Adherence to Dietary Recommendations in Organized Living Beneficiaries with Severe Mental Disorders and Their Caregivers.

People with severe mental disorders often require special care. Other than institutionalized care, some organizations provide housing options and special care in the form of organized living. Few studies provide a detailed description of nutrient intake in this type of care. The aim of this prospective study was to assess nutritional status and adherence to dietary recommendations in both people with mental disorders (beneficiaries) and their caregivers. Across three levels of care, 46 beneficiaries and 19 caregivers participated in the study. The mean intakes of energy (kcal/day) and macro- and micronutrients (g/day) were estimated from a 3-day dietary record and compared with dietary reference values (DRVs) set by the European Food Safety Authority (EFSA). The majority of participants did not meet energy intake recommendations (kcal/day). The contribution of total fat to energy intake (% E) was higher than recommended in both beneficiaries and caregivers with 42.1 ± 4.4% and 38.5 ± 6.5%, respectively. A total of 45.2% of beneficiaries and 61.1% of caregivers had their carbohydrate intake within the recommended range. Fiber intake was well below the recommendations (25 g/day) in all groups. Across all levels of care, lower micronutrient intake for pantothenic acid, biotin, folate, potassium, magnesium, copper, selenium, and iodine was observed. Based on the current results, the development and implementation of nutritional guidelines may be targeted to specific populations and nutrient intakes.

Simulated Gastric and Intestinal Fluid Electrolyte Solutions as an Environment for the Adsorption of Apple Polyphenols onto ß-Glucan.

Interactions with dietary fibers in the gastrointestinal tract might affect the potential bioactivities of phenolic compounds. In this study, the interactions between apple phenolic compounds and ß-glucan (a dietary fiber) were studied by studying the adsorption process in simulated gastric and intestinal fluid electrolyte solutions. Phenolic compounds were extracted from apples, adsorbed onto ß-glucan (2 h, 37 °C, in gastric or intestinal fluid electrolyte solutions), and determined using high performance liquid chromatography. Phenolic compounds (flavan-3-ols, flavonols, phenolic acids, and dihydrochalcone) were stable in the gastric fluid (pH 3). In the intestinal fluid (pH 7), flavan-3-ols were not found and chlorogenic acid isomerized. Polyphenols from the apple peel (up to 182 and 897 mg g-1) and flesh (up to 28 and 7 mg g-1) were adsorbed onto ß-glucan in the gastric and intestinal fluids, respectively. The adsorption was affected by the initial concentration of the polyphenols and ß-glucan and by the environment (either gastric or intestinal fluid electrolyte solution). By increasing the initial polyphenol amount, the quantity of adsorbed polyphenols increased. Increasing the amount of ß-glucan decreased the amount adsorbed. The results can be helpful in explaining the fate of phenolic compounds in the gastrointestinal tract.

Attitudes toward Nutrition Care among General Practitioners in Croatia.

Nutrition care should be an integral part of general practitioners' (GPs') daily work with patients. The aim of this study was to assess the attitudes of Croatian GPs toward nutrition and nutrition care, and to evaluate the interconnection between their attitudes and implementation of nutrition care in GPs offices. A cross-sectional study was conducted among 17.0% of randomly selected GPs, from May to July of 2013, via a specially designed anonymous questionnaire. The study showed that 36.0% of the Croatian GPs had satisfactory number of positive attitudes (5 or more) toward nutrition and nutrition care. There was statistically significant difference in the median number of positive attitudes based on the additional education of GPs in nutrition and their ailment from chronic diseases (p < 0.001 and p = 0.022, respectively). The Spearman rank correlation between GPs' attitudes toward nutrition and nutrition care and their practice, i.e., the implementation of nutrition care in GPs' everyday work with patients was rs = -0.235 (p < 0.001). In order to provide nutrition care in GPs' offices in Croatia, strategies for changing GPs' attitudes toward nutrition and nutrition care are needed.

Nutrition Counselling Practices among General Practitioners in Croatia.

Chronic non-communicable diseases are a significant public health problem and imbalanced nutrition is one of the most significant risk factor for them. The objective of this study was to examine Croatia's general practitioners' nutrition counselling practice and determine the factors that influence such practice. A cross-sectional study was conducted among 444 (17.0%) randomly selected general practitioners (GPs) in Croatia from May to July 2013 via a 32-item anonymous questionnaire. Study showed that 77.0% of participants had provided nutrition counselling exclusively to patients with specific health risks; 18.7% participants had provided nutrition counselling for all patients, regardless of their individual risks, while 4.3% had not provide nutrition counselling. As the most significant stimulating factor for implementing nutrition counselling in their daily work with patients, 55.6% of the participants identified personal interest regarding nutrition and the effects it has on health. The latter factor was more frequently emphasized among female general practitioners (p < 0.001) and general practitioners without chronic diseases (p < 0.001). The most significant barrier for nutrition counselling was lack of time (81.6%). It is necessary to make additional efforts to increase the frequency of nutrition counselling provided by general practitioners in Croatia. The majority of Croatian general practitioners could increase their nutrition counselling practice in order to promote balanced nutrition and improve the overall health status of their patients.

Cluster analysis as a prediction tool for pregnancy outcomes.

Considering specific physiology changes during gestation and thinking of pregnancy as a "critical window", classification of pregnant women at early pregnancy can be considered as crucial. The paper demonstrates the use of a method based on an approach from intelligent data mining, cluster analysis. Cluster analysis method is a statistical method which makes possible to group individuals based on sets of identifying variables. The method was chosen in order to determine possibility for classification of pregnant women at early pregnancy to analyze unknown correlations between different variables so that the certain outcomes could be predicted. 222 pregnant women from two general obstetric offices' were recruited. The main orient was set on characteristics of these pregnant women: their age, pre-pregnancy body mass index (BMI) and haemoglobin value. Cluster analysis gained a 94.1% classification accuracy rate with three branch- es or groups of pregnant women showing statistically significant correlations with pregnancy outcomes. The results are showing that pregnant women both of older age and higher pre-pregnancy BMI have a significantly higher incidence of delivering baby of higher birth weight but they gain significantly less weight during pregnancy. Their babies are also longer, and these women have significantly higher probability for complications during pregnancy (gestosis) and higher probability of induced or caesarean delivery. We can conclude that the cluster analysis method can appropriately classify pregnant women at early pregnancy to predict certain outcomes.

What Is the Real Public Health Significance of Iron Deficiency and Iron Deficiency Anaemia in Croatia? A Population-Based Observational Study on Pregnant Women at Early Pregnancy from Eastern Croatia.

AIM: Studies imply that significance of iron deficiency (ID) and iron deficiency anaemia (IDA) for pregnancy outcomes is especially highlighted in the early pregnancy. Prevalence around the world varies widely, however, no data is available up to date for Croatia or neighbouring countries. Therefore, the objective was to determine the prevalence of ID and IDA among pregnant women from Croatia at the first trimester. Also, the aim was to compare two criterions; the World Health Organization (WHO) one and the clinical one. METHODS: Randomised observational population based study was set up and 265 pregnant women at the first trimester were enrolled. RESULTS: Based on the WHO criteria, 17.7% on haemoglobin basis and 18.5% on haematocrit basis had either ID or IDA. Clinical criteria showed that even 32.8% had either ID or IDA (transferrin saturation <20.0%). The WHO criterion shows less sensitivity, especially in detecting less severe stages of IDA. CONCLUSIONS: Regardless of the criteria used, ID and IDA present a mild to moderate public health problem in pregnant women population. This high share of pregnant women who are starting their pregnancy as iron deficient, presents a potentially high risk for the pregnancy outcomes, especially in terms of a newborn, and it is fully justified to treat them as diseases of public health significance.

Changes in dietary intake and body weight in lactating and non-lactating women: prospective study in northern coastal Croatia.

Postpartum weight retention is a risk factor for the development of midlife obesity. Since dietary intake and breastfeeding practice could be promoters of weight loss during postpartum, the objective of this study was to investigate their influence on weight retention during six months postpartum. The study sample consisted of 83 lactating and 76 non-lactating Croatian women who were examined at three measurement waves: at 1 month +/- 1 week, 3 months +/- 1 week and 6 months +/- 1 week postpartum. At each measurement wave, two consecutive 24-hour dietary recalls were collected, and body weight measurements were made. Both groups had a daily energy intake lower by about 25% than recommended. Although both groups continuously decreased energy and macronutrient intake, lactating women had energy intake higher by 205 kcal (p = 0.048) and 370 kcal (p < 0.001) after one and three months, respectively. At six months postpartum lactating women had a higher intake of fat (p = 0.036) but a lower intake of protein (p = 0.009) compared with non-lactating mothers. After six months, lactating women retained 101.9% of pre-pregnancy weight, which was significantly less than the percentage of weight retained among non-lactating women (p = 0.014). Multiple regression analysis showed that weight retention were predicted by: type of feeding (beta = -0.281; p <0.001), and time since parturition (beta = -0.151; p < 0.001), while gestational weight gain (P = 0.491; p < 0.001), energy intake (b = 0.157; p < 0.001) and energy derived from fat (beta = 0.122; p = 0.035) were positive predictors. We concluded that the dietary intake of Croatian women and breastfeeding practice over six months significantly influence their weight loss.

Calcaneal bone mineral density and dietary calcium intake in healthy adults from eastern Croatia: what difference do gender and age make?

AIM: Adequate nutrition supports optimal bone development and prevents later metabolic bone diseases. The aim of this study was to assess calcium dietary intake and measure calcaneal bone mineral density and based on the obtained values to evaluate gender and age impact on the values itself as well as on their correlation. METHODS: Subjects recruited for this study were 120 healthy adults. Calcaneal bone mineral density was measured by quantitative ultrasound and expressed as estimated bone mineral density (eBMD). Calcium intake was assessed using ten 24-hours recalls. RESULTS: Values were compared between age and gender based sub-groups. The average value of eBMD of the study group was 0.543 g/cm2. There was no difference between females and males in eBMD. The average daily dietary intake of calcium was low (661 mg/day), and males had statistically significantly higher daily dietary intake than females (805 mg/day and 599 mg/day, respectively). The younger group had higher average value for eBMD (0.560 g/cm2), and higher dietary intake of calcium (10.5 mg/kg of body weight) than the older group (eBMD=0.527 g/cm2; calcium intake=9.4 mg/kg of body weight), but the difference was not significant. CONCLUSION: Lack of statistically significant difference in eBMD values between two observed study subgroups based on the years of age, and low eBMD value itself, are obvious evidence of the compromised bone health status within the study population as well as the need for preventive actions.

Breast vs. bottle: differences in the growth of Croatian infants.

The aim of the paper was to compare the growth of rural Croatian infants with 2000 Centers for Disease Control and Prevention (CDC) growth standards and to evaluate the potential preventive influence of breastfeeding on the development of obesity in infancy. Two hundred three infant-mother pairs from Baranja, an Eastern region of Croatia, were enrolled into this study. Retrospective evaluation of infants' medical charts was used to obtain anthropometric data recorded at the birth, 1, 3, 6, 9 and 12 months of age. Infant feeding mode was self-reported by mothers. Breastfed infants gained the least weight of all observed groups. Up to 6 months of age, formula fed infants had the highest weight gain and after 6 months of age, mixed milk fed infants had the highest weight gain. At 12 months of age, 6.4% of all study infants and 7.6% of mixed milk fed infants were at risk of overweight, while the same risk for the group of breastfed infants was 4%. Most of the study infants achieved higher values of body mass and length than the child growth standards. Exclusively breastfed infants, in comparison with other study groups (formula fed infants, mixed milk fed infants and cow's milk fed infants), had lower weight-for-length z-scores during the first year, which suggests that breastfeeding may have a preventive impact on obesity development.

Intake of some minerals in healthy adult volunteers from eastern Croatia.

Although minerals have important protective effects in human health, their role in nutrition is still underestimated and insufficiently investigated in Croatian population. The aim of this research was to examine sodium, potassium, magnesium, phosphorus, iron and copper intake in 120 adults, aged 18-54 years. The research was conducted using the 10 times repeated 24-h recall method during 1 year. Participants were separated according to age, as well as according to the sex and body mass index. There were significant differences in daily intake of sodium, potassium, magnesium and copper between age groups, but not for phosphorus and iron. When divided by sex, significant differences in daily intake were found for all minerals. When nutritive density was considered, significant difference was found only for potassium and magnesium regarding sex. In conclusion, considering recommendations, the sodium dietary intake of the examined population is too high, while the intake of iron is to low among women.

Intake of vitamins among clinically healthy adults from continental Croatia estimated by 24-h recall.

The role of vitamins in nutrition of the Croatian population is still underestimated and insufficiently investigated although they have important protective effects in human health. The aim of this research was to examine vitamin A, thiamine, riboflavin, pyridoxine, niacin and ascorbic acid intake in 120 adults, aged 18-54 years (mean 33.8 years). The research was conducted using a 24-h recall method, and was repeated 10 times during 1 year. Participants were separated according to age into two groups (< or = 30 years, and > 30 years), as well as according to sex. There were no significant differences in vitamins intake between age groups. When divided by sex, significant difference in vitamins intake was found. When nutritive density was considered, significant difference was found for more vitamins regarding age, and less regarding sex. In conclusion, considering recommendations, the examined population took adequate amounts of vitamins.

Flavonoid pattern of sage (Salvia officinalis L.) unifloral honey.

The aim of the present paper was to determine the flavonoids in monofloral sage (Salvia officinalis L.) honey which is characteristic and specific for the area of Croatian coast and islands. For that purpose 38 sage honey samples from two production seasons were analysed. After specific pollen content determination, and analyses of selected physicochemical parameters which confirmed that samples are in compliance with national and international regulations and can be regarded as unifloral sage honeys, flavonoid fraction was isolated and analysed using RP-HPLC/DAD method. The HPLC analysis showed that all examined sage honey samples contain quercetin (3,3',4',5,7-pentahydroxyflavone), luteolin (3',4',5,7-tetrahydroxyflavone), kaempferol (3,4',5,7-tetrahydroxyflavone), apigenin (4',5,7-trihydroxyflavone), chrysin (5,7-dihydroxyflavone) and galangin (3,5,7-trihydroxyflavone), as well as p-coumaric (trans-4-hydroxycinnamic acid) and caffeic acid (3,4-dihydroxycinnamic acid). Total amount of identified flavonoids varied from 109.4µg/100g of honey to 589.9µg/100g of honey, with the average of 288.5µg/100g of honey. All analysed honey samples showed common and specific flavonoid profile which could be the basis for differentiating sage from other monofloral honeys.

Calcium intake, food sources and seasonal variations in eastern Croatia.

The objective of this study was to examine the quantity of calcium intake among adults, the sources of calcium, differences among seasons, as well as the differences between sexes, correlation with body mass index (BMI), and age. The study included 161 healthy volunteers from the eastern part of Croatia. Each subject completed three food frequency questionnaires (FFQ) with 150 items, at an interval of 3-4 months. The mean calcium intake for whole population for all three FFQs was 965 mg/day. At the same time, the quantity of calcium for all subjects was 14.2 mg/kg, women 14.5 mg/kg, and men 13.6 mg/kg, respectively. There was an inverse relation between calcium intake and age for men (r = -0.32 p = 0.028), but not for women. Correlation between calcium intake and BMI was negative, but not significantly. Milk and dairy products were the main source of calcium. Marginally low mean calcium intake goes to show the needful to educate the population.