How is the process of setting micronutrients recommendations reflected in nutrition policies in Poland? The case study of folate.

INTRODUCTION AND OBJECTIVE: Ensuring the adequate intake of micronutrients by populations is an important aspect of public health. This study aims to elucidate the process of setting nutrition recommendations and the development of subsequent policies associated with micronutrients in Poland by using the case study of folate. MATERIAL AND METHODS: The study was based on 13 interviews conducted between October 2010 - February 2011, and desk research comprising a review of the associated scientific literature and relevant documents, such as scientific opinions and reports of the meetings of scientific committees. The interviews were conducted within the EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence in the frame of the European Union's 6th Framework Programme. RESULTS: Since 1997, the Experts Group of the Ministry of Health recommended that all women of childbearing age should consume folic acid as a supplement to prevent neural tube defects in their offspring. The fortification of foodstuffs with folic acid is not obligatory. This study describes the revision of the folate nutrient recommendation and the process by which strategies to increase the intake of this vitamin by the Polish population were identified. The institution responsible for the choice and implementation of folate policy is the Ministry of Health and the National Food and Nutrition Institute is responsible for setting/updating the nutrient recommendations. CONCLUSIONS: The current Polish nutrition recommendations for folate are consistent with the levels set by most other countries. The constant improvement of nutritional knowledge on folate among consumers, especially young women, is necessary.

Supplementation with [6S]-5-methyltetrahydrofolate or folic acid equally reduces serum homocysteine concentrations in older adults.

Folic acid (FA) supplementation reduces the elevated serum homocysteine (Hcy) concentrations. [6 S]-5-methyltetrahydrofolate ([6 S]-5-MTHF) is an alternative to FA due to possible advantages, that is, no masking cobalamin deficiency. The study aim was to evaluate the effectiveness of [6 S]-5-MTHF in relations to FA supplementation in reducing the serum Hcy. Healthy volunteers, aged 50-65, had normal serum folate and did not use supplements with B-vitamins for 6 months. Forty subjects were divided into two groups: receiving 400 µg/d FA or the equimolar amount of [6 S]-5-MTHF. Blood was collected at baseline and after 4 weeks. In both groups, a significant decrease in the mean Hcy level after intervention period was observed. Supplementation with [6 S]-5-MTHF was slightly less effective, but not significantly, in Hcy lowering than FA (p = .243 between the groups), that is, by 7.8% and 13.4%, respectively. The [6 S]-5-MTHF was shown to be an adequate alternative to FA in reducing Hcy concentrations.

[Calcium, magnesium, iron and zinc in drinking water and status biomarkers of these minerals among elder people from Warsaw region]. / Wapn, magnez, zelazo i cynk w wodzie pitnej a stan odzywienia tymi pierwiastkami osób starszych z rejonu warszawskiego.

The aim of this study was to estimate the influence of calcium, magnesium, iron and zinc contents in drinking water on chosen parameters of nutritional status of these minerals in 164 elder people, 75-80 age, living in Warsaw region. Blood, hair and saliva were collected to assess the calcium, magnesium, iron and zinc nutritional status, while the samples of drinking water were collected to determine these minerals in water Mineral concentrations in blood, hair saliva and water were assessment using the atomic spectrophotometer absorption method It was showed that contribution of drinking water to calcium, magnesium, iron and zinc intake was: 15%, 4%, 5%, 9%, respectively. The relationship between the contents of these minerals in drinking water and their levels in the blood, hair and saliva had low correlation coefficients. It probably showed that homeostasis was maintained in the human body and other factors such as demographic or lifestyle factors were important.

[Diet quality and mortality in elderly people living in Warsaw Region]. / Jakosc diety a umieralnosc osób starszych zamieszkalych w rejonie warszawskim.

The aim of this study was to examine the relationship between indicators of diet quality and all-cause mortality in a group of elderly people. The study was carried out among 411 participants aged 75-80 years (190 men and 221 women). During this study 78 men (42%) and 79 women (36.6%) died. Quality of diet was evaluated using following indicators: Greek Mediterranean Diet Score (GMDS), Mediterranean Diet Score (MDS), Healthy Diet Indicator (HDI), Healthy Eating Index (HEI), Diet Quality Index (DQI), and Diet Quality Index-Revised (DQI-R). Among men there were not significant relationships between all-cause mortality and diet quality measured by the indicators. While the risk of all-cause mortality was statistically significantly lower in women with lower HDI (RR = 0.61; 95% CI: 0.37-0.99) and DQI-R (RR = 0.60; 95% CI: 0.37-0.96) compared to women with higher quality of diet. A similar tendency was shown for MDS indicator (RR = 0.65; 95% CI: 0.40-1.05). It was concluded that indicators used to assessment of diet quality were not good predictors of mortality in Polish population. Therefore to continue study in this field it is necessary to create new diet quality indicator more suitable to nutritional habits in Poland.

Dietary calcium and magnesium intake and mortality: a prospective study of men.

The authors examined the association of dietary calcium and magnesium intake with all-cause, cardiovascular disease (CVD), and cancer mortality among 23,366 Swedish men, aged 45-79 years, who did not use dietary supplements. Cox proportional hazards regression models were used to estimate the multivariate hazard ratios and 95% confidence intervals of mortality. From baseline 1998 through December 2007, 2,358 deaths from all causes were recorded in the Swedish population registry; through December 2006, 819 CVD and 738 cancer deaths were recorded in the Swedish cause-of-death registry. Dietary calcium was associated with a statistically significant lower rate of all-cause mortality (hazard ratio (HR) = 0.75, 95% confidence interval (CI): 0.63, 0.88; P(trend) < 0.001) and a nonsignificantly lower rate of CVD (HR = 0.77, 95% CI: 0.58, 1.01; P(trend) = 0.064) but not cancer mortality (HR = 0.87, 95% CI: 0.65, 1.17; P(trend) = 0.362) when the highest intake tertile (mean = 1,953 mg/day; standard deviation (SD), 334) was compared with the lowest (990 mg/day; SD, 187). Dietary magnesium intake (means of tertiles ranged from 387 mg/day (SD, 31) to 523 mg/day (SD, 38) was not associated with all-cause, CVD, or cancer mortality. This population-based, prospective study of men with relatively high intakes of dietary calcium and magnesium showed that intake of calcium above that recommended daily may reduce all-cause mortality.

[Influence of chosen lifestyle and diet factors on mortality among elderly people living in Warsaw and surrounding villages]. / Wplyw wybranych czynników stylu zycia i czynników zywieniowych na umieralnosc osób starszych zamieszkalych w Warszawie i wsiach rejonu warszawskiego.

The aim of this study was to examine the relationship between lifestyle factors, nutrients intake and all-cause mortality in a chosen group of elderly participants. The study was carried out among 411 participants aged 75-80 years (190 men and 221 women). During this study 78 men (42%) and 79 women (36.6%) died. In men higher risk of death (by 147%) was observed among participants with lower physical activity and intake of saturated fatty acid below median (32.7 g/d). In women higher risk of death was observed among participants with lower level of education (by 109%), lower physical activity (by 96%), smoking (by 336%), supplement used (by 56%), intake of protein below median (74.7 g/d), intake of dietary fiber above median (18.3 g/d) and intake of phosphorus above median (1167 mg/d). Research on survival set one direction for future studies in the field of nutritional epidemiology. Development of this part of science about nutrition in Poland may help to establish specific for elderly people directions for nutrition improving.

[Survival and habitual nutrient intake among elderly men]. / Przezywalnosc a spozycie wybranych skladników pokarmowych przez mezczyzn w wieku podeszlym.

The aim of this paper was to determinate whether the intake of energy and nutrients was associated with all-cause mortality in the elderly men of the Warsaw region. Data on the intake of energy and nutrients were collected using a 3-day record method, in spring 1999. The mortality follow-up period lasted until December 31, 2003. During this period 43 men (29.5 % subjects) died. The all-cause mortality was higher among subgroup of elderly men with lower intake of carbohydrates, dietary fiber, vitamin B1, vitamin B6, vitamin PP, potassium, phosphorus, magnesium, zinc, copper and among subgroup of men with lower intake of total fat, saturated and monounsaturated fatty acids.

[Role of folates in the nutrition of the elderly]. / Rola folianów w zywieniu osób starszych.

Inadequate folate intake and in consequence deficient of plasma folate status may have a negative impact on human health. Among elderly the most important effects are related to hyperhomocysteinemia, a significant risk factor for cardiovascular diseases, procarcinogenic effects and cognitive dysfunctions. To prevent such situation and improve the quality of life of elderly people, in Poland as in many other countries, different strategies for increasing folate intake were applied, among them food fortification. At the same time it is important to educate people because food fortification and individual diet supplementation applied together could be a risk of exceeding upper level of folate intake.

[Nutrition in Warsaw nursing homes in the opinion of their residents]. / Ocena wyzywienia w domach pomocy spolecznej w Warszawie na podstawie opinii pensonariuszy.

The aim of the study was to meet the opinions of NHs' residents about the meals quality and nutrition system, with special consideration of meal ambience in canteens (appearance, atmosphere, etc.). Besides, other information about residents was collected: their self-perceived health status, psychical condition, physical activity, appetite and nutritional habits. Most of the subjects were single women, mainly with medium/technical education level, living in NHs over 3 years. Most of the NHs' residents evaluated their health status as average or bad, independently of the age or gender. Every second person indicated that health, loneliness and the feeling of isolation in their homes were the main reasons for coming to NH. Every third person still felt the loneliness or depression after staying in NH. The physical and intellectual activity of elderly depended on self-perceived health status. Over half of the subjects assessed their appetite as good, and said that their body mass was stable during staying in NH. The statistically significant relationship was found between the self-evaluated weight change and both age and gender. Additionally, the relationship was observed between psychical condition of residents and their appetite as also between the psychical condition and weight change during living in NH. The majority of the subjects (85%) said that they liked the canteen appearance, and they did not want to change anything in it. More women than men thought that canteens were spacious, clean and furnished with good taste, and those differences were significant. Part of studied population (25%) had some reservations about the atmosphere in canteen during the meals, mostly because of too much noise. In the opinions of most of the residents (over 80%) the nutrition organisation in NHs was good. Over half of the subjects assessed the meals quality in NHs also as good. Only some comments were about insufficient quantities of fruits and vegetables and meal monotony.

[Health status of people aged 75-80 living in Warsaw and its regions]. / Sytuacja zdrowotna osób w wieku 75-80 lat mieszkajacych w Warszawie i okolicach.

Chosen health related problems of elderly aged 75-80 years, living in Warsaw region, were analyzed. Almost 32% of respondents perceived their health as poor or very poor, and 84% declared suffering from chronic diseases (mainly cardiovascular, leg problems and hypertensive). Almost 70% of respondents used medicines, the most frequently used medicines were antihypertensives, nitroglicerine and diuretics. Almost 30% of the examined persons had BMI > or = 30 kg/m2. More than 83% of respondents used the glasses, but only 5% used hearing-aid. More women than men had high level of total cholesterol and LDL-cholesterol.

[Anthropometric measurements as indicators of nutritional status of the elderly]. / Somatometria osób starszych jako wskaznik stanu odzywienia.

This review contains details on anthropometric measurements required for assessment of nutritional status in the elderly. These measurements provide indicators of fat tissue content or body composition and evaluate trends in nutritional status. Anthropometric measurements in the elderly are similar to these in other groups of population but they have to be adopted according to changes in constitution and posture of elderly and disabled people. The following measurements are presented: stature, weight, skinfold thickness and mid upper-arm, waist and hip circumferences. Derived measurements and indices of nutritional status are also discussed.