Adherence to a Mediterranean-like dietary pattern in children from eight European countries. The IDEFICS study.

BACKGROUND: Despite documented benefits of a Mediterranean-like dietary pattern, there is a lack of knowledge about how children from different European countries compare with each other in relation to the adherence to this pattern. In response to this need, we calculated the Mediterranean diet score (MDS) in 2-9-year-old children from the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) eight-country study. SUBJECTS AND METHODS: Using 24 h dietary recall data obtained during the IDEFICS study (n=7940), an MDS score was calculated based on the age- and sex-specific population median intakes of six food groups (vegetables and legumes, fruit and nuts, cereal grains and potatoes, meat products and dairy products) and the ratio of unsaturated to saturated fats. For fish and seafood, which was consumed by 10% of the population, one point was given to consumers. The percentages of children with high MDS levels (>3) were calculated and stratified by sex, age and by having at least one migrant parent or both native parents. Demographic (sex and age) and socioeconomic characteristics (parental education and income) of children showing high (>3) vs low (⩽3) MDS levels were examined. RESULTS: The highest prevalence of children with MDS>3 was found among the Italian pre-school boys (55.9%) and the lowest among the Spanish school-aged girls (26.0%). Higher adherence to a Mediterranean-like dietary pattern was not associated with living in a Mediterranean country or in a highly educated or high-income family, although with some exceptions. Differences in adherence between boys and girls or age groups varied between countries without any general pattern. CONCLUSIONS: With the exception of Italian pre-schoolers, similar adherence levels to a Mediterranean-like dietary pattern have been observed among European children.

Exposure assessment within a Total Diet Study: a comparison of the use of the pan-European classification system FoodEx-1 with national food classification systems.

A Total Diet Study (TDS) consists of selecting, collecting and preparing commonly consumed foods purchased at retail level and analysing them for harmful and/or beneficial chemical substances. A food classification system is needed to link food consumption data with the contaminant concentration data obtained in the TDS for the exposure assessment. In this study a comparison was made between the use of a national food classification systems and the use of FoodEx-1, developed and recommended by the European Food Safety Authority (EFSA). The work was performed using data of six European countries: Belgium, Czech Republic, France, The Netherlands, Spain and the UK. For each population, exposure to contaminant A (organic compounds) and/or contaminant B (inorganic compound) was assessed by the Monte Carlo Risk Assessment (MCRA) software using the national classification system and FoodEx-1 for food consumption data and for TDS laboratory results. Minimal differences between both approaches were observed. This observation applied for both contaminant A and contaminant B. In general risk assessment will be similar for both approaches; however, this is not guaranteed. FoodEx-1 proved to be a valuable hierarchic classification system in order to harmonise exposure assessment based on existing TDS results throughout Europe.

Establishing a food list for a Total Diet Study: how does food consumption of specific subpopulations need to be considered?

A Total Diet Study (TDS) consists of selecting, collecting and analysing commonly consumed foods to obtain concentration data of different chemical compounds in foods as eaten. A TDS food list summarises the most consumed foods and represents the dietary habits of the general population of the country under study. The work reported here investigated whether TDS food lists that were initially designed for the whole population of the country under study also sufficiently cover the dietary pattern of specific subpopulations that are extra vulnerable for certain contaminants. The work was performed using data of three European countries: the Czech Republic, France and the UK. Each national food consumption database was combined with the corresponding national TDS food list (containing 336, 212 and 119 food items for the Czech Republic, France and the UK, respectively). The data were aggregated on the highest level of hierarchy of FoodEx-1, a pan-European food classification system, including 20 main FoodEx-1 groups. For the group 'milk and dairy products', the coverage of the consumption by the food list was investigated for more refined subgroups. For each food group or subgroup and country, the average percentage of coverage of the diet by the national TDS food list was calculated for different subpopulations, including children versus adults, women versus men, vegetarians versus non-vegetarians, and women of child-bearing age versus older women. The average diet of the different subpopulations was sufficiently covered by the food list of the Czech Republic and France. For the UK the average coverage was low due to a different food-coding approach and because food lists were not derived directly from national food consumption data. At the level of the 20 main food groups, differences between the subpopulations with respect to the average coverage of consumption by the TDS food list were minimal. The differences were more pronounced when looking in detail at the coverage of the dairy consumption. TDS food lists based on the mean consumption of the general population are also applicable to study the chemical exposure of different subpopulations, e.g. children, women of child-bearing age and vegetarians. This lowers the effort when performing a TDS.