The positive role of breastfeeding on infant health during the first 6 weeks: findings from a prospective observational study based on maternal reports.

This study aimed to report on adverse infant and maternal clinical outcomes, and investigate the relationship between infant feeding practice and such adverse clinical outcomes in infants during the first 6 weeks postpartum. From an eligible sample of 450 mother-term infant pairs recruited from the Coombe Women and Infants University Hospital in Dublin, 27.1% of infants (n=122) were maternally reported to have had an illness during the first 6 weeks that necessitated the provision of prescribed medication +/- general practitioner/paediatrician attendance +/- hospitalisation. Of these, 90 infants had > or =1 episode of infection +/- viral +/- gastro-intestinal-related condition. After adjustment, 'any' breastfeeding to 6 weeks was protective against such adverse infant outcomes (adjusted odds ratio [aOR] 0.44, P = 0.022). Attendance to the GP/paediatrician for > 1 visit (aOR 3.44, P = 0.000) and multiparity (aOR 1.76, P = 0.041) were also positively associated with such adverse infant outcomes. To decrease infant morbidity rates in Ireland, government investment in breastfeeding promotion, support and research should be a continued public health priority.

Maternal and infant nutritional supplementation practices in Ireland: implications for clinicians and policymakers.

This prospective Irish observational study examined maternal and infant nutritional supplement use. From an initial sample of 539 mothers recruited from the Coombe Women and Infants University Hospital in Dublin (during 2004-2006), 450 eligible mothers were followed up at 6 weeks and 6 months postpartum. Only 200 women (44.4%) complied with peri-conceptional folic acid at the recommended time with strong social patterning associated with its uptake. Almost 10% of the sample (n = 44) consumed a combined multivitamin and mineral supplement during pregnancy. A vitamin D-containing supplement was provided to only 5 (1.1%) and 15 (3.3%) infants at 6 weeks and 6 months, respectively. A national guideline that advises on adequate and safe use of both vitamin and multivitamin supplements during pregnancy with particular reference to vitamin A and D is warranted. Given the re-emergence of rickets in Ireland, and the reported morbidities associated with vitamin D insufficiency, promoting and monitoring compliance with 200 IU [5 microg] daily vitamin D supplements to all infants particularly those from higher risk groups from birth to 1 year, should be a public health priority.

Stages of dietary change among nationally-representative samples of adults in the European Union.

OBJECTIVE: To investigate the distribution across the different stages of change for each of the 15 participating European countries, and the effect of socio-demographic variables such as sex and education on this distribution. Also to assess the relationships between stages of change and influences of food choice, and other variables. DESIGN: A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. SETTING: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union. SUBJECTS: 14331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state. Subjects were divided into five different categories according to their attitudes towards 'changing their eating habits in order to eat healthier': (1) Precontemplation; do not consider any changes, (2) Contemplation; consider changes, (3) Decision; make plans to change, (4) Action; carry out the changes, and (5) Maintenance; maintained changes for more than six months. RESULTS: 52% of the subjects were in the precontemplation stage, whereas 31% of the subjects were in the maintenance stage. Two, one, and seven percent of subjects were in the contemplation, decision and action stage, respectively. In the Mediterranean countries, and in Germany, there were more people (55-64%) in the precontemplation stage, whereas in the Scandinavian countries there were less people in precontemplation stage (20-38%). The opposite was true for the maintenance stage, whereas women and people with a higher education level tended to be more in the maintenance stage. With respect to influence on food choice, subjects in precontemplation stage found that taste was more important, whereas people in maintenance stage found that health was more important. CONCLUSIONS: The stages of change model makes a useful distinction between people with different attitudes towards nutrition and health. Nutrition education can benefit from this distinction.

Sources used and trusted by nationally-representative adults in the European Union for information on healthy eating.

OBJECTIVE: To assess what sources of information on healthy eating are used and in particular to ascertain which are the most trusted by European adults. DESIGN: A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. SETTING: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union. SUBJECTS: 14331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state. RESULTS: The five sources of information most frequently selected were: TV/radio (29%), magazines and newspapers (27%), health professionals (26%), food packages (22%) and relatives/friends (22%). Those used by less than 5% of the population included vegetarian and slimming societies and women's organizations. The reliance on health professionals for information was stronger for females and tended to increase with age. The most trusted sources of information in almost all countries were health professionals (91%) and government agencies (80%) with great consistency across countries. 15% of Europeans stated that they did not get any information on healthy eating.

Perceived need to alter eating habits among representative samples of adults from all member states of the European Union.

OBJECTIVE: To examine the perceived need to alter eating habits among nationally-representative samples from each member state of the European Union (EU). DESIGN: A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. SETTING: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union. SUBJECTS: 14,331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state. RESULTS: 71% of EU subjects agreed with the statement 'I do not need to make changes to the food I eat, as it is already healthy enough'. There was wide variation between the member states ranging from 47% in Finland to 87% in Italy indicating agreement. Overall there was little difference between the sexes except in Austria, Belgium, Germany, Greece and Ireland, but the proportions of subjects agreeing with the statement generally increased with advancing age and decreased with higher levels of education. The effects of demographics were not consistent across member states. A total of 49% of EU subjects agreed with the statement 'I usually do not think of the nutritional aspects of the food I eat'. Significantly more females than males disagreed with the statement in all countries except Portugal. In all member states there were widespread beliefs that people in general should decrease their consumption of savoury snacks and increase their consumption of fruit and vegetables. CONCLUSIONS: The results of this study demonstrate that dietary advice may not be perceived as personally relevant among EU subjects. In addition important target groups for the promotion of healthy eating have been identified for example, males or subjects with low levels of education. Because of the variation in attitudes a single pan-EU healthy eating programme is unlikely to be effective for all countries or for different demographic groups.

Leaflet geometry and function in porcine bioprostheses.

The leaflet geometry and hydrodynamic function of five porcine bioprostheses have been studied and compared to a fresh tissue porcine valve. The neutral leaflet geometries in two high pressure fixed valves (Carpentier Edwards and Hancock) and two low pressure fixed valves (Carpentier Edwards Supra-Annular and Hancock 2) had been modified during fixation and mounting. The leaflets were extended or displaced downwards towards the base of the valve, producing a higher ratio of circumferential leaflet length to inter-commissural spacing than in the fresh tissue valve. This produced high bending strains in the commissural area of the open leaflet in hydrodynamic tests. The leaflet geometry of the fresh tissue porcine valve studied was defined by a cylindrical shell inclined at approximately 27 degrees to the base of the valve and showed reduced open leaflet bending strains. Leaflet opening at low flows was dependent on leaflet geometry. Geometrical changes which are induced during mounting and fixation produced higher bending strains in the commissural area of the open leaflets. These may be contributing factors to tissue degeneration and calcification in this area.

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.

Maternal health behaviours during pregnancy in an Irish obstetric population and their associations with socio-demographic and infant characteristics.

BACKGROUND/OBJECTIVES: To examine the prevalence and combined occurrence of peri-conceptional folic acid (FA) supplement use, smoking and alcohol consumption during pregnancy in a sample of women in Dublin, and determine the factors associated with these health behaviours. SUBJECTS/METHODS: A prospective observational study (2004-2006) involving the recruitment of 491 pregnant women from antenatal clinics in a Dublin maternity hospital, with postpartum follow-up of 450 eligible mothers. Data on FA use, maternal smoking and alcohol consumption patterns during pregnancy were collected from the antenatal patient-administered questionnaire, which was completed by participants, and returned to the investigator on the day of recruitment. RESULTS: The median gestational age of women at recruitment was 36 weeks. A combined 24.2% of mothers commenced FA at the recommended time, avoided alcohol consumption and smoking during pregnancy. In all, 35.3% of mothers reported to consuming alcohol, 20.9% smoked during pregnancy and 44.4% commenced FA at the recommended time. Mothers <25 years were more likely to have not taken FA at the recommended time (adjusted odds ratio (aOR): 4.0, 95% confidence interval (CI): 1.64-9.77) and were more likely to have smoked during pregnancy (aOR: 3.56, 95% CI: 1.32-9.57). Irish nationality positively predicted both alcohol consumption (aOR: 4.37, 95% CI: 1.88-10.15) and smoking (aOR: 10.92, 95% CI: 1.35-87.98) during pregnancy. CONCLUSIONS: Educational efforts are still necessary to convince women of Irish nationality, in particular, of the adverse effects of smoking and alcohol consumption on fetal outcome. Women <25 years should be specifically targeted in smoking cessation and FA promotional campaigns.

Dietary energy density as a marker of dietary quality in Swedish children and adolescents: the European Youth Heart Study.

OBJECTIVE: To investigate if dietary energy density is associated with measures of dietary quality (food group, micronutrient and macronutrient intakes) in children and adolescents. SUBJECTS/METHODS: In all, 551 children (mean age 9.6 years, 52% girls) and 569 adolescents (15.5 years, 55% girls), sampled from schools in Sweden, completed a single 24-h dietary recall. Dietary energy density (kJ/g) was calculated as the energy from all food consumed divided by the weight of all food consumed. Beverages were excluded from the calculation. Food and micronutrient intakes were adjusted for energy intake. A one-way analysis of variance (ANOVA) was used to test for differences in food group and nutrient intakes across age- and gender-specific tertiles of energy density. Discriminant analysis was used to confirm the groupings formed by tertiles. RESULTS: Subjects with low-energy-density diets were significantly more likely to consume fruits, vegetables, pasta, rice, potatoes and cereals and less likely to consume sweetened drinks, sweets and chocolate. After energy adjustment, their intakes of many foods recommended in the Swedish food-based dietary guidelines were higher and intakes of nutrient-poor foods were lower. The macronutrient energy profile (% energy) of low-energy-density diets was closest to the recommended level. Low-energy-density diets contained greater amounts of most micronutrients. Discriminant analysis confirmed the existence of heterogeneous dietary patterns and the likelihood of correct classification by energy density in 65% of cases. CONCLUSIONS: Lower dietary energy density is associated with better dietary quality in children and adolescents. Energy density has advantages over other whole diet analysis methods and may be suitable as a simple proxy of diet quality.

Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographic factors in a representative sample of Irish adults.

Attitudes towards healthy eating were explored according to dietary, lifestyle and socio-demographic correlates in a random sample of 1256 Irish adults. Data were obtained from an Irish cross-sectional survey (1997-1999). A self-administered questionnaire was used to obtain attitudinal information. Food consumption was estimated using a 7-d food diary. A majority of the sample had a positive attitude or motivation towards their healthy eating behaviour. Those who perceived their own eating habits to be healthy were more likely to comply with current dietary guidelines than those who did not. Females, increasing age, higher social class, tertiary education, non-smokers, lower body-weights and increased recreational activity were associated with a lower odds ratio (OR) for having a negative attitude towards their healthy eating behaviour. An increased intake (g/d) of breakfast cereals, vegetables, fruit and poultry dishes were associated with decreased OR for negative attitudes towards their healthy eating behaviour, while an increased intake of high-calorie beverages (g/d) was associated with an increased OR. It can be concluded that attitudes or motivation towards eating healthily was related to measured dietary and lifestyle behaviour in this sample. Future research is warranted to devise appropriate methods of instituting attitude change towards dietary behaviour in certain subgroups of the population.

An approach to the development of food-based dietary guidelines for Ireland.

The aim of the present study was to analyse the different food and nutrient intakes of the adult Irish population from the lowest and highest quartiles of intake for total fat (%energy) dietary fibre (g/MJ) and fruit and vegetables (g/day). Data on Irish adults (n = 715) from the Irish National Nutrition Survey conducted in 1989 were used for the analyses and showed that the average diet is low in dietary fibre, with fruit and vegetables being only half the recommended level of 400 g. Comparisons of people with low or high intakes (from lowest and highest quartiles) of total fat (%energy), dietary fibre (g/MJ) and fruit and vegetables (g/day) show patterns of food intake differing in both the percentage of consumers and in the mean intakes among consumers only. This analysis provides data which may be useful as a first step towards the development of food-based dietary guidelines for Ireland. In particular, the low intake of fruit and vegetables in the adult Irish population deserves special attention.

Perceived barriers in trying to eat healthier--results of a pan-EU consumer attitudinal survey.

Information on the perceived difficulties in trying to eat a healthier diet is important in assisting those in nutrition education devise more effective programmes. The objective of this study was to determine the main perceived barriers that people have in trying to eat a healthy diet in the 15 member states of the European Union (EU). A cross-sectional study in which quota-controlled nationally representative samples of approximately 1000 adults (15 years upwards) from each member state completed a face-to-face interview-assisted questionnaire. The most frequently mentioned perceived barriers to healthy eating concerned time and taste factors. Time-related factors were more important for younger respondents and those with a higher level of education, who appear to regard taste as being compromised by healthy eating. Variation exists both between member states and between demographic groups in the frequency of barriers mentioned. A lack of knowledge about healthy eating was not selected by many as an important barrier. A major obstacle to nutrition education is the fact that 70% of EU subjects believe their diets are already healthy. It may be that nutrition educators should concentrate on showing consumers how to evaluate their own diet appropriately in terms of fat, fibre, and fruit and vegetables. Food-based guidelines may be useful in this endeavour.

Eating patterns--temporal distribution, converging and diverging foods, meals eaten inside and outside of the home--implications for developing FBDG.

OBJECTIVE: A consideration of eating patterns in the general population is necessary when deriving food-based dietary guidelines (FBDG) as promoting the intake of one food may indirectly result in the increased consumption of another, which may not always be desirable. A number of issues that influence meal patterns such as temporal distribution of food intake (using data from the Netherlands), converging and diverging foods (using data from Ireland) and meals eaten inside and outside of the home (using data from the UK) are examined and discussed in the context of developing FBDG. SETTING: Food intake databases from three EU countries: The Netherlands, Ireland and the UK. RESULTS: The hot meal (dinner) was found to be the main contributor to the intake of energy and macro-nutrients in the Dutch population. It was also the main contributor to the intake of all micro-nutrients with the exception of calcium where the bread meal contributed a similar proportion as the hot meal to the intake of this micronutrient. Furthermore, fruit intake showed a very different temporal distribution to vegetable intake. Exploring the convergence of certain foods in the Irish population also revealed differences between fruit and vegetables. A low correlation was shown for consumers of fruit and vegetables indicating that being a high fruit consumer did not suggest being also a high vegetable consumer. An examination of where meals were consumed among British adults showed that 71% of all meals were consumed inside the home while 29% were consumed outside. 27% of food energy and 45% of alcohol energy was consumed out of home by the total population. In addition, those eating less of their foods out of home obtained a lower proportion of their food energy from fat and protein and a higher proportion from carbohydrate. A different demographic profile was associated with eating out compared to eating in, comprising more males and younger individuals. CONCLUSIONS: Information on patterns of food intake and food habits, specifically temporal distribution, the convergence and divergence of foods and foods consumed inside and outside of the home, give a culturally specific picture of food consumption practices within a population. This should enable the development of more culturally acceptable and realistic FBDG.

Chronic tension-type headache: an investigation of the appraisal process.

The few existing studies that have explicitly examined appraisal of stress in tension-type headache sufferers have found that these individuals perceive events in a more negative manner than headache-free controls. However, can it necessarily be assumed that they perceive events in a less accurate manner than headache-free controls? To answer this question, sixty chronic tension-type headache sufferers and 60 controls engaged in a 40-trial contingency learning task in which they had to estimate the amount of control they could exert. Results provide little support for the notion that the cognitive appraisal of tension-type headache sufferers is more accurate than that of headache-free individuals. However, differences were found in perceived control when behavioral involvement was considered. This result is discussed in terms of learned helplessness theory.

Methods used to conduct the pan-European Union survey on consumer attitudes to physical activity, body weight and health.

OBJECTIVE: The purpose of conducting this survey was to identify data on consumer attitudes towards and beliefs about physical activity, body weight and health among the 15 countries of the EU. DESIGN: A cross-sectional study to get a picture of the attitudes to physical activity, body weight and health in the EU. For this, it was considered important that samples be nationally representative so that inferences drawn from the data could be applied to the population in each country as well as to the EU population as a whole. Using a non-probability sampling method employing quota controls (and the national weight) we obtained large sample sizes from each country which were nationally representative in terms of the variables age, sex and regional distribution. To ensure samples were truly nationally representative a national weight was used when analysing the data using the same characteristics as those used to define quotas. When examining pooled estimates for the total EU sample a population weight was applied. RESULTS: In total, 15,239 subjects aged 15 years and upwards in the EU completed the survey. This article gives details on the methods used in carrying out the survey from design of the questionnaire to sample selection, questionnaire administration and analysis of the data. The methods and their limitations are discussed.