Food-related quality of life among older adults living in community: A multi-factorial approach.

BACKGROUND & AIMS: Food-related quality of life (FRQoL) assesses the specific impact of diet, eating behaviors, and food-related anxiety on a person's Health-related quality of life. The food serves a set of purposes that go beyond supplying the basic physiological needs, it also has a hedonic and social dimension. In addition, the relationship between food and health and well-being nowadays is unquestionable. This study aims to investigate the multidimensional aspects of FRQoL by identification the underlying factors associated to it. METHODS: This cross-sectional study is part of the Pronutrisenior project and included 602 older adults (>65 years old) from Vila Nova da Gaia, Portugal. Data were collected by a questionnaire of indirect application by trained nutritionists in a face-to-face situation. FRQoL was assessed by The Satisfaction with Food-Related Life Scale. RESULTS: Women, younger individuals and those with inadequate social support network had lower FRQoL. Insomnia and nutritional risk were also related to lower FRQoL. CONCLUSIONS: Our findings should be taken into account in clinical practice in order to optimize the intervention of health professionals, and the groups identified as having lower FRQoL should be given special attention.

The relationship between health self-perception, food consumption and nutritional status among Portuguese older adults.

In Portugal people aged 65 and above will be the populational group with the highest growth rate of the next decades. Healthy ageing constitutes a challenge as not only the number of years lived are essential, but also the quality of life becomes a priority. The aim of this study was to understand the relationship between health self-perception (HSP), food consumption and nutritional status among Portuguese older adults. Four hundred fifty-nine older adults (aged ≥ 65) were interviewed, almost half had a positive HSP. The most significant predictor of HSP was nutritional status, p = 0.005, but independence in shopping had the largest impact on how they compared to others, p < 0.001. Interventions need to focus on factors like nutritional status, independency on Activities of Daily Living, Satisfaction with Food-Related Life and utilize them to modify the negative HSP and attitudes towards ageing and health and maximize the positive aspects of old age.

Food choice and food consumption frequency of Cape Verde inhabitants.

The knowledge of the food pattern of a population is crucial for establishing nutritional and epidemiological profiles, as well as for controlling the market of foodstuffs and to help in the management of stock of staple foods. This study aims to evaluate food consumption and its association with the underlying motives for consumers' food choices, through the application of a Food Frequency Questionnaire (FFQ) followed by a Food Choice Questionnaire (FCQ). Face to face interviews were conducted with 503 participants, recruited at their homes, workplaces, health centers and other central locations in Cape Verde, only including subjects aged ≥18 years, without a self-reported history of chronic diseases. Food frequency analysis, as well as exploratory factorial analysis (EFA) were used to determine dietary patterns and nonparametric statistical tests for comparisons and associations of variables. The EFA yielded 4 patterns termed as: "Traditional", "Western", "Balanced" and "Energetic". Using an FCQ structure of 9 factors, three different groups were obtained from hierarchical clustering. (Cabral, de Almeida, & Cunha, 2017). The results show that Cape Verdean inhabitants follow global diet trends (towards the so-called "westernization"), however, in a more moderate rate if compared to other developing country populations. Consuming "junk food" is infrequent in Cape Verde, which appears to be due to limited availability and accessibility of this type of food. The rural coastal population remains more attached to traditional foods, consuming local products and traditional dishes, whereas in the urban population, one may notice the "westernization" of consumption. The application of an FFQ in combination with the FCQ provided in-depth information on eating attitudes and behaviors.

Portugal nutritional transition during the last 4 decades: 1974-2011.

OBJECTIVE: To examine trends in food availability for Portugal during the last 4 decades (1974-2011) and analyze such changes in accordance with the nutritional transition theory. METHODS: Food balance sheets from Portugal from 1974 to 2011 were analyzed for potential trends by linear regression to study the availability of protein, fat, carbohydrate, ethanol, and total energy and the availability of the following food groups: (i) cereals and tubers; (ii) vegetables; (iii) fruit; (iv) milk; (v) meat, fish, and eggs; (vi) fat; (vii) pulses; (viii) alcoholic beverages; and (ix) sugar and sweeteners. A comparison regarding protein, fat, and carbohydrate availability and WHO recommendation was also performed. RESULTS: The data suggest that in Portugal food availability and consumption have changed throughout the analyzed period. The national availability of most food groups increased considerably, which also resulted in an increase in daily energy. The consumption of cereals and tubers, pulses, and alcohol diminished during this time. Energy availability increased by 406 kcal/person/day, a result from an increase in protein and fat. Protein availability was in accordance with WHO recommendations during the 4 decades analyzed, whereas carbohydrate have always been below the recommended level and fat has been above the recommended level since the second decade (1984). CONCLUSION: Portugal has crossed into a nutritional transition over the last 4 decades, revealing characteristics of a pattern of degenerative diseases. The country may experience a new nutritional transition that would involve positive changes of behavior, as observed in other developed countries, driven by community multisectorial strategies.

General and abdominal adiposity in a representative sample of Portuguese adults: dependency of measures and socio-demographic factors' influence.

The aims of this study were: (i) to estimate the dependency between BMI and waist:height ratio (WHtR) as measures of general and abdominal adiposity, and (ii) to evaluate the influence of socio-demographic factors on both measures and on their dependency in risk classification. Data from a cross-sectional study conducted in 2009 among a representative sample of 3529 Portuguese adults were used. Height, weight and waist were measured and socio-demographic data (sex, age, education level, occupational status, marital status, region of residence) were obtained. Using logistic regression, crude and adjusted OR for high general (BMI≥25·0 kg/m²) and abdominal (WHtR≥0·5) adiposity, and for incompatible classification between them, were calculated. Above half (50·8%) of the respondents had high BMI and 42·1% had high WHtR, and the rates were higher in men than in women. There was an inverse association between education level and both adiposity measures. The lowest prevalence of high general and abdominal adiposity was observed in students and singles, whereas the highest was found in retired, widowed and respondents from Azores, Madeira and Alentejo. Nearly a quarter of respondents (24·0%) were incompatibly classified by BMI and WHtR, with higher prevalence in men than in women and in low- than in high-educated people. Future surveys should focus on developing at least sex-specific cut-offs for both measures. Implementation of effective strategies for preventing and reducing high adiposity levels in Portugal should be directed primarily to men, older, low-educated individuals, as well as those living in the islands and poor regions of the country.

Promoting healthy dietary behaviour through personalised nutrition: technology push or technology pull?

The notion of educating the public through generic healthy eating messages has pervaded dietary health promotion efforts over the years and continues to do so through various media, despite little evidence for any enduring impact upon eating behaviour. There is growing evidence, however, that tailored interventions such as those that could be delivered online can be effective in bringing about healthy dietary behaviour change. The present paper brings together evidence from qualitative and quantitative studies that have considered the public perspective of genomics, nutrigenomics and personalised nutrition, including those conducted as part of the EU-funded Food4Me project. Such studies have consistently indicated that although the public hold positive views about nutrigenomics and personalised nutrition, they have reservations about the service providers' ability to ensure the secure handling of health data. Technological innovation has driven the concept of personalised nutrition forward and now a further technological leap is required to ensure the privacy of online service delivery systems and to protect data gathered in the process of designing personalised nutrition therapies.

Mediation of parental educational level on fruit and vegetable intake among schoolchildren in ten European countries.

OBJECTIVE: To examine which factors act as mediators between parental educational level and children's fruit and vegetable (F&V) intake in ten European countries. DESIGN: Cross-sectional data were collected in ten European countries participating in the PRO GREENS project (2009). Schoolchildren completed a validated FFQ about their daily F&V intake and filled in a questionnaire about availability of F&V at home, parental facilitation of F&V intake, knowledge of recommendations about F&V intake, self-efficacy to eat F&V and liking for F&V. Parental educational level was determined from a questionnaire given to parents. The associations were examined with multilevel mediation analyses. SETTING: Schools in Bulgaria, Finland, Germany, Greece, Iceland, the Netherlands, Norway, Portugal, Slovenia and Sweden. SUBJECTS: Eleven-year-old children (n 8159, response rate 72%) and their parents. RESULTS: In five of the ten countries, children with higher educated parents were more likely to report eating fruits daily. This association was mainly mediated by knowledge but self-efficacy, liking, availability and facilitation also acted as mediators in some countries. Parents' education was positively associated with their children's daily vegetable intake in seven countries, with knowledge and availability being the strongest mediators and self-efficacy and liking acting as mediators to some degree. CONCLUSIONS: Parental educational level correlated positively with children's daily F&V intake in most countries and the pattern of mediation varied among the participating countries. Future intervention studies that endeavour to decrease the educational-level differences in F&V intake should take into account country-specific features in the relevant determinants of F&V intake.

Fruit and vegetables: intake and sociodemographic determinants among Portuguese mothers.

BACKGROUND: Fruit and vegetable intake is crucial in health promotion and disease prevention. Inadequate intake is found among adult populations worldwide. AIMS: To assess fruit and vegetable intake among Portuguese mothers and to examine its association with sociodemographic determinants. METHODS: A national cross-sectional survey was performed in Portugal as part of the Pro Children study. Data from self-administrated precoded 24-hour recall and food frequency questionnaires answered by 1,853 mothers of 11- to 13-year-old children were analyzed. Descriptive analysis of the data was followed by logistic regression to assess associations between daily fruit and vegetable intake and sociodemographic determinants. RESULTS: The mean fruit and vegetable intake was 221.2 and 170.0 g/day, respectively. Only 46% of the mothers met the WHO recommendations (≥400 g fruit and vegetables/day). Daily fruit intake was significantly higher among mothers who live with a spouse/partner, and who belong to a higher social class. For vegetables, daily intake was significantly higher among mothers with a higher education and social class. CONCLUSIONS: This study shows that the mean intake of fruit and vegetables among Portuguese mothers is far below international recommendations. Effective strategies to promote fruit and vegetable intake are needed, especially for mothers belonging to lower social classes and educational levels.

Metabolic syndrome, adipokines and ghrelin in overweight and obese schoolchildren: results of a 1-year lifestyle intervention programme.

The aim of this study was to evaluate the effect of a lifestyle intervention programme (nutrition and exercise counselling) on metabolic syndrome (MS) components, adipokines (leptin, adiponectin) and ghrelin levels in overweight children. A total of 61 overweight children aged 7-9 years (≥ 85th body mass index (BMI) percentile; 27 boys/34 girls) were randomly assigned and completed a 1-year individual (IT) or group-based treatment (GT). Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. Twenty-two normal weight children (<85th BMI percentile; 7-9 years old; 13 boys/nine girls) were also evaluated at baseline. Insulin resistance (IR) was determined by the homeostasis model assessment of IR (HOMA-IR). Overweight children presented significantly higher blood pressure, triglycerides, apolipoprotein B, insulin, HOMA-IR, leptin, C-reactive protein and homocysteine levels, while apolipoprotein A-I was significantly lower. At baseline, MS was present in ten overweight children, of which only five maintained it at 1 year. Leptin and ghrelin levels were associated with IR and MS components. MS was predicted by apolipoprotein A-I, insulin and pre-puberty. The lifestyle intervention led to a significant improvement in standard deviation score of BMI, waist circumference/height ratio and lipid profile. Changes in insulin, HOMA-IR, leptin and adiponectin were not significant. Ghrelin behaved differently between IT and GT. The GT intervention seems to be more successful, with a decrease in BMI Z-score and an improvement of metabolic parameters. In conclusion, overweight children have multiple risk factors associated with MS. A lifestyle intervention programme seems to be an effective mean for reducing obesity and MS components and improving adipokines concentrations.

[Validation of a questionnaire to evaluate alcohol related behaviours in excessive drinkers]. / Validação de um instrumento de avaliação da ingestão de bebidas alcoólicas e de etanol por consumidores excessivos.

UNLABELLED: The excessive consumption of alcohol and alcoholic drinks is an habit with high socioeconomic costs and a strong impact on health that requires research aiming at establishing adequate political options concerning trends, observed behaviours and consumption. OBJECTIVES: To validate an instrument to evaluate the consumption of the different kinds of alcoholic drinks and alcohol-related behaviours; to assess the determinants of alcoholic drinks consumption. TYPE OF STUDY: Validation study of an instrument to assess alcohol-related behaviours. PLACE: Coimbra. POPULATION: Excessive alcohol consumers. METHODS: Cross-sectional study based on a questionnaire and biochemical markers assessment, aiming to validate an instrument to evaluate alcohol consumption and alcohol-related behaviours. RESULTS: A correlation between age at first contact with alcohol and the beginning of the regular consumption(r = 0,72; p < 0,001) was found. Alcohol consumption in the last 12 months correlated with - % CDT (r = 0,54; p < 0,001) and with γ-GT (r = 0,47; p < 0,001). CONCLUSIONS: The validity of the instrument developed to evaluate alcohol-related behaviours is acceptable and therefore it may be used to establish hierarchy between levels of alcohol consumption defined by categories of ingestion and negative consequences.

Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas.

OBJECTIVE: The purpose of the present study was to evaluate the changes in the availability of the most important food components of the traditional Mediterranean diet and other food groups in five geographical areas during a 43-year period. DESIGN: Ecological study with food availability data obtained from FAO food balance sheets in forty-one countries for the period 1961-1965 and 2000-2004. SETTING: Mediterranean, Northern and Central Europe, Other Mediterranean countries and Other Countries of the World were the studied areas. RESULTS: The main changes since the 1960s, at an availability level, were found in European areas and in Other Mediterranean countries. The greatest changes were found in Mediterranean Europe, recording high availability of non-Mediterranean food groups (animal fats, vegetable oils, sugar and meat), whereas the availability of alcoholic beverages, including wine, and legumes decreased. Despite having lost some of its typical characteristics, Mediterranean Europe has more olive oil, vegetables, fruits and fish available than other areas. Although Northern Europe has a greater availability of non-Mediterranean foods, there has been a tendency towards a decrease in availability of some of these foods and to increase Mediterranean food such as olive oil and fruits. CONCLUSIONS: The present study suggests that European countries, especially those in the Mediterranean area, have experienced a 'westernisation' process of food habits, and have increasingly similar patterns of food availability (mainly non-Mediterranean food groups) among them. Measures must be taken to counteract these tendencies and to avoid their possible negative consequences. It is also crucial to find ways to promote and preserve the Mediterranean diet and its lifestyle in modern societies.

Worldwide variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003.

OBJECTIVE: The present study aimed to analyse the worldwide trends of adherence to the Mediterranean diet (MD), in 1961-1965 and 2000-2003. DESIGN: Data were obtained from the FAO food balance sheets in two periods: 1961-1965 and 2000-2003. In order to have a sample from across the world, forty-one countries were selected. The average of available energy for different food groups was calculated for all selected countries. These values were used to evaluate the adherence to the MD through a variation of Mediterranean Adequacy Index (MAI). RESULTS: The majority of the forty-one countries in this study have tended to drift away from a Mediterranean-like dietary pattern. Mediterranean Europe and the Other Mediterranean country groups suffered a significant decrease in their MAI values. The Mediterranean European group, especially Greece, experienced the greatest decrease in MAI value. In both periods, the Other Mediterranean countries showed the highest MAI values. In an analysis by countries, Iran had the highest increase in MAI across the time periods, and Egypt occupied the first place in the ranking in 2000-2003. The Northern European group was the only one that registered an increase in MAI, although this was not statistically significant. CONCLUSIONS: Many countries in the Mediterranean basin are drifting away from the Mediterranean dietary pattern (MDP). However, countries in Northern Europe and some other countries around the world are taking on a Mediterranean-like dietary pattern. The Other Mediterranean countries have the closest adherence to the MDP, currently and in the 1960s. Nutrition policy actions to tackle dietary westernisation and preserve the healthy prudent MDP are required.

The Women's Health Initiative. What is on trial: nutrition and chronic disease? Or misinterpreted science, media havoc and the sound of silence from peers?

The first results of the Women's Health Initiative dietary intervention trial were published in the USA in February. This is a colossal intervention designed to see if diets lower in fat and higher in fruits, vegetables and grains than is usual in high-income countries reduce the incidence of breast cancer, colorectal cancer, heart disease and other chronic diseases, in women aged 50-79 years. As interpreted by US government media releases, the results were unimpressive. As interpreted by a global media blitz, the results indicate that food and nutrition has little or nothing to do with health and disease. But the trial was in key respects not reaching its aims, was methodologically controversial, and in any case has not produced the reported null results. What should the public health nutrition profession do about such messes?

Promoting fruit and vegetable consumption among European schoolchildren: rationale, conceptualization and design of the pro children project.

BACKGROUND/AIMS: The Pro Children Project was designed to assess fruit and vegetable consumption in European schoolchildren and their parents, as well as determinants of the children's consumption patterns. A second objective was to develop and test strategies, applicable across Europe, for promoting consumption of fruits and vegetables among schoolchildren and their parents. In this paper, the rationale, theoretical background, overall design and implementation of the project is presented. METHODS: Surveys of national, representative samples of 11-year-old schoolchildren and their parents were conducted in 9 countries, i.e. in Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden. Comprehensive school-based educational programmes have been developed and tested in three settings, i.e. in Spain, the Netherlands and in Norway. A precoded 24-hour recall form combined with a set of food frequency questions assessing regular intake were used to assess fruit and vegetable consumption. Determinants were assessed employing a comprehensive theoretical framework including personal, social and environmental factors related to fruit and vegetable consumption. The intervention programmes have been tested employing a group-randomized trial design where schools have been randomly allocated to an intervention arm and a delayed intervention arm. Surveys among all participating children and their parents were conducted prior to the initiation of the intervention, immediately after the end of the intervention and at the end of the subsequent school year. CONCLUSION: The project is expected to provide new information of great importance for improving our understanding of consumption patterns of fruits and vegetables and for guiding future efforts to promote increased consumption patterns across Europe.

Fruit and vegetable intake of mothers of 11-year-old children in nine European countries: The Pro Children Cross-sectional Survey.

OBJECTIVE: To describe and compare fruit and vegetable intakes of mothers of 11-year-old children across Europe. METHODS: Cross-sectional surveys were carried out in 9 European countries in October/November 2003. Self-administered questionnaires assessing fruit and vegetable consumption were used for data collection. The current paper presents dietary intake data obtained by a precoded 24-hour recall and a food frequency questionnaire. RESULTS: The consumption levels of fruit and vegetables (without fruit juice) were in line with World Health Organization recommendations of > or =400 g/day for only 27% of all participating mothers. Based on both instruments, the Pro Children results showed comparatively high average fruit intake levels in Portugal, Denmark and Sweden (211, 203 and 194 g/day) and the lowest intake in Iceland (97 g/day). High vegetable intake levels were found in Portugal and Belgium (169 and 150 g/day), the lowest in Spain (88 g/day). A south-north gradient could not be observed in the Pro Children study. CONCLUSION: Fruit and vegetable intakes are low in mothers of 11-year-olds across Europe. Especially vegetable consumption can be regarded as marginal in most of the studied European countries. A high percentage of mothers indicated to eat fruit and vegetables less than once a day. The results have shown that national and international interventions are necessary to promote fruit and especially vegetable consumption in the European population of mothers.

Personal, social and environmental factors regarding fruit and vegetable intake among schoolchildren in nine European countries.

BACKGROUND/AIMS: Children in Europe are consuming less fruit and vegetables than recommended. Knowledge about the potential determinants of fruit and vegetable intake is vital to understand discrepancies in intake and to guide interventions. The aim of the present study was to assess personal, social and environmental factors regarding fruit and vegetable intake among 11- to 12-year-old children in Europe. METHODS: A cross-sectional survey was undertaken, with nationally or regionally representative samples of in total 13,305 children (mean age 11.4 years) from nine European countries. Pupils in the classroom completed a self-administered questionnaire measuring fruit and vegetable intake and personal, social and environmental factors during one school lesson. Age-adjusted covariance analyses were carried out by gender, for the full sample and for each country separately. Proportions responding positively to the constructs are presented. RESULTS: Overall, European children held a positive attitude towards fruit and vegetable intake. For some constructs, large between-country differences were found. Children had a more positive attitude towards fruit than towards vegetables, and girls were on average more positive than boys. The children perceived their social environment as supportive towards fruit and vegetable intake. They reported good to very good availability of fruit and vegetables at home. However, availability at school and during leisure time activities seemed to be low, both for fruit and for vegetables. CONCLUSION: A large majority of the children reported positively to the personal and social factors regarding fruit and vegetable intake. As regards availability of fruit and vegetables at school and leisure time, and accessibility of fruit and vegetables at home, there is room for improvement.