The Development and Validation of Food Atlas for Portion Size Estimation in the Balkan Region

Assessment of portion sizes is an important factor for the accuracy of food consumption surveys. The objective of this study was to develop and validate a food atlas of commonly consumed foods in the Balkan region in order to improve the accuracy of portion size estimation for food consumption surveys. A list of 135 foods and their portion sizes was based on previously conducted food consumption surveys in this region. Food was cooked, measured and served in three or four portion sizes right before being photographed. A validation study was conducted through the visual perception method. Without receiving training on usage of the food picture book, participants were asked to evaluate two portion sizes of 20 selected foods by comparison with a photo series of each food. Portion sizes were evaluated by 18 nutrition professionals and 17 lay individuals who had no nutritional education. Mean differences and the standard deviations of the mean differences (SD) between the portions estimated by each participant and the served portion were calculated. The percentages of participants who selected the correct, adjacent or distant portion size also were calculated. The number of food items that were quantified within the predefined acceptable range (i.e., mean difference lt vertical bar 0.7 vertical bar and SD lt 1) was 16 (80%) among lay individuals and 17 (85%) among nutritional professionals. Among 16 photo series that were assessed as "acceptable," the percentage of all participants, who selected the correct picture, was between 44.3 and 82.9%, with an average of 60.2%. Only three foods were assessed correctly by lt 50% participants. The percentage of participants who selected the correct or adjacent serving size was above 98% for both lay and professional evaluators. This is the first food atlas containing representative foods and recipes commonly consumed in the Balkan region. However, further adjustments of the methodology should include larger number of food items to be tested, involvement of more participants and provision of training for the users of the food atlas. This food atlas could be used in food consumption surveys in the Balkan region after further testing and validation

Sustainable food systems for healthy diets in Europe and Central Asia: Introduction to the special issue

This Special Issue highlights various good practices and food policy discussion in relation to the transformation of current food systems toward their social, environmental and economical sustainability. The papers describe policies, programmes and initiatives in developing and advanced economies of Europe and Central Asia that refer to the core elements of food systems, such as food supply, food environments, and consumers. The shared opinions, analyses, studies and approaches, experiences and insights contribute to a better understanding of regional specificities and support the efforts to guide the complex food systems' transformation for their improved capacity to deliver healthy diets

How dietary intake methodology is adapted for use in European immigrant population groups - a review

Immigrants comprise a noteworthy segment of the European Population whose numbers are increasing. Research on the dietary habits of immigrants is critical for correctly providing diet counselling and implementing effective interventions. The aim of the present study was to identify the presently used methods and adaptations required for measuring dietary intake in European immigrant groups. A comprehensive review strategy included a structured MEDLINE search, related references and key expert Consultations. The review targeted adults from non-European union (European union-15 countries) ethnic groups having the largest populations in Europe. As Studies evaluating nutrient intake were scarce, papers evaluating intake at the level of foods were included. Forty-six papers were selected. Although Eastern Europe, Turkey, Africa (North, Sub-Saharan and Afro-Caribbean), Asia and Latin America represented the most numerous immigrant groups, papers on dietary intake were not available for all populations. Interview-administered FFQ and repeated 24 hour recalls were the most frequently applied instruments. Inclusion of ethnic foods and quantification of specific portion sizes of traditional foods and dishes in assessment tools as well as food composition databases were commonly identified problems. For FFQ, food list elaboration required particular consideration to reflect key ethnic foods and relative contribution to nutrient intake. Extra efforts were observed to overcome Cultural barriers to Study participation. Evaluation-dietary intake of immigrant populations requires special attention to various methodological aspects (sampling, recruiting, instruments used, method of administration, food composition database, acculturation, etc.) so as to adequately address the range of socio-cultural factors inherent in these nutritionally at risk target groups

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

Professional training in nutrition in Central and Eastern Europe: current status and opportunities for capacity development

Objective: To examine the availability of academic programmes in nutrition and identify nutrition training needs in Central and Eastern Europe (CEE). Design: A questionnaire with close-ended and open-ended questions was distributed to the members of the United Nations University Standing Committee on Nutrition, Regional Network for Capacity Development in Nutrition in CEE (NCDN CEE). Setting: Participants' responses to the questionnaire including the comments of their colleagues from home institutions were obtained in group discussions during NCDN CEE meetings in 2010-2013. Subjects: Sixteen CEE countries' experts and their colleagues from home institutions involved in NCDN CEE activities 2007-2013. Results: The responses were obtained from fourteen out of sixteen participating countries; five countries have established Bachelor, Master and PhD studies in nutrition (Croatia, Czech Republic, Poland, Slovak Republic and Slovenia), whereas in Latvia and Republic of Macedonia only Bachelor and Master studies are set up. Seven countries have no Bachelor, Master or PhD studies: Bosnia and Herzegovina, Bulgaria, Estonia, Lithuania, Montenegro, Romania and Serbia. Introduction to data analysis and Nutritional epidemiology are the most needed nutrition trainings that would increase working competence of nutritionists and nutrition-related professionals in CEE. Conclusions: Availability of academic programmes in nutrition in CEE countries is limited. Opportunities for improving the competence of existing and future nutrition-related professionals should be addressed at national and regional level; distance learning courses and creation of a regional centre for nutrition training were seen as opportunities for sustainable capacity development in nutrition in CEE

Dietary Intake of Salt from Meat Products in Serbian Population

Salt intake above 5 g/day correlates with prevalence of hypertension and cardiovascular diseases (CVD). CVD, the leading cause of mortality and morbidity in Europe, account for 45% of all deaths, while, in Serbia in 2021, CVD accounted for 47.3%. The objective was to investigate salt content labelled on meat products from the Serbian market and estimate dietary exposure to salt from meat products in the Serbian population using consumption data. Data on salt content were collected from 339 meat products and classified in eight groups. Consumption data were collected using the EFSA EU Menu methodology (2017–2021) from 576 children and 3018 adults (145 pregnant women) in four geographical regions of Serbia. The highest salt content was in dry fermented sausages and dry meat, average 3.78 ± 0.37 g/100 g and 4.40 ± 1.21 g/100 g, respectively. The average intake of meat products is 45.21 ± 39.0 g/day and estimated daily salt intake from meat products per person is 1.192 g, which is 24% of the daily recommended amount. The actual meat product consumption and content of salt in meat products in Serbia present a risk factor for development of CVD and related comorbidities. A targeted strategy, policy and legislation for salt reduction are needed

The influence of food consumption and socio-economic factors on the relationship between zinc and iron intake and status in a healthy population

Objective: To examine Zn and Fe nutritional status of a healthy population by means of anthropometric, dietary and biochemical measurements and to investigate the relationship of usual Zn and Fe dietary intakes to Zn and Fe status. In addition, to examine the impact of food choices and socio-economic factors on Fe and Zn dietary intakes and status with the aim to identify groups at risk of dietary deficiency and suggest factors that may influence the status of these nutrients. Design: Food consumption was assessed by 24 h recall questionnaires. Twenty biochemical parameters were measured, of which Hb, haematocrit, erythrocyte count and plasma concentrations of Fe and Zn were directly related to Fe and Zn nutrition. The prevalence of study participants with inadequate micronutrient intakes was calculated using the Estimated Average Requirement cut-point method. Setting: Serbia, Europe. Subjects: Apparently healthy adults (25-65 years of age). Results: Mean daily Zn and Fe intakes were 9.1mg and 11.6 mg for males and 7.3 mg and 9.4 mg for females, respectively. Five per cent of the study population had inadequate dietary Fe intake and 15-25% had inadequate Zn intake. Lower Hb concentrations were measured in women with lower Zn intakes. No differences in Fe and Zn intakes and status among various socio-economic groups were observed, except for Fe intake between the low-income and affluent groups. Conclusions: Regular follow-ups are needed to ensure that potential deficiencies of Zn and Fe do get recognized and addressed in a timely manner

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

NUTRITION BASED ON DIFFERENT ORIGIN OF FATS AS A RISK FACTOR FOR CEREBROVASCULAR INSULT

Cerebrovascular insult (CVI) is one of leading causes of mortality and morbidity worldwide, with significant influence of lifestyle on its development.The aim of this study was to investigate the different risk factors and their impact on hyperlipidaemia in two ethnic groups of patients who were hospitalized after CVI during two years.The total of 230 patients, 35-65 years old, with the ischemic CVI who had been hospitalized and treated at the Clinical Center Priština were included in our study. The patients were divided into two groups: group A (n=130)- Muslim patients, and group S (n=100) – Orthodox patients. Their antropometric and serum lipid parameters were measured and nutritional habits were assessed by food frequency questionnaire (FFQ).The patients from both groups were classified as adipose, with BMI in males around 33, and in females 28-30. Percentage of body fat was also high in both groups, especially in women (p<0.001), without significant difference between groups A and S. Physical activity was very low in both studied groups. In the group A, 86.92% patients with CVI were physically inactive, while in the group S the percentage amounted to 92% (p<0.001). The number of smokers was rather high in both groups, particularly in group S (89%) and more than a half (53%) of examinees had been smoking for more than 10 years. Almost all smokers consumed more than 20 cigarettes per day (83%). In group A, there were 35% of non-smokers (p<0.001).The average diastolic blood pressure value in the groups A and S (Table 6,7) was 97.97±4.75 mmHg and 100.82±6.71 mmHg, respectively, while systolic pressure was 174.27±3.18 mmHg in group A and 183.73±11.39 mmHg in group S. In spite of different lifestyles in both groups, the studied risk factors were proved to have significant influence on the onset of hyperlipidemia. The S group patients whose diet was predominantly based on animal fats had significantly higher risk in comparison to the group whose diet was based on vegetable fats. Smoking habits and physical inactivity were widely present in both groups. Our results suggest the need for target nutrition messages and behavioral interventions in developing prevention strategies for reduction of cerebrovascular risk factors

Perikoncepcijska suplementacija folnom kiselinom - znanja, stavovi i savetodavna praksa farmaceuta i farmaceutskih tehničara u Srbiji

Background/Aim. The protective effect of periconceptional folic acid supplementation in reducing the risk of neural tube defects (NTDs) and other adverse pregnancy outcomes has been scientifically confirmed. The present study aimed to assess knowledge, attitudes, and practice (KAP) of community pharmacists and pharmacy technicians with regards to counselling women of reproductive age on adequate folate intake. Methods. The cross-sectional study was conducted among the nationwide stratified sample of pharmacists and pharmacy technicians, practicing in both private and state-owned community pharmacies in Serbia. The detailed literature review, expert consultation and pre-testing were employed in the questionnaire development. The descriptive and inferential statistical analyses were performed using the SPSS software ver. 22. Results. Among 730 survey participants, 96.6% correctly identified types of deformities that could be prevented by folic acid and 77.0% recognized recommended dosage for women capable of becoming pregnant. However, fewer were able to recognize the optimal timing for folic acid supplementation (61.1%) and the proper dose for the NTD recurrence prevention (42.9 %). While 43.2% of pharmacy technicians thought that it was not their responsibility to provide a counselling concerning the measures for the prevention of congenital anomalies, only 4.7% of licensed pharmacists and none of the interns were of that opinion (χ2 = 198.287; df = 4; p lt 0.001). The majority of respondents (54.7%) reported provision of informative consultation concerning folic acid once a week, or few times a month, while only 10 stated to do so on a daily basis. In addition, based on self-report, only 36.7% of participants communicates information and advice regarding adequate folate status at their own initiative, while the rest addresses this topic only on the patients request, i.e., reactively. Conclusion. Although participants acknowledged the importance of their role in preconception health promotion, our findings revealed certain knowledge gaps as well as dominantly reactive counselling practice. Tailored educational interventions and professional support are needed to improve the engagement of community pharmacy personnel in this area of public health.Uvod/Cilj. Naučno je potvrđen zaštitni efekat primene suplemenata folne kiseline u perikoncepcijskom periodu u redukciji rizika od nastanka defekata nervne cevi (DNC) i drugih neželjenih ishoda trudnoće. Cilj ove studije bio je ispitivanje znanja, stavova i prakse farmaceuta i farmaceutskih tehničara zaposlenih u javnim apotekama u vezi sa savetovanjem žena reproduktivne dobi o adekvatnom unosu folata. Metode. Sprovedenom studijom preseka obuhvaćen je nacionalni stratifikovani uzorak farmaceuta i farmaceutskih tehničara zaposlenih u državnim i privatnim javnim apotekama u Srbiji. Detaljan pregled literature, ekspertske konsultacije i pre-testiranje primenjeni su u procesu razvoja upitnika. Deskriptivna i inferencijalna statistička analiza realizovane su primenom SPSS softvera ver. 22. Rezultati. Od 730 ispitanika, 96,6% tačno je identifikovalo vrste deformiteta koji se mogu prevenirati primenom folne kiseline, a 77,0% prepoznalo je preporučenu dozu za žene sposobne da ostanu u drugom stanju. Ipak, manji udeo ispitanika prepoznao je optimalni vremenski okvir za suplementaciju (61,1%), kao i adekvatnu dozu za prevenciju rekurence DNC (42,9%). Dok je 43,2% farmaceutskih tehničara izrazilo uverenje da nije njihova obaveza da sprovode savetovanje o merama za prevenciju kongenitalnih anomalija, takvo mišljenje imalo je samo 4,7% licenciranih farmaceuta i nijedan farmaceut-stažer (χ2 = 198.287; df = 4; p lt 0,001). Većina učesnika studije (54,7%) izjavila je da pruža informativne konsultacije u vezi folne kiseline jednom nedeljno ili nekoliko puta mesečno, a samo 10 ispitanika tvrdilo je da to čini svakodnevno. Dodatno, na osnovu sopstvenog izveštaja, samo 36,7% ispitanika pruža savete i informacije o adekvatnom statusu folata na sopstvenu inicijativu, dok ostatak ovu temu pominje samo na zahtev pacijenta tj. reaktivno. Zaključak. Iako su ispitanici prepoznali značaj sopstvene uloge u promociji zdravlja u prekoncepcijskom periodu, naši rezultati ukazali su na određene propuste u znanju i dominantno reaktivan pristup savetovanju. Prilagođene edukativne intervencije i profesionalna podrška neophodni su za unapređenje javnozdravstvenog angažovanja farmaceutskog tima iz javnih apoteka u ovoj oblasti