Trends in dietary sources of nutrients among middle-aged men in southern Germany. Results of the MONICA Project Augsburg: dietary surveys 1984/1985 and 1994/1995. MONItoring trends and determinants in CArdiovascular disease

Causal effects of dietary calcium, zinc and iron intakes on coronary artery disease in men: G-estimation and inverse probability of treatment weighting (IPTW) analyses

BACKGROUND & AIMS

Dietary minerals have significant effects on the risk of cardiovascular disease. However, the results of previous studies were not uniform across different countries. The current study aims to determine the causal effects of dietary calcium, zinc, and iron intakes on coronary artery disease (CAD) among Nepalese men.

METHODS

A matched case-control study was carried out at Shahid Gangalal National Heart Center. Dietary intakes of 466 male participants over the past 12 months were evaluated using a semi-quantitative customized food frequency questionnaire. G-estimation and inverse probability treatment weighting (IPTW) analyses were performed to determine the causal odds of CAD due to dietary calcium, zinc, and iron intakes.

RESULTS

Daily dietary calcium, zinc, and iron intakes were categorized into two groups: less than versus more than the median value and less than versus equal or more than recommended daily allowance (RDA). In G-estimation, dietary calcium intake was inversely associated with CAD in both medians (OR: 91; 91%CI: 0.86, 95) and RDA categories (OR: 0.88: 95%CI: 0.84, 0.97). However, in IPTW analysis, only median calcium intake was significantly associated with CAD (OR: 7; 91%CI: 0.5, 98). We observed a significant inverse association of equal or more than RDA of dietary zinc intake with CAD (OR: 0.91: 95%CI: 0.87, 0.96 in G-estimation, OR: 0.73: 95%CI: 0.66, 0.82 in IPTW); however, more than median dietary zinc intake showed inverse but not significant association with CAD in both analyses. Dietary iron intake was inversely but not significantly associated with CAD in G-estimation in both groups. Nevertheless, in IPTW analysis, equal or more than RDA iron intake was significantly positively (OR: 1.4; 95%CI: 1.14, 1.73) related to CAD.

CONCLUSIONS

A significant inverse association of dietary zinc intake above RDA indicates the potential protective effect of higher dietary zinc against CAD. However, causal odds of CAD are inconsistent across the median or RDA of calcium and iron intakes. Therefore, cohort and randomized clinical trial studies with a large sample size are recommended to substantiate these nutrients' causal link with CAD development in the Nepalese population.

Association between dietary inflammatory index, and cause-specific mortality in the MONICA/KORA Augsburg Cohort Study

Background

Chronic diseases such as cancer and cardiovascular diseases (CVDs) are well-established causes of disability and premature death. Dietary components have been implicated in the etiology of these chronic diseases.

Methods

We examined the ability of the Dietary Inflammatory Index (DIITM) to predict all-cause, coronary heart disease (CHD), CVD and cancer mortality and incident CHD in the MONICA-KORA Cohort Studies. DII scores were computed from baseline 7-day dietary records in this cohort of 1297 men, who were aged 45-64 years when enrolled. During the follow-up period, 551 total (155 CHD, 244 CVD and 175 cancer-related deaths) and 213 validated incident CHD events were identified through mortality record linkage and active follow-up. Spearman correlation coefficients were calculated between DII scores and the inflammatory marker C-reactive protein (CRP). Cox proportional hazards regression was used to estimate hazard ratios (HR) for the endpoints described above.

Results

DII scores were significantly positively correlated with CRP (P value <0.0001). Positive associations were noted between DII and all-cause mortality (HRQ4vsQ1: 1.41; 95%CI 1.04-1.90; P-trend = 0.007) and incident CHD (HRQ4vsQ1: 1.83; 95%CI 1.12-3.01; P-trend = 0.008). These associations were attenuated after further adjustment for smoking status, but remained significant for all-cause mortality. When stratified by smoking status, DII was associated with all-cause and cancer mortality among ex-smokers, in the absence of significant heterogeneity.

Conclusion

These results indicate that a pro-inflammatory diet as expressed by higher DII scores is associated with all-cause mortality. This association was more pronounced among ex-smokers in whom a significant association with cancer mortality was observed.

Macronutrient Composition of the Australian Population's Diet; Trends from Three National Nutrition Surveys 1983, 1995 and 2012

Although the role of individual macronutrients in the development of obesity remains controversial, changes in macronutrient composition of the diet may have played a causal role in the obesity epidemic. The aim of this analysis was to determine the percentage energy (%E) for protein, carbohydrate and fat of Australian adults' diets over time. Cross-sectional, national nutrition surveys from 1983, 1995 and 2012 assessed diet using one 24 h recall. The prevalence of obesity increased between each survey, from 9.6% to 19.7% and 27.7%. Protein (%E) differed between each survey and contributed 17.7%, 16.8% and 18.3% energy in 1983, 1995 and 2012, respectively (p < 0.001). Carbohydrate (%E) increased from 40.0% in 1983 to 44.9% in 1995 (p < 0.001), with no change in dietary fibre but declined in 2012 to 43.1%. Fat (%E) declined between each survey from 35.3%, 31.9%, to 30.9%, respectively (p < 0.001). Alcohol (%E) has declined for younger adults and men but intake increased for women aged >45 years. Prospective cohort studies with comprehensive assessment of foods consumed, together with measurements of weight and height, will advance the understanding of the relationship between macronutrients and changes in body weight and obesity.

Contributions of risk factors and medical care to cardiovascular mortality trends

Ischaemic heart disease, stroke, and other cardiovascular diseases (CVDs) lead to 17.5 million deaths worldwide per year. Taking into account population ageing, CVD death rates are decreasing steadily both in regions with reliable trend data and globally. The declines in high-income countries and some Latin American countries have been ongoing for decades without slowing. These positive trends have broadly coincided with, and benefited from, declines in smoking and physiological risk factors, such as blood pressure and serum cholesterol levels. These declines have also coincided with, and benefited from, improvements in medical care, including primary prevention, diagnosis, and treatment of acute CVDs, as well as post-hospital care, especially in the past 40 years. These variables, however, explain neither why the decline began when it did, nor the similarities and differences in the start time and rate of the decline between countries and sexes. In Russia and some other former Soviet countries, changes in volume and patterns of alcohol consumption have caused sharp rises in CVD mortality since the early 1990s. An important challenge in reaching firm conclusions about the drivers of these remarkable international trends is the paucity of time-trend data on CVD incidence, risk factors throughout the life-course, and clinical care.

Food sources of nutrients among 13-year-old Portuguese adolescents

Objective

To identify food sources of nutrients in adolescents’ diets and to identify differences in food sources according to individual characteristics.

Design

A cross-sectional evaluation was carried out in the 2003/2004 school year. Self-administered questionnaires were used and a physical examination was performed. Diet was evaluated using an FFQ.

Setting

Public and private schools in Porto, Portugal.

Subjects

Adolescents aged 13 years (n 1522) enrolled at school.

Results

The main sources of energy were starchy foods (26·5 %), dairy (12·5 %) and meat (12·0 %). The major contributors to carbohydrate intake were starchy foods (38·2 %) and fruit (13·8 %) and to protein intake were meat (28·0 %), dairy products (20·3 %), starchy foods (15·3 %) and seafood (13·6 %). The main sources of total fat were meat (22·0 %), starchy foods (13·4 %) and dairy products (12·7 %). Sweets and pastries presented important contributions to energy (11·1 %), carbohydrate (12·4 %), total fat (13·3 %) and saturated fat (16·6 %) intakes. Parental education was inversely associated with the contribution of sweets and pastries to energy, carbohydrate and fat intakes and it was positively associated with the seafood contribution to protein intake.

Conclusions

The major sources of carbohydrates were starchy foods, which also accounted for a quarter of energy intake. Dairy products plus meat accounted for another quarter of energy. Meat was a major source of protein and fats. Sweets and pastries contributed more than 10 % to energy, carbohydrates, total and saturated fat. Parental education was the strongest determinant of food sources and was positively associated with a healthier contribution of food groups.

Fifteen-year time trends in energy and macronutrient intake in German children and adolescents: results of the DONALD study

The DONALD study (Dortmund Nutritional and Anthropometric Longitudinally Designed study) gives the opportunity to evaluate long-term food and nutrient intake data on the basis of 3 d weighed dietary records of infants, children and adolescents since 1985. In this paper, we examine changes in energy and macronutrient intakes (protein, fat, saturated, mono- and polyunsaturated fatty acids, carbohydrates and added sugars) of 795 2–18-year-old subjects between 1985 and 2000 (4483 records). No significant changes in intakes of energy and of protein, polyunsaturated fatty acids and added sugars (as % energy intake, E %) were found. Fat intake decreased significantly in all age groups (between -0·20 and -0·26 E %/year), as well as intake of saturated fatty acids (between -0·11 and -0·14 E %/year) and monounsaturated fatty acids (between -0·07 and -0·014 E %/year). This decline was compensated for by a significant increase in carbohydrate intake (between +0·18 and +0·27 E %/year). The changes in macronutrient intake were mainly due to a decreased consumption of fats–oils (between -0·29 and -1·26 g/year) and meat–fish–eggs (between -0·21 and -2·92 g/year), whereas consumption of bread–cereals (between +0·12 and +2·42 g/year) and potatoes–pasta–rice (between +0·15 and +2·26 g/year) increased slightly. However, since recommended fat intake and fatty acid composition was not reached at the end of the study period by far, further efforts will be necessary to improve macronutrient composition and to stabilize favourable dietary habits.

Eight-year trends in food, energy and macronutrient intake in a sample of elderly German subjects

Time trends in the food and the corresponding energy and macronutrient intake between 1994 and 2002 are investigated as part of the longitudinal study on nutrition and health status in an ageing population in Giessen, Germany (GISELA study). The dietary intake is assessed via a 3 d estimated dietary record especially developed and validated for this study. A total of 2135 records from 532 subjects, aged 60 years and over, are analysed separately according to sex and age groups (born 1904–1928 and born 1929–1942). Results show that the food, energy and macronutrient intake of the GISELA subjects stayed fairly stable over the study period. However, some significant changes in the consumption pattern are observed, predominantly in the women and the younger age groups, which correspond to the national trends in Germany. Most obvious changes observed among the GISELA subjects are the increased intake of water (between +21·05 and +41·61 ml/d per year) and vegetables (between +2·94 and +3·38 g/d per year) and a reduced consumption of coffee and tea (between −10·65 and −15·99 ml/d per year) as well as of meat (between −1·79 and −2·56 g/d per year). The healthier food choices and the ability to change food habits could be related to the relatively high health-awareness of the GISELA subjects compared to the federal average of equivalent age groups.

Trends of food intake in Portugal, 1987–1999: results from the National Health Surveys

OBJECTIVE

To assess trends of food intake in Portugal.

DESIGN

Analysis of three cross-sectional studies: 1987, 1995-1996 and 1998-1999.

SETTING

Representative samples of free-living individuals.

SUBJECTS

64 734 men and 71 282 women.

INTERVENTIONS

Food intake was assessed by questionnaires inquiring the number of meals and which foodstuffs (fish, meat, milk, rice/pasta/potatoes, soup, vegetables and fruit) had been consumed the day before.

RESULTS

Age-adjusted average number of meals decreased from 3.3+/-0.1 in 1987 to 2.9+/-0.1 in 1998-1999 in both genders (P<0.001). In men, the percentage of subjects consuming meat, milk and potatoes/rice/pasta increased from 73, 66 and 91% in 1987 to 83, 74 and 95% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 56% in 1987 to 62 and 53% in 1998-1999, respectively. In women, the percentage of subjects consuming meat, milk, potatoes/rice/pasta and vegetable increased from 70, 66, 89 and 71% in 1987 to 78, 77, 93 and 83% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 55% in 1987 to 64 and 53% in 1998-1999, respectively. These trends were more pronounced in the younger age, which also displayed a higher frequency of snacking. Multivariate analysis adjusting for age group, region and educational level showed that the consumption of meat, milk and vegetables increased and the consumption of soup, fish and fruit decreased in 1998-1999 relative to 1995-1996.

CONCLUSIONS

Within a decade, the Portuguese dietary pattern has changed considerably, shifting from a traditional, south European to a more Westernized, protein-rich diet.

SPONSORSHIP

The Unidade de Nutrição e Metabolismo of the Instituto de Medicina Molecular is partially funded by a grant from the FCT (Fundação para a Ciência e a Tecnologia) ref. RUN 437.

Impact of 'Mad Cow Disease' publicity on trends in meat and total vitamin A consumption in Geneva between 1993 and 2000

BACKGROUND

In March 1996, revelations about the possible risk for humans of the 'mad cow disease' epidemic had a sudden impact on the diets of European populations.

OBJECTIVE

To assess changes in meat and nutrient intakes in adults living in Geneva, Switzerland from 1993 to 2000.

DESIGN

Independent annual cross-sectional surveys (4047 women and 4092 men total).

MAIN OUTCOME MEASURE

Dietary habits assessed and compared to baseline (January 1993-April 1996) via validated semi-quantitative food-frequency questionnaire.

RESULTS

Women beef abstainers increased from 8.9 to 14.9% in late 1996 (P<0.001) and 13.3% in 1997 (P<0.05); among meat consumers, in late 1996 meat/beef intakes declined -10/-12% (both P<0.05). From 1997 to 2000 most intake levels drifted back toward those at baseline, but chicken intakes were significantly (all P<0.05) greater each year (+19% in 2000 (P<0.001). Consistent but less dramatic changes were observed among men. From late 1996 until 2000, liver abstention was significantly (all P<0.05) greater (women from 60 to 78%; men from 61 to 73% in 2000; (both P<0.001). The only nutrient intakes that decreased significantly (all P<0.05) each year from 1997 through 2000 were retinol and total vitamin A women: -22% (P<0.001); -11% (P<0.05) respectively; men: -16% (P<0.001); -10% (P<0.05) respectively, in 2000). Total vitamin A intakes exceeded the dietary reference intake (DRI) for liver eaters (women 185%, men 153%), but were below the DRI for liver abstainers (women 83%; men 66%) in 2000.

CONCLUSION

The decreases in beef and liver consumption since late 1996 led to the discovery of a long-term disparity in the retinol and total vitamin A intakes of liver eaters vs abstainers.

The contribution of foods to the dietary lipid profile of a Spanish population

OBJECTIVE

To identify the food that has the greatest effect on the variation in the percentage of energy intake derived from fat and saturated fatty acids for the consumption of a Spanish population.

DESIGN

A cross-sectional study of food consumption, using the 24-hour recall method for three non-consecutive days, one of which was a non-working day. Subjects were interviewed by trained interviewers in the subjects' homes. We used multiple linear regression for statistical analysis.

SETTING

The citizens of Reus.

SUBJECTS

One thousand and sixty subjects over five years old, randomly selected from the population census of Reus.

RESULTS

In both sexes, the foods that mainly determine a high consumption of fat are oil and red meat while those that determine a lower consumption of fat are bread, savoury cereals and fruit. The foods that mainly determine a high consumption of saturated fatty acids are red meat and whole-fat dairy products while those that determine a low consumption are bread, savoury cereals and fruit.

CONCLUSIONS

In our population, feasible variations in the intake of some foods - less than one portion - would reduce the estimated percentage of energy intake derived from fat and saturated fatty acids by a quantity considered important for cardiovascular disease prevention. The periodic identification and quantification of the food that most affects the dietary fat profile will help in drawing up dietary guidelines with more reasonable strategies for consuming a healthier diet and decreasing the risk of developing nutritional disorders.

Meat consumption in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts: results from 24-hour dietary recalls

OBJECTIVE

To evaluate meat intake patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts.

DESIGN AND SETTING

24-Hour dietary recalls were assessed within the framework of a prospective cohort study in 27 centres across 10 European countries by means of standardised computer-assisted interviews.

SUBJECTS

In total, 22 924 women and 13 031 men aged 35-74 years.

RESULTS

Mean total meat intake was lowest in the 'health-conscious' cohort in the UK (15 and 21 g day-1 in women and men, respectively) and highest in the north of Spain, especially in San Sebastian (124 and 234 g day-1, respectively). In the southern Spanish centres and in Naples (Italy), meat consumption was distinctly lower than in the north of these countries. Central and northern European centres/countries showed rather similar meat consumption patterns, except for the British and French cohorts. Differences in the intake of meat sub-groups (e.g. red meat, processed meat) across EPIC were even higher than found for total meat intake. With a few exceptions, the Mediterranean EPIC centres revealed a higher proportion of beef/veal and poultry and less pork or processed meat than observed in central or northern European centres. The highest sausage consumption was observed for the German EPIC participants, followed by the Norwegians, Swedish, Danish and Dutch.

CONCLUSIONS

The results demonstrate distinct differences in meat consumption patterns between EPIC centres across Europe. This is an important prerequisite for obtaining further insight into the relationship between meat intake and the development of chronic diseases.