and validated for this study. A total of 2135 records from 532 subjects, aged 60 years and over, are analysed separately according to sex and age groups (born 1904-1928 and born 1929-1942). Results show that the food, energy and macronutrient intake of the GISELA subjects stayed fairly stable over the study period. However, some significant changes in the consumption pattern are observed, predominantly in the women and the younger age groups, which correspond to the national trends in Germany. Most obvious changes observed among the GISELA subjects are the increased intake of water (between +21.05 and +41.61 ml/d per year) and vegetables (between +2.94 and +3.38 g/d per year) and a reduced consumption of coffee and tea (between -10.65 and -15.99 ml/d per year) as well as of meat (between -1.79 and -2.56 g/d per year). The healthier food choices and the ability to change food habits could be related to the relatively high health-awareness of the GISELA subjects compared to the federal average of equivalent age groups.

World Health Organization equations have shortcomings for predicting resting energy expenditure in persons from a modern, affluent population: generation of a new reference standard from a retrospective analysis of a German database of resting energy expenditure.

BACKGROUND: Reference standards for resting energy expenditure (REE) are widely used. Current standards are based on measurements made in the first part of the past century in various races and locations. OBJECTIVE: The aim of the present study was to investigate the application of the World Health Organization (WHO) equations from 1985 in healthy subjects living in a modern, affluent society in Germany and to generate a new formula for predicting REE. DESIGN: The study was a cross-sectional and retrospective analysis of data on REE and body composition obtained from 2528 subjects aged 5-91 y in 7 different centers between 1985 and 2002. RESULTS: Mean REE varied between 5.63 and 8.07 MJ/d in males and between 5.35 and 6.46 MJ/d in females. WHO prediction equations systematically overestimated REE at low REE values but underestimated REE at high REE values. There were significant and independent effects of sex, age, body mass or fat-free mass, and fat mass on REE. Multivariate regression analysis explained up to 75% of the variance in REE. Two prediction formulas including weight, sex, and age or fat-free mass, fat mass, sex, and age, respectively, were generated in a subpopulation and cross-validated in another subpopulation. Significant deviations were still observed for underweight and normal-weight subjects. REE prediction formulas for specific body mass index groups reduced the deviations. The normative data for REE from the Institute of Medicine underestimated our data by 0.3 MJ/d. CONCLUSIONS: REE prediction by WHO formulas systematically over- and underestimates REE. REE prediction from a weight group-specific formula is recommended in underweight subjects.

Effect of age on plasma homocysteine concentrations in young and elderly subjects considering serum vitamin concentrations and different lifestyle factors.

OBJECTIVES: The aim of this study was to investigate whether an increase in total homocysteine (tHcy) concentration with increasing age is due to diminishing serum concentrations of pyridoxal-5-phosphate (PLP), vitamin B-12, and folate. The possible influence of different lifestyle factors on tHcy concentration was considered. METHODS: Plasma tHcy, serum concentrations of pyridoxal-5-phosphate, vitamin B-12, and folate, intake of coffee and tea, alcohol, and methionine, as well as cigarette smoking, were determined in 252 elderly subjects (60-87 years old) of the longitudinal study on nutrition and health status in an aging population in Giessen (GISELA) and 99 young adults (20-34 years old) of the study on health and nutrition of young adults (GEJE). RESULTS: Mean plasma tHcy concentrations were significantly higher in elderly than in young female subjects (9.7 +/- 1.9 micromol/L vs. 9.0 +/- 1.6 micromol/L, p < 0.05), but there was no difference between elderly and young men (10.6 +/- 2.1 micromol/L vs. 10.7 +/- 2.6 micromol/L). No differences in tHcy were observed between young and elderly subjects after adjustment for serum concentrations of PLP, vitamin B-12, and folate. Multiple linear regression analysis revealed a significant influence of age only in elderly, but not in younger subjects. CONCLUSION: Higher tHcy concentrations in the elderly, in comparison to younger women, are due to lower serum concentrations of PLP, vitamin B-12, and folate, whereas within the age group of elderly subjects alone tHcy concentrations increase with age irrespective of serum vitamin concentrations.

Complex correlation structure in consumption rates of major food groups: implications for the assessment of radiation exposure.

OBJECTIVE: An extensive dataset on individual food consumption was analysed in order to study all pairwise correlations between the consumption rates of 11 major food groups. Additionally, the project aimed to examine and quantify the accuracy of a recently proposed estimator of total food consumption to be used for the estimation of radiation exposure by food. Such an inquiry seems justified, because the proposed estimator implicitly presumes an essentially positive correlation structure in food consumption rates. DESIGN: Statistical analysis using representative data gathered in Germany in a nation-wide food consumption survey. SETTING: Germany. SUBJECTS: Individuals aged between 4 and 94 years namely 10,901 males and 12,308 females. RESULTS: The consumption rates of 11 major food categories showed several significantly positive, but also a number of significantly negative, correlations. Negative associations between cereal and potato products persisted consistently over all age groups, independent of sex. Other significantly negative correlations were limited to certain age groups. Reflecting these negative correlations, a subsequent analysis of relative ranks of consumption revealed that no person in the sample had the highest consumption rates in all food groups simultaneously. Based on representative samples, overestimations of 34 to 53% were obtained if--as recently suggested in the context of radiation exposure prediction--the 95th percentiles of total food consumption were determined as sums of the corresponding percentiles of the food groups. CONCLUSIONS: The complex correlation structure of food group consumption rates, as identified in this study, bears important implications for various health-related issues. Ignoring them could lead to overly conservative estimations of radiation exposure due to food ingestion or to confounding effects in epidemiological studies on nutritional risk factors of diseases. The results also indicate that a distinction into different dietary patterns might be useful in characterising different consumption habits.

Paraoxonase 1 Q192R (PON1-192) polymorphism is associated with reduced lipid peroxidation in R-allele-carrier but not in QQ homozygous elderly subjects on a tomato-rich diet.

BACKGROUND: The oxidative modification of LDL is considered to play a central role in the pathogenesis of atherosclerosis and coronary heart disease (CHD). Paraoxonase (PON1) protects LDL from oxidation and may therefore retard the development of atherosclerosis. The PON1-192 polymorphism is associated with diminished PON1 concentrations and an increased risk for CHD in RR-allele subjects. AIM OF THE STUDY: To investigate the effect of tomato juice consumption on PON1 activity and other parameters related to oxidative stress in healthy elderly subjects. Furthermore, the PON1-192 genotype has been determined in the volunteers in order to see whether possible treatment effects are related to the PON1-192 polymorphism. METHODS: Fifty elderly subjects were randomly assigned to control (mineral water) or intervention group (tomato juice). Subjects of the tomato juice group consumed daily 330 mL tomato juice for 8 weeks. Antioxidant status was measured as LDL oxidation, plasma malondialdehyde, ferric reducing ability of plasma (FRAP) and PON1 activity. The PON1-192 polymorphism was determined by restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR). Plasma carotenoids were analyzed by HPLC. RESULTS: Tomato juice consumption reduced LDL-oxidation and improved antioxidant status in R-allele carriers, but not in the QQ genotype group. PON1 activity increased irrespective of the genotype in both, control and intervention group. CONCLUSIONS: The changes in antioxidant status after tomato juice consumption seem to depend on the PON1-192 genotype. Healthy elderly, carrying the R-allele, could specifically reduce their higher cardiovascular risk by changing dietary habits.

A new equation especially developed for predicting resting metabolic rate in the elderly for easy use in practice.

BACKGROUND: Equations published in the literature for predicting resting metabolic rate (RMR) in older individuals were exclusively derived from studies with small samples of this age group. AIM: of the present investigation was therefore to compare the measured RMR of a relatively large group of older females and males with values for RMR calculated from the most commonly used WHO [1] equations. Furthermore, on the basis of the data collected by our study group a new equation for calculating RMR in the elderly was to be developed. Variables used in this equation should be easily and exactly determinable in practice. SUBJECTS AND METHODS: RMR was measured by indirect calorimetry after an overnight fast in a sample of 179 female (age 67.8 +/- 5.7 y, BMI 26.4 +/- 3.7 kg/m(2)) and 107 male (age 66.9 +/- 5.1 y, BMI 26.3 +/- 3.1 kg/m(2)) participants in the longitudinal study on nutrition and health status in an aging population of Giessen, Germany. The subjects were at least 60 years old, did not suffer from thyroid dysfunction, and were not taking thyroid hormones. Stepwise multiple linear regression analysis was used to estimate the best predictors of RMR. RESULTS: In females there was no significant difference between our measured RMR (5504 +/- 653 kJ/d) and RMR predicted with the WHO [1] equation (5458 +/- 440 kJ/d), whereas in males measured RMR (6831 +/- 779 kJ/d) was significantly higher than calculated RMR (6490 +/- 550 kJ/d). Results of regression analysis, considering body weight, body height, age, and sex, showed that RMR is best calculated by the following equation: RMR [kJ/d]= 3169 + 50.0 x body weight [kg] - 15.3 x age [y] + 746 x sex [female = 0, male = 1]. The variables of this equation accounted for 74 % (R(2)) of the variance in RMR and predicted RMR within +/- 486 kJ/d (SEE). CONCLUSION: On the basis of the data determined in a large group of older individuals, we offer a new equation for calculating RMR in the elderly that is both easy and accurate for use in practice.