Improving health and carbon footprints of European diets using a benchmarking approach.

OBJECTIVE: This study aimed to identify diets with improved nutrient quality and environmental impact within the boundaries of dietary practices. DESIGN: We used Data Envelopment Analysis to benchmark diets for improved adherence to food-based dietary guidelines (FBDG). We then optimised these diets for dietary preferences, nutrient quality and environmental impact. Diets were evaluated using the Nutrient Rich Diet score (NRD15.3), diet-related greenhouse gas emission (GHGE) and a diet similarity index that quantified the proportion of food intake that remained similar as compared with the observed diet. SETTING: National dietary surveys of four European countries (Denmark, Czech Republic, Italy and France). SUBJECTS: Approximately 6500 adults, aged 18-64 years. RESULTS: When dietary preferences were prioritised, NRD15·3 was ~6 % higher, GHGE was ~4 % lower and ~85 % of food intake remained similar. This diet had higher amounts of fruit, vegetables and whole grains than the observed diet. When nutrient quality was prioritised, NRD15·3 was ~16 % higher, GHGE was ~3 % lower and ~72 % of food intake remained similar. This diet had higher amounts of legumes and fish and lower amounts of sweetened and alcoholic beverages. Finally, when environmental impact was prioritised, NRD15·3 was ~9 % higher, GHGE was ~21 % lower and ~73 % of food intake remained similar. In this diet, red and processed meat partly shifted to either eggs, poultry, fish or dairy. CONCLUSIONS: Benchmark modelling can generate diets with improved adherence to FBDG within the boundaries of dietary practices, but fully maximising health and minimising GHGE cannot be achieved simultaneously.

Fish - a source of dietary exposure to iodine and other chemicals.

Fish, fish products and seafood are an important part of a healthy diet. They make an important contribution as a dietary source of iodine, but also of other substances that have a positive effect on the human body. On the other hand, they contain contaminants (especially mercury/methylmercury) whose toxic properties affect food safety. Based on the results of dietary exposure monitoring and specialised studies by the National Institute of Health - Centre for Health, Nutrition and Food and international activities it can be concluded that there are clear benefits in terms of human health from the consumption of fishery products. Women and children should take care to include these products in their diets. The mercury/methylmercury content of common products in the Czech Republic is under control and the concentration levels are practically below the legislative limits. Care should be taken with fish and fish products where mercury may accumulate. The response of the European Commission, which is currently calling for a review of the maximum permissible limits for mercury/methylmercury in various fish species, is appropriate. This could help to further reduce dietary exposure to mercury in food and encourage fish consumption.

Geographic and socioeconomic diversity of food and nutrient intakes: a comparison of four European countries.

PURPOSE: Public health policies and actions increasingly acknowledge the climate burden of food consumption. The aim of this study is to describe dietary intakes across four European countries, as baseline for further research towards healthier and environmentally-friendlier diets for Europe. METHODS: Individual-level dietary intake data in adults were obtained from nationally-representative surveys from Denmark and France using a 7-day diet record, Italy using a 3-day diet record, and Czech Republic using two replicates of a 24-h recall. Energy-standardised food and nutrient intakes were calculated for each subject from the mean of two randomly selected days. RESULTS: There was clear geographical variability, with a between-country range for mean fruit intake from 118 to 199 g/day, for vegetables from 95 to 239 g/day, for fish from 12 to 45 g/day, for dairy from 129 to 302 g/day, for sweet beverages from 48 to 224 ml/day, and for alcohol from 8 to 15 g/day, with higher intakes in Italy for fruit, vegetables and fish, and in Denmark for dairy, sweet beverages and alcohol. In all countries, intakes were low for legumes (< 20 g/day), and nuts and seeds (< 5 g/day), but high for red and processed meat (> 80 g/day). Within countries, food intakes also varied by socio-economic factors such as age, gender, and educational level, but less pronounced by anthropometric factors such as overweight status. For nutrients, intakes were low for dietary fibre (15.8-19.4 g/day) and vitamin D (2.4-3.0 µg/day) in all countries, for potassium (2288-2938 mg/day) and magnesium (268-285 mg/day) except in Denmark, for vitamin E in Denmark (6.7 mg/day), and for folate in Czech Republic (212 µg/day). CONCLUSIONS: There is considerable variation in food and nutrient intakes across Europe, not only between, but also within countries. Individual-level dietary data provide insight into the heterogeneity of dietary habits beyond per capita food supply data, and this is crucial to balancing healthy and environmentally-friendly diets for European citizens.

Reporting accuracy of population dietary sodium intake using duplicate 24 h dietary recalls and a salt questionnaire.

High dietary Na intake is associated with multiple health risks, making accurate assessment of population dietary Na intake critical. In the present study, reporting accuracy of dietary Na intake was evaluated by 24 h urinary Na excretion using the EPIC-Soft 24 h dietary recall (24-HDR). Participants from a subsample of the European Food Consumption Validation study (n 365; countries: Belgium, Norway and Czech Republic), aged 45-65 years, completed two 24 h urine collections and two 24-HDR. Reporting accuracy was calculated as the ratio of reported Na intake to that estimated from the urinary biomarker. A questionnaire on salt use was completed in order to assess the discretionary use of table and cooking salt. The reporting accuracy of dietary Na intake was assessed using two scenarios: (1) a salt adjustment procedure using data from the salt questionnaire; (2) without salt adjustment. Overall, reporting accuracy improved when data from the salt questionnaire were included. The mean reporting accuracy was 0·67 (95 % CI 0·62, 0·72), 0·73 (95 % CI 0·68, 0·79) and 0·79 (95 % CI 0·74, 0·85) for Belgium, Norway and Czech Republic, respectively. Reporting accuracy decreased with increasing BMI among male subjects in all the three countries. For women from Belgium and Norway, reporting accuracy was highest among those classified as obese (BMI ≥ 30 kg/m2: 0·73, 95 % CI 0·67, 0·81 and 0·81, 95 % CI 0·77, 0·86, respectively). The findings from the present study showed considerable underestimation of dietary Na intake assessed using two 24-HDR. The questionnaire-based salt adjustment procedure improved reporting accuracy by 7-13 %. Further development of both the questionnaire and EPIC-Soft databases (e.g. inclusion of a facet to describe salt content) is necessary to estimate population dietary Na intakes accurately.

Feasibility of dietary assessment methods, other tools and procedures for a pan-European food consumption survey among infants, toddlers and children.

PURPOSE: To test the feasibility of tools and procedures for a pan-European food consumption survey among children 0-10 years and to recommend one of two tested dietary assessment methods. METHODS: Two pilot studies including 378 children were conducted in Belgium and the Czech Republic in the Pilot studies for Assessment of Nutrient intake and food Consumption among Kids in Europe. One protocol included a 3-day food diary which was checked with a parent, and data were entered afterwards using EPIC-Soft. The alternative protocol consisted of two non-consecutive 1-day food diaries followed by EPIC-Soft completion interviews. Both protocols included general and food propensity questionnaires and anthropometric measurements. The protocols were compared using evaluation questionnaires among the participating parents and study personnel. RESULTS: The parents found the questionnaires and instructions for filling in the food diaries understandable. Food description and food quantification was evaluated as problematic by 29 and 15% of the participants for the 3-day diaries versus 15 and 12% for the 1-day diaries. The protocol with 1-day food diaries was evaluated as less burdensome by the parents and logistically more challenging by the interviewers. CONCLUSIONS: Both dietary assessment methods with related tools and administration protocols were evaluated as feasible. The administration protocol with two 1-day food diaries with completion interviews offers more advantages for the future pan-European survey in children 0-10 years. The positive evaluation of feasibility of tools and materials is an important step towards harmonised food consumption data at European level among the younger age groups.

Comparison of two food record-based dietary assessment methods for a pan-European food consumption survey among infants, toddlers, and children using data quality indicators.

PURPOSE: We aimed (1) to describe and evaluate the "EPIC-Soft DataEntry" application developed as a user-friendly data entry tool for pan-European and national food consumption surveys among infants and children, and (2) to compare two food record-based dietary assessment methods in terms of food description and quantification using data quality indicators. EPIC-Soft DataEntry was used for both methods. METHODS: Two pilot studies were performed in both Belgium and Czech Republic in a total of 376 children (3 months to 10 year olds): one using a consecutive 3-day food diary; and the second with two non-consecutive 1-day food diaries with data entry during a completion interview. The collected dietary data were compared between the two dietary assessment methods by country and by age groups: (i) <1 year; (ii) 1-3 years; (iii) >3-10 years. RESULTS: Overall, 70% of the interviewers evaluated the work with EPIC-Soft DataEntry as easy. With both dietary assessment methods, an equally high proportion of specific food names (e.g., "yoghurt, strawberry") were reported, where only between 5 and 15% of foods were non-specified (e.g., "yoghurt, n.s."). The two 1-day food diaries yielded a higher proportion of foods with detailed description. For example, in the age category of 1-3 year olds in Belgium, for 7 out of 16 systematic questions on food description (e.g., "preservation method,") specific answers were significantly higher (all P < 0.03). The proportion of missing quantities of consumed foods was comparable between the two methods. CONCLUSIONS: The EPIC-Soft DataEntry application was positively evaluated by the majority of the interviewers. Two non-consecutive 1-day food diaries with data entry during a completion interview provide a more detailed description of consumed foods as compared with a 3-day food diary.

Ochratoxin A levels in blood serum of Czech women in the first trimester of pregnancy and its correspondence with dietary intake of the mycotoxin contaminant.

The mycotoxin ochratoxin A (OTA) can elicit a wide range of toxic properties including embryotoxicity and teratogenicity. OTA crosses the placenta at early gestation rather than in late gestation, maternal OTA exposure may represent a risk for the developing fetus. The study focuses on the assessment of OTA intake of pregnant women (aged 19-40 years) in the first trimester of pregnancy by means OTA levels in 100 blood serum samples by high-performance liquid chromotography with fluorescence detection (HPLC-FD) method and comparison with dietary OTA exposure in pregnant women. Of all, 96% tested serum samples were positive with values ranging from 0.1 to 0.35 µg/l with a mean value of 0.15 µg/l.

Validation of a food quantification picture book targeting children of 0-10 years of age for pan-European and national dietary surveys.

The aim of the present study was to validate thirty-eight picture series of six pictures each developed within the PANCAKE (Pilot study for the Assessment of Nutrient intake and food Consumption Among Kids in Europe) project for portion size estimation of foods consumed by infants, toddlers and children for future pan-European and national dietary surveys. Identical validation sessions were conducted in three European countries. In each country, forty-five foods were evaluated; thirty-eight foods were the same as the depicted foods, and seven foods were different, but meant to be quantified by the use of one of the thirty-eight picture series. Each single picture within a picture series was evaluated six times by means of predefined portions. Therefore, thirty-six pre-weighed portions of each food were evaluated by convenience samples of parents having children aged from 3 months to 10 years. The percentages of participants choosing the correct picture, the picture adjacent to the correct picture or a distant picture were calculated, and the performance of individual pictures within the series was assessed. For twenty foods, the picture series performed acceptably (mean difference between the estimated portion number and the served portion number less than 0.4 (SD < 1.1)). In addition, twelve foods were rated acceptable after adjustment for density differences. Some other series became acceptable after analyses at the country level. In conclusion, all picture series were acceptable for inclusion in the PANCAKE picture book. However, the picture series of baby food, salads and cakes either can only be used for foods that are very similar to those depicted or need to be substituted by another quantification tool.

Two non-consecutive 24 h recalls using EPIC-Soft software are sufficiently valid for comparing protein and potassium intake between five European centres--results from the European Food Consumption Validation (EFCOVAL) study.

The use of two non-consecutive 24 h recalls using EPIC-Soft for standardised dietary monitoring in European countries has previously been proposed in the European Food Consumption Survey Method consortium. Whether this methodology is sufficiently valid to assess nutrient intake in a comparable way, among populations with different food patterns in Europe, is the subject of study in the European Food Consumption Validation consortium. The objective of the study was to compare the validity of usual protein and K intake estimated from two non-consecutive standardised 24 h recalls using EPIC-Soft between five selected centres in Europe. A total of 600 adults, aged 45-65 years, were recruited in Belgium, the Czech Republic, France, The Netherlands and Norway. From each participant, two 24 h recalls and two 24 h urines were collected. The mean and distribution of usual protein and K intake, as well as the ranking of intake, were compared with protein and K excretions within and between centres. Underestimation of protein (range 2-13%) and K (range 4-17%) intake was seen in all centres, except in the Czech Republic. We found a fair agreement between prevalences estimated based on the intake and excretion data at the lower end of the usual intake distribution (< 10% difference), but larger differences at other points. Protein and K intake was moderately correlated with excretion within the centres (ranges = 0·39-0·67 and 0·37-0·69, respectively). These were comparable across centres. In conclusion, two standardised 24 h recalls (EPIC-Soft) appear to be sufficiently valid for assessing and comparing the mean and distribution of protein and K intake across five centres in Europe as well as for ranking individuals.

Fruit and vegetable intake in the Czech child population.

OBJECTIVE: To describe fruit and vegetable intake of pre-school and school children in the Czech Republic and to provide information about their preferences and dietary habits. DESIGN: Cross-sectional dietary survey conducted by the method of repeated 24 h recall on two non-consecutive days. Usual intakes were calculated for three age categories (4-6, 7-10 and 11-14 years). SETTING: The whole area of the Czech Republic. SUBJECTS: A subgroup of 602 children aged 4-14 years was extracted from the representative sample of respondents participating in a national dietary survey (SISP) realized in the years 2003 and 2004. RESULTS: Estimated average usual intakes of fruit and vegetables were 209 (sd 69) g/d in children aged 4-6 years, 230 (sd 84) g/d in children aged 7-10 years, and 284 (sd 133) g/d and 261 (sd 140) g/d respectively in boys and girls aged 11-14 years. Only 22 % of children had total daily intake of fruit and vegetables of five or more servings on the day of the survey. Fruits were consumed almost two times more often than vegetables in all age groups studied. The majority of fruit consumption comprised apples and bananas, which made up more than 60 % of the whole fruit intake. Fruiting vegetables were the most frequently consumed group of vegetables. CONCLUSIONS: Fruit and vegetable intakes in all age categories were under recommended levels and the diversity of fruit and vegetables consumed by the Czech children was relatively low.

Dietary exposure assessment of sum deoxynivalenol forms, sum T-2/HT-2 toxins and zearalenone from cereal-based foods and beer.

A dietary exposure assessment to sum of deoxynivalenol (DON) forms, sum of T-2/HT-2 toxins (T2/HT2) and zearalenone (ZEA) was conducted for Czech children 4-6 years and Czech men and women 18-59 years. Retail foods (25 different commodities, n = 336) were assessed by LC-MS/MS methods. The 95th percentile chronic exposure to sum of DON forms was determined in children from 648 to 1030 ng/kg bw/day (LB/lower bound/and UB/upper bound/), in men from 362 to 923 ng/kg bw/day and in women from 272 to 490 ng/kg bw/day. The 95th percentile chronic exposure to sum T2/HT2 was determined in children from 6.5 to 31 ng/kg bw/day, in men from 1.9 to 11.2 ng/kg bw/day and in women from 2.5 to 11.5 ng/kg bw/day. The 95th percentile chronic exposure to ZEA was determined in children from 11.9 to 24.9 ng/kg bw/day, in men from 5.9 to 27.5 ng/kg bw/day and in women from 4.8 to 12.6 ng/kg bw/day. The risk linked with the mean and the 95th percentile chronic exposure (LB scenario) to the sum of DON forms, sum of T2/HT2 and ZEA is considered to be out of health concern for the selected population groups.

Dietary Intake of Vitamin D in the Czech Population: A Comparison with Dietary Reference Values, Main Food Sources Identified by a Total Diet Study.

The usual dietary intake of vitamin D was studied in 10 subgroups of the Czech population. Food consumption data was collected using repeated 24 h recall in a national cross-sectional survey (the Study of Individual Food Consumption, SISP04), and the vitamin D content in marketed foods was quantified within the national Total Diet Study (2014⁻2015). The Monte Carlo Risk Assessment computational model (version MCRA 8.2) was used to assess usual intake. The median vitamin D intakes for the Czech population (aged 4⁻90 years, both genders) were within a range of 2.5⁻5.1 µg/day. The highest median intake, excluding dietary supplements, was observed in men aged 18⁻64, and the lowest was observed in children aged 4⁻6 and girls aged 11⁻17. The main sources in the diet were hen eggs (21⁻28% of usual dietary intake), fine bakery wares (11⁻19%), cow's milk and dairy products (7⁻23%), meat and meat products (4⁻12%), fish (6⁻20%), and margarines (7⁻18%). The dietary intake of vitamin D for more than 95% of the Czech population was below the recommended Dietary Reference Values (DRVs). These findings should encourage public health authorities to support interventions and education and implement new regulatory measures for improving intake.

Development of harmonised food and sample lists for total diet studies in five European countries.

A total diet study (TDS) is a public health tool for determination of population dietary exposure to chemicals across the entire diet. TDSs have been performed in several countries but the comparability of data produced is limited. Harmonisation of the TDS methodology is therefore desirable and the development of comparable TDS food lists is considered essential to achieve the consistency between countries. The aim of this study is to develop and test the feasibility of a method for establishing harmonised TDS food and sample lists in five European countries with different consumption patterns (Czech Republic, Finland, Germany, Iceland and Portugal). The food lists were intended to be applicable for exposure assessment of wide range of chemical substances in adults (18-64 years) and the elderly (65-74 years). Food consumption data from recent dietary surveys measured on individuals served as the basis for this work. Since the national data from these five countries were not comparable, all foods were linked to the EFSA FoodEx2 classification and description system. The selection of foods for TDS was based on the weight of food consumed and was carried out separately for each FoodEx2 level 1 food group. Individual food approach was respected as much as possible when the TDS samples were defined. TDS food lists developed with this approach represented 94.7-98.7% of the national total diet weights. The overall number of TDS samples varied from 128 in Finland to 246 in Germany. The suggested method was successfully implemented in all five countries. Mapping of data to the EFSA FoodEx2 coding system was recognised as a crucial step in harmonisation of the developed TDS food lists.

Ochratoxin A Dietary Exposure of Ten Population Groups in the Czech Republic: Comparison with Data over the World.

Ochratoxin A is a nephrotoxic and renal carcinogenic mycotoxin and is a common contaminant of various food commodities. Eighty six kinds of foodstuffs (1032 food samples) were collected in 2011-2013. High-performance liquid chromatography with fluorescence detection was used for ochratoxin A determination. Limit of quantification of the method varied between 0.01-0.2 µg/kg depending on the food matrices. The most exposed population is children aged 4-6 years old. Globally for this group, the maximum ochratoxin A dietary exposure for "average consumer" was estimated at 3.3 ng/kg bw/day (lower bound, considering the analytical values below the limit of quantification as 0) and 3.9 ng/kg bw/day (middle bound, considering the analytical values below the limit of quantification as 1/2 limit of quantification). Important sources of exposure for this latter group include grain-based products, confectionery, meat products and fruit juice. The dietary intake for "high consumers" in the group 4-6 years old was estimated from grains and grain-based products at 19.8 ng/kg bw/day (middle bound), from tea at 12.0 ng/kg bw/day (middle bound) and from confectionery at 6.5 ng/kg bw/day (middle bound). For men aged 18-59 years old beer was the main contributor with an intake of 2.60 ng/kg bw/day ("high consumers", middle bound). Tea and grain-based products were identified to be the main contributors for dietary exposure in women aged 18-59 years old. Coffee and wine were identified as a higher contributor of the OTA intake in the population group of women aged 18-59 years old compared to the other population groups.