A systematic review of methods to assess intake of fruits and vegetables among healthy European adults and children: a DEDIPAC (DEterminants of DIet and Physical Activity) study

Evidence suggests that health benefits are associated with consuming recommended amounts of fruits and vegetables (F&V), yet standardised assessment methods to measure F&V intake are lacking. The current review aims to identify methods to assess F&V intake among children and adults in pan-European studies and inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods suitable for use in future European studies. A literature search was conducted using three electronic databases and by hand-searching reference lists. English-language studies of any design which assessed F&V intake were included in the review. Studies involving two or more European countries were included in the review. Healthy, free-living children or adults. The review identified fifty-one pan-European studies which assessed F&V intake. The FFQ was the most commonly used (n 42), followed by 24 h recall (n 11) and diet records/diet history (n 7). Differences existed between the identified methods; for example, the number of F&V items on the FFQ and whether potatoes/legumes were classified as vegetables. In total, eight validated instruments were identified which assessed F&V intake among adults, adolescents or children. The current review indicates that an agreed classification of F&V is needed in order to standardise intake data more effectively between European countries. Validated methods used in pan-European populations encompassing a range of European regions were identified. These methods should be considered for use by future studies focused on evaluating intake of F&V

Southeast of What? Reflections on SEALS\u27 Success

In epidemiologic studies, measurement error in dietary variables often attenuates association between dietary intake and disease occurrence. To adjust for the attenuation caused by error in dietary intake, regression calibration is commonly used. To apply regression calibration, unbiased reference measurements are required. Short-term reference measurements for foods that are not consumed daily contain excess zeroes that pose challenges in the calibration model. We adapted two-part regression calibration model, initially developed for multiple replicates of reference measurements per individual to a single-replicate setting. We showed how to handle excess zero reference measurements by two-step modeling approach, how to explore heteroscedasticity in the consumed amount with variance-mean graph, how to explore nonlinearity with the generalized additive modeling (GAM) and the empirical logit approaches, and how to select covariates in the calibration model. The performance of two-part calibration model was compared with the one-part counterpart. We used vegetable intake and mortality data from European Prospective Investigation on Cancer and Nutrition (EPIC) study. In the EPIC, reference measurements were taken with 24-hour recalls. For each of the three vegetable subgroups assessed separately, correcting for error with an appropriately specified two-part calibration model resulted in about three fold increase in the strength of association with all-cause mortality, as measured by the log hazard ratio. Further found is that the standard way of including covariates in the calibration model can lead to over fitting the two-part calibration model. Moreover, the extent of adjusting for error is influenced by the number and forms of covariates in the calibration model. For episodically consumed foods, we advise researchers to pay special attention to response distribution, nonlinearity, and covariate inclusion in specifying the calibration model

Adipose Tissue Omega-3 and Omega-6 Fatty Acid Content and Breast Cancer in the EURAMIC Study

The fatty acid content of adipose tissue in postmenopausal breast cancer cases and controls from five European countries in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Cancer (EURAMIC) breast cancer study (1991 -1992) was used to explore the hypothesis that fatty acids of the omega-3 family inhibit breast cancer and that the degree of inhibition depends on background levels of omega-6 polyunsaturates. Considered in isolation, the level of omega-3 or omega-6 fat in adipose tissue displayed little consistent association with breast cancer across study centers. The ratio of long-chain omega-3 fatty acids to total omega-6 fat showed an inverse association with breast cancer in four of five centers. In Malaga, Spain, the odds ratio for the highest tertile relative to the lowest reached 0.32 (95% confidence interval 0.13-0.82). In this center, total omega-6 fatty acid was strongly associated with breast cancer. With all centers pooled, the odds ratio for long-chain omega-3 to total omega-6 reached 0.80 for the second tertile and 0.65 for the third tertile, a downward trend bordering on statistical significance (p for trend = 0.055). While not definitive, these results provide evidence for the hypothesis that the balance between omega-3 and omega-6 fat may play a rolein breast cancer. Am J Epidemiol 1998; 147: 342-5

EURRECA's General Framework to make the process of setting up micronutrient recommendations explicit and transparent

EURRECA is a Network of Excellence with the objective of addressing the problem of national variations in micronutrient recommendations and working towards a framework of advice to better inform policy-makers. It became apparent that the network needed a framework that puts the process of recommendation setting in the context of science, policy and society. Although variability in recommendations originates from the scientific evidence-base used and its interpretation (e.g. health outcomes, types and methods of evaluation of evidence, quantification of risk/benefit), the background information provided in the recommendation reports does not easily facilitate the disentangling of the relative contribution of these different aspects because of lack of transparency. The present report portrays the general framework (see Figure) that has been developed by and for EURRECA in order to make the process of setting up micronutrient recommendations explicit and transparent. In explaining the link from science to policy applications, the framework distinguishes four principal components or stages (see Figure). These stages are: a) Defining the nutrient requirements: A judgement about the (best) distribution(s) of the population requirement is necessary for estimating nutrient requirements. Many assumptions need to be made about the attributes of the population group. Furthermore, several factors (consumer behaviour as well as physiology) are to be included to characterize optimal health. b) Setting the nutrient recommendations: All available evidence is needed to formulate recommendations. Incorporating different endpoints provide the basis to formulate an optimal diet in terms of (non-)nutrients and food(group)s. c) Policy options: Policy options should be formulated on how the optimal diet can be achieved. They concern the advice of scientist and/or expert committees to the policy makers. Current policy options are setting up a task force, food based dietary guidelines, general health education, educational programme for specific group(s), voluntary or mandatory fortification, labelling, supplementation (general or for specific groups), inducing voluntary action in industry, legislation on micronutrient composition in food products, fiscal change, monitoring and evaluation of intake (via food consumption surveys) and/or nutritional status. d) Policy applications: Policies and planning, usually done by government, that lead to nutritional interventions or programmes. They usually require consideration of scientific, legal, regulatory, ethical and cultural issues, economic implications, and political and social priorities. This framework illustrates three dimensions of the process of setting (micro)nutrient requirements: 1) The logical sequence of scientific thinking from setting physiological requirements for nutritional health leading to evidence-based derivation of Nutrient Intake Values. 2) In the early stages nutritional and epidemiological science is the dominant source and in the later stages evidence from consumer and social sciences as well as stakeholder influences is used in deriving the options for changing the distribution of nutrient intakes. 3) The wider socio-political context: a feedback loop between health perception, actual health and food intake exists and is directly affected by the food industry and many other stakeholders. Moreover, from the viewpoint of policymakers, there are concerns for health promotion and disease prevention because of population health indices, costs of health care, and economic interests in the agro-food sector. In conclusion: A systematic approach for development and regular review of micronutrient requirements in Europe, transparently based on scientific evidence and best practices, enables national and international authorities/bodies to use the best available information obtained through evidence-based nutrition and accomplish well-considered food policy. Funded by an EU FP6 Network of Excellence (EURRECA, grant no. FP 6–036196-2). G. T. performed part of the work under a short-term contract for WHO Europe

EURRECA-Evidence-Based Methodology for Deriving Micronutrient Recommendations

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence explored the process of setting micronutrient recommendations to address the variance in recommendations across Europe. Work centered upon the transparent assessment of nutritional requirements via a series of systematic literature reviews and meta-analyses. In addition, the necessity of assessing nutritional requirements and the policy context of setting micronutrient recommendations was investigated. Findings have been presented in a framework that covers nine activities clustered into four stages: stage one Defining the problem describes Activities 1 and 2: Identifying the nutrition-related health problem and Defining the process; stage two Monitoring and evaluating describes Activities 3 and 7: Establishing appropriate methods, and Nutrient intake and status of population groups; stage three Deriving dietary reference values describes Activities 4, 5, and 6: Collating sources of evidence, Appraisal of the evidence, and Integrating the evidence; stage four Using dietary reference values in policy making describes Activities 8 and 9: Identifying policy options, and Evaluating policy implementation. These activities provide guidance on how to resolve various issues when deriving micronutrient requirements and address the methodological and policy decisions, which may explain the current variation in recommendations across Europe. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.]This is the peer-reviewed version of the article: Dhonukshe-Rutten Rosalie, Bouwman Jildau, Brown Kerry A., Cavelaars Adrienne E., Collings Rachel, Grammatikaki Evangelia, de Groot Lisette, Gurinović Mirjana A., Harvey Linda, Hermoso Maria, Hurst Rachel, Kremer Bas, Ngo Joy, Novaković Romana, Raats Monique M., Rollin Fanny, Serra-Majem Lluis, Souverein Olga W., Timotijević Lada, van't Veer Pieter, "EURRECA-Evidence-Based Methodology for Deriving Micronutrient Recommendations" 53, no. 10 (2013):999-1040, [https://doi.org/10.1080/10408398.2012.749209

Review Article Socio-economic determinants of micronutrient intake and status in Europe: a systematic review

Objective To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B-12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake. Design MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved gt 100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability. Setting Europe. Subjects Children, adults and elderly. Results Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5-47 %) and for vitamin D in total of four studies (4-31 %). Conclusions The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases

Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people

<p>Abstract</p> <p>Background</p> <p>The aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of intervening on the individual and on the environmental level. It is assumed that the components of a complex intervention interact with and reinforce each other. Furthermore, implementation is highly context-specific and its impact is influenced by external factors. Although the entire community is exposed to the intervention components, each individual is exposed to different components with a different intensity.</p> <p>Methods/Design</p> <p>A logic model of change is used to develop the evaluation design. The model describes what outcomes may logically be expected at different points in time at the individual level. In order to address the complexity of a real-life setting, the evaluation design of the loneliness intervention comprises two types of evaluation studies. The first uses a quasi-experimental pre-test post-test design to evaluate the effectiveness of the overall intervention. A control community comparable to the intervention community was selected, with baseline measurements in 2008 and follow-up measurements scheduled for 2010. This study focuses on changes in the prevalence of loneliness and in the determinants of loneliness within individuals in the general elderly population. Complementarily, the second study is designed to evaluate the individual intervention components and focuses on delivery, reach, acceptance, and short-term outcomes. Different means of project records and surveys among participants are used to collect these data.</p> <p>Discussion</p> <p>Combining these two evaluation strategies has the potential to assess the effectiveness of the overall complex intervention and the contribution of the individual intervention components thereto.</p

The Proper Motion of the Globular Cluster NGC 6553 and of Bulge Stars with HST

WFPC2 images obtained with the Hubble Space telescope 4.16 years apart have allowed us to measure the proper motion of the metal rich globular cluster NGC 6553 with respect to the background bulge stars. With a space velocity of (${\Pi}, {\Theta}, W$) = (-3.5, 230, -3) km s$^{-1}$, NGC 6553 follows the mean rotation of both disk and bulge stars at a Galactocentric distance of 2.7 kpc. While the kinematics of the cluster is consistent with either a bulge or a disk membership, the virtual identity of its stellar population with that of the bulge cluster NGC6528 makes its bulge membership more likely. The astrometric accuracy is high enough for providing a measure of the bulge proper motion dispersion and confirming its rotation. A selection of stars based on the proper motions produced an extremely well defined cluster color-magnitude diagram (CMD), essencially free of bulge stars. The improved turnoff definition in the decontaminated CMD confirms an old age for the cluster (~13 Gyr) indicating that the bulge underwent a rapid chemical enrichment while being built up at in the early Universe. An additional interesting feature of the cluster color-magnitude diagram is a significant number of blue stragglers stars, whose membership in the cluster is firmly established from their proper motions.Comment: version with full-page figure

Micronutrient intake and status in Central and Eastern Europe compared with other European countries, results from the EURRECA network

Objective: To compare micronutrient intakes and status in Central and Eastern Europe (CEE) with those in other European countries and with reference values. Design: Review of the micronutrient intake/status data from open access and grey literature sources from CEE. Setting: Micronutrients studied were folate, iodine, Fe, vitamin B-12 and Zn (for intake and status) and Ca, Cu, Se, vitamin C and vitamin D (for intake). Intake data were based on validated dietary assessment methods; mean intakes were compared with average nutrient requirements set by the Nordic countries or the US Institute of Medicine. Nutritional status was assessed using the status biomarkers and cut-off levels recommended primarily by the WHO. Subjects: For all population groups in CEE, the mean intake and mean/median status levels were compared between countries and regions: CEE, Scandinavia, Western Europe and Mediterranean. Results: Mean micronutrient intakes of adults in the CEE region were in the same range as those from other European regions, with exception of Ca (lower in CEE). CEE children and adolescents had poorer iodine status, and intakes of Ca, folate and vitamin D were below the reference values. Conclusions: CEE countries are lacking comparable studies on micronutrient intake/status across all age ranges, especially in children. Available evidence showed no differences in micronutrient intake/status in CEE populations in comparison with other European regions, except for Ca intake in adults and iodine and Fe status in children. The identified knowledge gaps urge further research on micronutrient intake/status of CEE populations to make a basis for evidence-based nutrition policy