Measuring the food and built environments in urban centres: reliability and validity of the EURO-PREVOB Community Questionnaire.

OBJECTIVES: The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project 'Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe' (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research. STUDY DESIGN: The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment. METHODS: Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs). RESULTS: Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects. CONCLUSIONS: The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants.

[Comparison of dietary habits in obese and thin women using the food frequency questionnaire]. / Srovnání stravovacích zvyklostí obézních a stíhlých zen metodou frekvencního potravinového dotazníku.

INTRODUCTION: Imbalance between energy intake and energy expenditure, influenced as well as by eating pattern, contributes to the development of obesity. The aim of retrospective "case-control" study was to compare dietary pattern of 246 obese women (O, BMI = 36.2 +/- 7.4 kg/m2) with 108 control, normal weight, women (C, BMI = 22.8 +/- 3.3 kg/m2). The examined groups were randomly selected according Body Mass Index from non dieting population. METHODS: The administration of Food frequency questionnaire [1] was used, evaluating three months period before administration. The eating patterns in the form of relative representation of the main food commodities, based on intake frequencies (RRFCI), were calculated using special mathematical procedure and were compared using the non-pair two sides' t-test. RESULTS: O performed significantly lower absolute number of intake of non-drink food per month (p = 0.01). RRFCI in the eating patterns of O and C is summarized in the next table: [table: see text] CONCLUSION: Obese women showed significantly higher relative number of frequencies of intake of meat and dairy products and lower proportion of frequencies of intake of cereals, free fat, sweets in their eating patterns in comparison to normal weight women.

Dietary guidelines in the Czech Republic III.: Challenge for the 3rd millennium.

In developed countries, dietary guidelines are more and more often used as a source of binding information not only in public health, food production, nutrition and agricultural policy, but in ecology and economy as well. In view of that, it is imperative to formulate such guidelines that would be supported by relevant population studies and correspond to the European model of WHO/CINDI guidelines. At the turn of the millennium, the Czech guidelines were updated in order that serving sizes of 5 basic food groups were brought closer to contemporary trends emphasizing lower protein intakes and at the same time, by setting limit ranges, they were able to meet specific need of people of different age group, sex, physiological status, physical activity, etc. The conversion of recommended servings to nutrients was compared with the results of the actual food basket of the Czech population and specific recommendations for amendments in proportions of individual food items in food groups and subgroups were given. On the basis of diet guidelines, conclusions describing tasks for the beginning of the third millennium were made. Besides them the most important are: production or health information systems with special emphasis to food intake and nutritional status report, policies to increase the access to vegetables and fruit for vulnerable groups, legislation to curb advertising high-fat energy-dense foods to children, policy to strengthen the operational targets of Innocenti Declaration and to increase the number of Baby Friendly Hospitals, legislation regarding food control systems based on international standards, sustainable campaigns to promote safe healthy diet, policies to ensure sustainable food production.

Dietary guidelines in the Czech Republic. II.: Nutritional profiles of food groups.

Modern dietary guidelines set in terms of food groups are easy to use and understand for target populations, but rather complicated from the point of view of quantification, i.e. the correctly set number of recommended servings in different population groups according to age, sex, physical activity and physiological status on the basis of required intake of energy and individual nutrients. It is the use of abstract comprehensive food groups that makes it impossible to use a simple database of food tables based on the content of nutrients in individual foods, rather than their groups. Using groups requires that their nutritional profiles be established, i.e. that an average content of nutrients and energy for individual groups be calculated. To calculate nutritional profiles for Czech dietary guidelines, the authors used three different methods: (1) Simple profiles, with all commodities with significant representation in the Czech food basket represented in equal amounts. (2) Profiles based on typical servings, with the same commodities as in (1) but in characteristic intake quantities (typical servings). (3) Food basket-based profiles with commodities constituting the Czech food basket in quantities identical for that basket. The results showed significant differences in profiles calculated by different methods. Calculated nutrient intakes were particularly influenced by the size of typical servings and it is therefore essential that a realistic size of servings be used in calculations. The consistent use of recommended food items throughout all food groups and subgroups is very important. The number of servings of foods from the five food groups is not enough if a suitable food item is not chosen within individual groups. On the basis of their findings, the authors fully recommend the use of nutritional profiles based on typical servings that give a realistic idea of the probable energy and nutrient content in the recommended daily intake. In view of regional cultural differences, national nutritional profiles play a vital importance. Population studies investigating the size of the typical servings and the most frequently occurring commodities in the food basket should be made every three years. Nutritional profiles designed in this way constitute an important starting point for setting national dietary guidelines, their implementation and revisions.

[Determinants of interest in primary preventive screening]. / Determinanty zájmu o screeningové primárne preventivní vysetrení.

BACKGROUND: Primary prevention care requires active approach not only from the health professionals but also from all individuals of the target population. People themselves have to be interested for their own health, for the preventive examinations, for their life-style. However, the health supporting activities based on the voluntary interest are most frequently exploited by people who actually do not need it, and people of the high risks stay apart. The aim of the study was to identify major differences among those who are interested in the preventive examinations and who are not, and answer the question whether those who declare their interest are the needful and primarily aimed population. METHODS AND RESULTS: Within the preventive project, 4353 parents of school-aged children in Brno were examined using a special questionnaire. Beside interest in examination, following criteria were questioned and analysed: age, education level, economical standard, subjective evaluation of health, occurrence of concrete health problems, family health history, adequacy of the body weight (according reported height and weight), dietary habits, alcohol consumation, smoking habits, recreation-sport activities, and selected subjective perceptions. Differences based on concern about examination were evaluated by the comparison of studied parameters in groups formed according the "interest" and also using the logistic regression analysis. We found that the dominating determinant of concern about the preventive examination was the interest of the family partner (harmony of interests). In the group of persons who declared their "interest", higher education level, worse subjective evaluation of health, higher occurrence of concrete health problems, and higher incidence of selected diseases in the family were more frequently reported. Obversely, the number of smokers was lower in this group. Incidence of overweight persons differed according to their sex--meanwhile more overweight women were among the "interested group", more overweight men were among the "not interested". Women in the "interested" group consumed alcohol less frequently, men in this group were often more active in sports. Dietary habits as well as economical standard did not differ among the two groups. CONCLUSIONS: Though the differences among groups with different concern about examination were statistically different, they were not very pronounced. It cannot be confirmed that the preventive examination is exploited preferably by people without major risk factors, those socio-demographically or otherwise specific, or generally those to whom the proposal of examination was not aimed.

Dietary guidelines in the Czech Republic. I.: Theoretical background and development.

Setting dietary guidelines for the healthy population of the Czech Republic has respected the methodical steps suggested by authors as follows: consideration of dietary guidelines was preceded by the consensus on general goals and methods, e.g. health and well-being promotion at the population level. The guidelines cover a total diet, not only a part of it and have to be realistic, with respect to actual frequency of food in majority of population. The second step was the declaration of nutritional goals with respect to achieving the RDI. The third step was dividing the food into defined food groups according to the following criteria: the food contained in one food group had the same/similar nutritional characteristics with regard to achieving the adequate of decreased intake. Within the groups several sub-groups were set, associating foods with another specific nutrient content. The fourth step was the setting the serving sizes as an equivalent for each food group. These equivalents must reflect typical average consumed amount of food and always within the group the content of the main nutrient has to be same/similar. The fifth step was setting nutritional profile of each group and/or sub-group. This profile represented the content of energy, proteins, lipids, carbohydrates, vitamins and minerals. The sixth step was deciding the daily number of servings of each food group, which must allow the flexibility as much as possible--authors recommend the interval solution. The seventh step was decision about the form (textual and graphic), which presents the guidelines. The decision was preceded by the study focused on accepting suggested possibilities. The last, eighth step was working out the strategy of implementation in practise, which means the summarizing organizational, administrative and political arrangements with the aim to be positively accepted by the population who identify itself with the principles of the dietary guidelines. In the formulation of dietary guidelines in the Czech Republic, the authors accepted methods described above and each of the eight steps was supported by adequately focused population study.

A comparison between the lifestyles of men and women--parents of school age children.

Women live longer than men and experience lower overall and specific mortality resulting from various diseases, even when younger. The reasons for this have yet to be satisfactorily explained. However, biological differences on one hand and differing lifestyles on the other might be responsible. The purpose of the study was to examine to what extent the lifestyle of men and women differs within a relatively homogeneous population group. The lifestyles of 4,353 parents of school age children (58% women and 42% men) were examined using questionnaires. The results show considerable differences between the genders. Men had worse dietary habits--consuming significantly less vegetables, fruit and milk, but too much meat; they consumed more processed meat and fat-containing items within the food sub-categories; they preferred less low-fat milk products and consumed less wholemeal products. Men more often consumed alcohol, drank more of it and often crossed the limits hazardous for health. There were more smokers among the men, they smoked more cigarettes and the non-smokers more often indicated passive exposure to cigarette smoke. Overweight and obesity occurred more often among men. Relatively minor differences, rather to the benefit of men, occurred in the field of leisure-time physical sporting activities, where slightly more men pursued regular sporting activities but in significantly higher amounts than the women, whereas the men did less regular daily walking. Women, as opposed to men, displayed more interest in comprehensive primary preventive medical examinations. The results obtained suggest that women lived a generally more healthy lifestyle than men within the examined homogeneous group of parents of school age children, consisting mostly of pairs of partners. They support the assumption that the healthier lifestyle of women very significantly contributes to their lower mortality.

[Effect of nonpharmacologic intervention on lowering plasma cholesterol levels]. / Efekt nefarmakologické intervence na snízení hladiny plazmatického cholesterolu.

UNLABELLED: Our study focused on the effect of non-pharmacological intervention based on the modification of dietary habits and increasing physical activity on the level of total plasma cholesterol. SAMPLE AND METHODS: Intervented sample was created by 279 highly motivated healthy adults from Brno (168 women and 111 men) of average age 43.5 +/- 10.3 years and average level of total plasma cholesterol 6.1 +/- 0.75 mmol/l and HDL-cholesterol 1.04 +/- 0.14 mmol/l. After medical and life-style history assessment, followed by clinical and biochemical checking and evaluation the risk from the life-style and biochemical and clinical parameters, the participants were individually informed about recommendations. These recommendations regarded detailed changes of dietary habits, quantified by the recommended number of servings of basic food groups and sub-groups daily and also increasing physical activity. RESULTS: After 3 months the changes of biochemical parameters were evaluated. After our non-pharmacological intervention we founded significantly lower average level of total plasma cholesterol 5.36 +/- 1.24 mmol/l (p < 0.001) and higher level of HDL-cholesterol 1.16 +/- 0.14 mmol/l. The level of TG's did not change significantly neither in whole sample, nor in the sub/sample of women and men. 26% of our sample was resistant to the intervention (the difference in the total cholesterol level between 2 assessment was lower than 0.5 mmol/l). No significant difference was found between men and women regarding the reaction of plasma lipoproteins. DISCUSSION AND CONCLUSIONS: Our results justify the adequacy and appropriety of primary preventive advising focusing on decrease of the risk of premature death using non-pharmacological intervention in highly motivated people with good compliance and sufficient responsibility for their personal health.

[Method for screening of dietary intake in pregnant women]. / Metoda screeningového hodnocení výzivové spotreby tehotných zen.

OBJECTIVE: Description and practical demonstration of the new method of dietary evaluation of pregnant women. DESIGN: Pilot study--testing of new method. SETTING: Department of Preventive Medicine, School of Medicine MU, Brno. METHODS: The authors describe a screening method of quick and easy dietary evaluation of pregnant women. This method used for the assessment of the healthy population employs standards formulated in terms of serving equivalents and food groups. The data are obtained by the 24-hr recall and the food is converted into 6 basic food groups. The consumption is compared with the recommended number of the servings of each food group. The result of the evaluation is practical and an early comprehensible recommendation for pregnant women. This method also allows the calculation of total energy and nutrients, using so-called nutrition profiles of each food group. The method involves the possibility of sell-assessment and self-evaluation using the questionnaire designed by WHO and modified by the authors according to the needs of Czech population. The article contains the results of a pilot study describing the dietary evaluation of 50 pregnant women from Brno. RESULTS: The pilot study proved the advantages of the described method for practical use. CONCLUSION: The authors consider the described new method of quick screening evaluation of dietary intake an applicable and desirable part of the health status assessment during pregnancy.

"Know and improve your health": symbiosis of preventive project and preventive medicine education at the medical faculty in Brno.

At the medical faculty in Brno we succeeded in combining the public health improvement project with the practical education of preventive medicine of medical students. The project "Know and improve your health" should enable individual estimation of the risk factors in people involved and, most of all, effectively decrease the risks by individual modification of their lifestyle. Until now, 1.588 participants were examined in the framework of the project and 147 medical students were actively involved during their preventive care rotations. Among the identified risk factors, the most prevalent were low physical activity (79% females and 75% males), imperfect nutrition (approx. 45% females and 65% males), increased level of blood cholesterol (33% females and 47% males), overweight and obesity (30 % females and 45% males), excessive alcohol intake (3% females and 30% males), increased blood pressure (19% females and 31% males) and smoking (22% females and 27% males). The efficiency of the intervention is determined by sending brief anonymous questionnaire to the participants after several months following the examination. We received 54% of the questionnaires back. 87% of respondents state change in their knowledge, opinions and attitudes as an effect of the project, 86% state their effort to change their lifestyle and 71% successfully realized change in their lifestyle. Students taking part in the project are influenced in the sense of "Broader application of preventive methods in their future medical practice" (79% probably, 21% definitely). Positive effect is perceived as beneficial above average by 62% of students for themselves and 59% for examined persons. 96% of students and 100% of involved people think the project should go on in future. Participation in the real preventive program seems to be very effective form in the study of preventive medicine.