Mapping low intake of micronutrients across Europe.

Achieving an understanding of the extent of micronutrient adequacy across Europe is a major challenge. The main objective of the present study was to collect and evaluate the prevalence of low micronutrient intakes of different European countries by comparing recent nationally representative dietary survey data from Belgium, Denmark, France, Germany, The Netherlands, Poland, Spain and the United Kingdom. Dietary intake information was evaluated for intakes of Ca, Cu, I, Fe, Mg, K, Se, Zn and the vitamins A, B1, B2, B6, B12, C, D, E and folate. The mean and 5th percentile of the intake distributions were estimated for these countries, for a number of defined sex and age groups. The percentages of those with intakes below the lower reference nutrient intake and the estimated average requirement were calculated. Reference intakes were derived from the UK and Nordic Nutrition Recommendations. The impact of dietary supplement intake as well as inclusion of apparently low energy reporters on the estimates was evaluated. Except for vitamin D, the present study suggests that the current intakes of vitamins from foods lead to low risk of low intakes in all age and sex groups. For current minerals, the study suggests that the risk of low intakes is likely to appear more often in specific age groups. In spite of the limitations of the data, the present study provides valuable new information about micronutrient intakes across Europe and the likelihood of inadequacy country by country.

Overweight and obesity in infants and pre-school children in the European Union: a review of existing data.

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

Effectiveness of the iodine prophylaxis model adopted in Poland.

OBJECTIVE: Most of the Polish territory has been classified as an iodine-deficient and endemic goiter area according to the International Council for Control of Iodine Deficiency (ICCIDD) criteria. In 1997 the obligatory model of iodine prophylaxis was implemented. Our investigations were aimed at the effectiveness of iodine prophylaxis in Poland. METHODS: We assessed urinary iodine excretion and goiter prevalence in 5663 children aged 6-12 yr. The population of children from the same 27 schools was investigated from 1992 to 1994 (1406 girls and 1244 boys) and from 1999 to 2005 (1563 girls and 1450 boys) using identical laboratory and ultrasound methods. RESULTS: We found significant increase in iodine urinary concentration (median 52 microg/l vs 93 microg/l, p<0.001) with accompanying drop in goiter prevalence (29.6% vs 5.2%, p<0.001) after implementation of iodine prophylaxis. Iodine excretion distribution changed significantly after 1997 with an increase in the percentage of children with iodine urinary concentration above 100 microg/l from 10.8% to 45.4%, respectively. A significantly higher iodine urinary concentration was observed in lowlands compared to uplands both before and after implementation of iodine prophylaxis (median, 50 microg/l vs 57 microg/l and 86 microg/l vs 114 microg/l, respectively, p<0.001). The goiter prevalence did not differ between girls and boys from 1992 to 1994 (28.8% vs 30.5%, p=0.35) and 1999 to 2005 (5.5% vs 4.9%, p=0.45). CONCLUSIONS: Implementation of the new model of iodine prophylaxis in Poland in 1997 has led to significant increase in iodine urinary concentration and decrease in goiter prevalence among Polish schoolchildren. In the youngest group of children (6-8 yr olds), prevalence of goiter decreased to 3.2%--i.e. below endemic levels.

Policy options for responding to the growing challenge from obesity (PorGrow) in Poland.

To explore the perspectives of stakeholders towards a range of policy options to respond to obesity in Poland, a multi-criteria mapping method was used. During structured interviews, stakeholders were invited to appraise policy options by reference to criteria of their own choosing. They also provided relative weightings to their criteria, generating overall rankings of the policy options in relation to each other. Efficacy, feasibility and societal benefits were the groups of criteria deemed most important. There was most consensus in favour of options related to health education, particularly in schools, compared with options that aimed at modifying the environment to prevent obesity, i.e. options around physical activity, modifying the supply and demand for food products, and information-related options. There was little support for technological solutions or institutional reforms. There was broad consensus that to reverse the rising trend in the incidence of obesity, it will be necessary to implement a portfolio of measures, but options related to behaviour change through education are most highly regarded. It will also be necessary to invest in improved surveillance and monitoring of Polish dietary practices, levels of physical activity and obesity in terms of data on height, weight and body mass indexes.

Comparison between household budget survey and 24-hour recall data in a nationally representative sample of Polish households.

OBJECTIVE: Household budget survey (HBS) data are used regularly for nutritional epidemiological purposes. The validity of HBS data, however, is not well established. The aim of this project was to compare HBS and individual nutrition survey (INS) data in a nationally representative sample of Polish households. DESIGN: Estimates of food consumption and nutrient intake were compared between household food acquisition data collected over 1 month and a single 24-hour recall collected from every household member in a nationally representative sample of Polish households surveyed between September and November 2000. To facilitate the comparison, INS food consumption data excluded food eaten away from home and were modified using a computer program to estimate food 'as purchased' (including disaggregation of recipe data) and to allow for wastage. SETTING: Poland. SUBJECTS: Participants were 3716 individuals in 1215 households (representing co-operation rates of 86.2% and 89.2%, respectively). RESULTS: Good agreement was shown between median estimates of foods such as potatoes, vegetables (including processed), meat, meat products and poultry, and animal fats (excluding butter), but agreement was poor for bread and rolls, fruit, vegetable fats and oils, eggs and six other food groups. Estimates of energy and nutrient intake were within +/-10% with the exceptions of polyunsaturated fats, potassium and vitamin C. CONCLUSIONS: Possible reasons for differences in findings between the two surveys include survey bias (e.g. social approval bias leading to overreporting of fruit), seasonal variations (e.g. high potato purchases between September and November) and aspects of the methodology (e.g. HBS data were based on records collected over 1 month, whereas 24-hour recall data were based on recalls collected from all household respondents on only 1 day and averaged for each household type). HBSs provide useful data for epidemiological research, but findings need to be interpreted in the light of other data regarding consumption, and numerous factors that may affect consumption need to be taken into account.

Trans fatty acids in human milk in Poland and their association with breastfeeding mothers' diets.

AIM: To determine the content of trans fatty acids in human milk in relation to breastfeeding mothers' diet. METHODS: Samples of milk were collected from 100 breastfeeding mothers and 7-d dietary records and anthropometry from 69 mothers were obtained. RESULTS: The following total trans fatty acids contents (median (lower-upper quartile); % wt/wt) in milk samples were determined: 1) data for Spring: colostrum--1.37 (1.00-2.00), mature milk at 5-6 wk of lactation--2.59 (1.49-3.34) and at 9-10 wk of lactation--2.36 (1.55-3.92); 2) data for Autumn: colostrum--1.80 (1.42-2.48), mature milk at 5-6 wk of lactation--2.41 (1.79-4.31) and at 9-10 wk of lactation--2.77 (1.53-4.18). The major sources of trans fatty acids in mothers' diets were bakery products, confectionery and snacks. Mothers who had high level of trans isomers in their milk consumed significantly higher amounts of these products. CONCLUSIONS: Bakery products, confectionery and snacks are a major source of trans fatty acids in maternal diet in Poland. The levels of trans fatty acids in human milk may reflect the current diet of the mother as well as the diet consumed early in pregnancy.

Studies on iodine content in daily diets, particularly elderly people's diets.

Poland represents moderate degree of severity of iodine deficiency. In 1997 a national program has been introduced of obligatory iodine prophylaxis including the iodination of household salt. In order to assess the extent of iodine consumption, the assessment were carried out on iodine content in average Polish diets with regard elderly people's diets. The aim of the study was also to analyse the composition of supplements allowed for trade in Poland, with regard to iodine content in these products. The assessment of iodine content in Polish diets was performed on the basis of the data of the household budgets and the data of iodine content in food products (without kitchen salt). The calculated iodine content in average Polish daily diets (adults and children) ranged from 40.4 microg to 50.7 microg. The iodine content in elderly people's diets was 75.5 microg/daily diets. In all studied diets the amount of iodine coming from food products, not taking into account iodinated salt, was insufficient for the realization of Polish RDA for this element. It shows that iodination of kitchen salt in Poland is necessary. Moreover on the Polish market exist supplements including iodine (20-200 microg iodine in tablet).

The Household Food Consumption and Anthropometric Survey in Poland.

OBJECTIVE: To provide an overview of the Household Food Consumption and Anthropometric Survey, undertaken in Poland from September to November 2000. DESIGN: A sub-sample of households participating in the countrywide, representative household budget survey (HBS) was selected to participate in the Household Food Consumption and Anthropometric Survey. Four thousand two hundred (4200) individuals provided 24-hour recalls that were subsequently evaluated. Body weight and height together with the mid-arm, waist and hip circumferences were measured. Laboratory analyses of contaminants that may be present in selected individual diets will be undertaken. SETTING: Poland, 2000. SUBJECTS: Four thousand two hundred individuals from 1362 households participating in the Polish HBS. RESULTS: Preliminary analyses of height and weight, as well as energy and nutrient intakes, were undertaken in a sub-sample of 484 boys and girls aged 10-15 years. Energy intakes were generally in line with or above the Polish Recommendations. CONCLUSIONS: Apart from serving as an important information source on individual food consumption and anthropometric status of the Polish population, the data collected through the Household Food Consumption and Anthropometric Survey will allow direct comparisons of food intake estimates, based on 24-hour recalls, with the results of the household budget survey. Such comparisons are expected to improve and refine interpretation of the data derived from both the individual nutrition survey and the household budget survey, and particularly to provide information on the importance of eating out, which is not covered in the Polish HBS.

[Sodium chloride in food rations and dinners in mass catering institutions]. / Chlorek sodu w racjach pokarmowych i posilkach obiadowych wydawanych w wybranych zakladach zywienia zbiorowego.

The sodium chloride content in meals given by mass catering institution in all over country in 1988-1998 years was estimated. This study included daily food rations from 183 mass catering institution as hospitals, sanatoriums for both children and adults, boarding schools, infant schools and social welfare homes. We assessed also school dinners from 422 randomized selected schools and dinners from 55 internal and 56 surgical departments of provincial and regional hospitals in Poland. The mass of each meal was evaluated and sodium chloride content by Mohr's method was assessed. In most cases the salt content by 100 g of meal of 1000 kcal was calculated. The dinners and daily food rations analyze showed that sodium chloride content in meals was much higher than value recommended by World Health Organization (WHO). Salt amount in daily food rations of both children and adults was above 16 g. This value didn't include salt added to meals by boarders. School dinners provided about 7-10 g of salt. The average sodium chloride content in hospital dinners was about 16-20 g. In each studied group the NaCl content per 100 g of meal was similarly high and was 0.7-0.9 g. The results of this study show that meals given by mass catering institutions can increase risk of hypertension, strokes and gastric cancers because of high sodium chloride content.

[Mass catering for school children in Poland]. / Zywienie zbiorowe dzieci i mlodziezy szkolnej w Polsce.

The assessment of organization and quality of nutrition was done in 184 urban and 156 rural schools in 1998 to obtain information about changes in that aspect during last few years. Data was collected using questionnaire method. The analysis of obtained results showed that the per-cent of schools organizing one form of nutrition in towns (95.1%) was higher than in villages (64.1%), but the per-cent of pupils consuming at least one meal served in school was lower in towns (22.2%) than in villages (31.3%). In comparison with situation in the beginning of the 90th nutrition was organized by significantly higher amount of schools but improvement of situation relevant to amount of pupils consuming school meals was not so significant. Urban schools the most frequently served full dinners, in rural schools it was often sticky bun or sandwich. Significant per-cent of rural schools did not serve any meal due to bad local conditions and financial problems. From the reason that the per-cent of pupils consuming school meals is too small, it is necessary to undertake actions leading to improvement of the situation in that aspect. These activities should be relevant to increased access to school meals, especially in rural area, decreased cost and quality improvement of these meals.

[Foodstuffs intended for special dietary uses for infants and young children in the light of the directives of the European Union and standards of the Codex Alimentarius FAO/WHO]. / Srodki spozywcze specjalnego zywieniowego przeznaczenia dla niemowlat i malych dzieci w swietle wymagan unii Europejskiej i standardów kodeksu zywnosciowego FAO/WHO.

Food products for infants and young children are included in the group of foodstuffs intended for special dietary uses. The classification of these products comprises the following groups: newborns infant formulas, infant formulas, processed cereal foods and other baby foods for infants and young children and gluten-free products. In the European Union countries the detailed requirements concerning their qualitative and quantitative composition, labeling, advertising and release on the market as well as the health quality of these products have been laid down in the Council Directive of 3 May 1989 on the approximation of the laws of the Member States relating to foodstuffs intended for particular nutritional uses (89/398/EEC with later amendments) and in the detailed directives. Presently, work is being continued on preparing standards of the Codex Alimentarius FAO/WHO for infant formulas for processed cereal foods for infants and young children and for gluten-free foods. In the successive sessions of the Codex Committee on Nutrition and Foods for Special Dietary Uses drafts of these standards are discussed. In the last session of the Committee in Berlin (19-23.06.2000) it was not possible to reach an agreement of views of the various delegations on the standards or their formulation. The work on them and trials at establishing international recommendations has been deferred to the next meeting.

Nutrition, physical activity and health status in Middle and East European countries.

In the Middle- and East-European countries the political, economic and social situation changed fundamentally in 1989 and 1990. These alterations are reflected in markers of dietary intake, physical activity and health with a trend similar in Czechia, East Germany, Lithuania and Poland. Thus, the previous increase in energy consumption stopped and was followed by a decline. The increasing preference for a lower level of activity is demonstrated by the number of private cars clearly accelerating its rate of growth after the change. Life expectancy had been increasing during the eighties only slightly. After the change the yearly increase became higher than before. The rate difference is higher in men than in women. Beginning from 1991 the CVD mortality decreased considerably.

[The role of nutrition in the development of circulatory system diseases]. / Rola zywienia w powstawaniu chorób ukladu krazenia.

In the paper the authors synthetically discuss the aetiology and pathogenesis and point to the possibilities of prevention of one of the most important groups of diseases developing as the result of faulty nutrition--circulatory system diseases. In the first part the epidemiology is discussed of the system's diseases--ischaemic heart disease, hypertension, cerebrovascular diseases--stressing the extent of the health problem caused by them--over 50% of deaths each year are due to these diseases. Then, the main cause is discussed of the development of cardiovascular system diseases, that is atherosclerosis. The risk factors are characterized in which nutrition plays an essential role - blood level of cholesterol, its content in low (LDL) and high (HDL) density lipoproteins, triglyceride level, content of saturated fatty acids in diet. Nutritional preventive factors are briefly described--mono- and polyunsaturated fatty acids, vitamin E, cellulose. The beneficial effect of increased fish consumption is stressed. The last part deals with arterial hypertension as the disease of the vascular system and as the risk factor of ischaemic heart disease. The attention is paid to the necessity of changes in nutrition mode--increase of the supply of mono- and polyunsaturated fatty acids with predominance of the former, decrease of the supply of saturated fatty acids, salt, ensuring of adequate supply of antioxidant vitamins and cellulose. In the paper it is stressed that the modern state of knowledge, used in practice may significantly decrease in Poland, through nutrition, the epidemic of circulatory system diseases similarly as it has been done in other countries.

[Calcium in the diet of selected groups of people]. / Wapn w pozywieniu wybranych grup ludnosci.

Calcium-content was determined in 23,557 daily food rations of the individuals fed individually or in sets of food or meals prepared in various institutions (3,298) in 1975-1987. Calcium deficit in daily food of girls and adult women has ranged from 50% to 6.2% in comparison with daily intakes recommended in Poland. Mean content of calcium per 1000 kcal ranged from 191.6 mg to 276.2 mg in 24 of the analysed meals. Calcium deficit amounted to 14-37.4% in 20 out of 24 analysed daily meals for boys and men. Calcium content in the remaining daily food rations was equal or even higher than the Polish daily intake recommendation. A mean calcium content per 1000 kcal ranged from 211.6 mg to 342.1 mg. These results suggest, that the daily calcium intake in several groups of the general population is to low, especially in women. Authors suggest, that such a low calcium intake in the diet increases the risk of osteoporosis, and intoxications with lead and cadmium salts, especially in children.

[Nutrition of men in Poland 1975-1984 (review and analysis of the literature)]. / Sposób zywienia mezczyzn w Polsce w latach 1975-1984 (przeglad i analiza prac).

The quality of nutrition of 22,249 men employed in Polish national economy was evaluated on the basis of own results and of literature data, obtained between years 1975-1984 in Poland. Energy content in the daily food ration (weighted mean) of the investigated men was 2879 kcal and was in agreement with the standard (lower level) recommended for men working moderately heavily. In the 14 publications considered, the mean value of energy content in the food ration fluctuated between 2495-3915 kcal/indiv. day. In the daily food ration (weighted mean), total protein content amounted to 93 g, with high participation of animal protein; it exceeded the recommended amount of protein. The amount of fat ingested daily by an average working man was 115 g, and exceeded the recommended fat intake by more than 20%. Evaluation of the daily food ration (weighted mean) from the standpoint of the groups of products showed that the daily intake of: a) meat, sausages and fish, 2) eggs and 3) fats, amounting to 292, 29.5 and 49 g, respectively, greatly exceeded that recommended by food standards, and accounted for 194, 177 and 141%, respectively, of the food allowance. In contrast, the mean daily intake of: 1) milk and its products, and 2) vegetables and fruits, was lowest, and accounted for 44 and 53%, respectively, of the food allowance.

[Nitrates and nitrites in the environment and their effect on human health]. / Azotany i azotyny w srodowisku oraz ich wplyw na zdrowie czlowieka.

The review was made on the major sources of human exposure to nitrates and nitrites, metabolism of these chemicals and their content in different body fluids. The health consequences of ingestion of nitrates and nitrites were presented. The methods of determination of nitrates, nitrites and nitrosamines were discussed.

[Nutrition of pregnant women working in large industrial plants]. / Zywienie kobiet ciezarnych zatrudnionych w duzych zakladach pracy.

In 1985 the dietary habits and daily food rations were analysed in 327 women in the first half, and 918 in the second half of pregnancy working, similarly as 921 non-pregnant healthy women, in 42 biggest Polish industrial plants as manual workers. The energy level (2623 kcal), total protein (75.3g) and the levels of the remaining nutrients in the daily food ration in women in the first half of pregnancy were either in agreement or higher (in the case of fats--108.5g) than the recommended ones, with the exception of calcium (669 mg) and percent of energy derived from protein (11.6%) which were lower. The mean daily food ration of women in the second half of pregnancy provided a sufficient amount of energy (2759 kcal), lower than recommended amount of total protein (79.9g), calcium (734 mg), and iron and vitamins B1, B2 and C. Pregnant women in relation to controls consumed significantly more energy daily (by 684 kcal in the first half--35%, and by 820 kcal--42% in the second half of pregnancy) and various nutrients, with the exception of vitamin C in the first half of pregnancy (p less than or equal to 0.05). In the second half of pregnancy the women took significantly more energy, total protein, animal protein, carbohydrates, calcium, iron and vitamin B1, B2 and C than in the first half (p less than or equal to 0.05). These differences were not statistically significant for the remaining nutrients. The study demonstrated that women in pregnancy took significantly different diets than non-pregnant women.