Methods and introductory results of the Greek national health and nutrition survey - HYDRIA

Background:  According to a large prospective cohort study (with baseline examination in the 1990s) and smaller studies that followed, the population in Greece has been gradually deprived of the favorable morbidity and mortality indices recorded in the 1960s. The HYDRIA survey conducted in 2013-14 is the first nationally representative survey, which collected data related to the health and nutrition of the population in Greece. Methods: The survey sample consists of 4011 males (47%) and females aged 18 years and over. Data collection included interviewer-administered questionnaires on personal characteristics, lifestyle choices, dietary habits and medical history; measurements of somatometry and blood pressure; and, blood drawing. Weighting factors were applied to ensure national representativeness of results. Results: Three out of five adults in Greece reported suffering of a chronic disease, with diabetes mellitus and chronic depression being the more frequent ones among older individuals. The population is also experiencing an overweight/obesity epidemic, since seven out of 10 adults are either overweight or obese. In addition, 40% of the population bears indications of hypertension. Smoking is still common and among women the prevalence was higher in younger age groups. Social disparities were observed in the prevalence of chronic diseases and mortality risk factors (hypertension, obesity, impaired lipid profile and high blood glucose levels). Conclusion: Excess body weight, hypertension, the smoking habit and the population’s limited physical activity are the predominant challenges that public health officials have to deal with in formulating policies and designing actions for the population in Greece

Dose-response relationships in health risk assessment of nutritional and toxicological factors in foods: development and application of novel biostatistical methods

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Green kiwifruit (lat. Actinidia deliciosa var. Hayward) and maintenance of normal defecation: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006

Following an application from Zespri International Limited, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Belgium, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to green kiwifruit (lat. Actinidia deliciosa var. Hayward) and maintenance of normal defecation. The scope of the application was proposed to fall under a health claim based on newly developed scientific evidence. The food proposed by the applicant as the subject of the health claim is green kiwifruit. The Panel considers that green kiwifruit (Actinidia deliciosa var. Hayward) is sufficiently characterised. The claimed effect proposed by the applicant is 'maintenance of normal defecation'. Maintenance of normal defecation is a beneficial physiological effect provided that it does not result in diarrhoea. All human intervention studies submitted had different limitations and could not be used on their own for the scientific substantiation of the claim. However, the results of six pertinent human intervention studies are consistent with respect to an effect of consuming daily between two and four green kiwifruits var. Hayward on an increase in stool frequency. Two out of four studies in which a validated instrument was used to assess stool consistency showed an effect also on stool consistency. There is evidence for a plausible mechanism by which kiwifruit could exert an effect on normal defecation. The consumption of kiwifruit in the studies did not result in diarrhoea. A cause and effect relationship has been established between the consumption of green kiwifruit (Actinidia deliciosa var. Hayward) and maintenance of normal defecation. The following wordings reflect the scientific evidence: 'consumption of kiwifruit contributes to the maintenance of normal defecation'. In order to obtain the claimed effect, two large green kiwifruits (i.e. around 200 g of kiwi flesh) should be consumed

Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category

Efficacy of an infant formula manufactured from a specific protein hydrolysate derived from whey protein isolate and concentrate produced by Société des Produits Nestlé S.A. in reducing the risk of developing atopic dermatitis

The European Commission asked EFSA to evaluate the efficacy of an infant formula, containing a specific protein hydrolysate derived from whey protein isolate and concentrate and manufactured by Société des Produits Nestlé S.A., in reducing the risk of developing atopic dermatitis in infants with a family history of allergy. This was following the submission of a dossier by Société des Produits Nestlé S.A. to the European Commission, in the context of Regulation (EU) 2016/127. The protein hydrolysate from which the infant formula is produced is included in Annex I and II of Commission delegated Regulation (EU) 2016/127 as suitable protein source for the manufacture of infant and follow-on formulae. This opinion does not cover the assessment of the nutritional safety and suitability of the infant formula or the safety of the food enzymes used in the manufacture of the protein hydrolysate. The Panel considers that, in relation to the effect that is claimed, the infant formula under evaluation is not sufficiently characterised with respect to the molecular weight distribution of peptides. From the human intervention studies submitted, no conclusions could be drawn on the efficacy of the infant formula in reducing the risk of developing atopic dermatitis. The Panel concludes that a cause-and-effect relationship has not been established between the consumption of the infant formula under evaluation and the reduction in the risk of developing atopic dermatitis in infants with a family history of allergy

Statement on additional scientific evidence in relation to the essential composition of total diet replacement for weight control

Acknowledgements: The Panel wishes to thank the following EFSA staff members for the support provided to this scientific output: Oceane Albert, Fabio Alfieri, Carsten Behring, Janusz Ciok, Ester Artau Cortacans, Jose Cortin~as Abrahantes, Ionut Craciun, Celine Dumas, Lucia Fabiani, Estefania Noriega Fernandez, Irene Mun~oz Guajardo, Tilemachos Goumperis, Leonard Matijevic, Charlotte Salgaard Nielsen, Gabriela Precup and Ruth Roldan.Peer reviewedPublisher PD

Scientific Opinion on the energy conversion factor of d‐tagatose for labelling purposes

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutritionand Allergies (NDA) was asked to deliver a scienti\ufb01c opinion on the energy conversion factor ofD-tagatose to be used for calculating the energy value of foods to be declared in nutrition labelling.Energy conversion factors for nutrients for the purpose of nutrition labelling have been set based onthe concept of metabolisable energy (ME). The same methodology has been applied to calculate theenergy conversion factor forD-taga tose in this opinion. The assessment is based on a dossier preparedfor Nutrilab NV and submitted by Bioresco Ltd. At present, data are insuf\ufb01cient to derive an accurateME value forD-tagatose. Relying on the human data indicating a mean absorption rate of 80% (range69\u201388%) and a urinary excretion of either 1% or 5%, the corresponding energy values forD-tagatosewould be 2.8 kcal/g (11.8 kJ/g) and 2.96 kcal/g (12.4 kJ/g), respectively. Taking into account that theremaining 20% ofD-tagatose which is not absorbed in the sma ll intestine is fermented in the colonand may deliver at least some energy, e.g. in form of short-chain fatty acids, the Panel concludes thata rounded estimate of the energy conversion factor forD-tagatose based on the available data andcalculated as ME would be 3 kcal/g (12.5 kJ/g). The Panel considers that additional data on theabsorption, distribution, metabolism and excretion ofD-tagatose in humans w ould help in thecalculation of a more accurate energy conversion factor forD-tagatose based on the concept of ME

Scientific opinion on the relationship between intake of alpha-lipoic acid (thioctic acid) and the risk of insulin autoimmune syndrome

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on the relationship between alpha-lipoic acid (ALA) and the risk of insulin autoimmune syndrome (IAS). The Panel was also asked to advise on the dose below which ALA added to foods is not expected to cause IAS. A review of all possible adverse effects associated with consumption of ALA was not requested. This mandate refers to the procedure under Article 8(2) of Regulation (EC) No 1925/2006 on addition of vitamins, minerals and certain other substances to foods. No pre-established rule exists for the evaluation of the safety of foods when classical toxicity tests cannot be used, e.g. for autoimmune diseases. Published scientific evidence was retrieved through comprehensive literature searches, particularly 49 case reports in which IAS developed following ALA consumption. In all cases, IAS resolved after a few weeks to months when ALA was discontinued. No publication linking the intake of ALA naturally occurring in foods to IAS was identified. The Panel concludes that the consumption of ALA added to foods, including food supplements, is likely to increase the risk of developing IAS in individuals with certain genetic polymorphisms, who cannot be readily identified without genetic testing. The plausible mechanism of such an effect has not yet been fully elucidated. The incidence of IAS in Europe is low and likely lower than in Japan where it has been estimated to be 0.017 per 100,000 inhabitants in 2017-2018. Considering the limited data available, the risk associated with the development of IAS following ALA consumption cannot be quantified precisely. An ALA dose below which IAS is not expected to occur is likely to vary between individuals and cannot be determined from the available data. (c) 2021 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority