Validation of a food quantification picture book targeting children of 0–10 years of age for pan-European and national dietary surveys

The aim of the present study was to validate thirty-eight picture series of six pictures each developed within the PANCAKE (Pilot study forthe Assessment of Nutrient intake and food Consumption Among Kids in Europe) project for portion size estimation of foods consumed byinfants, toddlers and children for future pan-European and national dietary surveys. Identical validation sessions were conducted in threeEuropean countries. In each country, forty-five foods were evaluated; thirty-eight foods were the same as the depicted foods, and sevenfoods were different, but meant to be quantified by the use of one of the thirty-eight picture series. Each single picture within a pictureseries was evaluated six times by means of predefined portions. Therefore, thirty-six pre-weighed portions of each food were evaluatedby convenience samples of parents having children aged from 3 months to 10 years. The percentages of participants choosing the correctpicture, the picture adjacent to the correct picture or a distant picture were calculated, and the performance of individual pictures withinthe series was assessed. For twenty foods, the picture series performed acceptably (mean difference between the estimated portion numberand the served portion number less than 0·4 (SD ,1·1)). In addition, twelve foods were rated acceptable after adjustment for density differences.Some other series became acceptable after analyses at the country level. In conclusion, all picture series were acceptable forinclusion in the PANCAKE picture book. However, the picture series of baby food, salads and cakes either can only be used for foodsthat are very similar to those depicted or need to be substituted by another quantification tool.</p

Dietary choices and environmental impact in four European countries

Effective food policies in Europe require insight into the environmental impact of consumers’ diet to contribute to global nutrition security in an environmentally sustainable way. The present study therefore aimed to assess the environmental impact associated with dietary intake across four European countries, and to explain sources of variations in environmental impact by energy intake, demographics and diet composition. Individual-level dietary intake data were obtained from nationally-representative dietary surveys, by using two non-consecutive days of a 24-h recall or a diet record, from Denmark (DK, n = 1710), Czech Republic (CZ, n = 1666), Italy (IT, n = 2184), and France (FR, n = 2246). Dietary intake data were linked to a newly developed pan-European environmental sustainability indicator database that contains greenhouse gas emissions (GHGE) and land use (LU) values for ∼900 foods. To explain the variation in environmental impact of diets, multilevel regression models with random intercept and random slopes were fitted according to two levels: adults (level 1, n = 7806) and country (level 2, n = 4). In the models, diet-related GHGE or LU was the dependent variable, and the parameter of interest, i.e. either total energy intake or demographics or food groups, the exploratory variables. A 200-kcal higher total energy intake was associated with a 9% and a 10% higher daily GHGE and LU. Expressed per 2000 kcal, mean GHGE ranged from 4.4 (CZ) to 6.3 kgCO2eq/2000 kcal (FR), and LU ranged from 5.7 (CZ) to 8.0 m2*year/2000 kcal (FR). Dietary choices explained most of the variation between countries. A 5 energy percent (50 g/2000 kcal) higher meat intake was associated with a 10% and a 14% higher GHGE and LU density, with ruminant meat being the main contributor to environmental footprints. In conclusion, intake of energy, total meat and the proportion of ruminant meat explained most of the variation in GHGE and LU of European diets. Contributions of food groups to environmental footprints however varied between countries, suggesting that cultural preferences play an important role in environmental footprints of consumers. In particular, Findings from the present study will be relevant for national-specific food policy measures towards a more environmentally-friendly diet.</p

Geographic and socioeconomic diversity of food and nutrient intakes: a comparison of four European countries

Purpose: Public health policies and actions increasingly acknowledge the climate burden of food consumption. The aim of this study is to describe dietary intakes across four European countries, as baseline for further research towards healthier and environmentally-friendlier diets for Europe. Methods: Individual-level dietary intake data in adults were obtained from nationally-representative surveys from Denmark and France using a 7-day diet record, Italy using a 3-day diet record, and Czech Republic using two replicates of a 24-h recall. Energy-standardised food and nutrient intakes were calculated for each subject from the mean of two randomly selected days. Results: There was clear geographical variability, with a between-country range for mean fruit intake from 118 to 199 g/day, for vegetables from 95 to 239 g/day, for fish from 12 to 45 g/day, for dairy from 129 to 302 g/day, for sweet beverages from 48 to 224 ml/day, and for alcohol from 8 to 15 g/day, with higher intakes in Italy for fruit, vegetables and fish, and in Denmark for dairy, sweet beverages and alcohol. In all countries, intakes were low for legumes ( 80 g/day). Within countries, food intakes also varied by socio-economic factors such as age, gender, and educational level, but less pronounced by anthropometric factors such as overweight status. For nutrients, intakes were low for dietary fibre (15.8–19.4 g/day) and vitamin D (2.4–3.0 µg/day) in all countries, for potassium (2288–2938 mg/day) and magnesium (268–285 mg/day) except in Denmark, for vitamin E in Denmark (6.7 mg/day), and for folate in Czech Republic (212 µg/day). Conclusions: There is considerable variation in food and nutrient intakes across Europe, not only between, but also within countries. Individual-level dietary data provide insight into the heterogeneity of dietary habits beyond per capita food supply data, and this is crucial to balancing healthy and environmentally-friendly diets for European citizens

Potential impact of meat replacers on nutrient quality and greenhouse gas emissions of diets in four European countries

Meat replacers could play a role in achieving more plant-based diets, but their current consumption is limited. The present modelling study aimed to explore the nutritional and greenhouse gas emissions impacts of meat replacers. Using dietary surveys from Denmark, Czech Republic, Italy and France (~6500 adults), we composed alternative diets in which all the meat in the observed diet (in grams) was substituted by similar use meat replacers (with and without fortification). Starting from the observed diets and meat-replacement diets, diets with improved adherence to food-based dietary guidelines (FBDGs) were modelled using Data Envelopment Analysis. These improved diets were then further optimised for dietary preferences (MaxP, diet similarity index), nutrient quality (MaxH, Nutrient Rich Diet score, NRD15.3) or diet-related greenhouse gas emissions (GHGE) (MaxS, CO2 equivalents). In all optimised modelled diets, the total amount of meat was lower than in the observed diets, i.e., 30% lower in the MaxP, 50% lower in the MaxH, and 75% lower in the MaxS diets. In the MaxP diet, NRD15.3 was ~6% higher, GHGE was ~9% lower, and ~83% of food intake remained similar. In the MaxH diet, NRD15.3 was ~17% higher, GHGE was ~15% lower, and ~66% of food intake remained similar. In the MaxS diet, NRD15.3 was ~9% higher, GHGE was ~33% lower, and ~65% of food intake remained similar. When using fortified meat replacers, for all modelled diets, the diet similarity was on average 2% lower and the GHGE reduction was on average 3% higher as compared with the same scenarios without fortification. This analysis showed that meat replacers, provided their preference is similar to meat, can provide benefits for GHGE, without necessarily compromising nutrient quality.</p

Improving health and carbon footprints of European diets using a benchmarking approach

Objective: This study aimed to identify diets with improved nutrient quality and environmental impact within the boundaries of dietary practices.Design:We used Data Envelopment Analysis to benchmark diets for improved adherence to food-based dietary guidelines (FBDG). We then optimised these diets for dietary preferences, nutrient quality and environmental impact. Diets were evaluated using the Nutrient Rich Diet score (NRD15.3), diet-related greenhouse gas emission (GHGE) and a diet similarity index that quantified the proportion of food intake that remained similar as compared with the observed diet.Setting:National dietary surveys of four European countries (Denmark, Czech Republic, Italy and France). Subjects: Approximately 6500 adults, aged 18-64 years. Results: When dietary preferences were prioritised, NRD15·3 was ∼6 % higher, GHGE was ∼4 % lower and ∼85 % of food intake remained similar. This diet had higher amounts of fruit, vegetables and whole grains than the observed diet. When nutrient quality was prioritised, NRD15·3 was ∼16 % higher, GHGE was ∼3 % lower and ∼72 % of food intake remained similar. This diet had higher amounts of legumes and fish and lower amounts of sweetened and alcoholic beverages. Finally, when environmental impact was prioritised, NRD15·3 was ∼9 % higher, GHGE was ∼21 % lower and ∼73 % of food intake remained similar. In this diet, red and processed meat partly shifted to either eggs, poultry, fish or dairy.Conclusions:Benchmark modelling can generate diets with improved adherence to FBDG within the boundaries of dietary practices, but fully maximising health and minimising GHGE cannot be achieved simultaneously.</p

Dietary choices and environmental impact in four European countries

Effective food policies in Europe require insight into the environmental impact of consumers’ diet to contribute to global nutrition security in an environmentally sustainable way. The present study therefore aimed to assess the environmental impact associated with dietary intake across four European countries, and to explain sources of variations in environmental impact by energy intake, demographics and diet composition. Individual-level dietary intake data were obtained from nationally-representative dietary surveys, by using two non-consecutive days of a 24-h recall or a diet record, from Denmark (DK, n = 1710), Czech Republic (CZ, n = 1666), Italy (IT, n = 2184), and France (FR, n = 2246). Dietary intake data were linked to a newly developed pan-European environmental sustainability indicator database that contains greenhouse gas emissions (GHGE) and land use (LU) values for ∼900 foods. To explain the variation in environmental impact of diets, multilevel regression models with random intercept and random slopes were fitted according to two levels: adults (level 1, n = 7806) and country (level 2, n = 4). In the models, diet-related GHGE or LU was the dependent variable, and the parameter of interest, i.e. either total energy intake or demographics or food groups, the exploratory variables. A 200-kcal higher total energy intake was associated with a 9% and a 10% higher daily GHGE and LU. Expressed per 2000 kcal, mean GHGE ranged from 4.4 (CZ) to 6.3 kgCO2eq/2000 kcal (FR), and LU ranged from 5.7 (CZ) to 8.0 m2*year/2000 kcal (FR). Dietary choices explained most of the variation between countries. A 5 energy percent (50 g/2000 kcal) higher meat intake was associated with a 10% and a 14% higher GHGE and LU density, with ruminant meat being the main contributor to environmental footprints. In conclusion, intake of energy, total meat and the proportion of ruminant meat explained most of the variation in GHGE and LU of European diets. Contributions of food groups to environmental footprints however varied between countries, suggesting that cultural preferences play an important role in environmental footprints of consumers. In particular, Findings from the present study will be relevant for national-specific food policy measures towards a more environmentally-friendly diet.</p

Comparison of two food record-based dietary assessment methods for a pan-European food consumption survey among infants, toddlers, and children using data quality indicators

We aimed (1) to describe and evaluate the "EPIC-Soft DataEntry" application developed as a user-friendly data entry tool for pan-European and national food consumption surveys among infants and children, and (2) to compare two food record-based dietary assessment methods in terms of food description and quantification using data quality indicators. EPIC-Soft DataEntry was used for both methods. Two pilot studies were performed in both Belgium and Czech Republic in a total of 376 children (3 months to 10 year olds): one using a consecutive 3-day food diary; and the second with two non-consecutive 1-day food diaries with data entry during a completion interview. The collected dietary data were compared between the two dietary assessment methods by country and by age groups: (i) 3-10 years. Overall, 70 % of the interviewers evaluated the work with EPIC-Soft DataEntry as easy. With both dietary assessment methods, an equally high proportion of specific food names (e.g., "yoghurt, strawberry") were reported, where only between 5 and 15 % of foods were non-specified (e.g., "yoghurt, n.s."). The two 1-day food diaries yielded a higher proportion of foods with detailed description. For example, in the age category of 1-3 year olds in Belgium, for 7 out of 16 systematic questions on food description (e.g., "preservation method,") specific answers were significantly higher (all P < 0.03). The proportion of missing quantities of consumed foods was comparable between the two methods. The EPIC-Soft DataEntry application was positively evaluated by the majority of the interviewers. Two non-consecutive 1-day food diaries with data entry during a completion interview provide a more detailed description of consumed foods as compared with a 3-day food diary

Reporting accuracy of population dietary sodium intake using duplicate 24 h dietary recalls and a salt questionnaire

High dietary Na intake is associated with multiple health risks, making accurate assessment of population dietary Na intake critical. In the present study, reporting accuracy of dietary Na intake was evaluated by 24 h urinary Na excretion using the EPIC-Soft 24 h dietary recall (24-HDR). Participants from a subsample of the European Food Consumption Validation study (n 365; countries: Belgium, Norway and Czech Republic), aged 45-65 years, completed two 24 h urine collections and two 24-HDR. Reporting accuracy was calculated as the ratio of reported Na intake to that estimated from the urinary biomarker. A questionnaire on salt use was completed in order to assess the discretionary use of table and cooking salt. The reporting accuracy of dietary Na intake was assessed using two scenarios: (1) a salt adjustment procedure using data from the salt questionnaire; (2) without salt adjustment. Overall, reporting accuracy improved when data from the salt questionnaire were included. The mean reporting accuracy was 0.67 (95% CI 0.62, 0.72), 0.73 (95% CI 0.68, 0.79) and 0.79 (95% CI 0.74, 0.85) for Belgium, Norway and Czech Republic, respectively. Reporting accuracy decreased with increasing BMI among male subjects in all the three countries. For women from Belgium and Norway, reporting accuracy was highest among those classified as obese (BMI >= 30 kg/m(2): 0.73, 95% CI 0.67, 0.81 and 0.81, 95% CI 0.77, 0.86, respectively). The findings from the present study showed considerable underestimation of dietary Na intake assessed using two 24-HDR. The questionnaire-based salt adjustment procedure improved reporting accuracy by 7-13%. Further development of both the questionnaire and EPIC-Soft databases (e.g. inclusion of a facet to describe salt content) is necessary to estimate population dietary Na intakes accurately