Inequalities in education and national income are associated with poorer diet: Pooled analysis of individual participant data across 12 European countries.

BACKGROUND: Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases. METHODS: Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored. FINDINGS: Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14µg, 95% CI 12, 16) in higher educated individuals. INTERPRETATION: Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.

[A comparative analysis of actual nutrition of children aged 9-10 years].

Aim of the study is to carry out a comparative analysis of actual nutrition of children aged 9-10 years with different nutritional status, to asses relationships between Energy Value (EV) of diet, BMI and diet composition. The study covers two groups of children residing in Almaty - 80 children aged 9-10 years with obesity (40 boys and 40 girls) and 80 normal-weight children (40 boys and 40 girls). To determine the nutritional status of the children, diagnostic criteria such as BMI-for-Age Z-score tables of WHO growth standards have been used. The nutrition was studied using the 24-hour recall method. The level of consumption across the entire range of food products, with the exception of cheese, cottage cheese, fish and eggs, turned out to be higher for the obese children with a difference range of 20-151% as compared to normal-weight children. Irrespectively of the nutritional status, all groups of children failed to achieve the recommended level of consumption of vegetables (1.7-fold less than recommended on average), potato (1.4-fold), milk and/or liquid fermented milk products (2.6-fold), fish (4.9-fold), eggs (3.1-fold), and consumed refined foods significantly higher than its limit level (confectionary items - 5.6-fold, flour - 2.9-fold). The contribution of sugar, pasta and sausages to EV of the diet was higher in diet of obese children as compared to normalweight children. The daily Energy Intake (EI) for the obese children was significantly higher than for the normal-weight children. The obese boys consumed 2174±564 kcal whereas normal-weight boys - 1625±343 kcal, obese girls - 2059±530 kcal, normalweight girls - 1532±293 kcal. The macronutrient composition of the diet for obese children differed from that of normal-weight children by increased proportions across all nutrients; however it didn't differ from the normal-weight children's diet in terms of the percentage content of macronutrients and the nature of imbalance. The imbalance took the form of a reduced quota of carbohydrates, excessive intake of simple carbohydrates (2-fold), saturated fats (1.5-fold), and a deficiency of dietary fibers, vitamins A, D, B group (thiamine, niacin, pantothenic acid, biotin, folic acid), zinc and calcium. The relative content of dietary fibers in the diet of obese children was lower than that in the diet of normal-weight counterparts. In obese children the percentage of carbohydrates contribution to EV of the diet served as a predictor of EI (ß=0.5, р=0.00). Elevated BMI was predicted by EI (ß=0.7, р=0.00), Carbohydrate to Fiber Ratio (ß=0.2, р=0.05), Carbohydrate to Fat Ratio (ß=0.3, р=0.01), Carbohydrate to Protein Ratio (ß=0.3, р=0.01), percentage of carbohydrate contribution to EV of the diet (ß=0.3, р=0.01). Thereby elevated BMI was predicted by EI, carbohydrate intake and by deficiency of the dietary fiber.

[The prevalence of anemia among children and women of reproductive age in Kazakhstan and basis of its prevention].

Results of the study on the prevalence of anemia among women of reproductive age and children, residing in the various regions of Kazakhstan, are presented in the article. Representational sampling which takes into account the divisional principle of medical service of children population in each of the 14th areas, Astana and Almaty cities has been implemented. Research involved participation of 1303 women at the age of 15-49 years, and of 1318 children, 353 (26.8%) of whom were in the age of 6 up to 23 months, and 985 (73.2%) were in the age range of 24-59 months. 89 women were pregnant, which constituted 6.8%. The average hemoglobin level in the blood of pregnant women was 11.1 +/- 1.6 g/dL, which was significantly lower compared to that of non-pregnant women, for whom the figure was 12.1 +/- 1.6 g/dL. The average level of hemoglobin in the blood of children in the age range of 6-23 months was 10.7 +/- 1.4 g/dL, and was significantly lower than that of children in the age range of 24-59 months, for whom the figure was, in average, 11.5 +/- 1.4 g/dL (p < 0.05). The rate of prevalence of iron deficiency anemia among pregnant women was 43.8%, among non-pregnant women--39.0%, among children aged 6-59 months--35.2%. It was found that the prevalence of anemia was significantly higher in children aged 6-23 months (53.3%) compared with children aged 24-59 months (28.8%). As for degree of severity of anemia, mild form prevailed in all of the examined groups: children--53.6%, pregnant women--51.2% and non-pregnant--77.2%. Moderate anemia was mostly diagnosed in children in the age range of 6 to 23 months and in pregnant women (50.5 and 43.6% relatively). Comprehensive program of prevention and control of iron-deficiency anemia among children and women includes food fortification, supplementation of target groups with iron preparation and folic acid, food diversification, monitoring and evaluation of program execution, as well as training of medical students and medical staff with policies and strategies of struggle against iron-deficiency anemia.

Analysis of breast milk to assess exposure to chlorinated contaminants in Kazakstan: high levels of 2,3,7, 8-tetrachlorodibenzo-p-dioxin (TCDD) in agricultural villages of southern Kazakstan.

To assess levels of chlorinated contaminants in breast milk, we measured organochlorine pesticides, polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) in breast milk samples collected in 1994 according to the World Health Organization protocol from 92 donors that were representative of regional populations in southern Kazakstan. High levels (10-120 pg/g fat) of 2,3,7, 8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic of the PCDD/PCDF congeners, were found in breast milk samples from an agricultural region. TCDD was the major contributor (75%) to the international toxicity equivalents of these samples. The same distinctive PCDD/PCDF congener pattern was found in 15 breast milk samples and 4 serum samples collected in 1996 in a follow-up study, and has now been confirmed by three analytical laboratories.

Breast milk contamination in Kazakhstan: implications for infant feeding.

To assist the Ministry of Health of Kazakhstan in making infant feeding recommendations, breast milk samples were analyzed for PCDDs/PCDFs, PCBs, chlorinated pesticides, toxic metals, and cesium-137. Sampling sites were selected to provide a profile of representative exposures to possible contaminants; 92 breastmilk samples from 7 sites were analyzed for chlorinated contaminants and 115 samples from 8 sites were analyzed for toxic metals and cesium-137. With three important exceptions, concentrations of chlorinated contaminants and toxic metals were similar to or lower than those in Europe. Cesium-137 was not detected in any samples. The exceptions were localized contamination with the most toxic dioxin congener, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), and generalized contamination with beta-hexachlorocyclohexane and 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDT). The localized high concentrations of TCDD (range 6.2 to 118.2 pg/g fat) are the highest documented in the world in a population currently of reproductive age. Calculated incremental lifetime excess cancer risk to an infant exposed to these high concentrations of TCDD range from 28 to 82 x 10(-5). Based in part on the results of this study, the Ministry of Health is promoting breast feeding. However, possible adverse developmental effects associated with both prenatal and postnatal (through breast milk) TCDD exposure have not been adequately assessed. Further epidemiologic research is needed to examine these effects in this newly identified high-risk population.

PIP: To assist the Ministry of Health of Kazakhastan in formulating infant feeding recommendations, 92 breast milk samples from 7 sites were analyzed for PCDDs/PCDFs, PCBs, and chlorinated pesticides and 115 samples from eight sites were assessed for toxic metals and cesium-137. The sites were selected to cover urban and rural settings, agricultural and industrial areas, and areas of mining and petrochemical exploration. Breast milk samples were obtained from women attending oblast or district-level maternal and child health clinics at each site. Cesium-137 was not detected in any samples. Total PCBs were below or on the low range of European concentrations. However, generalized contamination with DDT was observed (mean concentration total, 1730 ng/g fat) as was localized contamination with TCDD--the most toxic dioxin congener. TCDD concentrations (mean, 13.6 pg/g fat; range, 6.2-118.2 pg/g) obtained in this study are the highest documented anywhere in the world in a population of reproductive age. TCDD contamination was highest in cotton-growing areas. Although the Ministry of Health intends to continue to promote breast feeding, further epidemiologic research is essential to assess the effects of pre- and postnatal TCDD exposure.

[Nutritional status of early age children in Kazakhstan]. / Pishchevol status detel rannego vozrasta v respublike Kasakhstan.

An assessment of nutritional status children under 3-years old was given, which conducted within Kazakstan Dimography Health Survey, 1995. 717 children under 3 years old were examined, including Kazak--421, Russian--161 and other ethnicities--135. An assessment of nutritional status was conducted by the anthropometric indices: Height/Age, Weight/Height, Weight/Age. The most expressed degree of undernutrition was determined among rural children, Kazaks, and children living at the South and Center regions of republic. Demographic and background characteristics are the main determinants for nutritional status of children. Birth parity, birth interval, mother's educational level have influence for nutritional status of children.

Analysis of breast milk to assess exposure to chlorinated contaminants in Kazakstan: PCBs and organochlorine pesticides in southern Kazakstan.

Organochlorine pesticides (OC) and polychlorinated biphenyls (PCBs) were measured in samples of breast milk taken from 92 donors representative of regional populations in southern Kazakstan. The World Health Organization protocol for assessing levels of chlorinated contaminants in breast milk was followed. The most prevalent OC residues were beta-hexachlorocyclohexane (beta-HCH), p,p'-DDE, p,p'-DDT, hexachlorobenzene, and alpha-HCH. The measured levels of beta-HCH were among the highest reported in the published literature. Data from Aralsk, near the Aral Sea, indicated continuing DDT exposure. Overall PCB-toxic equivalent levels (22 pg/g fat) were similar to those reported in industrialized European countries. PCBs were highest in Atyrau in the Caspian oilfields.

Health care in Kazakstan.

Faced with major economic difficulties in the wake of political upheaval, Kazakstan is striving to strengthen its health care system, not only materially but also through the adoption of enlightened approaches by professionals and of beneficial lifestyles by the public at large.

PIP: The fall of the Soviet Empire led to considerable political and economic turmoil in Kazakhstan during its transition to an independent country. Presently, almost all indicators of public health are declining; the health budget fell from 4% of gross national product in 1991 to 1.6% in 1992 and severe pollution, poor nutrition, and increasing consumption of alcohol and cigarettes prevail. Kazakhstan enjoys a high ratio of 400 physicians per 100,000 population, but a shortage of material resources constrains the delivery of quality health care. Civil discord could result unless the interests of different population groups are met. In this context, Kazakhstan is trying to strengthen its health care system. Aid from international, national, and private groups during the past few years has led to improvements in maternal and child health services and in supplies of essential drugs, baby food, vaccines, and medical equipment. Health care facilities in most parts of the country, however, urgently need support and there is a need to develop training programs for administrators, public health professionals, educators, and family planning workers. The control of tuberculosis has received top priority, followed by esophageal cancer.

[External secretion of the liver in enteral and intragastric tube feeding]. / Vneshniaia sekretsiia pecheni v usloviiakh énteral'nogo i intragastral'nogo zondovogo pitaniia.

Hepatic external secretion and main lipid components of the bile and serum were studied under a long-term intragastric and enteral tube feeding using improved surgical and technical methods, Inritan and Peptisorb mixtures. It is shown that food entering the stomach directly does not affect hepatic excretion, while enteral 2-week feeding, especially with hydrolyzed products, deranged secretory mechanisms which entails unbalance in the main bile components and defective lipid metabolism.

[Induction of monooxygenase system and incorporation of radioactivity from 2-14C-lysine into proteins of rat liver microsomes under the action of phenobarbital and the background of lysine, methionine, threonine and vitamin A, C and E deficiencies]. / Induktsiia monooksigenaznoi sistemy i vkliuchenie radioaktivnoi metki iz 2-14C-lizina v belki mikrosom pecheni krys pri vozdeistvii fenobarbitala na fone defitsita lizina, metionina, treonina i vitaminov A, C i E

The effect of diet on induction of monooxygenases and distribution of radioactivity from 2-14-C-lysine in fractions of liver homogenate, muscle homogenate and blood of male rats treated with phenobarbital (80 mg/kg, three days) was studied. 2-14-C-lysine was injected intraperitoneally 24 h before the first injection of phenobarbital. It was demonstrated that monooxygenase induction, increase of relative liver weight and incorporation of radioactivity from 2-14-C-lysine into fractions of liver homogenate in phenobarbital-treated rats fed diet deficient in lysine, methionine, threonine and vitamins A, C and E were more pronounced as compared with the similarly treated rats which were fed a balanced diet. The possibility of mobilization of deficient essential components to liver from other organs and tissues for maintenance of monooxygenase induction is discussed.

[The induction of the monooxygenase system and the incorporation of the radioactive label from 2-14C-lysine into the liver microsome fraction of rats exposed to phenobarbital against a background of deficiencies in lysine, methionine, threonine and vitamins A, C and E]. / Induktsiia monooksigenaznoi sistemy i vkliuchenie radioaktivnoi metki iz 2-14C-lizina vo fraktsiiu mikrosom pecheni krys pri vozdeistvii fenobarbitala na fone defitsita lizina, metionina, treonina i vitaminov A, C i E.

The effect of diet on induction of monooxygenases and distribution of label from 2-14C-lysine in fractions of liver homogenate, muscle homogenate and blood of male rats treated with phenobarbital (80 mg/kg, three days) was studied. 2-14C-lysine was injected intraperitoneally 24 h before the first injection of phenobarbital. It was demonstrated that monoxygenase induction, increase of relative liver weight and incorporation of label from 2-14C-lysine into fractions of liver homogenate in phenobarbital-treated rats were more pronounced as compared with the similarly treated rats that were fed a balanced diet. The possibility of mobilization of deficient essential components to liver from other organs and tissues for maintenance of monoxygenase induction is discussed.

[Liver microsome monooxygenase activity in rats under the effects of organochlorine and organophosphorus pesticides and different nutrition background]. / Aktivnost' monooksigenaz mikrosom pecheni krys pri vozdeistvii smesi khlor- i fosfororganicheskikh pestitsidov na fone razlichnogo pitaniia.

The influence of acute and chronic intoxication with a mixture of lindane and trichlorometaphos-3 on monooxygenases of rat liver was studied in rats insufficiently provided with lysine and vitamins A, C and E. It has been found that in the presence of poly-nutrient insufficiency monooxygenase induction develops more rapidly and to a greater extent than in the presence of balanced nutrition. Chronic intoxication with the pesticide mixture leads to monooxygenase system induction under both regimens of nutrition. It has been noted that in most cases monooxygenase induction during intoxication in the presence of poly-nutrient insufficiency is attended by an increase of the relative mass of the liver. A possible role of this phenomenon has been considered.

[Clinico-biochemical evaluation of the effectiveness of diet therapy in gastroenterologic patients]. / Kliniko-biokhimicheskaia otsenka éffektivnosti dietoterapii gastroénterologicheskikh bol'nykh.

Dissimilar immunochemical, protein and vitamin parameters were found in blood of patients with gastroenterological diseases at the initial step of impairments under conditions of routine and special diets. Specific alterations in content of transferrin, haptoglobin, tocopherol as well as in glutathione peroxidase and glucose-6-phosphate dehydrogenase activities showed that compensatory mechanisms were maintained better under conditions of the special diet therapy.

[The use of a soy protein isolate in the diet therapy of patients with alimentary obesity]. / Primenenie belkovogo izoliata soi v dietoterapii bol'nykh alimentarnym ozhireniem.

Patients with alimentary obesity received a diet with 1/3 amount of protein substituted for soya protein isolate, daily, during 4 weeks. The influence of the dietotherapeutic course on protein, lipid metabolism, on bile acid and lipid composition of bile and on the immunologic state of the patients was studied. Blood and bile lipid content and the fraction of cholesterol esters were studied by thin-layer chromatography, lipid composition by disc electrophoresis in polyacrylamide gel, protein fractions by paper electrophoresis; the immunologic state was studied by the blast-transformation test and immunoglobulin assay. It has been established that this diet influences the parameters studied: the levels of total lipids, cholesterol, phospholipids, lipoproteins of low and very low density are decreased, the content of high density lipoproteins is increased, the level of globulin fractions is normalized, and the content of total protein is reduced to the normal, bile acid and lipid composition of bile and the immunologic state are improved.

[Characteristics of maternal and child nutrition in relation to infant mortality in Kazakh SSR]. / Osobennesti pitaniia detei i ikh materei v sviazi s problemoi detskoi smertnosti v Kazakhstane.

Studies of actual nutrition patterns of women in pregnancy and lactation living in Kazakhstan regions with highest infant mortality rates showed significant deficiency of animal proteins, essential amino acids, and vitamins A, E and C. The prevalence of anemias amounted to 40-90% and that of hypogalactia to 32%. At the same time, the breast milk was found to have reduced protein and fat content at its high carbophos contamination. From 70 to 90% of cow milk samples were found to be contaminated with carbophos. Food products for children showed high levels of contamination with aflatoxin producing strains of micromyces. The priority tasks of nutritionists are to create of specialized therapeutic and prophylactic food products and breast milk substitutes.

[Nutrition and health in relation to ecology]. / Pitanie i zdoro've v sviazi s ékologiei.

The ecological situation in the recent 20 years in the Kazakh SSR occupying one sixth of the USSR territory is analysed. The analysis shows a 3-29-fold rise in total morbidity for various infectious and somatic diseases associated with the drastic worsening of the ecological situation in the Aral Sea region; childhood and maternal mortality rates have significantly increased. Investigations made at the Institute for Regional Nutritional Problems of the USSR AMS have shown that pesticides, excessive mineral fertilisers, and various microorganisms and their metabolites (toxins) are priority food product pollutants for all Kazakhstan regions. An important role played by the nutritional status in showing a cancerogenic effect by nitro compounds has been established. A complex of sanitary-hygienic measures aimed at improving the State sanitary control over the environmental objects and food products has been elaborated that will improve the ecological situation in this republic.

[Effect of various dietary proteins on the processes of lipid transport in the blood serum]. / Vliianie razlichnykh pishchevykh belkov na protsessy transporta lipidov v syvorotke krovi.

The influence of isocaloric semi-synthetic rations with varying protein components (casein, wheat gluten, isolates of cotton, soybean and rice proteins) on lipid transport processes in the blood serum was studied in experiments on made August rats. It has been shown that the alimentary proteins studied affect blood serum lipids and lipoproteins by altering lypolysis activity in the serum, by modifying the hepatic production of high-density lipoproteins and their free cholesterol, by disturbance of low-density lipoprotein degradation. The rest mechanisms regulating lipid transport in the blood serum are changed insignificantly.

[Mathematical modelling of perorally induced immunological tolerance]. / Matematicheskoe modelirovanie peroral'no indutsirovannoi immunologicheskoi tolerantnosti.

A mathematical model of the mechanism of development of orally induced immunologic tolerance has been suggested. The model presents a system of differential non-linear equations, and it is realized as a program in FORTRAN. The model describes primary and secondary immune responses, reflects the main features of the immune system response to antigen intake with food. The immune system model response to varying doses and frequency of the antigen intake with food has been studied. It has been established that repeated administration of small doses of the food antigen leads to a deeper tolerance due to lower stimulation of the immune system. The existence of optimal tolerogenic doses of the food antigen has been proved. Qualitative changes in the immune system response to the food antigen have been recorded in case of increased permeability of the intestinal wall.

[Effect of a phosphatidylcholine-enriched diet on the structural and functional parameters of rat liver microsomes]. / Vliianie diety, obogashchennoi fosfatidilkholinom, na strukturno-funktsional'nye parametry mikrosom pecheni krys.

The authors studied the influence of the diet enriched with phosphatidylcholine on the structural-functional parameters of microsomes: lipid peroxidation activity, the levels of cytochromes b5 and P-450, microviscosity of the lipid phase of the membrane. In experiments in vivo it was found that phosphatidylcholine per se, not combined with antioxidants, did not show antioxidant properties. Biological effects of lecithin could be explained by its role as a catalyst of the monooxygenase system in the liver, based on the correlation (r = +0.8) between the high level of cytochrome b5 and the degree of eximerization of the fluorescent probe pyrene in the microsomes.