Nutrition and health among migrants in The Netherlands.

OBJECTIVE: this paper aims to give a broad overview of published data on nutrition and health among migrants in the Netherlands, as well as data on determinants of health. RESULTS AND CONCLUSIONS: Depending on the definition, 9 to 17% of the population belongs to the group 'migrants' and this proportion is expected to grow in the coming years. Roughly 2/3 of migrants are of the first generation and on average, they are younger than the Dutch population. Relatively few data concerning the health status of migrants are available. The diet of migrants showed both positive (macronutrients) and negative (micronutrients) differences with the general Dutch diet. The risk of overweight was high among both children and adult women, and the data suggest a higher risk for Turkish and Moroccan groups than for Dutch groups. The importance of health determinants, such as smoking, alcohol use and physical and social environment, was different for migrants than for the Dutch population; however, there were also differences between ethnic groups. The limited data on morbidity for migrants suggest higher risks than for the indigenous population. The same holds for mortality data, especially for the younger age groups. In general, the data that are available suggest that the health status of migrants was less favourable than that of the indigenous population. However, there were also differences between the various groups of migrants. The lower socio-economic position of migrant groups partly explained the differences in health status. Nevertheless, a study among Turkish people indicated that their health status was lower than that of Dutch people of comparable socioeconomic status.

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.

Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study.

BACKGROUND: Evidence on the relation between trans fatty acid intake and coronary heart disease is limited. We investigated this relation in a Dutch population with a fairly high trans fatty acid intake, including trans fatty acids from partly hydrogenated fish oils. METHODS: We prospectively studied 667 men of the Zutphen Elderly Study aged 64-84 years and free of coronary heart disease at baseline. We used dietary surveys to establish the participants' food consumption patterns. Information on risk factors and diet was obtained in 1985, 1990, and 1995. After 10 years of follow-up from 1985-95, there were 98 cases of fatal or non-fatal coronary heart disease. FINDINGS: Between 1985 and 1995, average trans fatty acid intake decreased from 4.3% to 1.9% of energy. After adjustment for age, body mass index, smoking, and dietary covariates, trans fatty acid intake at baseline was positively associated with the 10-year risk of coronary heart disease. The relative risk for a difference of 2% of energy in trans fatty acid intake at baseline was 1.28 (95% CI 1.01-1.61). INTERPRETATION: A high intake of trans fatty acids (all types of isomers) contributes to the risk of coronary heart disease. The substantial decrease in trans fatty acid intake, mainly due to industrial lowering of trans contents in Dutch edible fats, could therefore have had a large public-health impact.

Intake of fatty acids in western Europe with emphasis on trans fatty acids: the TRANSFAIR Study.

OBJECTIVE: To assess the intake of trans fatty acids (TFA) and other fatty acids in 14 Western European countries. DESIGN AND SUBJECTS: A maximum of 100 foods per country were sampled and centrally analysed. Each country calculated the intake of individual trans and other fatty acids, clusters of fatty acids and total fat in adults and/or the total population using the best available national food consumption data set. RESULTS: A wide variation was observed in the intake of total fat and (clusters) of fatty acids in absolute amounts. The variation in proportion of energy derived from total fat and from clusters of fatty acids was less. Only in Finland, Italy, Norway and Portugal total fat did provide on average less than 35% of energy intake. Saturated fatty acids (SFA) provided on average between 10% and 19% of total energy intake, with the lowest contribution in most Mediterranean countries. TFA intake ranged from 0.5% (Greece, Italy) to 2.1% (Iceland) of energy intake among men and from 0.8% (Greece) to 1.9% among women (Iceland) (1.2-6.7 g/d and 1.7-4.1 g/d, respectively). The TFA intake was lowest in Mediterranean countries (0.5-0.8 en%) but was also below 1% of energy in Finland and Germany. Moderate intakes were seen in Belgium, The Netherlands, Norway and UK and highest intake in Iceland. Trans isomers of C18:1 were the most TFA in the diet. Monounsaturated fatty acids contributed 9-12% of mean daily energy intake (except for Greece, nearly 18%) and polyunsaturated fatty acids 3-7%. CONCLUSION: The current intake of TFA in most Western European countries does not appear to be a reason for major concern. In several countries a considerable proportion of energy was derived from SFA. It would therefore be prudent to reduce intake of all cholesterol-raising fatty acids, TFA included.

Study on food intake and energy expenditure during extreme sustained exercise: the Tour de France.

Food intake and energy expenditure (EE) were studied in five cyclists during the 22-day race of the Tour de France. The course is about 4000 km including 30 mountain passages (up to 2700 m altitude) and can be considered as one of the most strenuous endurance endeavors. Nutritional intake was calculated from daily food records. EE was estimated from sleeping time and the low activity period. EE during cycling was predicted based on detailed information. Mean energy intake (EI) was 24.7 MJ with a highest mean daily EI of 32.4 MJ. Mean EE was 25.4 MJ with a highest mean daily EE of 32.7 MJ. Relative contribution of protein, CHO, and fat was 15, 62, and 23 En% resp. 49% of EI was taken during the race resulting in a CHO intake of 94 g.h-1 representing 69 en%. It is questioned whether this amount of CHO is optimal in relation to CHO oxidation and performance. About 30% from CHO intake came from CHO-rich liquids. High EI resulted in high Ca and Fe intake. For vitamins, especially B1, this relation was not found. Vitamin B1 nutrient density dropped to 0.25 mg/4.2 MJ during the race caused by a large intake of refined CHO-rich food items. However, vitamin supplementation was high. Daily water intake was 6.71 with extremes up to 11.81. Therefore, the strategy of intake of large quantities of CHO-rich liquids seems to be the appropriate answer to maintain energy and fluid balance under these extreme conditions.

Reproducibility of urinary 3-methylhistidine excretion in human subjects consuming freely selected diets.

Eight males and six females consumed their normal diet for 9 weeks, except for weeks 3 and 9 when they followed a self-selected diet free of 3-methylhistidine (3MH) for five subsequent weekdays (days 1 to 5). Timed 24-hours urine collections were obtained on days 3, 4, and 5 of these 3MH-free dietary periods and on one day during weeks 1 and 7. At the group level, no differences in 3MH excretion (P greater than .05) between days 3, 4, and 5 in weeks 3 and 9 and between these weeks were observed. Reproducibility at the individual level was indicated by the within-subject coefficient of variation (CVw). CVw within weeks 3 and 9 was 2.5% and 5.1% for men and 4.8 and 8.0% for women. CVw between these weeks was highest when more than one measurement per week was performed. Relating 3MH to creatinine decreased the CVw between weeks. If muscle protein breakdown is to be measured at the individual level, a reasonably large biologic variation is to be taken into account and repeated measurements should be done to decrease the CVw.

Adequacy of vitamin supply under maximal sustained workloads: the Tour de France.

In the Tour de France competing cyclists must pedal about 4000 km over a period of three weeks with only one day allowed for rest. The course includes 30 mountains, the highest of which reaches an altitude of approximately 2700 m. The energy expenditure values of these cyclists range from a mean of 25.4 MJ/day to peak values of 32.7 MJ/day. These are the highest values that have ever been reported for a period longer than seven days. On the basis of the food records of 5 cyclists, it turned out that 62 En.% is derived from CHO, 15 En.% from protein, and 23 En.% from fat. Since the food choice is primarily focused on digestibility and energy content, this results in a frequent consumption of sweet cakes and CHO-rich fluids. Some 49% of the energy is consumed in between meals. Such a nutritional pattern leads to a lowering of the nutrient density especially with respect to the B-vitamins. Intake of vitamins B1, B2, B6, and C, including contribution from enriched sport drinks, was 1.97 mg, 4.96 mg, 2.40 mg, and 158 mg, respectively. Besides this, intramuscular injections of megadosis vitamins of B1, B2, B6, nicotinamide, pantothenic acid, and especially B12 did increase the intake drastically. This was reflected in high blood concentrations of vitamins. Except for folic acid, vitamins (B1, B2, B6, and B12) exceeded the upper limits of the values from a reference group, particularly B12, which exceeded the reference values by up to 400%. During the Tour, vitamin concentrations remained essentially unchanged.