Are sleep duration, midpoint of sleep and sleep quality associated with dietary intake among Bavarian adults?

BACKGROUND/OBJECTIVES: Only few epidemiologic studies examined sleep characteristics in relation to dietary behaviour. Our aim was to analyse associations of sleep duration, midpoint of sleep and sleep quality with dietary intake among the Bavarian population. SUBJECTS/METHODS: Within the cross-sectional Bavarian Food Consumption Survey II, 1050 subjects aged 13-81 years were recruited. Dietary intake was assessed with three 24-h dietary recalls by telephone (EPIC-Soft). In our study, 814 participants aged 18 years or older, who completed at least two 24-h dietary recalls and who had complete and plausible information on sleep characteristics were analysed. Dietary intake was described by the consumption of main food groups, energy-proving nutrients and energy intake. Sleep was measured by the Pittsburgh Sleep Quality Index Questionnaire, from which categories of self-reported usual sleep duration in half-h-steps per night, midpoint of sleep and overall sleep quality were derived. RESULTS: Sleep duration was associated with intake of non-alcoholic beverages (P<0.01), carbonated beverages (P=0.04), water (P=0.04) and coffee/black tea (P=0.01) with higher intake among short duration sleepers. No association was found between the consumption of other main food groups, energy-proving nutrients or total daily energy intake and sleep duration. Midpoint of sleep was associated with intake of carbonated beverages (P=0.02, highest intake among subjects with early midpoint of sleep). No association between sleep quality and dietary intake was detected. CONCLUSIONS: Our findings demonstrate only specific associations between sleep characteristics and dietary intake, and mainly sleep duration was associated with beverage intake.

Eating at restaurants, at work or at home. Is there a difference? A study among adults of 11 European countries in the context of the HECTOR* project.

BACKGROUND/OBJECTIVES: To compare macronutrient intakes out of home-by location-to those at home and to investigate differences in total daily intakes between individuals consuming more than half of their daily energy out of home and those eating only at home. SUBJECTS/METHODS: Data collected through 24-h recalls or diaries among 23 766 European adults. Participants were grouped as 'non-substantial', 'intermediate' and 'very substantial out-of-home' eaters based on energy intake out of home. Mean macronutrient intakes were estimated at home and out of home (overall, at restaurants, at work). Study/cohort-specific mean differences in total intakes between the 'very substantial out-of-home' and the 'at-home' eaters were estimated through linear regression and pooled estimates were derived. RESULTS: At restaurants, men consumed 29% of their energy as fat, 15% as protein, 45% as carbohydrates and 11% as alcohol. Among women, fat contributed 33% of energy intake at restaurants, protein 16%, carbohydrates 45% and alcohol 6%. When eating at work, both sexes reported 30% of energy from fat and 55% from carbohydrates. Intakes at home were higher in fat and lower in carbohydrates and alcohol. Total daily intakes of the 'very substantial out-of-home' eaters were generally similar to those of individuals eating only at home, apart from lower carbohydrate and higher alcohol intakes among individuals eating at restaurants. CONCLUSIONS: In a large population of adults from 11 European countries, eating at work was generally similar to eating at home. Alcoholic drinks were the primary contributors of higher daily energy intakes among individuals eating substantially at restaurants.

A feasibility study of using a diet optimization approach in a web-based computer-tailoring intervention for adolescents.

OBJECTIVE: Adolescents are an interesting but neglected target group in obesity prevention. We assessed the feasibility of using a diet optimization approach for computer-tailored nutrition interventions for adolescents. METHOD: Development of an optimization model based on the public health approach to diet optimization. On the basis of food frequency questionnaires (FFQ) of 48 adolescents (14-17 years) optimized diets were calculated. RESULTS: The optimization calculations for all cases resulted in individual advice. On a total of 137 items included in the FFQ, the individualized advice included changes in a minimum of 36 and a maximum of 88 items (mean: 61 items), recommendations for changes in the food items ranged from less than 1 g day(-1) up to 1660 g day(-1). In almost all cases a higher intake of fruit and vegetables was recommended; some unexpected advice was also generated (for example, to decrease the consumption of brown bread and to increase the consumption of pizza). The strengths and weaknesses of the optimized diets are discussed. CONCLUSION: Using the optimization approach is a step forward in nutrition tailoring interventions but the model used in the present feasibility study still needs to be refined.

Depression, comorbidities and the TNF-alpha system.

Depression has frequently been reported to be associated with other physical diseases and changes in the cytokine system. We aimed to investigate associations between a medical history of depression, its comorbidities and cytokine plasma levels in the Bavarian Nutrition Survey II (BVS II) study sample and in patients suffering from an acute depressive episode. The BVS II is a representative study of the Bavarian population aged 13-80years. The disease history of its 1050 participants was assessed through face-to-face interviews. A sub-sample of 568 subjects and 62 additional acutely depressed inpatients of the Max Planck Institute of Psychiatry participated in anthropometric measurements and blood sampling. Tumor necrosis factor-alpha (TNF-alpha) and soluble TNF receptor (sTNF-R) p55 and sTNF-R p75 plasma levels were measured using enzyme-linked immunosorbent assays. A history of depression was associated with a higher incidence of high blood pressure, peptic ulcer, dyslipoproteinemia, osteoporosis, allergic skin rash, atopic eczema and thyroid disease. Within the BVS II sample, participants with a history of depression differed from subjects who had never had depression with regard to sTNF-R p55 and sTNF-R p75 levels even when controlling for age, BMI and smoking status. Acutely depressed inpatients showed even higher levels of sTNF-R p55 and sTNF-R p75 than subjects in the normal population. TNF-alpha levels were also significantly elevated in acutely depressed patients. These results confirm earlier studies regarding the comorbidities of depression and support the hypothesis that activation of the TNF-alpha system may contribute to the development of a depressive disorder.

Estimations of daily energy and nutrient availability based on nationally representative household budget survey data. The Data Food Networking (DAFNE) project.

OBJECTIVE: To describe a cost-efficient method for estimating energy and nutrient availability using household budget survey (HBS) data. DESIGN: Four different approaches were tested and the results were compared with published nutrient intake data. The selected method was exemplarily applied in German and Greek data. SETTING: Germany, 1998; Greece, 1998/99. MATERIAL: Nationally representative HBSs. RESULTS: Comparisons showed that HBS-based estimates were generally close to intake data when results were presented as contributions to daily energy intake. Daily energy and protein availabilities were similar in Germany and Greece. Differences were observed in the availability of carbohydrates (German households reported a 5 percentage points higher contribution to daily energy availability) and lipids (Greek households recorded higher values for total fat, but lower values for saturated fat). Meat, added lipids and potatoes were important energy suppliers in Germany, whereas in Greece the first three energy suppliers were added lipids, cereals and meat. In both countries, meat, cereals, milk and cheese were important protein sources and cereals, potatoes, fruits and nuts contributed more than 60% of the daily carbohydrate availability. Added lipids were the major source of fat in the daily diet of both countries, but their contribution amounted to less than one-third in Germany and two-thirds in Greece. CONCLUSIONS: National HBS data can be used for monitoring and comparing nutrient availability among representative population samples of different countries. The ground is set for the development of a harmonised food composition table to be applied to HBS food data at international level.

Dietary patterns and their socio-demographic determinants in 10 European countries: data from the DAFNE databank.

OBJECTIVE: To describe the dietary patterns of 10 European countries and their socio-demographic determinants, using the comparable between-countries DAFNE data. DESIGN: Analysis of standardized and postharmonized data collected through the national household budget surveys. SETTING: Nationally representative surveys undertaken in 10 European countries, generally in the second half of the 1990s. RESULTS: The differences in the fruit and vegetable consumption previously identified between Mediterranean and Northern European countries seem to be leveling out, particularly in relation to fruit consumption. Pulses, however, still characterize the diet of the Mediterraneans. Straying from their traditional food choices, Mediterraneans recorded high availability of unprocessed red meat, while Central and Northern Europeans preferably consumed meat products. The household availability of beverages (alcoholic and non-alcoholic) is generally higher among Central and Northern European populations. Principal component (PC) analysis led to the identification of two dietary patterns in each of the 10 countries. The first was similar in all countries and indicated 'wide-range' food buyers. The second was slightly more varied and described 'beverage and convenience' food buyers. PC1 was common among households of retired and elderly members, while PC2 was common among households located in urban or semi-urban areas and among adult Scandinavians living alone. CONCLUSIONS: The dietary patterns identified point towards a progressive narrowing of dietary differences between North and South European countries. The comparable between-countries DAFNE data could prove useful in ecological studies, in the formulation of dietary guidelines and public health initiatives addressing specific population groups. SPONSORSHIP: European Commission.

Allergic sensitisation and allergic rhinitis are associated with n-3 polyunsaturated fatty acids in the diet and in red blood cell membranes.

OBJECTIVE: Due to inconsistent results based on dietary intake data, unsaturated fatty acids in red blood cell (RBC) membranes and diet were used to investigate their association with allergic sensitisation and allergic rhinitis. DESIGN: Cross-sectional, population-based study. SETTING: Bavarian Nutrition Survey II (2002-03), Germany. SUBJECTS: A total of 568 adult participants, 325 women and 243 men. METHODS: By means of logistic regression models, the relation of fatty acids to (i) allergic sensitisation as defined by means of specific serum immunoglobulin E analysis (CAPSX1 class > or = 2), and (ii) self-reported allergic rhinitis was examined. RESULTS: A high cell membrane level of eicosapentaenoic acid (EPA, 20:5 n-3) was inversely associated with allergic sensitisation, the adjusted odds ratio (OR) and 95% confidence interval (95% CI) were 0.52 (0.30-0.90) for the highest (vs lowest) quartile. A similar effect was observed for allergic rhinitis with an OR (95% CI) of 0.50 (0.24-1.03; P = 0.027 for trend). A higher dietary intake of alpha-linolenic acid (ALA, 18:3 n-3) was associated with a decreased risk of allergic sensitisation and allergic rhinitis with ORs (95% CIs) of 0.51 (0.28-0.93) and 0.43 (0.20-0.93), respectively, in the highest quartiles. No other dietary or cell membrane unsaturated fatty acid was significantly associated with the outcome variables, nor was the n-6/n-3 ratio. The strongest effects were observed among subjects under the age of 40 y. CONCLUSIONS: In this cross-sectional study among adults, a high content of n-3 fatty acids in RBC membranes (EPA) or in the diet (ALA) is associated with a decreased risk of allergic sensitisation and allergic rhinitis.

How optimal are computer-calculated optimal diets?

OBJECTIVE: This paper aims at clarifying the meaning of 'optimal diets'. DESIGN: Two different optimization approaches are considered. Both depart from people's actual diets which in general do not meet all their nutrient requirements. In the first case (non fuzzy approach) the actual diets are modified such that all nutrient intake recommendations are met and the resulting changes in the persons' food habits are as little as possible. In the second case (fuzzy approach) the actual diets are modified such that the persons' food habits undergo little change and the nutrient intake recommendations are met as well as possible. Both approaches are evaluated using data on the actual diets of three randomly chosen participants of the Bavarian Food Intake Survey. RESULTS: With both approaches feasible solutions can be found. The optimal diets computed with the non fuzzy approach satisfy all the persons' nutrient requirements, but make it necessary to change the persons' food habits considerably. When compared to the subjects' actual diets, the optimal diets computed with the fuzzy approach yield improvements for the intake of many nutrients, but in some cases deteriorations also occur (for example, concerning folate, calcium and iodine). So, the process and the results of the fuzzy approach are not 'Pareto efficient'. But it has the advantage that the corresponding optimal diets deviate from the actual diets by no more than about 3-5 kitchen units per day. CONCLUSIONS: The term 'optimal' does not have a general meaning. An 'optimal diet' does not necessarily meet all the nutrient requirements of a person. Optimality only depends on the respective conditions any optimization is based on.

Sucrose intake in Germany.

The present investigation reevaluated the German National Food Consumption Survey in order to obtain data on sucrose intake and food sources of sucrose intake in Germany. Moreover, it focused on the effect of sucrose intake on nutrient intake. By means of the food composition data base Bundeslebensmittelschlüssel, version II.2, 7-days dietary records of a representative sample of 15,838 persons aged 4 years and older were analyzed. The relation between sucrose and nutrients intake was investigated by variance and regression analyses. Low, moderate, and high sucrose intake categories were defined by means of sucrose density quartiles and comparisons were made for the percentages of persons meeting the German nutrient intake recommendations. Mean daily sucrose intake ranges between 43.2 g/d (f, 51-64 years) and 82.3 g/d (m, 13-14 years). The mean contribution of sucrose to total energy intake is highest with 14% in young age (4-6 years) and decreases to 9% and 7% in 51-64 year old women and men, respectively. The food groups "table sugar", "confectionery and ice cream", "biscuits, cake and pastries", "preserves", "dairy products", and "non-alcoholic beverages" are the main sucrose sources with varying importance in different age groups. The average amount of naturally occurring sucrose in the Germans' diet is estimated to 15-25% of total sucrose intake. Sucrose contributes 80-90% to total disaccharides intake in Germany. With each gram of sucrose the intake of energy rises on the average by 12.5 kcal (52.4 kJ), of protein by 0.3 g (9% of the energy increase), of fat by 0.5 g (34%), and of carbohydrates by 1.8 g (57%). Consequently, the higher the sucrose content of a diet, the lower is the contribution of fat to total energy intake. In contrast, the energy-adjusted effect of sucrose was found to be negative for energy-providing nutrients (except mono- and disaccharides) as well as for all the selected micronutrients, except calcium, vitamin E, vitamin C, and dietary fiber. Accordingly, the comparison between moderate and high sucrose consumers revealed a lower percentage of persons meeting nutrient intake recommendations in the high sucrose category under the condition of a comparable energy intake. This unfavorable effect of high sucrose intake is most prominent in 4-6 year old boys and girls as the groups with the highest sucrose intake. Since from the present data no exact figure for a sucrose or sugars intake recommendation can be deduced, it is suggested to keep on the WHO recommendation for a moderate sugar intake of 10% of energy intake.