Improving health and carbon footprints of European diets using a benchmarking approach.

OBJECTIVE: This study aimed to identify diets with improved nutrient quality and environmental impact within the boundaries of dietary practices. DESIGN: We used Data Envelopment Analysis to benchmark diets for improved adherence to food-based dietary guidelines (FBDG). We then optimised these diets for dietary preferences, nutrient quality and environmental impact. Diets were evaluated using the Nutrient Rich Diet score (NRD15.3), diet-related greenhouse gas emission (GHGE) and a diet similarity index that quantified the proportion of food intake that remained similar as compared with the observed diet. SETTING: National dietary surveys of four European countries (Denmark, Czech Republic, Italy and France). SUBJECTS: Approximately 6500 adults, aged 18-64 years. RESULTS: When dietary preferences were prioritised, NRD15·3 was ~6 % higher, GHGE was ~4 % lower and ~85 % of food intake remained similar. This diet had higher amounts of fruit, vegetables and whole grains than the observed diet. When nutrient quality was prioritised, NRD15·3 was ~16 % higher, GHGE was ~3 % lower and ~72 % of food intake remained similar. This diet had higher amounts of legumes and fish and lower amounts of sweetened and alcoholic beverages. Finally, when environmental impact was prioritised, NRD15·3 was ~9 % higher, GHGE was ~21 % lower and ~73 % of food intake remained similar. In this diet, red and processed meat partly shifted to either eggs, poultry, fish or dairy. CONCLUSIONS: Benchmark modelling can generate diets with improved adherence to FBDG within the boundaries of dietary practices, but fully maximising health and minimising GHGE cannot be achieved simultaneously.

Geographic and socioeconomic diversity of food and nutrient intakes: a comparison of four European countries.

PURPOSE: Public health policies and actions increasingly acknowledge the climate burden of food consumption. The aim of this study is to describe dietary intakes across four European countries, as baseline for further research towards healthier and environmentally-friendlier diets for Europe. METHODS: Individual-level dietary intake data in adults were obtained from nationally-representative surveys from Denmark and France using a 7-day diet record, Italy using a 3-day diet record, and Czech Republic using two replicates of a 24-h recall. Energy-standardised food and nutrient intakes were calculated for each subject from the mean of two randomly selected days. RESULTS: There was clear geographical variability, with a between-country range for mean fruit intake from 118 to 199 g/day, for vegetables from 95 to 239 g/day, for fish from 12 to 45 g/day, for dairy from 129 to 302 g/day, for sweet beverages from 48 to 224 ml/day, and for alcohol from 8 to 15 g/day, with higher intakes in Italy for fruit, vegetables and fish, and in Denmark for dairy, sweet beverages and alcohol. In all countries, intakes were low for legumes (< 20 g/day), and nuts and seeds (< 5 g/day), but high for red and processed meat (> 80 g/day). Within countries, food intakes also varied by socio-economic factors such as age, gender, and educational level, but less pronounced by anthropometric factors such as overweight status. For nutrients, intakes were low for dietary fibre (15.8-19.4 g/day) and vitamin D (2.4-3.0 µg/day) in all countries, for potassium (2288-2938 mg/day) and magnesium (268-285 mg/day) except in Denmark, for vitamin E in Denmark (6.7 mg/day), and for folate in Czech Republic (212 µg/day). CONCLUSIONS: There is considerable variation in food and nutrient intakes across Europe, not only between, but also within countries. Individual-level dietary data provide insight into the heterogeneity of dietary habits beyond per capita food supply data, and this is crucial to balancing healthy and environmentally-friendly diets for European citizens.

From Plant Compounds to Botanicals and Back: A Current Snapshot.

This work aims at giving an updated picture of the strict interaction between main plant biologically active compounds and botanicals. The main features of the emerging class of dietary supplements, the botanicals, are highlighted. Focus is also on the definition of actual possibilities of study approach and research strategies. Examples of innovative directions are given: assessment of interaction of bioactive compounds, chemometrics and the new goal of biorefineries. Current models of existing databases, such as plant metabolic pathways, food composition, bioactive compounds, dietary supplements, and dietary markers, are described as usable tools for health research. The need for categorization of botanicals as well as for the implementation of specific and dedicated databases emerged, based on both analytical data and collected data taken from literature throughout a harmonized and standardized approach for the evaluation of an adequate dietary intake.

Intakes of whole grain in an Italian sample of children, adolescents and adults.

PURPOSE: There is wide evidence that regular consumption of whole grain foods may reduce the risk of chronic diseases. The aim of this work was to quantify the intake of whole grains and identify main dietary sources in the Italian population. METHODS: Whole grain intakes were calculated in a sample of 2830 adults/older adults and of 440 children/adolescents from the last national survey INRAN-SCAI 2005-06. Food consumption was assessed from a 3-day food record. The whole grain content of foods was estimated mainly from quantitative ingredient declarations on labels. RESULTS: Mean whole grain intakes were 3.7 g/day in adults/older adults and 2.1 g/day in children/adolescents. Overall, 23 % of the sample reported consumption of whole grain foods during the survey, among which mean whole grain intakes ranged from 6.0 g/day in female children to 19.1 g/day in female older adults. The main sources of whole grains were breakfast cereals in children/adolescents (32 %) and bread in adults/older adults (46 %). Consumption of whole grain among adults was associated with significantly higher daily intakes and adequacy of dietary fibre, several vitamins (thiamine, riboflavin, vitamin B6) and minerals (iron, calcium, potassium, phosphorus, zinc, magnesium) compared to non-consumption. Among children, whole grain intake was associated with significantly higher intakes of iron and magnesium. CONCLUSIONS: The study reveals very low whole grain intakes across all age groups of the Italian population. Considering the positive association in consumers between whole grain intakes and fibre and micro-nutrient intakes, public health strategies to increase whole grain consumption should be considered.

A teachers' training program accompanying the "School Fruit Scheme" fruit distribution improves children's adherence to the Mediterranean diet: an Italian trial.

The effects of a nutrition education program, led by trained teachers within the Italian School Fruit Scheme, were evaluated. Pre-post intervention children's adherence to the Mediterranean diet (MD) was assessed by the KIDMED test. A representative cluster sample of 494 fourth grade students from thirteen Italian schools in the three areas of low (North), medium (Centre) and high (South) prevalence of overweight and obesity was investigated. Within the same schools, the intervention group (n = 395) received the program, the control group (n = 99) did not. In the intervention group, the proportion of children with high adherence to the MD significantly increased in the total sample, females and South in the post-intervention; no significant changes in levels of adherence related to ponderal status were detected. A significant increase was found, particularly, in the proportion of children who improved their frequency of consumption of fruit and vegetables (FV) daily, especially in the South.

Diet quality of Italian yogurt consumers: an application of the probability of adequate nutrient intake score (PANDiet).

The diet quality in yogurt consumers and non-consumers was evaluated by applying the probability of adequate nutrient intake (PANDiet) index to a sample of adults and elderly from the Italian food consumption survey INRAN SCAI 2005-06. Overall, yogurt consumers had a significantly higher mean intake of energy, calcium and percentage of energy from total sugars whereas the mean percentage of energy from total fat, saturated fatty acid and total carbohydrate were significantly (p < 0.01) lower than in non-consumers. The PANDiet index was significantly higher in yogurt consumers than in non-consumers, (60.58 ± 0.33 vs. 58.58 ± 0.19, p < 0.001). The adequacy sub-score for 17 nutrients for which usual intake should be above the reference value was significantly higher among yogurt consumers. The items of calcium, potassium and riboflavin showed the major percentage variation between consumers and non-consumers. Yogurt consumers were more likely to have adequate intakes of vitamins and minerals, and a higher quality score of the diet.

Overweight and Obesity in Italian Adolescents: Examined Prevalence and Socio-Demographic Factors.

AIM: This study aimed to evaluate the prevalence of overweight and obesity derived from measured data of weight and height in a cross-sectional sample of adolescents in the Italian region of Lazio and to analyse their association with different socio-demographic factors. METHODS: The study was conducted in a representative sample of 15-16-year-old adolescents recruited in secondary schools between December 2011 and May 2012. 369 adolescents were investigated. Body weight, height and waist circumference were measured. The BMI of each subject was calculated, and the prevalence of overweight and obesity was determined by age and sex using the IOTF reference values and WHO growth standards. Waist circumference/height ratio (WC/Ht) was calculated and the subjects were classified using the cut-off of 0.5: WC/Ht≥0.5 and WC/Ht<0.5. Selected socio-demographic characteristics were assessed via questionnaire. RESULTS: The percentages of overweight and obesity were high, 15.4% and 7.9%, respectively, with significant difference between males and females (19.1% vs. 12.6% for overweight and 11.1% vs. 5.3% for obese) using the IOFT reference. The ratio WC/Ht≥0.5 was observed in 12.7% of the sample (all the obese and 29.8% of the overweight subjects). Multiple logistic regression analysis indicated that gender, school municipality, mother's employment status, and family structure had a significant effect on ponderal status (overweight/obesity vs. normal weight). CONCLUSION: These findings show a high prevalence of body weight excess associated with socio-demographic factors in the Italian sample investigated, and the need for effective public health interventions to combact obesity with particular attention to disadvantaged adolescents.

Dietary intake and food sources of choline in European populations.

Choline is an important nutrient for humans. Choline intake of the European population was assessed considering the European Food Safety Authority European Comprehensive Food Consumption Database and the United States Department of Agriculture Nutrient Database. Average choline intake ranges were 151-210 mg/d among toddlers (1 to ≤3 years old), 177-304 mg/d among other children (3 to ≤10 years old), 244-373 mg/d among adolescents (10 to ≤18 years old), 291-468 mg/d among adults (18 to ≤65 years old), 284-450 mg/d among elderly people (65 to ≤75 years old) and 269-444 mg/d among very elderly people (≥75 years old). The intakes were higher among males compared with females, mainly due to larger quantities of food consumed per day. In most of the population groups considered, the average choline intake was below the adequate intake (AI) set by the Institute of Medicine in the USA. The main food groups contributing to choline intake were meat, milk, grain, egg and their derived products, composite dishes and fish. The main limitations of this study are related to the absence of choline composition data of foods consumed by the European population and the subsequent assumption made to assess their intake levels. Given the definition of AI, no conclusion on the adequacy of choline intake can be drawn for most European population groups. Such results improve the knowledge on choline intake in Europe that could be further refined by the collection of choline composition data for foods as consumed in Europe.

Adherence to the Mediterranean diet in Italian school children (The ZOOM8 Study).

The adherence to the Mediterranean diet (MD) of 1740 Italian 8-9-year-olds was evaluated using the KIDMED index and a descriptive analysis of it by socio-demographic and lifestyle factors was performed. Only 5.0% of the children resulted "high" adherers of MD (62.2% "average" and 32.8% "poor"). This scarce adherence was due to a low consumption of fruit, vegetables, legumes, dairy products and a high intake of commercially baked goods for breakfast and sweets. Hindrances to fruit, vegetables and pulses consumption were reported for one-third of the sample. The adherence rates did not differ significantly with BMI and gender. Adherence improved with: having lunch at school; liking lunch at school; breakfast with family; no free access to food; availability of fruit and pulses; liking vegetables; higher maternal education; lower child screen time; population size of place of residence. The results show it is important to improve family food habits and dietary knowledge.

FoodEx2 Harmonization of the Food Consumption Database from the Italian IV SCAI Children's Survey.

Estimating the habitual food and nutrient intakes of a population is based on dietary assessment methods that collect detailed information on food consumption. Establishing the list of foods to be used for collecting data in dietary surveys is central to standardizing data collection. Comparing foods across different data sources is always challenging. Nomenclatures, detail, and classification into broad food groups and sub-groups can vary considerably. The use of a common system for classifying and describing foods is an important prerequisite for analyzing data from different sources. At the European level, EFSA has addressed this need through the development and maintenance of the FoodEx2 classification system. The aim of this work is to present the FoodEx2 harmonization of foods, beverages, and food supplements consumed in the IV SCAI children's survey carried out in Italy. Classifying foods into representative food categories predefined at European level for intake and exposure assessment may lead to a loss of information. On the other hand, a major advantage is the comparability of data from different national databases. The FoodEx2 classification of the national food consumption database represented a step forward in the standardization of the data collection and registration. The large use of FoodEx2 categories at a high level of detail (core and extended terms) combined with the use of descriptors (facets) has minimized information loss and made the reference food categories at country level comparable with different food databases at national and international level.

Overweight/obesity and lifestyle factors among Italian adolescents: the ALIADO study.

BACKGROUND: Childhood obesity is associated with many lifestyle factors. The aim of the present study was to evaluate the relationship between overweight/obesity and abdominal obesity and several lifestyle factors in a sample of Italian adolescents. METHODS: A representative cluster sample of 15-16-year-old adolescents in secondary school in the Lazio region (Italy) was recruited. Body weight, height and waist circumference were measured. Ponderal status was assessed by the IOTF and WHO definitions. Waist-to-height ratio (WtHR) cut-off of 0.5 was used to classify subjects with the highest cardiometabolic risk. Selected dietary habits and lifestyle characteristics were assessed by questionnaires. RESULTS: Three hundred sixty-nine adolescents (162 males and 207 females) were studied. Prevalence of overweight/obesity was 23.3%, according to the IOTF criteria with a higher percentage of males than females (30.2% vs. 17.9%; P=0.031), and 26% according to WHO references with significant differences between males and females (respectively, 33.9% vs. 19.8%; P=0.002). The WtHR≥0.5 was observed in 12.7% of the total sample with a higher percentage in males than in females (16% vs. 10.1%). Males reported an increased likelihood of being overweight or obese, as well as of having a WtHR≥0.5 (aOR 2.76 and 2.18, respectively). Adolescents that had breakfast regularly everyday were less likely to be overweight/obese and to have a WtHR≥0.5 (aOR 0.52 and 0.49, respectively). CONCLUSIONS: These results showed a high prevalence of overweight/obesity in the sample, and food habits and lifestyle not in accordance with recommendations, especially regarding breakfast. A Surveillance System of Italian adolescents should also be implemented through anthropometric measurement data to monitor the effectiveness of the policies to counteract obesity.

Dietary assessment training: The Italian IV SCAI study on 10-74 year-old individuals' food consumption.

Dietary surveys are conducted to examine the population's dietary patterns that require a complex system of databases, and rules for constructing the data matrix (precision, coding, deriving new variables, e.g., body mass index from individual's height and weight, classes, e.g., age-class, socio-economic status, physical activity, etc.). Management of the data collection requires specialized fieldworkers to allow for the collection of harmonized and standardized data. In this way, only statistical variability is envisaged and any eventual biases are due to probabilistic distribution but data are not affected by inaccuracy. Training the fieldworkers is a crucial part of each dietary survey. The idea to provide constant training throughout the whole survey period, from the preparatory phase to the data collection phase, relies on the necessity to train fieldworkers and monitor the skills acquired during the study, in addition to helping fieldworkers to gain the necessary experience. This study aims to relate the experience in conducting the course path to high specialized interviewers who carried out the cycle devoted to the 10-74 age class of the fourth nationwide food consumption study in Italy (IV SCAI ADULT) according to the European Food Safety Authority (EFSA) guide. A course path was structured in three steps corresponding to the preparation, pilot, and collection phases. The whole path achieved the goal of collecting data related to 12 individuals by each participant, with an overall success rate (successful trainees/total participants) of 16.8% (84 out of an initial 500). The study aimed to provide good quality data in the short term and a highly specialized community in the long term. Surveillance nutritional systems can count on a highly skilled community, so decision-making in public health nutrition and a sustainable and healthy food system can rely on this infrastructure.

An Italian Case Study for Assessing Nutrient Intake through Nutrition-Related Mobile Apps.

National food consumption surveys are crucial for monitoring the nutritional status of individuals, defining nutrition policies, estimating dietary exposure, and assessing the environmental impact of the diet. The methods for conducting them are time and resource-consuming, so they are usually carried out after extended periods of time, which does not allow for timely monitoring of any changes in the population's dietary patterns. This study aims to compare the results of nutrition-related mobile apps that are most popular in Italy, with data obtained with the dietary software Foodsoft 1.0, which was recently used in the Italian national dietary survey IV SCAI. The apps considered in this study were selected according to criteria, such as popularity (downloads > 10,000); Italian language; input characteristics (daily dietary recording ability); output features (calculation of energy and macronutrients associated with consumption), etc. 415 apps in Google Play and 226 in the iTunes Store were examined, then the following five apps were selected: YAZIO, Lifesum, Oreegano, Macro and Fitatu. Twenty 24-hour recalls were extracted from the IV SCAI database and inputted into the apps. Energy and macronutrient intake data were compared with Foodsoft 1.0 output. Good agreement was found between the selected apps and Foodsoft 1.0 (high correlation index), and no significant differences were found in the mean values of energy and macronutrients, except for fat intakes. In conclusion, the selected apps could be a suitable tool for assessing dietary intake.

A Dietary Assessment Training Course Path: The Italian IV SCAI Study on Children Food Consumption.

The eating patterns in a population can be estimated through dietary surveys in which open-ended assessment methods, such as diaries and interviews, or semi-quantitative food frequency questionnaires are administered. A harmonized dietary survey methodology, together with a standardized operational procedure, in conducting the study is crucial to ensure the comparability of the results and the accuracy of information, thus reducing uncertainty and increasing the reliability of the results. Dietary patterns (i) include several target variables (foods, energy and nutrients, other food components), (ii) require several explanatory variables (age, gender, anthropometric measurements, socio-cultural and economic characteristics, lifestyle, preferences, attitudes, beliefs, organization of food-related activities, etc.), and (iii) have impacts in several domains: imbalance diets; acute and chronic exposures affect health, specifically non-communicable diseases; and then sanitary expenditure. On the other hand, food demand has impacts on the food system: production, distribution, and food services system; food wastes and other wastes generated by food-related activities of the households (e.g., packaging disposal) have consequences on the "health of the planet" which in turn can have effects on human health. Harmonization and standardization of measurement methods and procedures in such a complex context require an ad hoc structured information system made by databases (food nomenclatures, portion sizes, food atlas, recipes) and methodological tools (quantification methods, food coding systems, assessment of nutritional status, data processing to extrapolate what we consider validated dietary data). Establishing a community of professionals specialized in dietary data management could lead to build a surveillance system for monitoring eating habits in the short term, thus reducing costs, and to arrange a training re-training system. Creating and maintaining the dietary data managers community is challenging but possible. In this context, the cooperation between the CREA Research Centre for Food and Nutrition and the Italian National Health Institute (ISS) promoted and supported by the Italian Ministry of Health may represent a model of best practice that can ensure a continuous training for the professional community carrying out a nutritional study.

Corrigendum: A Dietary Assessment Training Course Path: The Italian IV SCAI Study on Children Food Consumption.

[This corrects the article DOI: 10.3389/fpubh.2021.590315.].

Development of Dietary Supplement Label Database in Italy: Focus of FoodEx2 Coding.

The sector of food supplements is certainly varied and growing: an ever wider offer of new products is launched on the market every year. This is reflected in new reorganization of drug companies and new marketing strategies, in the adoption of new production technologies with resulting changes in dietary supplements regulation. In this context, information on composition reported in labels of selected dietary supplements was collected and updated for the development of a Dietary Supplement Label Database according to products' availability on the Italian market and also including items consumed in the last Italian Dietary Survey. For each item, a code was assigned following the food classification and description system FoodEx2, revision 2. A total of 558 products have been entered into the database at present, trying to give a uniform image and representation of the major classes of food supplements, and 82 descriptors have been compiled. Various suggestions on how the number of FoodEx2 system descriptors could be expanded were noted during the compilation of the database and the coding procedure, which are presented in this article. Limits encountered in compiling the database are represented by the changes in the formulation of products on the market and therefore by the need for a constant database update. The database here presented can be a useful tool in clinical trials, dietary plans, and pharmacological programs.

A conceptual framework for the collection of food products in a Total Diet Study.

A total diet study (TDS) provides representative and realistic data for assessing the dietary intake of chemicals, such as contaminants and residues, and nutrients, at a population level. Reproducing the diet through collection of customarily consumed foods and their preparation as habitually eaten is crucial to ensure representativeness, i.e., all relevant foods are included and all potential dietary sources of the substances investigated are captured. Having this in mind, a conceptual framework for building a relevant food-shopping list was developed as a research task in the European Union's 7th Framework Program project, 'Total Diet Study Exposure' (TDS-Exposure), aimed at standardising methods for food sampling, analyses, exposure assessment calculations and modelling, priority foods, and selection of chemical contaminants. A stepwise approach following the knowledge translation (KT) model for concept analysis is proposed to set up a general protocol for the collection of food products in a TDS in terms of steps (characterisation of the food list, development of the food-shopping list, food products collection) and pillars (background documentation, procedures, and tools). A simple model for structuring the information in a way to support the implementation of the process, by presenting relevant datasets, forms to store inherent information, and folders to record the results is also proposed. Reproducibility of the process and possibility to exploit the gathered information are two main features of such a system for future applications.

Beverage Consumption Habits among the European Population: Association with Total Water and Energy Intakes.

BACKGROUND: Fluid and water intake have received limited attention in epidemiological studies. The aim of this study was to compare the average daily consumption of foods and beverages in adults of selective samples of the European Union (EU) population in order to understand the contribution of these to the total water intake (TWI), evaluate if the EU adult population consumes adequate amounts of total water (TW) according to the current guidelines, and to illustrate the real water intake in Europe. METHODS: Three national European dietary surveys have been selected: Spain used the Anthropometry, Intake, and Energy Balance Study (ANIBES) population database, Italy analyzed data from the Italian National Food Consumption Survey (INRAN-SCAI 2005-06), and French data came from the NutriNet-Santé database. Mean daily consumption was used to compare between individuals. TWI was compared with European Food Safety Authority (EFSA) reference values for adult men and women. RESULTS: On average, in Spain, TWI was 1.7 L (SE 22.9) for men and 1.6 L (SE 19.4) for women; Italy recorded 1.7 L (SE 16.9) for men and 1.7 L (SE 14.1) for women; and France recorded 2.3 L (SE 4.7) for men and 2.1 L (SE 2.4) for women. With the exception of women in France, neither men nor women consumed sufficient amounts of water according to EFSA reference values. CONCLUSIONS: This study highlights the need to formulate appropriate health and nutrition policies to increase TWI in the EU population. The future of beverage intake assessment requires the use of new instruments, techniques, and the application of the new available technologies.

Assessment of dietary intake of 10 intense sweeteners by the Italian population.

The aim of the present study was to monitor the consumption of foods containing intense sweeteners present on the Italian food market and to investigate whether the Italian general population (aged >3-65+) was at risk for exceeding the Acceptable Daily Intake (ADI) of 10 intense sweeteners. A food label survey was performed in Rome (Italy), using market share data to identify the brands more representative of the market. A sample of 326 foods (table-top sweeteners included), beverages and food supplements containing intense sweeteners was collected and analyzed in order to establish the concentration levels. Intense sweeteners were only found in foods belonging to 8 sugar-free food categories out of 37 regulated. The dietary exposure was estimated using the tiered approach. Food consumption data from the last Italian national survey (INRAN-SCAI 2005-06) were combined with Maximum Levels at Tier 2, and with the actual concentration of sweeteners in the collected food products at Tier 3. The estimated exposure among consumers of sweeteners in Italy was well below the ADIs, in both tiers; non-alcoholic beverages, table-top sweeteners and food supplements were main contributors to exposure.