Nutritional risk factors in Hungarian elderly-Biomarker2019 survey

 

In Hungary, about a quarter of the population is over the age of 60 and their proportion is projected to increase considerably within a few decades. According to the 2009 and 2014 European Health Interview Survey data, 87% of Hungarian older adults suffer from at least one non-communicable disease (NCD). Many of the NCDs are associated with poor nutrition. Reliable data on nutritional status of this age group is scarce. The Biomarker2019 survey provides comprehensive data on the nutritional status of this vulnerable age group. The cross-sectional survey was carried out in western Hungary. Participants aged ≥60y were selected from non-institutionalized patients of general practitioners' practicing in Western Hungary (n = 200). Data collection involved a questionnaire, physical examinations, three-day dietary record, and a collection of biological samples (fasting blood and 24-hour urine). 77% of the participants had high blood pressure diagnosed by a physician. 85% of men and 76% of women were overweight or obese, according to the BMIs. The mean proportion of energy from fat was higher (men: 39 E%, women: 37 E%), that from carbohydrates was lower in men (43 E%) than recommended, while it was adequate in women (47 E%). The mean protein intake was adequate in both sexes. Cholesterol intake was 433 mg/day for men and 317 mg/day for women, both higher than the Hungarian recommendations. The fiber intake was 23.8 g/day for men and 23.6 g/day for women, both below the recommended values. Based on the estimates of salt intake from 24-hour urine, 90% of participants had a higher salt intake than recommended. Nutritional risk factors predisposing to the development of NCDs were identified in the sample. The results of the study contributed to the development of a food-based dietary guideline tailor made to the Hungarian elderly population (60+ Health - Dietary Guideline for the Elderly), its dissemination to the target audience has been started.

Key messages

The identification of nutritional risk factors in a sample of older adults contributed to the development of a new food-based dietary guideline for the elderly population. The results can form the basis of further public health interventions.

Impact assessment of the public health product tax in Hungary

Many countries apply fiscal policies to promote healthy diets to reduce the risk factors of NCDs. In 2011, a public health product tax (PHPT) was introduced in Hungary, taxing non-staple food products that carry proven health risks when consumed. The objectives of PHPT were to promote healthier eating habits by increasing the availability of healthy choices; to encourage reformulation; and to increase revenues for public health. With the purpose of evaluating the social and economic effects of PHPT, impact assessments (IAs) were conducted in 2012, 2014, and in 2018. The IA in 2018 was conducted within the framework of an EU-cofunded development project. To measure the awareness of the population on the law; to assess the population's attitude towards PHPT; to map the consumption patterns and to examine the major factors influencing food choices were fundamental parts of the IAs. We aim to present the findings of the latest IA and compare them to the results of the previous studies. Population surveys with questionnaires including the same questions were applied in the three assessments, hence changes during the 6 years could be detected. A sample of the adult population was involved in form of personal interviews in each IA. Based on the results, the awareness of PHPT was less (66%) in 2018 than in 2012 (72%). The adult population's consumption of the taxed products increased in all categories between 2012 and 2018 (except for salty condiments). Sociodemographic factors and awareness of the law correlated with the consumption of certain PHPT products. Taste was the primary determinant of food choice both in 2012 and 2018. The role of the price and the energy content in food choices were decreased significantly by 2018. A higher proportion of people identified the aims of PHPT correctly and agreed with them in 2018. The results draw attention to the importance of further interventions and the need of targeted health communication.

Key messages

The impact of the PHPT should continue to be monitored and evaluated. To achieve the aims of PHPT in the long term, it is needed to use more effective health communication, furthermore harmonized intersectoral actions should be also implied to promote healthy diet.

Impact assessment of the TFA regulation on fatty acid composition of foods in Hungary

Trans fatty acids are formed during the industrial processing of food, and are proven to be harmful for the human body. They have been associated with increased risk of cardiovascular disease, abdominal obesity, diabetes, and certain types of cancer. Decree 71/2013. (XI. 20.) of the Ministry of Human Capacities, which has been in force since 2014, defines the highest permitted amount of trans fats in food products placed on the market in Hungary. The impact of the decree on the industrially produced trans fatty acids (iTFA) availability and population intake was assessed in 2017. Results demonstrated that iTFA were replaced by other fatty acids due to the legislation. In 2019, we investigated food groups which had high measured TFA content before the regulation entered into force and compared the total fat and fatty acid profiles to the same brand or similar products being on the market afterwards. In collaboration with the World Health Organization, this was the first assessment to determine to which extent manufacturers increased saturated fat (SFA) content of foodstuffs to reduce iTFA content. In those product groups, which were identified as significant food sources of iTFA before introducing the regulation (biscuits, coffee creamers and flavorings, sweets, bakery products, confectionary, wafers, margarines) we found no significant changes in the total fat content, while in most foodstuffs the average proportion of SFA was higher after reformulation, as iTFA were mainly substituted with SFA in 61% of the products, with cis-MUFA in 25% and cis-PUFA in 14% of the products, respectively. Evidence from this analysis supports concerns that eliminating iTFA in certain foodstuffs leads to unwanted substitution with saturated fat, hence reducing the possible health benefits. Given the high SFA intake and the unfavourable cardiovascular statistics in Hungary, the consumption frequency and portion size control of these products are advised.

Key messages

Monitoring the changes of food composition is important in order to evaluate the effect of the regulation. Manufacturers should be encouraged to reduce the SFA content to a technologically feasible level.

Traditional Eastern European diet and its relationship with mortality: results from the HAPIEE study

Background

Cardiovascular disease (CVD) and cancer mortality rates in Eastern European countries are among the highest in the world. Although unhealthy diet is an important risk factor for both of these chronic diseases, traditional eating habits and their health effects in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European population-based cohorts.

Methods

We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) multi-centre prospective cohort study based in Russia, Poland and the Czech Republic (age range at baseline: 45-70 years). Diet was assessed by food frequency questionnaire, and we constructed an Eastern European diet score (EEDS) from nine food groups considered as “traditional” in this region. The relationship between EEDS and all-cause, CVD and cancer mortality was calculated with Cox-regression models.

Results

From the 18,852 participants, 2,234 died during the average follow-up of 11.7 years. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.20; 95% CI 1.05-1.38) and CVD deaths (1.32; 1.05-1.64) compared to those with low adherence. The association with cancer mortality was not significant (1.12; 0.90-1.40). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while processed fruit or vegetable consumption showed consistent inverse associations.

Conclusions

Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential.

Key messages

This work indicates that traditional dietary habits in Eastern European countries may be one of the reasons for the poor health status of populations in this region. Public health nutritional interventions which target traditional but unhealthy foods, such as lard, have the potential to considerably improve population health in Eastern Europe.

Abstract P3-03-27: Can we select patients suitable for targeted axillary dissection after neoadjuvant chemotherapy who originally presented with involved axillary nodes?

Introduction:

The current recommended management for patients with involved lymph nodes at diagnosis of breast cancer is to perform an axillary node dissection after receiving neoadjuvant chemotherapy (NAC), regardless of response. A number of studies have proposed de-escalation of this practice by performing sentinel node biopsies and targeted axillary dissections in those with response to chemotherapy. We have audited our practice to assess the safety of introducing management change.

Methods:

Cancer data was collected between 2014 and 2018 for patients who had NAC and further selection criteria for those with lymph node involvement at diagnosis and subsequently underwent NAC. Assessment of radiological response at NAC completion, tumour hormone receptors and HER2 status along with axillary nodal response on final histopathology were reviewed to assess whether patients can be stratified to less extensive axillary management.

Results:

290 patients underwent NAC, 60 of whom had nodal involvement at diagnosis:

- All had USS axilla, MRI at baseline and completion of NAC

- All 60 node positive patients underwent axillary clearance, as per current local protocol

- Out of those 60 node positive patients, 39 had breast conserving surgery, whilst 21 patients had mastectomy

- 20 (33%) patients showed complete radiological response (CRR) on MRI in both breast and nodes

- 23 (38%) patients achieved pathological complete response (PCR) in their nodes

- 17 patients showed both CRR and PCR

- 4 patients showed CRR but did not achieve PCR:

o patient 1: 1 macromet / 7 nodes - NEG/NEG/NEG

o patient 2: 1 micromet / 14 nodes - POS/POS/POS

o patient 3: 7 macromet / 10 nodes - POS/POS/NEG

o patient 4: 5 macromet / 19 nodes - POS/POS/NEG

- Large volume of nodal disease remained in 2 patients with POS/POS/NEG despite CRR

Conclusion:

MRI can be safely and reliably used in patients who show CRR with TNBC and HER2+ cancers to select patients for de-escalating axillary surgery. Caution in those patients with POS/POS/NEG cancers as MRI may show CRR but large volume disease in nodes may still persist. Further prospective audit of de-escalating treatment will be essential to ensure locoregional control and long-term disease-free survival outcomes.

Citation Format: Nagy ES, Whisker L, Asgeirsson K. Can we select patients suitable for targeted axillary dissection after neoadjuvant chemotherapy who originally presented with involved axillary nodes? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-27.

Oak canopy effects on the distribution patterns of two annual grasses: the role of competition and soil nutrients

Within the oak woodlands of California there is often a distinct shift in the botanical composition between the open grassland and the herbaceous understory beneath oak canopy. Botanical sampling at two woodland sites indicated that the annual grass Bromus diandrus was dominant under deciduous blue oak canopy, while a congener, Bromus hordeaceus, was dominant in open grassland. We examined the relative importance of congeneric competition and edaphic factors in creating these differences in species distribution in two separate field experiments that manipulated both congeneric and intraspecific competition, as well as soil type. We used the demographic measure of relative reproductive rate as an index of population growth. In general, demographic performance correctly predicted the distribution of the two annual grasses in the field. Our results indicate that reduced abundance of B. hordeaceus under canopy reflects the negative effects of competition with B. diandrus. In contrast, B. diandrus is little affected by competition from B. hordeaceus. The reduced abundance of B. diandrus in open grassland may result, in part, from its inability to adapt as well as B. hordeaceus to lower nutrient availability in soils of the open grassland.

[Heart-blood-pool scintigraphy in dialyzed chronic uremic patients)]

The author have carried out scintigraphic measurements of the heart in order to diagnose the presence of an exudative pericarditis 50 times in 26 dialyzed uremic patients. Within the one year's observation 13 patients had an exudative pericarditis from the beginning on. In 8 cases a regression of the exudation could be observed. The examination has a low risk for the patient and is suitable to demonstrate clinically relevant pericardial liquid accumulation.