Energy, macronutrients and dietary fibre intake among adults in North Macedonia

Objective: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. Methods: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. Results: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, beta = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, beta = -2.077) and among highly educated participants (p = 0.018, beta = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, beta = 4.213). Conclusion: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases

Implementation of Harmonized Food Consumption Data Collection in the Balkan Region According to the EFSA EU Menu Methodology Standards

Initiatives in the Capacity Development in Nutrition Research in the Balkan region in the last decade have been toward the creation of contemporary, harmonized Research Infrastructure (RI) compliant with European standards. This study describes the process of creation and implementation of the European Food Safety Authority (EFSA) EU Menu methodology in the Balkan region during the EFSA support projects for food consumption data collection in four countries (Serbia, Montenegro, Bosnia and Herzegovina, and North Macedonia). This process entailed the application and improvement of an innovative tool, the DIET ASSESS and PLAN (DAP), a platform for standardized food consumption data collection and dietary intake assessment. DAP comprises computerized food consumption, anthropometric measurements, and physical activity questionnaires, validated food picture book, and FoodEx2 exposure hierarchy with sets of facet descriptors of the interest. It hosts the Balkan food platform with a Serbian food composition database (FCDB) and Regional FCDB, compliant with European Food Information Resource (EuroFIR™) standards. The implementation of the DAP platform in national dietary surveys conducted with the support of the EFSA EU Menu project in Balkan countries enabled harmonized food consumption data compilation and reporting. Application of the methodology entailed the development of study protocol and extensive education and training of study personnel. The entire data collection process was managed by internal and external survey coordinators. A pilot study was conducted to test the entire data collection and control process and was afterward used to make necessary improvements and adjustments to meet EU Menu requirements. Data collected are internationally comparable with food consumption data in other European countries within the framework of the EU Menu program. The existence of such data in the Balkan region will catalyze research activities in emerging topics, such as identification of dietary patterns, the establishment of national nutrient reference values and food-based dietary guidelines (not only in Serbia, but in the whole Balkan region), dietary exposure assessments, the endorsement and evaluation of new food legislations, the environmental and other effects of diet on the food system. The developed and implemented methodology underpins evidence-based policy-making processes lacking in the field of public health nutrition in the region

Development and Sustainability of National Food Composition Databases for use in Dietary Monitoring and Public Health Nutrition in the Eastern Mediterranean Region

Background:Similar to Western Countries, the Eastern Mediterranean Region (EMR) also presents major public health issues associated with the increased consumption of sugar, fat (saturated fatty acids, trans fatty acids), salt. Therefore, one of the policies of the World Health Organization’s (WHO) EMRO is to reduce the intake of these, to address the risk of obesity and non-communicable diseases such as diabetes, cardiovascular disease and cancer. In order to do this, access to updated, standardized, harmonized food composition data (FCD) is essential. Aims: Objectives within this Medical Research Council GCRF project, working jointly with WHO–EMRO, are to assess the status of national FCD and to provide training and capacity development in the use of improved standardized methodologies to update FCD as well as dietary intake methods, use of suitable biomarkers of nutritional value and to determine health outcomes in the low- and middle-income countries (LMIC) of this region. By identifying specific regional needs for FCD compilation, detailed training workshops can be developed to enable the production of vital high-quality harmonised data in the EMR including: Iran, Iraq, Pakistan, Kuwait, Tunisia, Morocco, Sudan, Egypt, Jordan together with Mauritania. This capacity building will lead to the development and sustainability of up-to-date national and regional FCD for use in dietary monitoring assessment in food and nutrient intakes. Methods: Training needs were identified, and short-term scientific missions organized for researchers via training, knowledge exchange workshops and short-term exchange of researchers. Training at CAPNUTRA (Serbia) and INNTA (Tunisia) included the use of improved standardized methodologies for food composition and food intake for 7 EMR countries leading to development of national FCD, enabling upload onto the EuroFIR data platform. A 3-week training course on analytical methods was carried out at INSA (Portugal) for analysts from Egypt, Jordan and Sudan. Key findings: A total of 45 participants from 13 countries including 10 EMR and 3 invited West African countries attended 5 workshops and training exchanges. Training topics included: value documentation and quality assessment; food composition data tools (Food Composition And System Environment (FoodCASE), Diet assess and Plan (DAP), Nutritics; food classification and description of composite dishes, recipe calculation approaches; use of yield and retention factors; EuroFIR e-learning tools and case studies; laboratory food analysis (vitamins A, B1, B2, C, D2, D3 and E, fatty acids, amino acids, minerals, fibre); quality management system; food metrology principles; validation of chromatographic methods; and food label legislation. 6 countries have imported their FCD, as open access, into the EuroFIR FoodEXplorer platform. The WHO-EMRO jointly with MRC GCRF project funded and mobilized research institutions in over 10 countries, with more focus on identifying traditional dishes and micronutrients. Conclusions and project Implications: The use of improved standardized methodologies for food composition and dietary intake will produce robust measurements that will reinforce dietary monitoring and policy in LMIC. The capacity building from this project has led to searchable national food composition data from developing/emerging countries being made available in an open access form for the first time. WHO-EMRO, is funding further updates of FCD tables in Jordan, Lebanon, Oman, Sudan, Tunisia, Morocco, Pakistan, Iran Egypt, and UAE, with the focus on identifying TFA, SFA, salt and sugar in addition to micronutrients.Project supported by Global Challenges Research Funds (UK) and Medical Research Council (MR/R019576/1), is grateful to WHO EMRO.info:eu-repo/semantics/publishedVersio

EURRECA nutritional planning and dietary assessment software tool: NutPlan

Background/Objectives: 'NutPlan' is developed within the EURRECA Network of Excellence (EURopean micronutrient RECommendations Aligned (http://www.eurreca.org). It is a user-friendly software programme with multiple functions: individual and group nutrition planning, recipe calculation, creating food labels, diet planning and nutrient intake assessment. This paper describes the newly developed software and its features. Subjects/Methods: 'NutPlan' contains the following databases: foods, dish recipes, meals, menus, average menus and glossary. These databases enable diet planning and diet analysis by comparing foods, dishes, meals or menus with currently available nutritional recommendations accessible by a link to EURRECA tool Nutri-RecQuest to meet individual/group nutritional needs. The software is upgraded by inserting new items (for example, foods, dishes, meals) and for a connection to other software programmes, thus allowing more advanced calculations to be completed. Conclusion: 'NutPlan' might be the software of choice for individual and group diet planning. It is aimed particularly at Eastern European and West Balkan countries, which currently lack dietary software. It is envisaged for use by small and medium enterprises in the food industry, as well as by health professionals, researchers and policy makers, and can be recommended for educational purposes. Given its characteristics of being upgraded to include new country-specific food data/database, it can be recognized as an important tool in nutritional capacity development in the Central Eastern European and other regions. European Journal of Clinical Nutrition (2010) 64, S38-S42; doi:10.1038/ejcn.2010.5

Evaluation of Dietary Intake and Anthropometric Status in 1–9-Year-Old Children Living in Serbia: National Food Consumption Survey according to the EU Menu Methodology

The Serbian Food Consumption Survey among 1–9-year-old-children was conceptualized and conducted in compliance with the principles, established protocols, and guidelines of the EU Menu project between 2017 and 2021. Valid data were collected for 576 individuals (290 1–3-year-old toddlers and 276 3–9-year-old children). Regardless of age and gender category, the majority (68.80%) of children had normal weights according to the Body Mass Index-for-age classification system. The median daily energy intake was 1406.71 kcal with no differences between the settlement types. The overall median contributions of carbohydrates, protein, and fat to the total energy intake were 47.54%, 14.06%, and 37.88%, respectively. The proportions of the macronutrient intake deviated from the dietary reference values with compliance to the recommendations being particularly poor for fat and fiber. The consumption of energy-dense food groups such as meat and meat products, fat and oil, sugar, and confections was more pronounced among older children. The survey results provide a valuable insight into the nutritional status and dietary habits of toddlers and children 1–9 years old living in Serbia. They may serve as an evidence platform for public health programs, a valuable asset for decision-makers, and a reliable reference to guide nutritional policies, diet monitoring, and interventions targeting this population group in the future

Development and Sustainability of Eastern Mediterranean Region and South African National Food Composition Databases

Introduction: The World Health Organization’s (WHO)-Eastern Mediterranean Region Office (EMRO) aims to reduce the consumption of sugar, fat (saturated fatty acids, trans fatty acids) and salt; and decrease the risk of obesity and non-communicable diseases in the Eastern Mediterranean Region (EMR). To address this Quadram Institute Bioscience is working jointly with WHO-EMRO in providing training and capacity development to national experts, leading to standardized, harmonized, comprehensive, open access Food Composition Data (FCD) to underpin food and nutrition programs and policies in these low- and middle-income countries (LMIC). Materials and Methods: By identifying specific regional needs for FCD compilation, detailed training workshops were developed to enable the production of vital high-quality harmonised data in the EMR including: Iran, Iraq, Pakistan, Kuwait, Tunisia, Morocco, Sudan, Egypt, and Jordan. Training on standardized methodologies for food composition and dietary intake methods, biomarkers, analytical methods and FCD tools were provided by experts from UK, Serbia, Portugal and WHO-EMRO, via knowledge exchange workshops and short-term training exchange of researchers. Results: A total of 45 FCD expert compilers from 13 countries attended 2 workshops and 3 training exchanges. Knowledge transfer consisted of: value documentation; quality assessment; online food composition data tools; food classification and description of composite dishes; recipe calculation; yield and retention factors; and laboratory food analysis (vitamins A, B1, B2, C, D2, D3 and E, fatty acids, amino acids, minerals, fibre). FCD from 6 countries was standardized using the EuroFIR data template and Theasuri (standardised vocabularies). The final datasets from Iran, Iraq, Pakistan, Kuwait, Tunisia and Morocco were made available via FoodExplorer an innovative interface for FCD which allows users to search information from food composition data simultaneously across many countries. Discussion: The use of improved standardized methodologies for food composition and dietary intake will produce robust measurements that will reinforce dietary monitoring and policy in LMIC. The capacity building from this project has led to searchable national food composition data from LMIC being made available as open access form for the first time. WHO-EMRO, is funding further updates of FCD tables in Jordan, Lebanon, Oman, Sudan, Tunisia, Morocco, Pakistan, Iran, Egypt, and UAE, with the focus on identifying TFA, SFA, salt and sugar in addition to micronutrients.Project supported by Global Challenges Research Funds (UK) and Medical Research Council (MR/R019576/1), is grateful to WHO EMRO.info:eu-repo/semantics/publishedVersio

Supplementary data for the article: Djekic-Ivankovic, M.; Weiler, H. A.; Nikolic, M.; Kadvan, A.; Gurinovic, M.; Mandic, L. M.; Glibetic, M. Validity of an FFQ Assessing the Vitamin D Intake of Young Serbian Women Living in a Region without Food Fortification: The Method of Triads Model. Public Health Nutr. 2016, 19 (4), 437–445. https://doi.org/10.1017/S136898001500138X

Supplementary material for: [https://doi.org/10.1017/S136898001500138X]Related to published version: [http://cherry.chem.bg.ac.rs/handle/123456789/1905

Validity of an FFQ assessing the vitamin D intake of young Serbian women living in a region without food fortification: the method of triads model

Objective: The objective of the present study was to examine the external validity of an FFQ designed to estimate dietary vitamin D intake compared with a plasma biomarker and three repeated 24 h dietary recalls in women of reproductive age in Serbia, where there is no exposure to food fortified with vitamin D. The method of triads was applied. Design: In a cross-sectional study, 422 women completed the Women and Reproductive Health FFQ (WRH-FFQ) during the winter months. From a representative subgroup (n 44), three 24 h dietary recalls and anthropometric parameters were collected as well as a fasting blood sample for vitamin D biomarker analyses. Correlation coefficients were calculated between each of the dietary methods. Validity coefficients, as a correlation between the measured and estimated 'true' exposure, were calculated using the method of triads. Bland-Altman plots were also constructed. Setting: Three major universities in Serbia. Subjects: Healthy young women (n 422) aged 18-35 years. Results: The WRH-FFQ estimate of vitamin D intake for all participants was 4.0 (SD 3.3) mu g/d and 3.1 (SD 2.3) mu g/d for the subgroup. Bland-Altman plots for these intakes showed high agreement. Validity coefficients for the FFQ, 24 h recall and biomarker were. rho(QI) = 0.847 (95 % CI 0.564, 0.928), rho(RI) = 0.810 (95 % CI 0.537, 0.997) and rho(BI) = 0.499 (95 % CI 0.190, 0.840), while the correlation coefficients were 0.686, 0.422 and 0.404. Conclusions: The FFQ applied in the present study is a valid tool for assessing dietary vitamin D intake in women living in Serbia, a region without mandatory vitamin D food fortification

Nutri-RecQuest: a web-based search engine on current micronutrient recommendations

Background: The EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence collated current micronutrient recommendations. A user-friendly tool, Nutri-RecQuest, was developed to allow access to the collated data and to create a database source for use in other nutritional software tools. Methods: Recommendations, that is, intakes of micronutrients sufficient to meet the requirements of the majority of healthy individuals of that population, from 37 European countries/organizations and eight key non-European countries/regions comprising 29 micronutrients were entered into a database. General information on the source of the recommendations, as well scientific background information, was added. Results: A user-friendly web-based interface was developed to provide efficient search, comparison, display, print and export functions. Conclusion: Easy access to existing recommendations through the web-based tool may be valuable for bodies responsible for setting recommendations, as well as for users of recommendations including scientists, policy makers, health professionals and industry. Adding related dietary reference values such as average nutrient requirements and upper limits may extend the utility of the tool. European Journal of Clinical Nutrition (2010) 64, S43-S47; doi:10.1038/ejcn.2010.6

Assessment of vitamin D intake among Libyan women - adaptation and validation of specific food frequency questionnaire

Vitamin D deficiency (VDD) has pandemic proportions worldwide. Numerous studies report on high prevalence of VDD in sunny regions like Near East and North Africa (NENA). Previous studies indicated that Libyan population was at risk of VDD. To contribute to the body of evidence, measurement of vitamin D status on children, adults, in Misurata region was conducted, and confirmed with validated dietary intake study. Serum 25(OH)D was analysed using electrochemiluminescence protein binding assay. Existing Food Frequency Questionnaires (FFQ) were adapted to Libyan Women Food Frequency Questionnaire (LW-FFQ). Repeated 24h dietary recalls and LW-FFQ were employed in vitamin D intake evaluation. LW-FFQ was validated using 24h dietary recall and vitamin D status as referent methods. The questionnaires included anthropometry and lifestyle information. Vitamin D status assessment revealed inadequate levels (25(OH)D lt 50nmol/l) in almost 80% of participants. Women (25-64y) were identified as the most vulnerable group with vitamin D inadequacy present in 82% (61.6% had 25(OH)D lt 25nmol/l, and 20.2% had 25-50nmol/l 25(OH)D). Average Vitamin D intake within the study sample (n=316) was 3.9 +/- 7.9 mu g/d, with 92% participants below both Institute of Medicine (IOM) (10 mu g/d) and European Food Safety Authority (15 mu g/d) recommendations. Measured vitamin D status, in 13% of this group, correlated significantly (p=0.015) with intake estimates. Based on self-report, consumption of vitamin D supplements does not exist among study participants. Additional lifestyle factors influencing vitamin D status were analysed. Only 2% of study participants spend approximately 11 min on the sun daily, 60.4% were obese, 23.1% were overweight and 71.2% reported low physical activity. These findings confirm previous reports on high prevalence of VDD in women across NENA, and in Libya. The situation calls for multi-sectoral actions and public health initiatives to address dietary and lifestyle habits