Auditing the frequency and the clinical and economic impact of testing for Fabry disease in patients under the age of 70 with a stroke admitted to Saint Vincent's University Hospital over a 6-month period.

BACKGROUND: Fabry disease is an X-linked recessive lysosomal storage disorder that provokes multi-organ morbidity, including early-onset stroke. Worldwide prevalence may be greater than previously estimated, with many experiencing first stroke prior to diagnosis of Fabry disease. AIMS: The aim of this study is to screen a cohort of stroke patients under 70 years of age, evaluating the clinical and economic efficacy of such a broad screening programme for Fabry disease. METHODS: All stroke patients under 70 years of age who were entered into the Saint Vincent's University Hospital stroke database over a 6-month period underwent enzyme analysis and/or genetic testing as appropriate for Fabry disease. Patients' past medical histories were analysed for clinical signs suggestive of Fabry disease. Cost-effectiveness analysis of testing was performed and compared to overall economic impact of young stroke in Ireland. RESULTS: Of 22 patients tested for Fabry disease, no new cases were detected. Few clinical indicators of Fabry disease were identified at the time of testing. CONCLUSION: Broad screening programmes for Fabry disease are highly unlikely to offset the cost of testing. The efficacy of future screening programmes will depend on careful selection of an appropriate patient cohort of young stroke patients with multi-organ morbidity and a positive family history.

The effect of equine chorionic gonadotropin (eCG) on pregnancy rates of white-tailed deer following fixed-timed artificial insemination.

Control of the white-tailed doe's reproductive cycle is not well documented. The objective was to determine the effects of giving equine chorionic gonadotropin (eCG) at progesterone device removal on fixed time artificial insemination (FTAI) pregnancy rates in white-tailed does. All does (n = 74) were synchronized with a vaginal progesterone implant (CIDR; 0.3 g progesterone), inserted on Day 0 (without regard to stage of estrous cycle), removed 14 days later, and subjected to FTAI, on average, 60 h post-CIDR removal. Of these, 34 were given 200 IU (im) of eCG at CIDR removal. Overall, FTAI pregnancy rate was 50% across 2 yrs (effect of year, P = 0.35). Administration of eCG at CIDR removal did not affect (P = 0.16) pregnancy rate (eCG = 59%; no eCG = 43%). Pregnancy rates were not affected by vulva score or doe disposition. Does that were ≤ 4 yrs old were more likely (P = 0.01) to become pregnant than does > 4 yrs of age. Does inseminated ≥ 60.5 h after CIDR removal were 22 times more likely (P = 0.002) to become pregnant to FTAI than does inseminated < 60.5 h. When frozen-thawed semen was deposited in the cervix or uterus, does were 17 times more likely (P = 0.005) to become pregnant compared with those receiving intravaginal insemination. Fecundity was not different (P = 0.73) across treatment groups (1.6 ± 0.11; no eCG vs. 1.7 ± 0.10; eCG). Furthermore, fecundity of does pregnant to FTAI was not different (P = 0.72) compared with does pregnant to clean-up bucks (1.7 ± 0.08; AI does vs. 1.7 ± 0.09; clean-up bucks). In summary, white-tailed does were successfully inseminated using a 14 days FTAI protocol, eCG may not be essential for acceptable pregnancy rates, and increased pregnancy rates may result when FTAI is done ≥ 60.5 h after progesterone device removal.

Effect of high levels of intense sweetener intake in insulin dependent diabetics on the ratio of dietary sugar to fat: a case-control study.

OBJECTIVE: To examine the influence of intense sweetener consumption on nutrient intakes in insulin dependent diabetics compared to controls. DESIGN: Case-control food consumption survey. SETTING: Dietary data were collected from individuals in Ireland between 1998 and 1999. SUBJECTS: Diabetics were recruited through diabetic outpatient departments of St. James's Hospital Dublin. Controls were friends of the patients or staff/students of Trinity College and University College Dublin. Of the 171 diabetics contacted, 122 agreed to participate (70% response rate) and 119 completed the study. INTERVENTIONS: In all, 3-day food diaries were used to collect the food consumption data. MAIN OUTCOME MEASURES: Fat--sugar seesaw, intense sweetness. RESULTS: Patients had significantly higher % energy from starch, lower % energy from sugars and a high intake of fibre compared to controls. In both groups, there was an inverse relationship between % energy from fat and % en from sugar, with the diabetics at the lower level of sugar intake. A score of intense sweetness intakes was computed and across tertiles of this score, there were no significant effects on macronutrient intakes. CONCLUSION: The fat-sugar seesaw present in the diabetic group was at a lower level compared to the control group. A high intake of intense sweeteners does not have a detrimental effect on macronutrient and micronutrient intakes.

Assessment of food intake input distributions for use in probabilistic exposure assessments of food additives.

A key component of a food chemical exposure assessment using probabilistic analysis is the selection of the most appropriate input distribution to represent exposure variables. The study explored the type of parametric distribution that could be used to model variability in food consumption data likely to be included in a probabilistic exposure assessment of food additives. The goodness-of-fit of a range of continuous distributions to observed data of 22 food categories expressed as average daily intakes among consumers from the North-South Ireland Food Consumption Survey was assessed using the BestFit distribution fitting program. The lognormal distribution was most commonly accepted as a plausible parametric distribution to represent food consumption data when food intakes were expressed as absolute intakes (16/22 foods) and as intakes per kg body weight (18/22 foods). Results from goodness-of-fit tests were accompanied by lognormal probability plots for a number of food categories. The influence on food additive intake of using a lognormal distribution to model food consumption input data was assessed by comparing modelled intake estimates with observed intakes. Results from the present study advise some level of caution about the use of a lognormal distribution as a mode of input for food consumption data in probabilistic food additive exposure assessments and the results highlight the need for further research in this area.

Validation analysis of probabilistic models of dietary exposure to food additives.

The validity of a range of simple conceptual models designed specifically for the estimation of food additive intakes using probabilistic analysis was assessed. Modelled intake estimates that fell below traditional conservative point estimates of intake and above 'true' additive intakes (calculated from a reference database at brand level) were considered to be in a valid region. Models were developed for 10 food additives by combining food intake data, the probability of an additive being present in a food group and additive concentration data. Food intake and additive concentration data were entered as raw data or as a lognormal distribution, and the probability of an additive being present was entered based on the per cent brands or the per cent eating occasions within a food group that contained an additive. Since the three model components assumed two possible modes of input, the validity of eight (2(3)) model combinations was assessed. All model inputs were derived from the reference database. An iterative approach was employed in which the validity of individual model components was assessed first, followed by validation of full conceptual models. While the distribution of intake estimates from models fell below conservative intakes, which assume that the additive is present at maximum permitted levels (MPLs) in all foods in which it is permitted, intake estimates were not consistently above 'true' intakes. These analyses indicate the need for more complex models for the estimation of food additive intakes using probabilistic analysis. Such models should incorporate information on market share and/or brand loyalty.

Assessment of intake from the diet.

Exposure assessment is one of the key parts of the risk assessment process. Only intake of toxicologically significant amounts can lead to adverse health effects even for a relatively toxic substance. In the case of chemicals in foods this is based on three major aspects: (i) how to determine quantitatively the presence of a chemical in individual foods and diets, including its fate during the processes within the food production chain; (ii) how to determine the consumption patterns of the individual foods containing the relevant chemicals; (iii) how to integrate both the likelihood of consumers eating large amounts of the given foods and of the relevant chemical being present in these foods at high levels. The techniques used for the evaluation of these three aspects have been critically reviewed in this paper to determine those areas where the current approaches provide a solid basis for assessments and those areas where improvements are needed or desirable. For those latter areas, options for improvements are being suggested, including, for example, the development of a pan-European food composition database, activities to understand better effects of processing on individual food chemicals, harmonisation of food consumption survey methods with the option of a regular pan-European survey, evaluation of probabilistic models and the development of models to assess exposure to food allergens. In all three areas, the limitations of the approaches currently used lead to uncertainties which can either cause an over- or underestimation of real intakes and thus risks. Given these imprecisions, risk assessors tend to build in additional uncertainty factors to avoid health-relevant underestimates. This is partly done by using screening methods designed to look for "worst case" situations. Such worse case assumptions lead to intake estimates that are higher than reality. These screening methods are used to screen all those chemicals with a safe intake distribution. For chemicals with a potential risk, more information is needed to allow more refined screening or even the most accurate estimation. More information and more refined methods however, require more resources. The ultimate aims are: (1) to obtain appropriate estimations for the presence and quantity of a given chemical in a food and in the diet in general; (2) to assess the consumption patterns for the foods containing these substances, including especially those parts of the population with high consumption and thus potentially high intakes; and (3) to develop and apply tools to predict reliably the likelihood of high end consumption with the presence of high levels of the relevant substances. It has thus been demonstrated that a tiered approach at all three steps can be helpful to optimise the use of the available resources: if relatively crude tools - designed to provide a "worst case" estimate - do not suggest a toxicologically significant exposure (or a relevant deficit of a particular nutrient) it may not be necessary to use more sophisticated tools. These will be needed if initially high intakes are indicated for at least parts of the population. Existing pragmatic approaches are a first crude step to model food chemical intake. It is recommended to extend, refine and validate this approach in the near future. This has to result in a cost-effective exposure assessment system to be used for existing and potential categories of chemicals. This system of knowledge (with information on sensitivities, accuracy, etc.) will guide future data collection.

Comparison of stochastic modelling of the intakes of intentionally added flavouring substances with theoretical added maximum daily intakes (TAMDI) and maximized survey-derived daily intakes (MSDI).

Estimates of exposure to intentionally added flavouring substances based on two indirect methods, namely the theoretical added maximum daily intake (TAMDI) and maximized survey-derived daily intake (MSDI), were compared with exposure estimates based on a flavourings stochastic model (FSM). Twelve flavouring substances were chosen to reflect broadly the large number of flavouring substances currently used in Europe. Over 40,000 flavour formulae used at known levels of incorporation in 31 different categories of food and beverages were examined to provide maximum concentrations, distributions of concentrations and an indication of the probability of encountering each substance in a flavoured food or beverage in any category. Food consumption data were based on the intakes of males, aged 16-24 years, according to the Dietary and Nutritional Survey of British Adults (1988). The percentage of flavoured brands within food groups was estimated using the Irish National Food Ingredient Database. For all 12 flavouring substances, the estimates of TAMDI were > 97.5th percentile of the FSM, sometimes by > 3 orders of magnitude. With the exception of 2,6-dimethyl pyrazine, the 97.5th percentile of the FSM was less than the MSDI estimate. The probability of the FSM estimates exceeding the TAMDI ranged from < 0.0001 to 0.0037 for the 12 substances, while the probability of exceeding the MSDI estimates ranged from 0.0004 to 0.0753. The study supports the findings of a recent publication using detailed dietary analysis of US data that also indicated that the MSDI appeared, within the limits of the studies, to be a practical and conservative method for assessing exposure to intentionally added flavouring substances.

Irish National Food Ingredient Database: application for assessing patterns of additive usage in foods.

Patterns of food additive usage in the Irish food supply and changes in patterns of usage between 1995-97 and 1998-99 were assessed by means of an Irish National Food Ingredient Database (INFID). Of the 300 additives permitted for use according to the European Union food additives Directives, some 54% were recorded in foods in INFID. Colours, emulsifiers and acids were the most frequently used additive categories, representing 18, 13 and 12% of the total additives used, respectively. Colours were most commonly recorded in sauces (n = 182 brands, 26% of sauces), emulsifiers were most commonly recorded in biscuits (n = 181 brands, 47% of biscuits) and acids were most commonly recorded in sauces (304 brands, 43% of sauces). Carotenes (E160a), Annatto (E160b), mono- and diglycerides of fatty acids (E471) and citric acid (E330) were the most commonly used colour, emulsifier and acid, respectively. All diet soft drinks (n = 37), low-fat spreads (n = 25) and liver pâtés (n = 10) recorded the use of at least one additive. When expressed in terms of the number of brands that contain additives, sauces (n = 522, 73% of sauces), biscuits (n = 323, 84% of biscuits) and preserves (n = 321, 85% of preserves) were ranked highest. For most categories of additive (n = 24), there appeared to be a minimal change in qualitative additive usage between 1995-97 and 1998-99. However, there was a significant increase in the frequency of use of emulsifiers (p < 0.001), acids (p < 0.01), sweeteners (p < 0.05) and acidity regulators (p < 0.05), and a significant decrease in the frequency of use of antioxidants (p < 0.05) during the period 1998-99 compared with 1995-97. Despite changes in additive usage patterns, it appeared that changes in the types of brands on sale between both periods were more apparent than actual changes in qualitative ingredient formulations across brands, as some 17% of brands that were on sale in 1995-97 were no longer on sale in 1998-99.

The North/South Ireland Food Consumption Survey: survey design and methodology.

OBJECTIVE: The purpose of this survey was to establish a database of habitual food and drink consumption in a representative sample of Irish adults aged 18-64 years. DESIGN: A cross-sectional food consumption survey was carried out. Food intake data were collected using a 7-day estimated food diary. Anthropometric data included measurements of weight, height, waist and hip circumferences and body composition using bioelectrical impedance analysis. Questionnaire data included assessments of health, lifestyle and socio-demographic status, levels of physical activity, attitudes to diet and health and restrained eating. SETTING: Northern Ireland and Republic of Ireland between 1997 and 1999. RESULTS: In total, 1379 adults aged 18-64 years participated in the survey and completed the 7-day food diary. This paper gives details of the methods used to carry out the survey. Sampling, respondent recruitment, dietary assessment, collection of anthropometric and questionnaire data and data management and analysis are described. CONCLUSION: The North/South Ireland Food Consumption Survey is unique in being the first food consumption survey ever to be carried out in the Republic of Ireland and Northern Ireland concurrently using the same methodology.

Enhancing the capacity of food consumption surveys of short duration to estimate long-term consumer-only intakes by combination with a qualitative food frequency questionnaire.

In principle, a proper risk assessment for a food chemical requires that the time-frame for food chemical intake estimates matches the time-frame for the toxicological assessments upon which the safety statements (ADI, PTWI, etc.) are based. For food additives, the toxicological assessments are based on exposure over a lifetime. While food consumption data cannot be collected over the lifetimes of individuals, the information should reflect habitual intakes as closely as possible. This study investigated the possibility of combining a 3-day food diary with a food frequency questionnaire to estimate mean consumer-only food intakes comparable to estimates based on a 14-day diary. The study population consisted of 948 teenagers and analysis was based on 32 clearly defined foods. For 47% of the foods, the difference was < or = 1 g/day. When expressed as portion sizes, 56% of the foods showed differences representing < 5% of an average portion and no food showed a difference > 14% of an average portion. When between-method differences (portions/day) were plotted against the mean of the methods, the mean between-method difference was 0.02(+/- 0.06) portions/day with limits of agreement of -0.10 to 0.14. This preliminary investigation suggests that the combined 3-day diary and FFQ method provides comparable estimates of mean consumer only intakes to a 14-day diary. Therefore, a qualitative FFQ may be a useful adjunct to a food consumption survey of short duration if estimates of longer term food intakes are required.

Por una política de nutrición en Europa en el siglo XXI: desarrollo de unas guías alimentarias basadas en el consumo de alimentos / Towards a nutrition policy in Europe for the XXI centruy: development of food-based dietary guidelines

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The influence of survey duration on estimates of food intakes and its relevance for public health nutrition and food safety issues.

OBJECTIVE: To examine the influence of food consumption survey duration on estimates of percentage consumers, mean total population intakes and intakes among consumers only and to consider its relevance for public health nutrition and food safety issues. DESIGN: Prospective food consumption survey. SETTING: A multicentre study in five centres in the European Union-Dublin, Ghent, Helsinki, Potsdam and Rome. SUBJECTS: Teenage subjects were recruited through schools; 948 (80%) out of 1180 subjects completed the survey. INTERVENTIONS: 14-day food diaries were used to collect the food consumption data. RESULTS: For mean total population intakes, 53% of the foods had slopes significantly different to 0 (P<0.05). In practical terms (g/day), these differences were small, with 41% of foods having differences of

An analysis of the incremental value of retaining brand-level information in food consumption databases in estimating food additive intake.

In the Dietary and Nutritional Survey of British Adults (DNSBA) food consumption database, brand level intake data are recorded for 2197 subjects over 7 days. This study set out to examine the incremental value of such brand level data in food consumption studies to estimate additive intake. The food codes in the DNSBA database were re-arranged into 14 food categories within each of which were varying numbers of both sub-categories of foods and of brands. Intake of the 97.5th percentile for brands and sub-categories were compared with intakes at the 97.5th percentile of the appropriate food category. Taking > or = 60 consumers as the minimal sample size for which a 97.5th percentile statistic can be calculated, only 6% of the 1363 brands listed had sufficient data to work with. Of the 14 food categories, six had a sub-category with a 97.5th percentile in excess of that of the category but none exceeded 1.3 x 97.5th percentile intake of the category. Of the 85 brands for which there were > or = 60 consumers, only 11 had 97.5th percentile intakes in excess of that statistic for the relevant food category and none exceeded a multiple of 1.3 times the category 97.5th percentile intakes. Unless dietary surveys are very large and carried out for longer periods of time, there is little value in retaining food consumption data at brand level. If 1.3x the intake of an additive from a given food category at the 97.5th percentile does not exceed the ADI, no sub-category or brand appears to do so. This may provide a valuable technique in crude estimates of food additive intake.

Intake of saccharin, aspartame, acesulfame K and cyclamate in Italian teenagers: present levels and projections.

The intake of saccharin, aspartame, acesulfame K and cyclamate was assessed in 212 Italian teenagers aged 13-19 in 1996. Total daily intake of intense sweeteners was assessed on the basis of dietary records (14 consecutive days). The sweetener content of sugar-free products (soft drinks, candies, chewing gums, yoghurts, jam and table-top sweeteners) was provided by manufacturers. Sugar-free products were consumed by 77% of the subjects. Mean daily intake among consumers was 0.24 mg/kg body weight (bw) for cyclamate (13 subjects), 0.21 mg/kg bw for saccharin (9 subjects), 0.03 mg/kg bw for aspartame (162 subjects), and 0.02 mg/kg bw for acesulfame K (56 subjects). No subject exceeded the ADI (Acceptable Daily Intake) of an intense sweetener. Projections based on the present levels of use of intense sweeteners in sugar-free products and on the dietary pattern observed in the sample suggest that approaching the ADI could be possible only if subjects with high intakes of both soft drinks and table-top sugar substituted these items with respectively sugar-free beverages and table-top sweeteners containing either saccharin or cyclamate.

The influence of survey duration on estimates of food intakes--relevance for food-based dietary guidelines.

Development of food-based dietary guidelines relies on correct identification and interpretation of current dietary intake patterns. The process involves assessing which foods discriminate between those with desirable and undesirable intakes of particular nutrients. It is therefore important that those involved in this task are aware of any source of variability in the underlying food consumption data that cannot be attributed to true differences between individuals. A short survey duration can introduce a high degree of within-person variation and not reflect usual or more long-term food or nutrient intakes. As survey duration increases, the % consumers identified by a survey increases and the intakes among consumers only decrease while the total population intakes do not change. A short survey duration may also lead to misclassification of individuals into high and low consumers. Survey duration is therefore an issue that should be considered in the interpretation of dietary data when developing food-based dietary guidelines.

Predicting percentage of individuals consuming foods from percentage of households purchasing foods to improve the use of household budget surveys in estimating food chemical intakes.

OBJECTIVE: To examine the hypothesis that there is sufficient agreement between percentage of households purchasing selected foods using household budget surveys and percentage of individuals consuming these foods as determined in individual-based surveys to allow the former to act as a surrogate for the latter when estimating food chemical intakes using household budget data. DESIGN: Database study. SETTING: Databases from Sweden, The Netherlands. Ireland and the UK. SUBJECTS: 319 foods (Sweden n = 60, The Netherlands n = 80, Ireland n = 90, UK n = 89). RESULTS: Pearson correlations demonstrated a high degree of linear association between % households purchasing and % consumers (r = 0.86). Regression analysis defined a close positive relationship between the two datasets (slope 0.95, intercept +2.74). Across countries, using the regression equation, the % households predicted % consumers to within 5% of the true value for between 33 and 48% of foods and to within 10% for between 53 and 78% of foods. CONCLUSIONS: Values for % households can be used as a crude surrogate for % consumers and can thus play a role in improving estimates of food additive intake.