Nutritional Status among Portuguese and Turkish Older Adults Living in the Community: Relationships with Sociodemographic, Health and Anthropometric Characteristics

Malnutrition is widespread among older adults, and its determinants may differ between countries. We compared Portuguese and Turkish non-institutionalized older adults regarding nutritional status, sociodemographic, health and anthropometric characteristics and studied the relationships between nutritional status and those characteristics. This cross-sectional study analyzed data from 430 Portuguese and 162 Turkish non-institutionalized older adults regarding sociodemographics, health conditions, the Mini-Nutritional Assessment (MNA-FF) and anthropometry. Turkish older adults were more likely to be malnourished or at risk of malnutrition and had lower average BMI but a higher calf circumference. A higher proportion of the Portuguese sample had tooth loss, diabetes, hypertension, oncologic diseases, kidney diseases, osteoarticular problems or eye problems, while less had anemia. A better nutritional status (higher MNA-FF score) was found among the Portuguese, males, people using dentures, those without tooth loss, hypertension, cardiovascular diseases, anemia or oncological diseases and was related to younger age, higher BMI and a higher calf circumference. Malnutrition and its risk were higher among older adults from Turkey, despite Portuguese older adults presenting a higher prevalence of chronic diseases. Being female, older age, tooth loss, hypertension, anemia, CVD or oncological disorders and having a lower BMI or CC were associated with higher rates of malnutrition among older adults from Portugal and Turkey.

Possible predictors for sarcopenia in community-dwelling elderly: neck and calf circumferences

The aim of this study was to determine the relationship between sarcopenia and calf and neck circumferences. One hundred seventy-seven community-dwelling elderly individuals (over 65 years old) were recruited. A questionnaire was applied via face-to-face interview and the MNA-SF was used to assess nutritional status. In addition, some anthropometric measurements and handgrip strength were assessed by dieticians to determine sarcopenia. Sarcopenia was defined according to the European consensus definition of the EWGSOP-2 criteria. Neck (p<0.001), calf (p=0.001), and waist circumference (p<0.001) were significantly higher in nonsarcopenic elderly women but in men. According to ROC analyses, neck (AUC: 74.7%), calf circumferences (AUC: 74.3%), and BMI (AUC: 80.4%) are possible predictors of sarcopenia in elderly women. This is the first study to demonstrate that neck circumference can be useful for predicting sarcopenia in community-dwelling women over 65 years old. These findings may contribute to the development of new strategies to screen for sarcopenia.

Food-related quality of life among older adults living in community: A multi-factorial approach

BACKGROUND & AIMS

Food-related quality of life (FRQoL) assesses the specific impact of diet, eating behaviors, and food-related anxiety on a person's Health-related quality of life. The food serves a set of purposes that go beyond supplying the basic physiological needs, it also has a hedonic and social dimension. In addition, the relationship between food and health and well-being nowadays is unquestionable. This study aims to investigate the multidimensional aspects of FRQoL by identification the underlying factors associated to it.

METHODS

This cross-sectional study is part of the Pronutrisenior project and included 602 older adults (>65 years old) from Vila Nova da Gaia, Portugal. Data were collected by a questionnaire of indirect application by trained nutritionists in a face-to-face situation. FRQoL was assessed by The Satisfaction with Food-Related Life Scale.

RESULTS

Women, younger individuals and those with inadequate social support network had lower FRQoL. Insomnia and nutritional risk were also related to lower FRQoL.

CONCLUSIONS

Our findings should be taken into account in clinical practice in order to optimize the intervention of health professionals, and the groups identified as having lower FRQoL should be given special attention.

Food choice and food consumption frequency of Cape Verde inhabitants

The knowledge of the food pattern of a population is crucial for establishing nutritional and epidemiological profiles, as well as for controlling the market of foodstuffs and to help in the management of stock of staple foods. This study aims to evaluate food consumption and its association with the underlying motives for consumers' food choices, through the application of a Food Frequency Questionnaire (FFQ) followed by a Food Choice Questionnaire (FCQ). Face to face interviews were conducted with 503 participants, recruited at their homes, workplaces, health centers and other central locations in Cape Verde, only including subjects aged ≥18 years, without a self-reported history of chronic diseases. Food frequency analysis, as well as exploratory factorial analysis (EFA) were used to determine dietary patterns and nonparametric statistical tests for comparisons and associations of variables. The EFA yielded 4 patterns termed as: "Traditional", "Western", "Balanced" and "Energetic". Using an FCQ structure of 9 factors, three different groups were obtained from hierarchical clustering. (Cabral, de Almeida, & Cunha, 2017). The results show that Cape Verdean inhabitants follow global diet trends (towards the so-called "westernization"), however, in a more moderate rate if compared to other developing country populations. Consuming "junk food" is infrequent in Cape Verde, which appears to be due to limited availability and accessibility of this type of food. The rural coastal population remains more attached to traditional foods, consuming local products and traditional dishes, whereas in the urban population, one may notice the "westernization" of consumption. The application of an FFQ in combination with the FCQ provided in-depth information on eating attitudes and behaviors.

Portugal nutritional transition during the last 4 decades: 1974-2011

Objective:

To examine trends in food availability for Portugal during the last 4 decades (1974–2011) and analyze such changes in accordance with the nutritional transition theory.

Methods:

Food balance sheets from Portugal from 1974 to 2011 were analyzed for potential trends by linear regression to study the availability of protein, fat, carbohydrate, ethanol, and total energy and the availability of the following food groups: (i) cereals and tubers; (ii) vegetables; (iii) fruit; (iv) milk; (v) meat, fish, and eggs; (vi) fat; (vii) pulses; (viii) alcoholic beverages; and (ix) sugar and sweeteners. A comparison regarding protein, fat, and carbohydrate availability and WHO recommendation was also performed.

Results:

The data suggest that in Portugal food availability and consumption have changed throughout the analyzed period. The national availability of most food groups increased considerably, which also resulted in an increase in daily energy. The consumption of cereals and tubers, pulses, and alcohol diminished during this time. Energy availability increased by 406 kcal/person/day, a result from an increase in protein and fat. Protein availability was in accordance with WHO recommendations during the 4 decades analyzed, whereas carbohydrate have always been below the recommended level and fat has been above the recommended level since the second decade (1984).

Conclusion:

Portugal has crossed into a nutritional transition over the last 4 decades, revealing characteristics of a pattern of degenerative diseases. The country may experience a new nutritional transition that would involve positive changes of behavior, as observed in other developed countries, driven by community multisectorial strategies.

Does eating family meals and having the television on during dinner correlate with overweight? A sub-study of the PRO GREENS project, looking at children from nine European countries

OBJECTIVE

Family meals have been negatively associated with overweight in children, while television (TV) viewing during meals has been associated with a poorer diet. The aim of the present study was to assess the association of eating family breakfast and dinner, and having a TV on during dinner, with overweight in nine European countries and whether these associations differed between Northern and Southern & Eastern Europe.

DESIGN

Cross-sectional data. Schoolchildren reported family meals and TV viewing. BMI was based on parental reports on height and weight of their children. Cut-off points for overweight by the International Obesity Task Force were used. Logistic regressions were performed adjusted by age, gender and parental education.

SETTING

Schools in Northern European (Sweden, the Netherlands, Iceland, Germany and Finland) and Southern & Eastern European (Portugal, Greece, Bulgaria and Slovenia) countries, participating in the PRO GREENS project.

SUBJECTS

Children aged 10-12 years in (n 6316).

RESULTS

In the sample, 21 % of the children were overweight, from 35 % in Greece to 10 % in the Netherlands. Only a few associations were found between family meals and TV viewing during dinner with overweight in the nine countries. Northern European children, compared with other regions, were significantly more likely to be overweight if they had fewer family breakfasts and more often viewed TV during dinner.

CONCLUSIONS

The associations between family meals and TV viewing during dinner with overweight were few and showed significance only in Northern Europe. Differences in foods consumed during family meals and in health-related lifestyles between Northern and Southern & Eastern Europe may explain these discrepancies.

Fruit and vegetable consumption in a sample of 11-year-old children in ten European countries--the PRO GREENS cross-sectional survey

OBJECTIVE

To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines.

DESIGN

Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol.

SETTING

Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries.

SUBJECTS

A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project.

RESULTS

The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8-37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded).

CONCLUSIONS

Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.

Fruit and vegetables: intake and sociodemographic determinants among Portuguese mothers

BACKGROUND

Fruit and vegetable intake is crucial in health promotion and disease prevention. Inadequate intake is found among adult populations worldwide.

AIMS

To assess fruit and vegetable intake among Portuguese mothers and to examine its association with sociodemographic determinants.

METHODS

A national cross-sectional survey was performed in Portugal as part of the Pro Children study. Data from self-administrated precoded 24-hour recall and food frequency questionnaires answered by 1,853 mothers of 11- to 13-year-old children were analyzed. Descriptive analysis of the data was followed by logistic regression to assess associations between daily fruit and vegetable intake and sociodemographic determinants.

RESULTS

The mean fruit and vegetable intake was 221.2 and 170.0 g/day, respectively. Only 46% of the mothers met the WHO recommendations (≥400 g fruit and vegetables/day). Daily fruit intake was significantly higher among mothers who live with a spouse/partner, and who belong to a higher social class. For vegetables, daily intake was significantly higher among mothers with a higher education and social class.

CONCLUSIONS

This study shows that the mean intake of fruit and vegetables among Portuguese mothers is far below international recommendations. Effective strategies to promote fruit and vegetable intake are needed, especially for mothers belonging to lower social classes and educational levels.

Factors influencing European consumer uptake of personalised nutrition. Results of a qualitative analysis

The aim of this research was to explore consumer perceptions of personalised nutrition and to compare these across three different levels of "medicalization": lifestyle assessment (no blood sampling); phenotypic assessment (blood sampling); genomic assessment (blood and buccal sampling). The protocol was developed from two pilot focus groups conducted in the UK. Two focus groups (one comprising only "older" individuals between 30 and 60 years old, the other of adults 18-65 yrs of age) were run in the UK, Spain, the Netherlands, Poland, Portugal, Ireland, Greece and Germany (N=16). The analysis (guided using grounded theory) suggested that personalised nutrition was perceived in terms of benefit to health and fitness and that convenience was an important driver of uptake. Negative attitudes were associated with internet delivery but not with personalised nutrition per se. Barriers to uptake were linked to broader technological issues associated with data protection, trust in regulator and service providers. Services that required a fee were expected to be of better quality and more secure. An efficacious, transparent and trustworthy regulatory framework for personalised nutrition is required to alleviate consumer concern. In addition, developing trust in service providers is important if such services to be successful.

[Validation of a questionnaire to evaluate alcohol related behaviours in excessive drinkers]

The excessive consumption of alcohol and alcoholic drinks is an habit with high socioeconomic costs and a strong impact on health that requires research aiming at establishing adequate political options concerning trends, observed behaviours and consumption.

OBJECTIVES

To validate an instrument to evaluate the consumption of the different kinds of alcoholic drinks and alcohol-related behaviours; to assess the determinants of alcoholic drinks consumption.

TYPE OF STUDY

Validation study of an instrument to assess alcohol-related behaviours.

PLACE

Coimbra.

POPULATION

Excessive alcohol consumers.

METHODS

Cross-sectional study based on a questionnaire and biochemical markers assessment, aiming to validate an instrument to evaluate alcohol consumption and alcohol-related behaviours.

RESULTS

A correlation between age at first contact with alcohol and the beginning of the regular consumption(r = 0,72; p < 0,001) was found. Alcohol consumption in the last 12 months correlated with - % CDT (r = 0,54; p < 0,001) and with γ-GT (r = 0,47; p < 0,001).

CONCLUSIONS

The validity of the instrument developed to evaluate alcohol-related behaviours is acceptable and therefore it may be used to establish hierarchy between levels of alcohol consumption defined by categories of ingestion and negative consequences.

The Women's Health Initiative. What is on trial: nutrition and chronic disease? Or misinterpreted science, media havoc and the sound of silence from peers?

The first results of the Women's Health Initiative dietary intervention trial were published in the USA in February. This is a colossal intervention designed to see if diets lower in fat and higher in fruits, vegetables and grains than is usual in high-income countries reduce the incidence of breast cancer, colorectal cancer, heart disease and other chronic diseases, in women aged 50-79 years. As interpreted by US government media releases, the results were unimpressive. As interpreted by a global media blitz, the results indicate that food and nutrition has little or nothing to do with health and disease. But the trial was in key respects not reaching its aims, was methodologically controversial, and in any case has not produced the reported null results. What should the public health nutrition profession do about such messes?

Fruit and Vegetable Intake of Mothers of 11-Year-Old Children in Nine European Countries: The Pro Children Cross-Sectional Survey

OBJECTIVE

To describe and compare fruit and vegetable intakes of mothers of 11-year-old children across Europe.

METHODS

Cross-sectional surveys were carried out in 9 European countries in October/November 2003. Self-administered questionnaires assessing fruit and vegetable consumption were used for data collection. The current paper presents dietary intake data obtained by a precoded 24-hour recall and a food frequency questionnaire.

RESULTS

The consumption levels of fruit and vegetables (without fruit juice) were in line with World Health Organization recommendations of > or =400 g/day for only 27% of all participating mothers. Based on both instruments, the Pro Children results showed comparatively high average fruit intake levels in Portugal, Denmark and Sweden (211, 203 and 194 g/day) and the lowest intake in Iceland (97 g/day). High vegetable intake levels were found in Portugal and Belgium (169 and 150 g/day), the lowest in Spain (88 g/day). A south-north gradient could not be observed in the Pro Children study.

CONCLUSION

Fruit and vegetable intakes are low in mothers of 11-year-olds across Europe. Especially vegetable consumption can be regarded as marginal in most of the studied European countries. A high percentage of mothers indicated to eat fruit and vegetables less than once a day. The results have shown that national and international interventions are necessary to promote fruit and especially vegetable consumption in the European population of mothers.

Promoting Fruit and Vegetable Consumption among European Schoolchildren: Rationale, Conceptualization and Design of the Pro Children Project

BACKGROUND/AIMS

The Pro Children Project was designed to assess fruit and vegetable consumption in European schoolchildren and their parents, as well as determinants of the children's consumption patterns. A second objective was to develop and test strategies, applicable across Europe, for promoting consumption of fruits and vegetables among schoolchildren and their parents. In this paper, the rationale, theoretical background, overall design and implementation of the project is presented.

METHODS

Surveys of national, representative samples of 11-year-old schoolchildren and their parents were conducted in 9 countries, i.e. in Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden. Comprehensive school-based educational programmes have been developed and tested in three settings, i.e. in Spain, the Netherlands and in Norway. A precoded 24-hour recall form combined with a set of food frequency questions assessing regular intake were used to assess fruit and vegetable consumption. Determinants were assessed employing a comprehensive theoretical framework including personal, social and environmental factors related to fruit and vegetable consumption. The intervention programmes have been tested employing a group-randomized trial design where schools have been randomly allocated to an intervention arm and a delayed intervention arm. Surveys among all participating children and their parents were conducted prior to the initiation of the intervention, immediately after the end of the intervention and at the end of the subsequent school year.

CONCLUSION

The project is expected to provide new information of great importance for improving our understanding of consumption patterns of fruits and vegetables and for guiding future efforts to promote increased consumption patterns across Europe.

Validity and Reproducibility of a Precoded Questionnaire to Assess Fruit and Vegetable Intake in European 11- to 12-Year-Old Schoolchildren

BACKGROUND/AIMS

Validity and reproducibility were evaluated of a new questionnaire to assess fruit and vegetable intakes in 11- to 12-year-old children.

METHODS

The precoded teacher-assisted self-administered questionnaire included two sections: a 24-hour recall part and a food frequency part. Validity was tested in 4 countries (Denmark, Iceland, Norway, Portugal; n = 43-60 per country) using a 1-day weighed food record and 7-day food records as reference methods. Test-retest (7-12 days apart) reproducibility was assessed in 6 countries (Belgium, Denmark, Iceland, Norway, Portugal, Spain; n = 60-74 per country).

RESULTS

Spearman rank correlations for fruit and vegetable intake according to the frequency part and the 7-day food record ranged between r = 0.40-0.53. Between 25-50% were classified into the same quartile and 70-88% into the same or adjacent quartile. Test-retest Spearman rank correlations for the food frequency part were r = 0.47-0.84. Three countries showed no significant difference between fruit intake as assessed with the 24-hour recall part and the 1-day weighed food record, and 2 countries showed no significant difference for vegetables. In the other countries, the 24-hour recall part resulted in substantially higher mean intake levels.

CONCLUSION

Validity and reproducibility as to ranking of subjects were regarded to be satisfactory in all countries. Group mean intake, based on the original 24-hour part, was valid for fruit in 3 countries and for vegetables in 2 countries, and this part was subsequently adjusted to avoid overestimation, before the questionnaire was used in the Pro Children study.

Personal, Social and Environmental Factors regarding Fruit and Vegetable Intake among Schoolchildren in Nine European Countries

BACKGROUND/AIMS

Children in Europe are consuming less fruit and vegetables than recommended. Knowledge about the potential determinants of fruit and vegetable intake is vital to understand discrepancies in intake and to guide interventions. The aim of the present study was to assess personal, social and environmental factors regarding fruit and vegetable intake among 11- to 12-year-old children in Europe.

METHODS

A cross-sectional survey was undertaken, with nationally or regionally representative samples of in total 13,305 children (mean age 11.4 years) from nine European countries. Pupils in the classroom completed a self-administered questionnaire measuring fruit and vegetable intake and personal, social and environmental factors during one school lesson. Age-adjusted covariance analyses were carried out by gender, for the full sample and for each country separately. Proportions responding positively to the constructs are presented.

RESULTS

Overall, European children held a positive attitude towards fruit and vegetable intake. For some constructs, large between-country differences were found. Children had a more positive attitude towards fruit than towards vegetables, and girls were on average more positive than boys. The children perceived their social environment as supportive towards fruit and vegetable intake. They reported good to very good availability of fruit and vegetables at home. However, availability at school and during leisure time activities seemed to be low, both for fruit and for vegetables.

CONCLUSION

A large majority of the children reported positively to the personal and social factors regarding fruit and vegetable intake. As regards availability of fruit and vegetables at school and leisure time, and accessibility of fruit and vegetables at home, there is room for improvement.

[Body mass index: sensitivity and specificity]

INTRODUCTION

Self-reported height and weight data have been used in several studies with the purpose of determining the prevalence of overweight and obesity. Despite being a simple methodology, little information exists about the reliability of these measures, namely, in university students. The objective of this study was to determine the sensitivity and specificity of self-reported body mass index (BMI) to evaluate the prevalence of overweight and obesity in university students.

METHODS

In a convenience sample of 380 university students (226 women and 154 men), weight and height were obtained by self-reported measures and anthropometric assessment according to international standards methodology (objective). BMI was calculated from self-reported and direct measures.

RESULTS

The discrepancy between objective and self-reported weight was not significative. For height, this discrepancy was significantly different in women, in men, and between genders. The difference between BMI values was significantly different in women (0.8 +/- 1.1 kg/m2), in men (0.4 +/- 1.1 kg/m2) and between genders. Concerning overweight and obesity, according to the objective BMI, the sensitivity was only 50% in women, and 70% in men, while the specificity was 99% in women and 98% in men.

CONCLUSION

Our results show a poor sensitivity of self-reported weight and height data, to estimate overweight and obesity, thus, this method might not be reliable for studies of prevalence of obesity in this population.

[Validity assessment of a food frequency questionnaire by comparison with a 4-day diet record]

When dietary methods are used to evaluate nutritional intake, it is important to know which methods are most appropriate to ensure validity in nutrient intake studies. Our main objective was to assess the validity of a semi-quantitative food-frequency questionnaire (FFQ) developed for Portuguese adults by comparing nutrient intake (energy and 44 nutrients) assessed by FFQ with the nutritional data from a four-day diet record (DR). The FFQ was developed by the Epidemiology Department, Faculty of Medicine, University of Porto, and allowed the subjects to indicate their daily, weekly or monthly intake of 89 foods. Subjects were 246 university students (159 females and 87 males, aged 18 to 29 years). Mean intakes from the FFQ were generally higher than those from the DR. Pearson correlation coefficients between FFQ and DR ranged from 0.21 for vitamin D, to 0.73, for iodine. When energy-adjusted, this coefficients ranged from 0.20, for selenium, to 0.75 for iodine. Misclassification in opposite extreme quintiles varied from 0% to 16%, and the proportion of subjects correctly classified within the lowest two quintiles ranged between 52% and 84%. The distribution of those correctly classified within the highest two quintiles ranged between 51% and 88%. Exact classification in the same quintile of ingestion varied from 26% and 41%. These data suggest that this FFQ provides valid estimates of intakes for major nutrients, comparable to those reported from other studies in the literature.