Effect of sociodemographic variables and time on food group contribution to total food availability in Portuguese elderly households.

OBJECTIVE: To analyze the simultaneous effects of sociodemographic variables and time on each food group contribution to total Portuguese elderly household food availability. DESIGN: Four cross sectional Portuguese Household Budget Surveys were used. A multivariate analysis of variance (MANOVA), using a general linear model (GLM), was applied to analyze the simultaneous effects of sociodemographic variables and time. SETTING: Portuguese population. SUBJECTS: Nationally representative samples of households with members aged ≥ 65 years were selected and categorized as solitary elderly female, solitary elderly male, or couple (one elderly female and one elderly male). Samples included 1,967 households in 1989-1990, 2,219 households in 1994-1995, 2,533 households in 2000-2001 and 2,441 households in 2005-2006. RESULTS: The simultaneous effects of sociodemographic variables and time were significant for all food groups (P<0.001). The highest contribution for the total household food availability was found for cereals, potatoes, alcoholic beverages, non-alcoholic beverages and fruits. The effects were large for "household food availability" and medium for "elderly household type", "urbanization degree", "income", "food expenses" and "eating out expenses". Solitary elderly male households had the highest proportion of cereals and alcoholic beverages, whilst solitary elderly female households had higher availability of milk/milk products and fruits. Households located in urban areas had higher contribution of milk/milk products while rural, had higher contribution of potatoes. CONCLUSIONS: The simultaneous effect of the studied variables on food group contribution to total household food availability can be considered when addressing dietary recommendation for providing an insight into the motivations associated with food purchases.

Diet quality in elderly Portuguese households.

OBJECTIVE: To identify diet quality time trends in Portuguese elderly households and the association of diet quality with sociodemographic characteristics. DESIGN: Set of four cross-sectional studies. SETTING: Portuguese population. SUBJECTS: Nationally representative samples from Household Budget Surveys (1989-1990, 1994-1995, 2000-2001 and 2005-2006 versions). Households with members aged ≥ 65 years were categorized as solitary elderly female, solitary elderly male, or elderly couple (composed of one elderly female and one elderly male) and compared with adult households with the same composition. METHODS: Diet quality was assessed through a revised version of the Healthy Diet Indicator (HDIr). Univariate and multiple backward linear regression models were used to study the association with sociodemographic characteristics. RESULTS: Mean values of dietary index were low and the proportion of elderly households with low diet quality (HDIr≤4) was high (between 47.4% and 68.4%). However, the frequency of HDIr inadequacy for adult household was even higher (P<0.05). In general, adjusted coefficients for survey year, educational level of the household head, and eating out expenses were inversely associated with HDIr; whilst semi-urban and rural location of the households predicted higher HDIr values. Exceptions were found in elderly male households where the educational level of the household head was positively associated with HDIr values. CONCLUSIONS: Overall, diet quality was low and decreased over time but lonely elderly female and elderly couple households had higher values of HDIr. Adherence to a healthier diet was associated with lower educational level of the household head and location of the household in less urbanized areas.

Nutritional risk of European elderly.

BACKGROUND/OBJECTIVES: The elderly constitute a population group with a high prevalence of non-communicable chronic diseases and high risk of malnutrition. The aim of this study was to identify factors associated to nutritional risk in free-living European elderly. SUBJECTS/METHODS: The sample included 644 European citizens, free living in the community, aged 65 years or more. The sample was quota controlled for age groups (65-74, ≥75 years), gender (male/female) and living circumstances (living alone/with others). Logistic regression was performed to identify factors associated with nutritional risk. RESULTS: Several variables regarding socio-demographic characteristics, food choice, health status and the satisfaction with food-related life were included in the analysis. According to the recoded score of the 'Determine your nutritional health' (NSI checklist), 53% of the elderly were at nutritional risk. Nutritional risk was more likely to occur in elderly who considered that it was more important to choose foods 'easy to chew'; with lower average number of fruit and vegetables (F&V) intake episodes and lower score for general health. It was also found in non-married participants; those that did not identify changes in their appetite; and those that felt changes in health status. In this sample, the lowest nutritional risk was found for body mass index (BMI) around 18.5 kg/m(2). Country of residence, gender and age were not found to have a significant effect on nutritional risk. CONCLUSIONS: Attention should be drawn to the living circumstances, changes in appetite or health, the general heath perception, F&V intake, choice of foods easy to chew and having a low or high BMI.

Growth trends in boys and girls (10-17 years-old) from autonomous region of Madeira, Portugal between 1996-1998 and 2007-2009.

BACKGROUND: Growth trends have never been studied in adolescents of the Autonomous Region of Madeira, Portugal. AIMS: To analyse growth trends in weight, height, body mass index (BMI), waist circumference (WC), mid-upper arm circumference (MUAC) and triceps skin-fold thickness (TST) of adolescents (10-17 years old) of the Autonomous Region of Madeira between 1996-1998 and 2007-2009. SUBJECTS AND METHODS: A cross-sectional study was carried out between 2007-2009, including 4314 adolescents, 2237 girls and 2077 boys (10-17 years old). To study secular growth trends, data were compared with a sample from 1996-1998, comparing the means for each anthropometric variable by age and sex using the independent-sample t-test. RESULTS: An average increase was found in weight of 5.8 kg in boys and 6.3 kg in girls; in height of 3.0 cm in boys and 3.7 cm in girls; in BMI of 1.5 kg/m(2) in boys and 1.7 kg/m(2) in girls; in WC a difference of 5.6 cm and 4.9 cm for boys and girls, respectively, and for MUAC a difference of 2.7 cm in boys and 2.0 cm in girls. No differences were found in TST in boys, but in girls an increase of 1.2 mm was observed. CONCLUSIONS: A general increase in anthropometric measurements, more marked in weight, BMI, WC and MUAC and at younger ages, was observed.

Markers of metabolic syndrome in obese children before and after 1-year lifestyle intervention program.

PURPOSE: Excess weight may be related to the development of adverse cardiometabolic risk factors in children. The aim of this study was to evaluate the effect of a lifestyle intervention program (nutrition and exercise counseling) on anthropometric parameters and metabolic syndrome (MS) components in Portuguese overweight/obese children. METHODS: A total of 83 overweight/obese children aged 7-9 years were assigned to a 1-year individual or group-based treatment (GT); 61 children (z-score BMI (zBMI): 1.93 ± 0.28; 27 boys and 34 girls) completed the program. Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. RESULTS: The overweight/obese children, compared to normal-weight ones, presented significantly higher blood pressure, total-cholesterol, total-cholesterol/high density lipoprotein cholesterol (HDL) ratio, triglycerides, Apolipoprotein B and C-reactive protein levels, while HDL and Apolipoprotein A-I were significantly lower. At baseline, the prevalence of MS was 16.4% in overweight/obese and 0% in normal-weight children. The number of components of MS was significantly higher in children with higher zBMI. Lifestyle intervention led to a significant improvement in zBMI, waist circumference/height ratio, HDL, triglycerides, Apolipoprotein A-I, and Apolipoprotein B levels. The prevalence of MS decreased to 14.8%. The GT intervention seems to be more successful, with a significant decrease in zBMI and an increase in HDL and a lower drop-out rate. CONCLUSIONS: Overweight/obese children have multiple risk factors associated with the MS. Lifestyle intervention, both individual and group-based treatment, led to an improvement in the degree of overweight/obesity and in MS components.

General parenting styles are not strongly associated with fruit and vegetable intake and social-environmental correlates among 11-year-old children in four countries in Europe.

OBJECTIVES: To investigate whether fruit and vegetable (F&V) intake in 11-year-olds, and social-environmental correlates of F&V intake such as parental modelling and encouragement, family food rules and home availability, differ according to general parenting styles in Belgium, The Netherlands, Portugal and Spain. DESIGN: Cross-sectional study. SETTING: Primary schools in four countries. SUBJECTS: Pupils and one of their parents completed questionnaires to measure F&V intake, related social-environmental correlates and general parenting styles. The sample size was 4555 (49.3 % boys); 1180 for Belgium, 883 for The Netherlands, 1515 for Portugal and 977 for Spain. Parenting styles were divided into authoritative, authoritarian, indulgent and neglectful. RESULTS: No differences were found in F&V intake across parenting styles and only very few significant differences in social-environmental correlates. The authoritarian (more parental encouragement and more demands to eat fruit) and the authoritative (more availability of fruit and vegetables) parenting styles resulted in more favourable correlates. CONCLUSION: Despite earlier studies suggesting that general parenting styles are associated with health behaviours in children, the present study suggests that this association is weak to non-existent for F&V intakes in four different European countries.

Portuguese households' diet quality (adherence to Mediterranean food pattern and compliance with WHO population dietary goals): trends, regional disparities and socioeconomic determinants.

OBJECTIVE: To evaluate households' diet-quality trends and regional disparities, as well as to identify the influence of its socioeconomic determinants. METHODS/SUBJECTS: Two dietary indexes were applied: a revised Healthy Diet Indicator version (HDIr) and the Mediterranean Adequacy Index (MAI). The socioeconomic differences between households with low-diet quality (if their scoring in HDIr or MAI was below the national median) and the remaining ones were analysed by means of logistic regression. Representative samples of households among each region were analysed. RESULTS: Adherence to a Mediterranean diet was poor in all Portuguese regions; the proportion of households adhering to it has diminished in the North, Centre, Lisbon and Tejo valley. The proportion of households with high HDIr decreased in the North, Centre, Lisbon and Tejo valley and Algarve. In multivariate analysis, households whose head had secondary or higher education, living in semi-urban or urban areas, from the Azores region, within the higher income or outside home food expenditures groups were more likely to be in low-quality diet. CONCLUSIONS: The decreasing adherence to a Mediterranean food pattern and the diminishing compliance with World Health Organization dietary goals show that Portuguese households have reduced their diet quality. The observed influence of urbanization and region on diet quality highlights the importance of considering regional nutrition strategies.

A new food guide for the Portuguese population: development and technical considerations.

The methodological approach used for the development of a new food guide for the Portuguese population is discussed. The new food guide, composed of seven groups, was achieved with the assistance of an expert panel, using existing international recommendations and nutrient composition tables. A range of recommended food portions was established for the groups of fats and oils; milk and dairy products; meat, fish, seafood, and eggs; pulses; potatoes, cereals, and cereal products; vegetables; and fruits. Posters and leaflets were produced and presented to the media with the support of health authorities and the scientific community. The dissemination materials were freely distributed to institutions and professionals responsible for health promotion.

Validity of a questionnaire to assess fruit and vegetable intake in adults.

OBJECTIVE: To validate a method for assessing fruit and vegetable intake among adults in a population of low intake. The method assesses mean intake and ranks individuals by their usual intake. DESIGN: A precoded fruit and vegetable Questionnaire included a 24-h recall and a food frequency. The participants filled in the Questionnaire, a week later they started a 7-day food record, 1-day weighed record and 6 days using household measures. SUBJECTS: Following advertisements 40 participants were recruited, 36 returned food records(mean age=37 years). RESULTS: No difference was observed between the average intake yielded by the 24-h recall and that from the 1-day weighed food record of fruits or vegetables. Correlation coefficients between results from the food frequency questionnaire and the 7-day food records were 0.45 (P=0.007) for vegetables, 0.63 (P<0.001) for fruits and 0.73 (P<0.001) for fruits and vegetables combined. Cross-classification into quartiles showed that the proportion of participants in the same or the adjacent quartile of the intake distribution were 94% for fruit intake and 80% for vegetable intake. Registered intake of fruits and vegetables was higher the first 4 days of the record than the last 3 days (P=0.002). The 4-day food record correlated with the food frequency questionnaire in similar manner as the 7-day record. CONCLUSION: The present study indicates that the precoded 24-h recall may be valuable tool for measuring average intake of fruits and vegetables among adults in a population of low intake. Moreover, the food frequency questionnaire was valid for ranking individuals according to their usual intake. A 4-day food record might be sufficient when validating food frequency questionnaires for fruits and vegetables.

Cognitive restraint is associated with higher intake of vegetables in a sample of university students.

The main objective of this study was to determine the association between cognitive restraint, nutritional intake and eating patterns in free-leaving subjects. We administered a questionnaire that included information about eating behaviour (restraint, disinhibition, and hunger), dietary intake, and physical activity; 380 students (60% female) completed the study. The association of restraint (low/high) and disinhibition (low/high) with dietary intake was tested using MANOVA in a 2x2 factorial design. Statistically significant main effects were further analyzed using ANOVAs. To identify eating patterns, factorial analysis was employed. Among women, high restrainers reported lower consumption of energy, pastry, and starchy foods, and higher consumption of vegetables, and fish, than low restrainers. In male subjects, high restrainers consumed significantly more vegetables than low restrainers. The major food pattern in female restrainers aggregate: higher consumption of legumes and fruit intake; and lower consumption of pastry, sugar, and starchy foods. In restrained men, the more important food pattern consists of vegetable soup, fruit, milk, and eggs. These differences should be considered in clinical interventions for individuals seeking a better body weight control.

Physical activity in European seniors: attitudes, beliefs and levels.

BACKGROUND: It is important to study the factors which modulate ageing, among which physical activity (PA) seems to have a very important role on the health status and quality of life of the elderly. To be effective, any intervention specifically targeted to promote PA should be based on the knowledge of the population, namely on their needs, attitudes and behaviour. OBJECTIVE: To identify in the elderly European population, the attitudes to PA and health, in order to define adequate strategies of promotion. DESIGN: Cross-sectional survey using a face-to-face interview-assisted questionnaire. This project belongs to the multicentric Pan-EU Survey on Consumer Attitudes to PA, Body Weight and Health under the leadership of the Institute of European Food Studies - Dublin with the cooperation of members from all European Union countries. 1914 European citizens, aged > or = 65, were interviewed. The data's descriptive analysis, was followed by univariate analysis to characterise the study's sample. RESULTS: PA was not viewed by the elderly as a major health determinant as it was ranked only 5th (18%), preceded by food (42%), smoking habits (40%) and alcohol (24%). 41% of elderly were not engaged in any type of PA, but 50% dedicated more than 3,5 hours/week on various activities. At EU level the most common activities included walking, gardening, cycling and swimming. 64% of the elderly thought that they do not need to do more PA, and 37% were in the pre-contemplation stage as they were currently not very physically active and they didn't intend to become physically active in the next 6 months. A large variation in attitudes, and behaviours in relation to PA, was found amongst European countries. CONCLUSION: Programmes to promote PA need to be tailored to the different countries in order to increase/maintain PA in the elderly.

Healthy eating in European elderly: concepts, barriers and benefits.

BACKGROUND: The promotion of healthy eating is more likely to be effective if based on the understanding of how the elderly perceive their own diets and healthy eating. OBJECTIVES: The objectives of this study were to identify in the elderly European population, the attitudes to food, nutrition and health, in order to define adequate strategies of health promotion. DESIGN: Cross-sectional survey using a face-to-face interview-assisted questionnaire. This project belongs to the multicentric Pan-EU Survey on Consumer Attitudes to Food, Nutrition and Health under the leadership of the Institute of European Food Studies - Dublin with the cooperation of members from all EU countries. 1843 European citizens, aged > or = 65, were interviewed. The data's descriptive analysis, was followed by univariate analysis to characterise the study's sample according to the defined objectives. RESULTS: The most important factors influencing elderly's food choice were quality and freshness (54%), trying to eat healthy and price (8%). Healthy eating was defined as "less fat" (37%) "more fresh vegetables and fruit" (34%), and "natural foods" (11%). To stay healthy (36%), to prevent disease (26%) and to promote quality of life (10%) were the major benefits associated to healthy eating. However several barriers to the adoption of healthy eating were identified, namely self-control (27%), the resistance to change (23%) and price (15%). 86% of the elderly people believe they don't need to change their eating habits as they already eat healthily. CONCLUSION: Results of this study will help to improve eating habits in the elderly, as health professionals will be able to choose the most appropriate strategies for the different groups and settings, and provide a base for future interventions in European countries for this growing age group.

Portuguese household food availability in 1990 and 1995.

OBJECTIVE: To examine the changes in Portuguese household food availability from 1990 to 1995. DESIGN: Using the DAta Food NEtworking (DAFNE) classification scheme for nutritional and socio-economic variables, data from the Portuguese Household Budget Surveys collected in 1989/90 and 1994/95 were analysed. The mean availability (quantity person(-1) day(-1)) for the total population, by locality and by level of education of the household head, was computed for each of the main food and beverage groups. SETTING: Portugal, 1989 to 1995. RESULTS: Although still among one of the countries with high availability of cereals, pulses, fish and seafood and olive oil, Portugal is gradually moving away from the traditional 'Mediterranean diet'. Between 1989 and 1995, the availability of complex carbohydrates and olive oil was reduced, while the availability of protein-supplying food groups increased. Considerable disparities can be observed by locality and by the level of education of the household head. Households in urban areas and of higher socio-economic status are the main actors of the changes in 'traditional' food habits. CONCLUSION: Although these findings are based on household food availability rather than consumption, they indicate the direction of the changes taking place in the Portuguese diet and can be used effectively by agriculture specialists, nutrition experts and policy makers.

Preferential recruitment of phagocytes into the lung of patients with advanced acquired immunodeficiency syndrome and tuberculosis.

Limited data are available on the cellular and immunocytological characteristics of bronchoalveolar lavage (BAL) fluid in individuals infected with the human immunodeficiency virus (HIV) and pulmonary tuberculosis (TB). The immune host response against tuberculosis in early HIV-infection may differ from that in later stages of HIV disease, as is strongly suggested by different clinical and radiographic patterns. We studied the cellular elements in the lungs of 15 HIV-infected patients with advanced immunosuppression and pulmonary tuberculosis (TB/AIDS). The findings were compared with data from four other groups: 1) 15 HIV-seronegative patients with pulmonary TB; 2) 12 HIV-seropositive TB patients without previous AIDS-defining illnesses and with CD4+ >200 cells mm(-3); 3) five AIDS patients without pulmonary lesions; and 4) five healthy controls. BAL fluid and differential cell counts, as well as lymphocyte subsets, were determined. Despite a low CD4/CD8 ratio, the TB/AIDS group had a higher absolute number of CD8+ lymphocytes in the BAL fluid than the other groups. Alveolar macrophages and neutrophils were significantly increased in TB/AIDS patients compared to control groups. The number of eosinophils was increased in TB/HIV--patients but not in TB/AIDS patients. We conclude that tuberculosis in late stage HIV-infected patients has a distinct inflammatory cell profile, suggesting an enhanced compensatory mechanism that amplifies the unspecific inflammatory reaction.

Regional, demographic and national influences on attitudes and beliefs with regard to physical activity, body weight and health in a nationally representative sample in the European Union.

INTRODUCTION: Although the benefits of physical activity regarding body-weight gain and health in general are now widely accepted, physical activity levels remain low among citizens in the western world. This could be attributed to certain attitudes and beliefs about physical activity. Identifying and understanding these parameters would be the first step in an attempt to increase the levels of physical activity in populations generally characterized as having a sedentary lifestyle. OBJECTIVE: The aim of the present study was to identify the attitudes and beliefs regarding physical activity, body weight and health in a nationally representative sample in the EU and in particular to explore the demographic and national (cultural) influences on attitudes towards physical activity. DESIGN: In each member state of the EU, approximately 1000 adults aged 15 years and over, were selected to complete an interviewer-assisted face-to-face questionnaire. Overall, a sample of 15,239 individuals in the EU participated in the study. Subject selection was quota-controlled to ensure samples in each country were nationally representative. RESULTS: On a European level wide variations were observed regarding the levels, beliefs and attitudes towards physical activity. More positive beliefs were observed among Finns, while less positive beliefs were observed among southern Europeans. A similar pattern was observed for attitudes, with the Portuguese having the highest percentage feeling that they do not need to be more physically active than they already are. However, most southern Europeans felt that a campaign would encourage them to become more active than they already are. On a demographic level, the youngest, more educated and most physically active subjects had more positive attitudes and beliefs towards physical activity and the health benefits derived from it; while for the overweight, beliefs and attitudes toward physical activity were related primarily to the benefits related to weight control. CONCLUSIONS: Lower levels of physical activity, an unwillingness to become active among non-participants and confusion regarding the weight gain benefits and general health benefits of exercise were reported more frequently among southern Europeans and older and less educated subjects. The Finns scored highest in all these parameters, possibly due to the programmes implemented and the beliefs and behaviour changes observed in this country during the last few years. The actions taken in Finland and their benefits could be employed appropriately in the other European states.

Physical activity levels and body weight in a nationally representative sample in the European Union.

OBJECTIVES: The main objectives of this pan-European study were: (1) to identify different types of physical activity and the time devoted to them, (2) to assess physical activity/inactivity at work and in leisure time, and (3) to determine self-reported body weight and height. DESIGN AND SUBJECTS: In each member state of the EU, approximately 1000 adults, aged 15 years or more, were selected to participate in an interview-assisted face-to-face questionnaire on physical activity and body weight. In each country, sample selection was quota-controlled to ensure national representativeness. Overall, 15,239 subjects in the EU completed the study. RESULTS: On average in the EU, nearly three-quarters of the population participate in some kind of activity. In general, the highest proportions of participants were found in the Nordic countries and the lowest in the southern ones. At the European level, the five most common activities include walking, gardening, cycling, keep fit and swimming. Higher participation rates were found among men, younger subjects and those with a higher level of education. The majority of Europeans fall within the normal body mass index (BMI) range but more than one-third are overweight (31%) or obese (10%) and 11% have a BMI below 20. CONCLUSIONS: Several risk groups related to physical activity emerge from this survey: women, those with a lower level of education, older subjects, the overweight/obese and the underweight. Programmes to promote physical activity need to be tailored to the different groups identified in each country/region in order to increase adherence of non-participants and for the maintenance of those already engaged in activities.