The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study.

OBJECTIVE: This paper describes the ad hoc methodological concepts and procedures developed to improve the comparability of Nutrient databases (NDBs) across the 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). This was required because there is currently no European reference NDB available. DESIGN: A large network involving national compilers, nutritionists and experts on food chemistry and computer science was set up for the 'EPIC Nutrient DataBase' (ENDB) project. A total of 550-1500 foods derived from about 37,000 standardized EPIC 24-h dietary recalls (24-HDRS) were matched as closely as possible to foods available in the 10 national NDBs. The resulting national data sets (NDS) were then successively documented, standardized and evaluated according to common guidelines and using a DataBase Management System specifically designed for this project. The nutrient values of foods unavailable or not readily available in NDSs were approximated by recipe calculation, weighted averaging or adjustment for weight changes and vitamin/mineral losses, using common algorithms. RESULTS: The final ENDB contains about 550-1500 foods depending on the country and 26 common components. Each component value was documented and standardized for unit, mode of expression, definition and chemical method of analysis, as far as possible. Furthermore, the overall completeness of NDSs was improved (>or=99%), particularly for beta-carotene and vitamin E. CONCLUSION: The ENDB constitutes a first real attempt to improve the comparability of NDBs across European countries. This methodological work will provide a useful tool for nutritional research as well as end-user recommendations to improve NDBs in the future.

Assessment of dietary intake among Moroccan women and Surinam men.

OBJECTIVE: To establish a method for food consumption data collection in ethnic groups in the Netherlands. METHODS: Two pilot studies have been carried out, one among Moroccan women and one among Surinam men. First, focus group discussions were held to obtain background information from members of the target population. For food consumption assessment 2 X 24-h recall was chosen. Furthermore, background information on age, place of birth, frequency of visits to Morocco or Surinam, Dutch language skills, meal pattern, food purchases and antropometric measurements were taken. RESULTS: It was found that the diets of both Moroccan women and Surinam men tended to approach the recommended daily intake of macronutrients more than the average intake of a Dutch person. However, reported energy and micronutrient intake on the second day of the dietary recall was lower than on the first recall day. CONCLUSION: The 24-h recall is a suitable method for food consumption measurements among Moroccan and Surinam people. On the other hand, the interviewer must be aware of potential under-reporting, especially during the second recall.

A semiquantitative food frequency questionnaire for use in epidemiologic research among the elderly: validation by comparison with dietary history.

A self-administered semiquantitative food frequency questionnaire including 75 food items and providing information on the habitual intake of 31 nutritional parameters, based on the intake of protein, fat, carbohydrate, fiber and 11 vitamins and minerals, was developed for use in epidemiologic research on chronic disease among the elderly, such as diabetes and cardiovascular disease. By means of detailed frequency and quantity questions, specifications of types of food, preparation methods and seasonal variation, the questionnaire was expected to be an improvement on existing instruments. The relative validity of the questionnaire was examined in 74 men and women, aged 50-75, by comparison with a modified dietary history. Systematic differences were absent or negligible for all nutrients, except vitamin C. Bias depending on the level of intake could be ruled out for all but seven nutrients. Pearson correlation coefficients for estimates from the questionnaire and dietary history were on average 0.71 (range: 0.65-0.78) and 0.66 (range: 0.36-0.81) for macronutrients, and vitamins and minerals, respectively. Classifying individual intake estimates into tertiles of the distribution for both methods, on average 62.4 and 54.7% of the intakes were categorized into the same tertile and 3.9 and 5.9% into the opposite tertile for macronutrients, vitamins and minerals, respectively. These results demonstrate an acceptable relative validity for this newly developed questionnaire, as compared to the dietary history method.

Nutrition and serum cholesterol levels among elderly men and women (Dutch Nutrition Surveillance System).

Associations of serum cholesterol with relevant dietary intake variables (assessed with the dietary history method) and body mass index were investigated in elderly men (n = 199) and women (n = 180) 65-79 years old. All subjects were apparently healthy, nondiabetic, and not on a dietary regimen. The associations were studied separately for men and women using linear regression analysis and all possible subsets regression analysis. Among men, body mass index (kg/m2) and intake of monounsaturated fat and of alcohol were positively and consistently associated with serum total cholesterol. Among women, intake of alcohol and of saturated fat were positively associated, and intake of polysaccharides was inversely associated with serum total cholesterol. The intake of monounsaturated fatty acids was highly (r greater than .60) positively correlated with the intake of total fat and saturated fatty acids, and inversely with carbohydrates. HDL-cholesterol was positively associated with alcohol intake (significant for men only), and inversely with body mass index (women). The results indicate that the effect of dietary factors on serum cholesterol levels is probably not age-limited. Elderly people may potentially benefit from weight reduction or control, moderate alcohol consumption, and avoidance of too much dietary fat. These suggestions are in fair accordance with general population-based guidelines for a healthy diet. However, as our study was cross-sectional, causation as well as the public health impact remains to be proven.

Adequacy of a vegetarian diet at old age (Dutch Nutrition Surveillance System).

To assess the adequacy of a vegetarian diet at old age, the dietary intake (assessed through dietary history with cross-check) of 44 apparently healthy lacto-(ovo-)vegetarians, aged 65-97 years, was evaluated. Adequacy was assessed by a comparison of nutrient intake with (Dutch) recommendations and by evaluating data on nutritional status. The results were also compared with data of elderly omnivores. In contrast to elderly omnivores, percentages of energy from protein (13%), fat (37%), and carbohydrates (50%) as well as P/S ratio (0.63) were close to or within the range of Dutch guidelines regarding a healthy diet (percentages of energy from protein, fat, and carbohydrates 10-15, 30-35, and 55%, respectively: P/S ratio 0.5-1.0). For most of the micronutrients studied intake was adequate, and nutrient density of the vegetarian diet was higher than of the omnivorous diet. However, the supply of zinc (average daily intake 8.5 and 7.6 mg for men and women, respectively), iron (because of lower bioavailability of nonheme iron), vitamin B12 (women only: intake 2.3 micrograms/day), and water (daily intake less than 1600 ml for 30% of the vegetarians) need special attention, considering the relatively high prevalence of a marginal status of these nutrients. In conclusion, a lacto-(ovo-)vegetarian diet can be adequate at old age, provided that it is carefully planned, especially with respect to the supply of iron, zinc, and vitamin B12.

Nutrition and aging: dietary intake of "apparently healthy" elderly (Dutch Nutrition Surveillance System).

The dietary intake (assessed through dietary history) of 539 apparently healthy, independently living elderly aged 65-79 years, was evaluated in a nationwide random sample. Except for pyridoxine, the intake of vitamins, minerals, and water was adequate according to the Dutch recommended dietary allowances. Fat intake (40 energy%) as well as P/S ratio (0.41) was assessed as being unfavorable, whereas the intake of vitamin B6 was marginal. The prevalence of obesity was higher among the women, while food selection was healthier as reflected in the higher nutrient density than among the men. Food consumption of elderly men (26%) and women (33%) on a dietary regimen was more prudent and nutrient density higher than among the elderly not on a diet. Our results are in accordance with previous food consumption studies among elderly in The Netherlands, but differ substantially from dietary intake figures for American elderly. Although the intake of energy and nutrients was lower among elderly men than among younger men, we conclude that age per se is not an important determinant of dietary intake among Dutch apparently healthy elderly aged 65-79 years.

Dose-response relationships regarding vitamin B-6 in elderly people: a nationwide nutritional survey (Dutch Nutritional Surveillance System).

The dietary intake and biochemical status of vitamin B-6 in 476 apparently healthy Dutch elderly people (aged 65-79 y), who were not using drugs known to affect vitamin B-6 metabolism, were evaluated. Intake of vitamin B-6 per gram protein was related to biochemical data, namely plasma pyridoxal 5'-phosphate (PLP) and cofactor stimulation of aspartate aminotransferase in erythrocytes (AST-AC). Based on a cutoff point of 2.02 for AST-AC, approximately 9% of the elderly people not using vitamin B-6 supplements had a marginal vitamin B-6 status. About 7% were using vitamin B-6 supplements. Dietary intake of vitamin B-6 per gram protein was negatively related to AST-AC. Vitamin B-6 intakes per gram protein higher than 0.020 mg were necessary to ensure an AST-AC value less than 2.02. At high PLP values AST-AC hardly varied. The results seem to indicate a higher requirement of vitamin B-6 in elderly people than in younger adults.

Effect of household size on nutritional patterns among the Dutch elderly.

Elderly persons are vulnerable to nutritional risks. Factors such as living alone make the elderly prone to poor nutritional status as a result of inadequate diets. The results of a Dutch national nutrition survey of food consumption and nutritional status among 539 independently living, apparently healthy elderly persons, aged 65 to 79 years, show that in general the intake of macronutrients deviates from the Dutch recommendations. In particular, saturated fat intake and P:S ratio were unfavorable, especially for the solitary elderly persons (saturated fat intake 19.0 +/- 3.2% and 17.7 +/- 3.3% total energy for men and women, respectively). Except for vitamin B-6 (about 92% of the recommendation on a group level for men and 78% for women), the intake of micronutrients studied is considered to be adequate. Elderly women living alone had a higher calcium:phosphorus ratio (0.76 +/- 0.12), lower meat consumption (90 +/- 31 gm), and a lower mean HDL-cholesterol concentration (1.22 +/- 0.28 mmol/L) in serum than non-solitary elderly women (Ca:P ratio 0.73 +/- 0.12, meat consumption 100 +/- 36 gm, HDL-cholesterol concentration 1.45 +/- 0.38 mmol/L). Potatoes, vegetables, and meat were more often prepared for more than one day at a time by elderly persons living alone than by the non-solitary elderly.

[Is vitamin intake by the elderly in The Netherlands precarious?]. / Is de vitaminevoorziening van ouderen in Nederland zorgwekkend?

The elderly are vulnerable to nutritional risks. The vitamin intake (assessed through dietary history) and vitamin status of 539 independently living persons aged 65-79 years and 44 lacto-(ovo)-vegetarian persons aged 65-97 years were evaluated. All respondents were apparently healthy. Compared with the Dutch recommended dietary allowances the intake of vitamins was assessed as adequate except for vitamin B6. The marginal intake of vitamin B6 is reflected in the vitamin B6 status. The prevalence of low 25-hydroxyvitamin D concentrations in plasma is high among elderly people as compared with younger adults (blood donors); the concentration is negatively correlated with age. The vegetarian elderly appeared to be at risk regarding the vitamin B12 status. In conclusion, the average intake of vitamins is assessed as adequate, whereas the intakes of vitamin B6 and vitamin D of Dutch apparently healthy elderly need more attention.

Determinants of total and high density lipoprotein cholesterol in boys from Finland, The Netherlands, Italy, the Philippines and Ghana with special reference to diet.

We have studied the determinants of total and high density lipoprotein (HDL) cholesterol in young boys from five countries characterized by different lifestyles, dietary consumption profiles and mortality rates from coronary heart disease. All measurements including the estimation of dietary intake, physical activity, body mass index and the concentrations of total and HDL cholesterol were carefully standardized. The mean concentrations of total and HDL cholesterol were higher in the European boys (4.1-4.9 mmol/l and 1.45-1.57 mmol/l, respectively) than in the boys from Ghana and the Philippines (3.3-3.8 mmol/l and 0.93-1.10 mmol/l, respectively). A positive correlation was found between the concentration of total cholesterol and the intake of saturated fatty acids in four out of five countries. The concentration of HDL cholesterol was also related to various dietary variables in some of the groups. Using the regression coefficients from a multiple regression analysis on the pooled data, it could be calculated that on average 24 per cent of the inter-country differences in the levels of total cholesterol is explained by differences in the intakes of saturated fatty acids. Differences between the groups of the different countries in the intakes of carbohydrate explained on average 29 per cent of the differences in the concentrations of HDL cholesterol. The results obtained support the hypothesis that higher concentrations of total and HDL cholesterol are associated with western types of diets rich in saturated fatty acids and relatively poor in complex carbohydrates.