Diet and lifestyle characteristics associated with dietary supplement use in women

Lifestyle and genetic determinants of folate and vitamin B12 levels in a general adult population

Danish legislation regarding food fortification has been very restrictive resulting in few fortified food items on the Danish market. Folate and vitamin B12 deficiency is thought to be common due to inadequate intakes but little is known about the actual prevalence of low serum folate and vitamin B12 in the general population. The aim of the present study was to evaluate the folate and vitamin B12 status of Danish adults and to investigate associations between vitamin status and distinct lifestyle and genetic factors. The study included a random sample of 6784 individuals aged 30–60 years. Information on lifestyle factors was obtained by questionnaires and blood samples were analysed for serum folate and vitamin B12 concentrations and several genetic polymorphisms. The overall prevalence of low serum folate ( < 6·8 nmol/l) was 31·4 %. Low serum folate was more common among men than women and the prevalence was lower with increasing age. Low serum folate was associated with smoking, low alcohol intake, high coffee intake, unhealthy diet, and the TT genotype of the methylenetetrahydrofolate reductase (MTHFR)-C677T polymorphism. The overall prevalence of low serum vitamin B12 ( < 148 pmol/l) was 4·7 %. Low serum vitamin B12 was significantly associated with female sex, high coffee intake, low folate status, and the TT genotype of the MTHFR-C677T polymorphism. In conclusion, low serum folate was present in almost a third of the adult population in the present study and was associated with several lifestyle factors whereas low serum concentrations of vitamin B12 were less common and only found to be associated with a few lifestyle factors.

The acceptability of isoflavones as a treatment of menopausal symptoms: a European survey among postmenopausal women

OBJECTIVE

To investigate determinants of the acceptability of isoflavone products among postmenopausal women with regard to social and lifestyle factors, dietary habits, health concerns, food beliefs, menopausal symptoms and therapies, and to elucidate preferences for specific products.

METHODS

A consumer survey was conducted among postmenopausal women in four European countries (Germany, Denmark, Italy and the UK), including a total of 465 respondents.

RESULTS

The declared acceptability of isoflavones was highest in Germany (80%), followed by Italy (75%), the UK (59%) and Denmark (55%; p < 0.001). Among other factors, prior information about isoflavones (odds ratio (OR) 2.64, 95% confidence interval (CI) 1.54-4.51, p < 0.001) and belief that foods can be used to treat medical conditions (OR 2.18, 95% CI 1.17-4.05, p = 0.014) were the strongest predictors of potential acceptability. The preferred forms in which isoflavones might be taken differed markedly between countries.

CONCLUSIONS

Information about the health effects of isoflavones and health-diet links should be considered the most important factors in attempts to influence the potential acceptability of isoflavone products. Foods enriched with isoflavones need to be developed with regard to specific cultural demands in order to assure consumer acceptance on the marketplace.

Dietary supplement use among elderly, long-term cancer survivors

INTRODUCTION

The purpose of the present study was to assess dietary supplement use and its association with micronutrient intakes and diet quality among older (>or=65 years), long-term survivors (>or=5 years post-diagnosis) of female breast, prostate, and colorectal cancer.

METHODS

The sample included 753 survivors who participated in telephone screening interviews to determine eligibility for a randomized diet and physical activity intervention trial entitled RENEW: Reach-out to ENhancE Wellness in Older Cancer Survivors. Telephone surveys included two 24-hour dietary recalls and items regarding supplement use (type, dose, and duration). Nutrient intakes were compared to Dietary Reference Intakes (DRIs). Diet quality was assessed using the revised Healthy Eating Index (HEI). Descriptive statistics and multivariate logistic regression were used in this cross-sectional study.

RESULTS

A majority of survivors (74%) reported taking supplements, with multivitamins (60%), calcium/vitamin D (37%), and antioxidants (30%) as the most prevalent. Overall proportions of the total sample with dietary intakes below Estimated Average Requirements (EARs) were substantial, although supplement users had more favorable mean HEI scores (P < 0.01) and nutrient intakes for 12 of the 13 vitamins and minerals investigated (P values < 0.05). Supplement use was positively associated with older age (>or=70 years) (odds ratio (OR)=1.70; 95% confidence interval (95% CI)=1.17, 2.46) and female gender (OR=1.49; 95% CI=1.04, 2.13), and negatively associated with current smoking (OR=0.40, 95% CI=0.21, 0.76). Individuals scoring higher on the Total Fruit (OR=1.12, 95% CI=1.01, 1.23), Whole Grain (OR=1.14, 95% CI=1.04, 1.25), and Oil (OR=1.10, 95% CI=1.01, 1.11) components of the HEI were significantly more likely to take supplements, while those scoring higher on the Meat and Beans category (OR=0.81, 95% CI=0.71, 0.93) were significantly less likely to take supplements. Compared to those with less than a high school education, survivors with a professional or graduate degree were significantly more likely to use supplements (OR=2.18, 95% CI=1.13, 4.23).

DISCUSSIONS/CONCLUSIONS

Demographic, disease, and health-related correlates of supplement use follow similar trends observed in the general population as well as previous reports from other cancer survivor populations. Supplement use may reduce the prevalence of nutrient inadequacies in this population, though survivors who use supplements are the least likely to need them.

IMPLICATIONS FOR CANCER SURVIVORS

Supplement use may be an effective means for many survivors to achieve adequate nutrient intakes; however, open communication between healthcare providers and survivors is needed to ensure potential concerns are addressed as supplement use may not always be beneficial.

Dietary intake and status of folate and vitamin B12 and their association with homocysteine and cardiovascular disease in European populations

BACKGROUND/OBJECTIVES

Folate and vitamin B12 have been suggested to play a role in chronic diseases like cardiovascular diseases. The objectives are to give an overview of the actual intake and status of folate and vitamin B12 in general populations in Europe, and to evaluate these in view of the current vitamin recommendations and the homocysteine concentration.

METHODS

Searches in Medline with 'folic acid', 'folate' and 'vitamin B12', 'B12' or 'cobalamin' as key words were combined with the names of the European countries. Populations between 18 and 65 years were included.

RESULTS

Sixty-three articles reporting on studies from 15 European countries were selected. Low folate intakes were observed in Norway, Sweden, Denmark and the Netherlands. Low intakes of vitamin B12 were not common and only seen in one small Greek study. In the countries with a low intake of folate, the recommended levels were generally not achieved, which was also reflected in the folate status. Vitamin B12 intake was not strongly associated with the vitamin B12 status, which can explain why in the Netherlands and Germany the vitamin B12 status was inadequate, despite sufficient intake levels. In countries with a low folate intake in particular, the Hcy concentration was higher than ideal.

CONCLUSIONS

Populations from the Nordic countries, the Netherlands, Germany and Greece may need to improve their intakes of folic acid, B12 or both to either meet the recommendations or to optimize their statuses. This could be achieved via a food-based approach, food fortification or supplements.

Older Adults Who Use Vitamin/Mineral Supplements Differ from Nonusers in Nutrient Intake Adequacy and Dietary Attitudes

OBJECTIVE

To measure nutrient intake adequacy of vitamin/mineral supplement users and nonusers aged 51 years and older, determine the efficacy of supplement practices in compensating for dietary deficits, and identify predictors of supplement use.

DESIGN

Analyses of two 24-hour recalls, demographic variables, and attitude questions collected during the Continuing Survey of Food Intakes by Individuals and Diet and Health Knowledge Survey in 1994 to 1996. Data were weighted to be representative of older Americans.

SUBJECTS

Four thousand three hundred eighty-four adults aged 51 years and older (1,777 daily supplement users, 428 infrequent users, and 2,179 nonusers) residing in households in the United States.

STATISTICAL ANALYSES

Usual nutrient intake distributions were estimated using the Iowa State University method. The Estimated Average Requirement (EAR) cutpoint method was applied to determine the proportion of older adults not meeting requirements before and after accounting for nutrient intake from supplements. Student t tests were used to assess differences between users and nonusers. Logistic regression was used to determine sociodemographic and attitudinal predictors of supplement use.

RESULTS

For one or more of the sex-age groups studied, a significantly smaller proportion of supplement users than nonusers had intakes from food alone below the EAR for vitamins A, B-6, and C; folate; zinc; and magnesium. Even so, less than 50% of both users and nonusers met the EAR for folate, vitamin E, and magnesium from food sources alone. Overall, supplements improved the nutrient intake of older adults. After accounting for the contribution of supplements, 80% or more of users met the EAR for vitamins A, B-6, B-12, C, and E; folate; iron; and zinc, but not magnesium. However, some supplement users, particularly men, exceeded Tolerable Upper Intake Levels for iron and zinc and a small percentage of women exceeded the Tolerable Upper Intake Level for vitamin A. Significant sociodemographic factors related to supplement use for older men were age group, metropolitan area, and educational status. Race, region, smoking status, and vegetarian status were significant factors for women. Attitude about the importance of following a healthful diet was a consistent predictor of supplement use for both men and women.

CONCLUSIONS

A large proportion of older adults do not consume sufficient amounts of many nutrients from foods alone. Supplements compensate to some extent, but only an estimated half of this population uses them daily. These widespread inadequacies should be considered when developing recommendations for supplement use for clients in this age group. Modifying dietary attitudes may result in a higher rate of supplement use in this at-risk population.

Lifestyle and diet in people using dietary supplements

BACKGROUND

The use of dietary supplements is often associated with a healthy lifestyle. Due to high variation in supplementation practice by country, these associations will be investigated in a large German cohort study.

AIM OF THE STUDY

To describe the prevalence of dietary supplement use in the EPIC-Heidelberg cohort and to illuminate differences in health-relevant characteristics between regular users and non-users.

METHODS

At cohort recruitment, 13,615 women aged 35-65 and 11,929 men aged 40-65 were asked for regular dietary supplementation over the past year.

RESULTS

Regular use of any supplement was reported by 47% of the women and 41% of the men, vitamin or mineral supplements were taken by 40% and 33%, respectively. The use of vitamin and/or mineral supplements was significantly associated with higher age, being non- or ex-smoker, lower BMI, higher physical leisure time activity, and higher educational level. After adjustment for these factors, we observed positive associations between supplement use and the consumption of milk, milk products, and fish as well as the intake of vitamin C and beta-carotene. In contrast, the supplement use was related to lower meat and meat product consumption, saturated fat intake, and n6/n3-fatty acid ratio in the diet, both in women and men. Except for Hemoccult((R)) testing in women, no association with participation in cancer screening was observed.

CONCLUSIONS

The high prevalence of supplement use in EPIC-Heidelberg was associated with several presumably healthier lifestyle and diet characteristics. This needs to be considered in further evaluations of the risk of chronic diseases.

Dietary intake and use of dietary supplements in relation to demographic variables among pregnant Finnish women

Proper nutrition during pregnancy may be important for maternal health and fetal growth and development. In Finland, targeted recommendations are given to guide pregnant women in their food choice and dietary supplement use so that they may obtain adequate nutritional status and meet the increased need for nutrients. The aims of the present study were to examine food choices, nutrient intake and dietary supplement use of pregnant Finnish women in association with demographic variables. One thousand and seventy-five families were invited to a birth cohort study during 1998-9. Mothers of 797 newborns completed a validated 181-item food-frequency questionnaire from which the food and nutrient intakes were calculated. The information about supplement use was collected concerning the whole pregnancy. The results of the present study suggest that healthy food choices are rather common among pregnant Finnish women and the choices are positively correlated with age and education. Nutrient supplements were used by 85 % of the women. Supplements were favoured by the older and well-educated women and by those who had normal weight before pregnancy. Of the women in the present study, 31 % received vitamin A-containing supplements, although it is not recommended during pregnancy. Taking food and supplementation into account, the intake of vitamin D did not meet the dietary recommendation and folic acid intake was below recommendation in 44 % of the women. Therefore there seemed to be unnecessary nutrient supplementation and at the same time lack of relevant supplementation among these pregnant women.

Dietary and cancer-related behaviors of vitamin/mineral dietary supplement users in a large cohort of French women

BACKGROUND

Several epidemiological studies suggested an association between vitamin/mineral dietary supplement use and cancer risk. However, characteristics of supplement users may themselves be related to cancer risk, and therefore could confound such etiological studies. Very little is known about the characteristics of French supplement users.

AIM OF THE STUDY

To identify cancer-related behaviors and dietary characteristics of vitamin/mineral supplement users in the E3N cohort of French women.

METHODS

Data on supplement use and cancer-related and socio-demographic characteristics were collected by self-administered questionnaires completed by 83,058 women, 67,229 of whom also completed a food frequency questionnaire. Supplement users were compared to non-users by unconditional logistic regression.

RESULTS

Vitamin/mineral supplement users were significantly older and leaner (odds ratio [OR] for BMI >or= 30 vs. <18.5 kg/m2 = 0.35, 95% confidence interval [CI] 0.31-0.39), were less often current smokers, had a higher level of education and had more leisure physical activity. They used more phytooestrogen supplements (OR=3.95, 95 % CI 3.69-4.23), had more often a family history of breast cancer and had more often undergone cancer-screening. Users tended to have a healthier diet: less alcohol, more vegetables, fruit, dairy products, fish and soups. They had higher dietary intakes for most micro-nutrients, fiber and omega3 fatty acids, lower fat intake and either similar or lower prevalence of inadequate dietary intake for all relevant nutrients except magnesium.

CONCLUSIONS

To avoid major confounding, the lifestyle characteristics of supplement users should be considered in studies investigating the association between supplement use and cancer risk.

Prevalence of natural health product use in healthy postmenopausal women

OBJECTIVES

Population studies examining dietary supplement use reveal that users are more likely to be women of older age, yet there are few focused studies among postmenopausal women. The purpose of this study was to determine the prevalence of natural health product (NHP) use, as well as the attitudes and motivations associated with NHP use, among postmenopausal women.

DESIGN

Healthy postmenopausal women were recruited from shopping malls and community centers to complete a questionnaire that collected information regarding use of NHPs; attitudes and motivations about NHPs; and demographic, health, and lifestyle characteristics.

RESULTS

The prevalence of NHP use among the 204 subjects was 83.3%. There were no significant differences in characteristics between NHP users and non-users, with the exception of a lower body mass index among NHP users (P = 0.01). The most commonly consumed NHP was calcium, followed by multivitamins/minerals, vitamin C, and vitamin E. Almost all NHP users (98.8%) believed that NHPs improved their overall health, and most (70.6%) attributed specific positive effects to their NHPs. Three quarters of NHP users believed that their NHPs could not cause adverse effects, and 64.2% believed that their NHPs could not interact negatively with medications. The most common source of NHP information was magazines/books, and 71.8% of NHP users indicated they did not need further information about their NHPs.

CONCLUSIONS

In this study, we found that the prevalence of NHP use among a sample of 204 healthy postmenopausal women was 83.3% and that, apart from body mass index, there were no variables that predicted NHP use.

Nutritional factors, cognitive decline, and dementia

Nutritional factors and nutritional deficiencies have been repeatedly associated with cognitive impairment. Most of the evidence is based on cross-sectional studies, which cannot prove whether a nutritional deficit is the cause or the consequence of an impaired cognitive status. In fact, cognitive impairment, in turn, can determine changes in dietary habits and consequent nutritional deficiencies. We reviewed clinical and epidemiological studies from January 1983 to June 2004. Several cross-sectional and fewer prospective studies reported an association between dietary or supplemental intake of antioxidants and protection from cognitive decline and dementia. There are negative reports as well and some methodological biases might have affected the consistencies across studies. Deficiencies of several B vitamins have been associated with cognitive dysfunction in many observational studies. More recently, deficiencies of folate (B9) and cobalamine (B12) have been studied in relation to hyperhomocysteinemia as potential determinants of cognitive impairment, dementia, and Alzheimer's disease (AD). A small number of studies assessed the association between intake of macronutrients and cognitive function or dementia. Among the others, the intake of fatty acids and cholesterol has received particular attention. Although the results are not always consistent, most studies have reported a protective role of dietary intakes of poly- and mono-unsaturated fatty acids against cognitive decline and AD. We point out that well designed intervention studies are warranted in order to establish specific levels of micro- and macronutrient deficiencies and to set general recommendations for the population.

Dietary supplement consumption among urban adults influenced by psychosocial stress: its pronounced influence upon persons with a less healthy lifestyle

In order to examine the consumption of dietary supplements among urban adults and the impact of psychological stress on supplement use in relation to lifestyle, 375 interviews of a population-based sample of urban Japanese in 2002 were analysed. The usage of various supplements, stress process (daily stressors, psychological moderators, stress outcomes), personal health practices (smoking, alcohol drinking, physical exercise, fruit and vegetable juice consumption, health-conscious eating habits) and other background factors were measured. We examined the impacts of stress on the use of vitamin tablets and capsules, vitamin-enriched health drinks and health drinks for intestinal adjustment. The percentages of these three categories of supplement user were 26.9, 18.7 and 35.7%, respectively. After adjusting for potential confounders, subjects with 'two or more' daily stressors out of the eight stressors investigated consistently showed 2-fold higher levels of consumption of either vitamin tablets and capsules or vitamin-enriched drinks compared with their counterparts with 'one or less' daily stressors. Stress-outcome indicators also related, to a greater or less extent, to the elevated consumption of various supplements. Further lifestyle-stratified analyses revealed that the stress-supplementation relationships were weaker in subjects fulfilling more than three of the five investigated health practices (i.e. the healthy lifestyle group), but stronger in subjects with fewer than two healthy practices (i.e. the less healthy lifestyle group). In conclusion, dietary supplement consumption is independently associated with stress in urban adults. The uncontrolled use of supplements for the self-medication of stress or to compensate for unhealthy behaviour represents a health concern for the general population.

Supplement use is associated with health status and health-related behaviors in the 1946 British birth cohort

Use of dietary supplements may be one of a number of health-related behaviors that cluster together. The current study investigated the underlying diet, health-related characteristics, and behaviors of users and nonusers of dietary supplements in a longitudinal study of health. Participants (n = 1776) completed a 5-d food diary including information on dietary supplement use (vitamins, minerals, and nutraceuticals) at age 53 y. Sociodemographic information and data on smoking, alcohol, and physical activity were obtained along with anthropometric measurements, blood pressure, and a blood sample (nonfasting subjects). A significantly greater percentage of women reported supplement use compared with men (45.1 vs. 25.2%). Supplement use was associated with lower BMI, lower waist circumference, higher plasma folate and plasma vitamin B-12 concentrations, nonsmoking, participation in physical activity, and nonmanual social class in women and with plasma folate concentrations and participation in physical activity in men. Nonsupplement users tended to be nonconsumers of breakfast cereals, fruit, fruit juice, yogurt, oily fish, and olive oil and had lower dietary intakes of potassium, magnesium, phosphorus, iron, and vitamin C even after adjustment for sociodemographic and behavioral factors. Overall, supplement users tended to differ from nonsupplement users on a range of health-related behaviors and health status indicators, although there were fewer significant associations in men. Similarly, dietary supplements users tended to have underlying diets that, were healthier and those taking supplements may be the least likely to need them. These results support the notion of a clustering of healthy behaviors and cardiovascular risk factors, particularly for women.

Overweight consumers' salient beliefs on omega-3-enriched functional foods in Australia's Illawarra region

OBJECTIVE

To determine consumer salient beliefs toward functional foods enriched with omega-3 fatty acids.

DESIGN

Focus group interviews with adult consumers using the Theory of Planned Behavior (TPB) as a theoretical framework.

SETTING

Community-based residents living in the Illawarra region of New South Wales, Australia.

PARTICIPANTS

Forty-two overweight participants (29 female, 13 male) aged 30 to 80 years recruited by advertisement and attending 1 of 6 focus groups, which were recorded and transcribed verbatim.

ANALYSIS

Content analysis was carried out, and subcategories were developed to capture the emerging themes according to the TPB model.

RESULTS

Most participants were aware of a range of potential benefits of omega-3 fatty acids, but they had reservations about the ability of omega-3-enriched foods to deliver a health benefit. They were concerned about whether these foods were labeled clearly and about the possibility of overdosing. Family and friends were viewed as important in introducing participants to novel foods on the market. Participants regarded dietitians as a credible source and were least trusting of food companies and scientists. Overall, participants reported that cost was a major barrier, and that they would not necessarily trade taste for health benefits. Adding omega-3 fatty acids to foods regarded as less healthful was viewed more as a gimmick rather than a real health benefit.

CONCLUSIONS AND IMPLICATIONS

The consumer attitudes and purchase intentions identified in this study will be helpful to educators as they plan messages and strategies to guide dietary choices related to products enriched with omega-3 fatty acids.

Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994

OBJECTIVES

We sought to determine prevalence rates of vitamin C deficiency and depletion in the United States.

METHODS

We used data from the Third National Health and Nutrition Examination Survey to assess intake of dietary, supplemental, and serum vitamin C.

RESULTS

Mean intakes and serum levels of vitamin C were normal; however, vitamin C deficiency and depletion were common (occurring among 5%-17% and 13%-23% of respondents, respectively). Smokers, those who did not use supplements, and non-Hispanic Black males had elevated risks of vitamin C deficiency, while Mexican Americans had lower risks.

CONCLUSIONS

Health professionals should recommend consumption of vegetables and fruits rich in vitamin C and should recommend supplementation for individuals at risk of vitamin C deficiency.

Are those in need taking dietary supplements? A survey of 21 923 adults

Many people take dietary supplements, but information on characteristics associated with their use is lacking. The relationship between lifestyle behaviours, morbidity and use of dietary supplements has not been examined and earlier studies have limited applicability to a general population. These issues were addressed in the current study. Information was obtained by postal questionnaire sent to a sample of the general population. The questionnaire was completed by 70.5 % of the sample (15 465 from a total sample of 21 923), with at least one-third (35.5 %) taking dietary supplements. In adjusted analyses, supplement users were more likely to be women, white, home-owners, non-smokers and physically active. Use of vitamin, mineral and/or antioxidant supplements was associated with eating more fruits and vegetables, and taking fish-oil supplements was associated with eating oil-rich fish. A history of CVD or risk factors for CVD reduced the risk of taking vitamins, minerals and/or antioxidants or fish-oil supplements. Those reporting musculoskeletal disorders such as arthritis were more likely to take fish-oil supplements For the first time, we have shown that dietary supplement use is related to different types of morbidity. In particular, people at risk of primary or secondary CVD seem less likely to use dietary supplements, despite possible benefits shown in clinical trials. Public health organisations need to develop guidelines for the public and health professionals regarding the uncontrolled use of dietary supplements in the community.

Dietary intakes and lifestyle factors of a vegan population in Germany: results from the German Vegan Study

OBJECTIVE

Evaluation of dietary intakes and lifestyle factors of German vegans.

DESIGN

Cross-sectional study.

SETTINGS

Germany.

SUBJECTS

Subjects were recruited through journal advertisements. Of 868 volunteers, only 154 participated in all study segments (pre- and main questionnaire, two 9-day food frequency questionnaires, blood sampling) and fulfilled the following study criteria: vegan dietary intake at least 1 year prior to study start, minimum age of 18 y, no pregnancy or childbirth during the last 12 months.

INTERVENTIONS

No interventions.

RESULTS

All the 154 subjects had a comparatively low BMI (median 21.2 kg/m(2)), with an extremely low mean consumption of alcohol (0.77+/-3.14 g/day) and tobacco (96.8% were nonsmokers). Mean energy intake (total collective: 8.23+/-2.77 MJ) was higher in strict vegans than in moderate ones. Mean carbohydrate, fat, and protein intakes in proportion to energy (total collective: 57.1:29.7:11.6%) agreed with current recommendations. Recommended intakes for vitamins and minerals were attained through diet, except for calcium (median intake: 81.1% of recommendation), iodine (median: 40.6%), and cobalamin (median: 8.8%). For the male subgroup, the intake of a small amount of food of animal origin improved vitamin and mineral nutrient densities (except for zinc), whereas this was not the case for the female subgroup (except for calcium).

CONCLUSION

In order to reach favourable vitamin and mineral intakes, vegans should consider taking supplements containing riboflavin, cobalamin, calcium, and iodine. Intake of total energy and protein should also be improved.

Dietary supplement use by American women: challenges in assessing patterns of use, motives and costs

The 1994 passage of Public Law 103-417, the Dietary Supplement and Health Education Act, resulted in an exponential increase in the number and variety of dietary supplements available for over-the-counter purchase. Surveys conducted on random samples of U.S. residents have shown that approximately half of all American women use dietary supplements regularly, but very little is known about the risks and benefits of long-term and widespread supplement use. To accurately evaluate the health effects of supplement use, it is important to characterize usage patterns, motivations and costs of supplement use. However, this is a considerable challenge because accurate supplement data are difficult to collect, product databases with consistent and reliable information are lacking and survey instruments or interview protocols currently in use may not capture information about product selection for specific health conditions, motivations for use, or out-of-pocket expenditures. Future research would benefit from collaborative efforts among governmental scientists, academic scientists and industry to improve dietary supplement data collection methods and develop appropriate tools for analysis.

Demographic and lifestyle characteristics of functional food consumers and dietary supplement users

Functional foods and/or supplements may be used in the context of a healthy lifestyle or as a means to compensate for an unhealthy lifestyle. Adverse long-term and/or cumulative effects of functional food or supplement intake are of public health concern; it is therefore important to identify functional food and supplement users. The present study compared Dutch functional food and supplement consumers with non-consumers with regard to demographic and lifestyle factors. The consumption of the most common functional foods and supplements in 2000 was studied (yoghurt with extra lactic acid bacteria, cholesterol-lowering margarine, lemonade and sweets with extra vitamins and minerals, milk and margarine with extra Ca, Ca tablets, multivitamin and mineral supplements, and Echinacea supplements). Data were obtained from self-administered questionnaires filled in by a consumer panel, aged 19-91 years (response rate 76 %, n 1183), representative of the Dutch population. The number of daily consumers of functional foods or supplements appeared to be relatively low (daily use of multivitamin and mineral supplements, 20 %; all other products, 3-9 %). Explanatory variables depended on the type of product; but gender, age, education, and vegetable intake were significant factors in the logistic regression model. Consumption of cholesterol-lowering margarines was more likely to be reported by individuals with a poorer subjective health (odds ratio 2.62 (95 % CI 1.15, 6.05)) and by smokers (odds ratio 2.93 (95 % CI 1.34, 6.40)). In conclusion, determinants of functional food or supplement use depended on the type of product, so generalisation of consumer characteristics over different foods is not legitimate. In addition to research on lifestyle factors, surveys about consumers' attitudes, norms and knowledge regarding functional foods in relation to actual dietary patterns and health risk profiles are necessary.

Dietary intake and nutritional status of young vegans and omnivores in Sweden

BACKGROUND

Adolescents sometimes become vegetarian for ethical rather than health reasons. This may result in health problems caused by lack of interest in and knowledge of nutrition.

OBJECTIVE

We compared the dietary intake and nutritional status of young Swedish vegans and omnivores.

DESIGN

The dietary intakes of 30 vegans (15 males and 15 females; mean age: 17.5 +/- 1.0 y) and 30 sex-, age-, and height-matched omnivores were assessed with the use of a diet-history interview and validated by the doubly labeled water method and by measuring nitrogen, sodium, and potassium excretion in urine. Iron status and serum vitamin B-12 and folate concentrations were measured in blood samples.

RESULTS

The diet-history method underestimated energy intake by 13% and potassium intake by 7% compared with the doubly labeled water method and 24-h urine excretion, respectively. Reported dietary nitrogen and sodium intakes agreed with the 24-h urinary excretion measure. Vegans had higher intakes of vegetables, legumes, and dietary supplements and lower intakes of cake and cookies and candy and chocolate than did omnivores. Vegans had dietary intakes lower than the average requirements of riboflavin, vitamin B-12, vitamin D, calcium, and selenium. Intakes of calcium and selenium remained low even with the inclusion of dietary supplements. There was no significant difference in the prevalence of low iron status among vegans (20%) and omnivores (23%). Two vegans with low intakes of vitamin B-12 had low serum concentrations.

CONCLUSION

The dietary habits of the vegans varied considerably and did not comply with the average requirements for some essential nutrients.

Motivations for fruit and vegetable consumption in the UK Women's Cohort Study

BACKGROUND

Despite recommendations to increase fruit and vegetable consumption within the UK population, intakes are still too low. In order to stimulate dietary behaviour change the determinants of food choice need to be explored.

OBJECTIVES

To investigate how the priorities of high consumers of fruit and vegetables differ from those of low consumers, with respect to food choice motivations, and to identify what value high and low consumers place on different aspects of food choice behaviour.

DESIGN

A 4-day food diary and a questionnaire, including The Food Choice Questionnaire (FCQ) and a measure of Stage of Change (SOC) for fruit and vegetable consumption, were administered to subjects. Motivation scores from the FCQ were compared with fruit and vegetable intake and SOC data.

SUBJECTS

Nine hundred and ninety-eight females, aged 35-69 years, participating in the UK Women's Cohort Study.

RESULTS

In a multiple linear regression model, including age, education level and all FCQ motivations, the strongest motivations specifically affecting fruit and vegetable intake were health and natural content. It was found that, for a one point increase (measured on a scale of 0-4) in health and natural content scores, fruit and vegetable consumption increased by 1.11 portions (95% confidence interval (CI) 0.5-1.7) and 0.84 portions (95% CI 0.4-1.3), respectively The SOC evaluation showed significant associations with portions of fruit and vegetables consumed Women whose SOC was classed as maintenance phase were found to score higher on health, natural content, weight control and ethical concern factors These women also scored lower on convenience questions

CONCLUSION

In this particular group of women the most important motivating factors for food choice, within the high fruit and vegetable consumers, were health and natural content of the food.

Use of dietary supplements in Denmark is associated with health and former smoking

OBJECTIVES

To describe the use of dietary supplements in a group of Danish adults and to investigate the differences between users and non-users with respect to age, gender, health and lifestyle factors.

DESIGN

Cross-sectional study in two Danish cities.

SETTING

The Danish Investigation on Iodine Intake and Thyroid Diseases, 1997-1998.

SUBJECTS

Participants were 3707 women (selected age groups between 18 and 65 years) and 942 men (60-65 years). Participation rate was 50%. Supplement data were collected in a personal interview. Data on education, smoking, alcohol intake, physical activity, use of medication and self-perceived health were derived from a self-administered questionnaire. Multiple logistic regression was used for the statistical analysis.

RESULTS

Participants were asked about all kinds of supplements, ranging from products containing vitamins and minerals, to fish oils and products of herbal origin. On average 59% reported use of some kind of dietary supplement. Most common were combined multivitamin/mineral products (48%) followed by single vitamin C products (10%). Twelve per cent used three or more different supplements. Supplement use was strongly associated with age and gender, being highest among elderly women (78%). Ex-smokers were more likely to use supplements than subjects who had never smoked (odds ratio (OR) 1.36, 95% confidence interval (CI) 1.09-1.76). Supplement use was more likely among subjects who had many days of illness 95% CI 1.12-1.66) and among users of medication 95% CI 1.04-1.42). Subjects who perceived their health as poor were more likely to use supplements other than just a multivitamin/mineral tablet 95% CI 1.31-3.77).

CONCLUSIONS

Use of dietary supplements was related to age, gender and smoking, but also to poor self-perceived health status and absence from work. This indicates that a group of people use supplements as a form of self-medication.

Stakeholder interactions and the development of functional foods

OBJECTIVE

This paper investigates the roles of the individual stakeholders involved in the development of functional foods and the implications of their actions for public perception of this new food concept.

RESULTS

At a time when consumer awareness of the link between diet and health is strong, a new food concept incorporating of a wide spectrum of foods has captured the imagination of the food industry and consumers alike. Functional foods provide a new category of foods that appear to be offering the public the opportunity to achieve a healthy lifestyle with minimal effort. Public perception may determine whether this new food concept is to become the next successful breakthrough in nutritional science or just another marketing gimmick devised by food manufacturers. The paper also addresses issues that arise directly as a result of the emergence of functional foods, such as appropriate legislation in connection to health claims in order to ensure consumer protection and also the lack of clarity in relation to definitions of what constitutes a functional food.

CONCLUSION

The paper concludes that functional foods can only reach their maximum potential if the food industry, government and health professionals work together to improve communication between themselves and consumers and also to educate consumers, thereby allowing them to make informed decisions about dietary choices.

Liberal fortification of foods: the risks. A study relating to Finland

STUDY OBJECTIVE

The free circulation of goods in the European Union (EU) has increased the number of fortified foods available to consumers in Finland. Fortification of foodstuffs with calcium is currently widespread. To assist decision making relating to fortification, the object of this study was to determine whether there might be a risk of excessive levels of calcium. The study was done using the dietary data of adult population by sex and calcium intake deciles, taking account of intakes of calcium from normal diets and from fortified foods.

STUDY DESIGN

Calcium intakes for deciles were calculated from dietary data of the population involved in the 1992 FINDIET survey. Calcium fortification was evaluated by considering foodstuffs to which calcium has already been added or which producers might wish to fortify and market in Finland. Situations in which a fortified product replaced its unfortified equivalent were envisaged. Daily calcium intakes (mg) from particular foodstuffs were calculated based on known amounts of calcium (mg) per 100 g of each foodstuff and amounts of each product consumed per day. Total calcium intakes of people in different deciles were calculated by adding amounts of calcium contributed by each fortified product to normal dietary intakes. Calcium intakes were also calculated for consumption by persons of all foodstuffs that are or intended to be fortified with calcium.

STUDY PARTICIPANTS

Adults aged 25 to 64 representing populations in four regions of Finland, who recorded food consumption over three day periods in spring 1992.

STUDY SETTING

North Karelia, Kuopio Province, Turku-Loimaa, and the capital area Helsinki-Vantaa, Finland. MAIN STUDY RESULTS: The results indicate that the highest 10% of Finnish adult men receive on average 2315 mg calcium per day from diets that do not include fortified foodstuffs. These people whose energy consumption was high consumed substantial amounts of dairy products. Consumption of fortified foods would increase the calcium intake further to levels exceeding the tolerable upper intake level (2500 mg/d).

CONCLUSIONS

Liberal addition of calcium to various groups of foodstuffs could increase the calcium intake in the highest decile to levels with potentially untoward health effects. In assessing benefits and possible disadvantages of fortification of foodstuffs, the dietary habits of the population concerned, probable consumption of fortified products and nutritional intakes, especially at extremes, need to be taken into account, by total risk assessment.

Sociodemographic and health behaviour factors among dietary supplement and natural remedy users

OBJECTIVE

To investigate which subgroups of the Swedish adult population use dietary supplements and natural remedies, taking into account sociodemographic and health behaviour factors.

DESIGN

A cross-sectional survey conducted in 1996/1997 by Statistics Sweden was used for the analyses. In face-to-face interviews participants reported consumption of dietary supplements and natural remedies during the previous 2 weeks.

SETTING

Sweden

SUBJECTS

A nationally representative sample of 11 422 adults (5596 men, 5826 women) aged 16-84 y. The response rate was 78%.

RESULTS

Overall, 33% of Swedish women and 22% of Swedish men reported use of dietary supplements; prevalence of natural remedy users was 14 and 7%, respectively. The best predictors for use of dietary supplements and natural remedies were age, sex and subjective health. Women and older individuals were more likely to be dietary supplement and/or natural remedy users. Obese men and women were less likely to use dietary supplements than underweight ones. Among men subjective health was significantly related to use of these preparations. Men who reported excellent health ate less than men reporting poor health. This association was weaker among women. Exercise was another important factor. Both men and women (except female dietary supplement users) who reported moderate or heavy exercise were significantly more frequent users of these preparations than those who reported practically no exercise.

CONCLUSION

Use of dietary supplements and natural remedies is associated with several sociodemographic and health behaviour factors.

SPONSORSHIP

Karolinska Institutet Research Fund.

Effects of habitual physical activity on the resting metabolic rates and body compositions of women aged 35 to 50 years

OBJECTIVE

To examine the effect habitual physical activity has on resting metabolic rate (RMR) and body composition (fat-free mass[FFM], fat mass, and percent body fat) in active compared to sedentary adult women.

DESIGN

RMR was measured (by indirect calorimetry) twice after a 12-hour fast at the same point of the menstrual cycle and 48 hours after exercise. FFM, fat mass and percent body fat were measured using whole body air displacement plethysmography. Energy intake and expenditure were determined using 7-day weighed-food records and activity logs.

SUBJECTS

Healthy, weight-stable premenopausal women aged 35 to 50 years classified as either active (approximately 9 hours per week of physical activity for 10 or more years) (n= 18) or sedentary (approximately 1 hour per week of physical activity) (n= 14).

STATISTICAL ANALYSES

Analysis of covariance was used to investigate differences in mean RMR (kcal/day) between the groups adjusted for FFM, and independent t tests were used to determine differences in demographic, energy expenditure, and diet variables.

RESULTS

Percent body fat and fat mass were lower (P<.0005) and RMR (adjusted for FFM) was significantly higher in the active women (P=.045) compared with sedentary controls. In the active and sedentary groups respectively, mean adjusted RMR was 1,510 kcal/day and 1,443 kcal/day, body fat was 18.9% and 28.8%, and fat mass was 11.1 kg and 18.8 kg. Groups were similar in body mass, FFM, body mass index, and age. Mean energy balance appeared to be more negative in the active group (P=.0059) due to significantly higher mean self-reported energy expenditures (P=.0001) and similar mean self-reported energy intakes (P=.52) compared with sedentary controls. These data indicate that active women who participate in habitual physical activity can maintain lower body fat and a higher RMR than sedentary controls with similar body mass, FFM, and body mass index.

APPLICATIONS/CONCLUSIONS

This research supports and emphasizes the benefits of habitual physical activity in maintaining RMR and lower body fat levels in middle-aged women.

Lifestyle factors affecting fruit and vegetable consumption in the UK Women's Cohort Study

The UK Women's Cohort Study (UKWCS) was originally set up to look at morbidity and mortality data on subjects with a wide range of dietary intakes including vegans, lacto-ovo vegetarians, non-red meat eaters and red meat eaters. The aim of the present study was to investigate factors that affect fruit and vegetable consumption within this particular cohort of women. Females of ages 35-69 years, taking part in the UK Women's Cohort Study (N=35 367), provided health and lifestyle information including a 217-item food frequency questionnaire. In multiple logistic regression, the strongest predictors of a higher reported level of fruit and vegetable consumption were being a vegetarian or vegan, taking vitamin or mineral supplements, being married, educated to A-level or degree level and belonging to a higher socio-economic group. Conversely, smokers were found to be only half as likely as non-smokers to be high fruit and vegetable consumers. These lifestyle distinctions among three levels of reported fruit and vegetable consumption are relevant to the future targeting of health promotion strategies.

Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking

Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.

Folate intake, lifestyle factors, and homocysteine concentrations in younger and older women

BACKGROUND

An elevated total homocysteine (tHcy) concentration is considered to be an independent risk factor for cardiovascular diseases and has also been associated with an increased risk of neural tube defects.

OBJECTIVE

The objective of this study was to investigate folate intake, folate status, and the association between folate intake, other dietary and lifestyle factors, and tHcy concentrations in young and older women.

DESIGN

tHcy concentrations were measured in 290 young women aged 25-30 y and in 288 older women aged 60-65 y. All participants completed questionnaires about factors including lifestyle, health, and use of vitamin supplements. Red blood cell folate was measured in 204 of the participants. A subgroup of 258 participants completed dietary records.

RESULTS

Median tHcy was 7.6 micromol/L (range: 6.5-8.9) in the younger women and 9.4 micromol/L (7.7-11.1) in the older women. Folate intake from diet was 283 (224-348) and 268 (210-326) microg/d, respectively, in the 2 age groups. Folic acid intake from supplements (P: < 0.001 for the younger women and P: = 0.026 for the older women) and total folate intake (P: = 0.024 and P: = 0.079) were inversely associated with log tHcy in multiple linear regression analyses. Smoking status, coffee consumption, systolic blood pressure, and body mass index were positively associated and estrogen replacement therapy and tea consumption were inversely associated with log tHcy in some of the models.

CONCLUSIONS

According to the criteria used, between 1% and 36% of the women had suboptimal folate intake. Folic acid is a strong predictor of tHcy concentration; however, several dietary and other lifestyle factors seem to be important as well.

Micronutrient intakes in a group of UK vegans and the contribution of self-selected dietary supplements

Micronutrient intakes and the contribution of self-selected dietary supplements were investigated in 26 vegans, comprising 17 non-supplement users (NSU) and nine supplement users (SU), consuming their habitual diet. Micronutrient intakes were estimated using a four-day weighed record and the contribution of self-selected dietary supplements was assessed according to the manufacturers' declarations on the packaging. Mean daily intakes from food sources were similar in NSU and SU. Dietary supplements significantly increased intakes of riboflavin (p < 0.05), niacin (p < 0.05), folate (p < 0.01), vitamin A (p < 0.05) and vitamin D (p < 0.05). The mean daily contribution of dietary supplements ranged from 7-1640% of the reference nutrient intake (RNI). Intakes of vitamin B12 and selenium (Se) were below the appropriate lower reference nutrient intake (LRNI) in 80% and 65% of NSU respectively. After supplements, 33% of SU remained below the LRNI for vitamin B12 and 33% below the LRNI for Se. Some vegans who took supplements were not taking certain micronutrients in amounts sufficient to meet the RNIs but were taking a mix of micronutrients, some of which they needed and others which they did not need. Some vegans who did not take supplements had a potential need for the addition of supplements to their diets. Advice on the appropriate usage of dietary supplements for those on a vegan diet is needed.