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

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

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

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

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

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

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

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

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

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

Physical activity in European seniors: attitudes, beliefs and levels.

BACKGROUND: It is important to study the factors which modulate ageing, among which physical activity (PA) seems to have a very important role on the health status and quality of life of the elderly. To be effective, any intervention specifically targeted to promote PA should be based on the knowledge of the population, namely on their needs, attitudes and behaviour. OBJECTIVE: To identify in the elderly European population, the attitudes to PA and health, in order to define adequate strategies of promotion. DESIGN: Cross-sectional survey using a face-to-face interview-assisted questionnaire. This project belongs to the multicentric Pan-EU Survey on Consumer Attitudes to PA, Body Weight and Health under the leadership of the Institute of European Food Studies - Dublin with the cooperation of members from all European Union countries. 1914 European citizens, aged > or = 65, were interviewed. The data's descriptive analysis, was followed by univariate analysis to characterise the study's sample. RESULTS: PA was not viewed by the elderly as a major health determinant as it was ranked only 5th (18%), preceded by food (42%), smoking habits (40%) and alcohol (24%). 41% of elderly were not engaged in any type of PA, but 50% dedicated more than 3,5 hours/week on various activities. At EU level the most common activities included walking, gardening, cycling and swimming. 64% of the elderly thought that they do not need to do more PA, and 37% were in the pre-contemplation stage as they were currently not very physically active and they didn't intend to become physically active in the next 6 months. A large variation in attitudes, and behaviours in relation to PA, was found amongst European countries. CONCLUSION: Programmes to promote PA need to be tailored to the different countries in order to increase/maintain PA in the elderly.

Healthy eating in European elderly: concepts, barriers and benefits.

BACKGROUND: The promotion of healthy eating is more likely to be effective if based on the understanding of how the elderly perceive their own diets and healthy eating. OBJECTIVES: The objectives of this study were to identify in the elderly European population, the attitudes to food, nutrition and health, in order to define adequate strategies of health promotion. DESIGN: Cross-sectional survey using a face-to-face interview-assisted questionnaire. This project belongs to the multicentric Pan-EU Survey on Consumer Attitudes to Food, Nutrition and Health under the leadership of the Institute of European Food Studies - Dublin with the cooperation of members from all EU countries. 1843 European citizens, aged > or = 65, were interviewed. The data's descriptive analysis, was followed by univariate analysis to characterise the study's sample according to the defined objectives. RESULTS: The most important factors influencing elderly's food choice were quality and freshness (54%), trying to eat healthy and price (8%). Healthy eating was defined as "less fat" (37%) "more fresh vegetables and fruit" (34%), and "natural foods" (11%). To stay healthy (36%), to prevent disease (26%) and to promote quality of life (10%) were the major benefits associated to healthy eating. However several barriers to the adoption of healthy eating were identified, namely self-control (27%), the resistance to change (23%) and price (15%). 86% of the elderly people believe they don't need to change their eating habits as they already eat healthily. CONCLUSION: Results of this study will help to improve eating habits in the elderly, as health professionals will be able to choose the most appropriate strategies for the different groups and settings, and provide a base for future interventions in European countries for this growing age group.

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

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

Attitudes towards and beliefs about nutrition and health among a random sample of adults in the Republic of Ireland and Northern Ireland.

OBJECTIVES: For effective healthy eating promotion, it is necessary to understand the attitudes towards and beliefs about nutrition of the general public. The objective of this study was to provide data on attitudes towards eating a healthy diet and the perceived need to alter eating habits from a random sample of adults in the Republic of Ireland and in Northern Ireland, using a self-administered questionnaire. DESIGN: Cross-sectional survey using a self-administered attitudinal questionnaire on beliefs and attitudes to healthy eating. SETTING: The survey was carried out between October 1997 and October 1999 in the Republic of Ireland and in Northern Ireland. SUBJECTS: A randomly selected sample of 1256 adults from the Republic of Ireland and Northern Ireland completed the attitudinal questionnaire. RESULTS: A majority of subjects (62%) perceived that they make conscious efforts to eat a healthy diet either most of the time or quite often, while just over half (52%) agreed that they do not need to make changes to their diet as it is healthy enough. Subjects most likely to make conscious efforts to try to eat a healthy diet were females, older subjects (51-64 years) and those with the highest intakes of fruit and vegetables and lowest quartile of fat (% food energy). When self-assessed adequacy of fruit and vegetables was examined, two-thirds of the total sample felt they ate too little fruit while just one-third felt they ate too little vegetables. CONCLUSION: Results of the present study, in general, revealed good agreement between attitude and behaviour with respect to healthy eating. This suggests that people appear to be reasonably accurate at evaluating their own diet in terms of how healthy it is. In terms of the two food groups examined in this study, some optimistic bias was evident for vegetables but not for fruit. It may be useful therefore to assess attitudes and beliefs about healthy eating by way of examining attitudes to such food groups individually.

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

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

Stages of change towards physical activity in a nationally representative sample in the European Union.

OBJECTIVE: To examine the distribution of the stages of change towards physical activity across Europe and the influence of sociodemographic variables on this distribution. DESIGN: A cross-sectional study in which quota-controlled, nationally representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. SETTING: The survey was conducted in the 15 member states of the European Union between March and April 1997. SUBJECTS: The questionnaire was completed by 15,239 subjects (aged 15 years upwards). Data were weighted by population size for each country and by sex, age and regional distribution within each member state. RESULTS: Twenty-nine per cent of subjects were in the precontemplation stage, while a similar proportion (30%) were in the maintenance stage. Ten per cent had been physically active but had relapsed recently. Considerable intercountry variation existed with Scandinavian countries tending to be lower in the precontemplation stage and southern countries tending to be higher (particularly Greece and Portugal). Men and younger subjects with a higher education level were more likely to be in the maintenance stage. Overweight and obese subjects were more likely to be in the precontemplation stage than normal-weight subjects. In terms of barriers to participating in physical activity 'not being the sporty type' was more important for those in precontemplation stages, while 'work/study commitments' was more important for those people in the maintenance stage. CONCLUSIONS: The model of the stages of behavioural change towards physical activity was able to distinguish people according to their level and attitude to physical activity. The considerable intercountry and sociodemographic variation in the distribution of stages of change suggest that targeted programmes aimed at specific subgroups in the population identified using the model may be more effective in promoting physical activity.

Variables independently associated with self-reported obesity in the European Union.

OBJECTIVE: The rapid increase in obesity rates over recent years suggest that cultural and societal influences are affecting the adjustment in the energy balance equation in addition to other physiopathological or genetic determinants. Therefore, a pan-EU study was carried out to explore the influence of sociodemographic factors as well as some attitudes (smoking and exercise) on the prevalence of obesity in the adult population of all 15 member states of the EU. DESIGN: Overall, a sample of 15,239 individuals aged 15 years and upwards in the EU completed the questionnaire. Subject selection was quota-controlled to make the sample nationally representative following a multistage stratified cluster sampling. Self-reported height and weight were used to calculate body mass index (BMI). RESULTS: From the EU average results, it can be seen that only about half of the EU population (48%) is within the normal weight range, while the obesity (BMI > or = 30 kg m(-2)) prevalence was about 10% in the EU and the overweight prevalence was 36.6% and 25.6% among men and women, respectively. UK subjects had the highest prevalence of obesity (12%), while Italians, French and Swedes had the lowest levels of obesity (about 7%). Concerning age and social class interactions, logistic regression analysis showed that high social class and younger individuals in all groups had a lower odds ratio for obesity prevalence. People with a higher level of education are less likely to be obese, while the interaction between educational levels and obesity was different for men and women. A low participation in various leisure-time physical activities, the lack of interest (precontemplation) in being involved in exercise/physical activity and the increasing number of hours sitting down at work appear to be predictors of obesity. Single individuals were less prone to become obese than couples or widowed/divorced people. Finally, smoking status was statistically linked to the prevalence of obesity, since non-smokers or ex-smokers for more than 1 year presented a higher tendency for a BMI > 30. CONCLUSIONS: This survey confirms that a priority area for health intervention aimed at preventing the development of obesity should be to increase levels of physical activity, although the approach will depend on the population, especially with respect to educational and socioeconomic aspects.

Body image perception in relation to recent weight changes and strategies for weight loss in a nationally representative sample in the European Union.

OBJECTIVES: To assess body image perception and satisfaction with current body image across the EU and to explore the influence of sociodemographic variables, body-weight change and strategies for losing weight on body image perception. DESIGN: A cross-sectional study in which quota-controlled, nationally representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire. SETTING: The survey was conducted in the 15 member states of the EU between March and April 1997. SUBJECTS: The questionnaire was completed by 15,239 subjects (aged 15 years and upwards). Data were weighted by population size for each country and by sex, age and regional distribution within each member state. RESULTS: Just 39% of respondents in the EU were satisfied with their weight and these were more likely to be male (46%) rather than female (31%). Across the EU 29% of Finnish subjects were content with their weight compared with 47% in Belgium and 48% in Luxembourg. The highest percentage of subjects who were content with their body weight was among females who were underweight (58%) and males who were normal weight (66%). A further 20% of underweight females wished to be lighter compared to only 5% of males. Diet was the most frequently selected method for losing weight especially among females wishing to be considerably lighter (27%) while males were as likely to use exercise as diet as a strategy to lose weight. CONCLUSIONS: Geographical and sociodemographical influences on body image perception are evident across the EU. There were clear gender differences in the desire to be thinner with a high proportion of females who were underweight being content to be so.

Perceived benefits and barriers to physical activity in a nationally representative sample in the European Union.

OBJECTIVE: To examine the attitudes of consumers, in particular their perceived benefits and barriers to physical activity from all EU member states, and having a measure of prevailing levels of activity, inactivity and self-reported body weight and body shape. DESIGN: Cross-sectional survey using an interview-assisted face-to-face questionnaire. SETTING: The survey was conducted between March and April 1997 in the 15 member states of the EU. SUBJECTS: Overall, 15,239 EU subjects, classified according to sex, age (six levels) and highest level of education attained (primary, secondary or tertiary), completed the survey. Sample selection of subjects in each EU member state was quota-controlled to ensure they were nationally representative. RESULTS: The most important motivation for people to participate in physical activity is to maintain good health (42%), to release tension (30%) and to get fit (30%). The importance of the health argument is highest in older persons and in subjects with a primary education level. Only 13% of the EU population (16% of women, 10% of men) perceived losing weight as a benefit of physical exercise. The most important barriers to increase physical activity are work or study commitments (28%) and the subjects' belief that they are not 'the sporty type' (25%). There is considerable between-country variation in the answering pattern within the EU.

Perceptions about body weight and weight reduction in Spain.

OBJECTIVE: To assess the more prevalent beliefs about body weight and the factors involved in weight changes in the Spanish adult population. DESIGN: A national survey was carried out according to an established protocol on Spanish subjects selected by a multistage procedure following a random route model, which was quota-controlled for several sociodemographic variables. This study was undertaken by the Spanish arm of a pan-European survey and was performed with a validated questionnaire. It contained questions to evaluate some aspects concerning the relationship between obesity, physical activity and health. We also estimated the proportion of self-reported overweight and obesity. SETTING: Spain. SUBJECTS: The sample included 1,000 subjects aged 15 years or older. RESULTS: Eleven per cent of the sample were obese (body mass index, BMI > 30 kg/m-2) and an additional 32% were overweight (BMI > 25 and < 30 kg/m-2). Obesity prevalence was higher among older individuals, those with lower education and socioeconomic levels, and among housewives and retired or unemployed people. Most Spanish people believed that fat intake (51%) and the amount of food consumption (44%) were the major factors involved in weight gain, while physical activity was less mentioned (12%). The method most frequently used to lose weight was diet (9%). Individuals from central and southern regions payed more attention to genetics (20-27%) and physical activity (12-20%) as determinants of weight gain than people living in the north or northwest regions (15-17% and 8-9%, respectively). Normal weight people participated more often in some physical activity during their leisure time. CONCLUSIONS: The Spanish population is not familiar with factors influencing weight gain. Health promotion strategies should emphasize the role of physical activity, especially among older individuals, retired or unemployed subjects, those from lower educational or socioeconomic levels and among people living in the north or northwest of Spain.

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

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

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

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