Epidemiology and management of obesity in Portugal.

Although new studies are needed, the combination of the results of several studies in adults, adolescents and children suggests that the prevalence of obesity is increasing and is close to that of the developed countries with the highest prevalence. A public health approach against obesity has started only very recently.

Nutrition and osteoporosis: facts and uncertainties about calcium and vitamin D recommendations.

The current calcium recommendations in Europe are lower than in USA. During the growth, although intervention studies had shown bone mass gains with calcium supplementation, these effects did not persist after withdrawal of the supplements and so the long-term effects of calcium supplementation on peak bone mass are not known. Besides, the relative importance of the several factors that influence peak bone mass needs to be established.

Gender, cohort and geographical differences in 10-year mortality in elderly people living in 12 European towns.

BACKGROUND: In 1988/89, 2586 randomly selected elderly of both sexes born between 1913 and 1918 and living in 19 centres of 12 European countries participated in the SENECA Study on Nutrition and the Elderly in Europe. Differences in nutritional and health status as well in lifestyle factors, namely dietary habits, between the elderly living in the several centres were observed. OBJECTIVE: To study gender, cohort and geographical differences in 10-year mortality in elderly people from the SENECA Study. DESIGN: Longitudinal study. Information on vital status of the elderly people who participated in the baseline study performed in 1988/89 was obtained by standardized procedures in 1999, until 30 April. RESULTS: In all centres, men had higher mortality rates than women. A cohort effect in mortality is observed, particularly in men. A geographical pattern in mortality also more evident in men is shown. In fact, elderly men living in Eastern Europe, represented by the Polish centre, had the highest average hazard rate, 108, while those living in Southern Europe, including the French, the Swiss, the Italian, the Spanish and the Portuguese centres, had the lowest average hazard rates, ranging from 52 in Betanzos/Spain to 67 in the two French towns. Finally, those living in Northern Europe, represented by the Danish, the Dutch and the Belgian centres had intermediate values, from 68 in Roskilde/ Denmark to 85 in Culemborg/the Netherlands. Kaplan-Meier survival curves confirmed the gender, cohort and geographical differences in survival (log-rank test P 0.0001). CONCLUSION: The gender and geographical differences in mortality observed in elderly people living in different regions of Europe put in evidence the potential for increasing the life expectancy in Europe through intervention programs tackling the lifestyle and socio-economic factors behind those differences.

Selection of methodology to assess food intake.

OBJECTIVE: The aim of the EFCOSUM project was to develop a method to estimate both acute and usual consumption levels in European countries and for the sake of comparison, a common basic method for dietary assessment was needed. The method should allow a reliable comparison of the intake of relevant dietary indicators among large population groups. DESIGN AND RESULTS: The selection of methodology was based on the available literature and the expertise of the participants. To guide the selection process, decision trees containing all relevant moments of choice, alternatives and criteria for the selection of a method for food consumption measurement were developed. Considering that insight into average food and nutrient intake and their distribution in well-defined groups of individuals was important, it was decided that for the monitoring of the selected dietary indicators food consumption data should be collected at an individual level. Different methods were reviewed (24 h recall, dietary record, food frequency questionnaire, dietary history method). CONCLUSIONS: Since the 24 h recall method is applicable in large European populations of different ethnicity, has a relatively low respondent and interviewer burden, is open-ended and is cost-effective, this method can be considered as the best method for EFCOSUM to get population mean intakes and distributions for subjects aged 10 y and over in different European countries. Usual intake should be estimated by statistical modelling techniques, using two non-consecutive 24 h recalls and a food list to assess the proportion non-users for infrequently consumed foods.

Vitamin and mineral intakes in elderly.

OBJECTIVE: To assess the dietary intake of vitamins and minerals in elderly Portuguese aged 81-86 years. DESIGN: Cross-sectional study in elderly born 1913-1918, who are participants of the SENECA study. SETTING: Vila Franca de Xira, small town located near Lisbon. SUBJECTS AND METHODS: Using standardized methodology data have been collected from 81 elderly subjects, 41 men and 40 women,who are the survivors of the participants in the SENECA baseline study performed in 1988/89. Dietary intake data were collected using a 24-hour dietary recall interview. RESULTS AND DISCUSSION: The nutrient densities were higher than the values observed in the follow up study in 1993, except for vitamin A in both sexes and iron in women, and they were lower than "Nordisk Recommended Daily Nutrient Densities" only for vitamin A and calcium in both sexes and iron in women. The percentage of elderly below the Lowest European Recommended Dietary Intake (LRDI) increased, in relation to the 1993 follow up of SENECA study, for the micronutrients in men and in women, except for vitamins B1 and B6 in women. The highest percentage of subjects with micronutrient intakes below LRDI was detected for vitamin A, 78% in men and 73% in women. Regarding calcium the percentage of subjects below LRDI was 39% in men, and 45% in women, and for iron was 49% in men and 73% in women. CONCLUSION: An increased risk of micronutrient deficiencies was detected.

Association between trans fatty acid intake and cardiovascular risk factors in Europe: the TRANSFAIR study.

BACKGROUND: High intakes of trans fatty acids (TFA) have been found to exert an undesirable effect on serum lipid profiles, and thus may increase the risk for cardiovascular disease. OBJECTIVES: Investigation of the association between TFA intake and serum lipids. DESIGN: Cross-sectional study in eight European countries (Finland, France, Greece, Iceland, The Netherlands, Portugal, Spain, Sweden) among 327 men and 299 women (50-65 y). Using a dietary history method, food consumption was assessed and TFA intake was calculated with recent figures on TFA levels of foods, collected in the TRANSFAIR study. RESULTS: Mean (+/-s.d.) TFA intake was 2.40+/-1.53 g/day for men and 1.98+/-1.49 g/day for women (0.87+/-0.48% and 0. 95+/-0.55% of energy, respectively), with the highest consumption in Iceland and the lowest in the Mediterranean countries. No associations were found between total TFA intake and LDL, HDL or LDL/HDL ratio after adjustment for cardiovascular risk factors. Additional adjustment for other fatty acid clusters resulted in a significant inverse trend between total TFA intake and total cholesterol (Ptrend<0.03). The most abundantly occurring TFA isomer, C18:1 t, contributed substantially to this inverse association. The TFA isomers C14:1 t9, C16:1 t9 and C22:1 t were not associated or were positively associated with LDL or total cholesterol. CONCLUSIONS: From this study we conclude that at the current European intake levels of trans fatty acids they are not associated with an unfavourable serum lipid profile. SPONSORSHIP: Unilever Research Laboratorium, the Dutch Dairy Foundation on Nutrition and Health, Cargill BV, the Institute of Food Research Norwich Laboratory, the Nutrition Branch of the Ministry of Agriculture, Fisheries and Food, the International Fishmeal and Oil Manufacturers' Association, Kraft Foods, NV Vandemoortele Coordination Center, Danone Group, McDonalds Deutschland Inc, Danish Veterinary and Food Administration, Valio Ltd, Raisio Group. European Journal of Clinical Nutrition (2000) 54, 126-135

Longitudinal changes in the intake of energy and macronutrients of elderly Europeans. SENECA Investigators.

OBJECTIVE: To assess longitudinal changes in intakes of energy and macronutrients in elderly Europeans. DESIGN: Longitudinal study including a dietary assessment in 1988/1989, which was repeated in 1993. SETTING: Serial data were collected in nine European towns: Belgium: Hamme (H/B); Denmark: Roskilde (R/DK); France: Haguenau (H/F) and Romans (R/F); Italy: Padua (P/I); the Netherlands: Culemborg (C/NL); Portugal: Vila Franca de Xira (V/P); Spain: Betanzos (B/E) and Switzerland: Yverdon (Y/CH). In other centres dietary intake data were collected in 1993 only: Portugal: Coimbra (C/P); Poland: Marki (M/PL); Northern Ireland: Ballymoney-Limavady-Portstewart (BLP/NI/UK) and United States: Mansfield (Connecticut) (M/CT/USA). SUBJECTS AND METHODS: Using standardized methodologies, data were collected from a random stratified sample of elderly men and women born between 1913 and 1918. In 1993 dietary intake data were collected from 1125 subjects by a modified validated dietary history method. RESULTS: Over the 4-year study period, a decline in mean energy intake of one MJ or less per day was observed in most towns, which was significant (P < 0.01) in only four of the towns. The within- and between-centre variation of change was large. Overall, a slight decline was reported for all macronutrients and with the exception of protein, large within and between centre variations were observed in both men and women. CONCLUSION: Intake of energy and macronutrients was found to decline with age. This may be of special concern for small eaters.

Longitudinal changes in the intake of vitamins and minerals of elderly Europeans. SENECA Investigators.

OBJECTIVE: To assess longitudinal changes in intake of vitamins and minerals in elderly Europeans. DESIGN: Longitudinal study including the collection of dietary intake data in 1988/1989 and in 1993. SETTING: Baseline and follow-up data were collected from nine European towns: Belgium: Hamme (H/B); Denmark: Roskilde (R/DK); France: Haguenau (H/F) and Romans (R/F); Italy: Padua (P/I); the Netherlands: Culemborg (C/NL); Portugal: Vila Franca de Xira (V/P); Spain: Betanzos (B/E) and Switzerland: Yverdon (Y/CH). In four other towns dietary intake data were collected in 1993 only: Portugal: Coimbra (C/P); Poland: Marki (M/PL); Northern Ireland: Ballymoney-Limavady-Portstewart (BLP/NI/UK) and United States: Mansfield (Connecticut) (M/CT/USA). SUBJECTS AND METHODS: Using standardized methods, data were collected from a random sample of 658 elderly men and 731 women born between 1913 and 1918. Dietary intake data were collected by a validated modified dietary history method. RESULTS: A significant decrease in the median intake of vitamin B1, vitamin B2, vitamin B6, vitamin C or iron was observed in several towns and for most of these nutrients in H/B, R/DK, R/F and V/P. Over the 4-y follow-up period, the proportion of elderly people with nutrient intakes below the lowest European RDI's increased for various nutrients in most towns, whereas the nutrient density of the diet, especially for iron and vitamin C, decreased significantly only in a few towns. The proportion of elderly people taking nutrient supplements varied from less than 5% in H/B to 60% in R/DK. CONCLUSION: The observed decrease in intake of some vitamins and minerals in most of the participating towns, indicates an increased risk for malnutrition in elderly Europeans.