Content uploaded by Ulrich Keil
Author content
All content in this area was uploaded by Ulrich Keil on Mar 12, 2016
Content may be subject to copyright.
A preview of the PDF is not available
Comparison of dietary intakes in four selected European populations
Abstract and Figures
The composition of diet and food intakes in four selected European populations were compared. Dietary data (from the World Health Organization Project on Monitoring Trends and Determinants in Cardiovascular Disease) were measured by record methods and were available for middle-aged men in Finland (n = 653), France (n =1128), Northern Ireland (n = 356), and southern Germany (Augsburg region; n = 899). Nutritional variables — which are independent of the absolute energy intake, such as the percentage supply of energy from macronutrients and the ratio of polyunsaturated to saturated fatty acids — were on the whole similar. However, striking differences were found in food intake and in the percentage supply of fat from different foods. The results indicate that detailed knowledge of consumption figures is necessary to develop prudent and acceptable nutrition intervention programs.
Figures - uploaded by Ulrich Keil
Author content
All figure content in this area was uploaded by Ulrich Keil
Content may be subject to copyright.
Populations with Mediterranean diet experience a lower cancer incidence than populations with northern European dietary habits. Thus, the cancer mortality (per 100,000) e.g. in the region of Granada (Spain) is 209.8 for men and 127 for women, in Scotland 306.5/234. Differences in consumption of fats and complex carbohydrates explain some of the variation. The biggest influence is attributed to the different intake of essential micronutrients and non-essential dietary antioxidants. Selenium, vitamin C and E, carotene, carotenoids, flavonoids and other nonessential antioxidants as well as vitamin A and folic acid influence cancer incidence. In the Basel Study, relative risk for lung cancer was four times higher in subjects with low vitamin C and vitamin E plasma concentrations, compared with subjects with values above quartile 1. The same was found for low vitamin A and carotene plasma concentration (rel. risk 3.6). Total cancer mortality was significantly higher (rel. risk 2.2) in subjects with low vitamin A and carotene levels. The protective effect of essential and non-nutritive substances is probably confined to the early stages of cancer development, i.e. initiation and promotion, and less to later stages.
The term 'Mediterranean diet' has been used during the 50's by A. Keys, following the Seven Countries Study. Each increase in fatty acids intake induced an increase in cholesterolemia and therefore a higher frequency in ischaemic heart disease. Cretan diet can be defined, in a first analysis, as a low saturated fatty acid food consumption but other food and nutrients such as wine and antioxidant (Vit E, Vit C) play an important part too. This diet differs from the Anglo-Saxon diet but also from the French Southwest one. The latter has proved its positive effects on health. P/S ratio is identically favourable in both regions but unsaturated fatty acids intake is from animal origin (chicken) in France and from vegetable origin (olive oil) in the Mediterranean area. The Lyon Study is a secondary prevention trial which studied the effects of the Cretan diet on recurrent myocardial infarction. The decrease observed in clinical events was not due to the decrease of lipoproteins which is in agreement with the influence of alpha-linolenic acids on the profile. The Mediterranean diet has a favourable impact not only on cardiovascular diseases but also on cancers. Epidemiological studies in the Mediterranean countries will be necessary to clarify the concept of a diet which is currently confounded with the Cretan diet.
The role of nutrition in cardiovasuclar disease, particularly in Coronary Heart Disease is well established. Knowledge is supported by epidemiological, clinical and experimental data. Nutrition is involved in each step of atherosclerosis and thrombosis: in lipoprotein metabolism, lipoprotein oxidative process, platelet aggregability and fibrinolysis mechanism, endothelial relaxation. Primary or secondary prevention trials and regresssion studies prove the importance of nutrition in a public health policy and in prevention and treatment of these chronic diseases. Established and recent data are presented.
Cited By (since 1996):7, Export Date: 18 October 2014
The aim of this work was to assess, the effect of a dietary supplement of soyabean lecithin on the apoprotein (apo) AI–high density lipoprotein system in humans. Adult outpatients (three women and seven men, aged 52 ± 5 years) were selected on the basis of a major type IIA hypercholesterolemia (>6.5 mmol/L). For each subject, a previous control period of 6 weeks consisted in a daily dietary supplement of 3 g soyabean oil (SO) as placebo distributed in two capsules at three main meals. Subjects then were given a daily dietary supplement of 3 g purified soyabean phosphatidylcholine (SPC) for 6 weeks, also distributed in two capsules at the three main meals. The usual basal diet of each subject was monitored every 4 weeks by a 3-day food recall. Between the end of the SO period and the end of the SPC period, plasma level of apo AI significantly increased (from 1.01 to 1.23 g/L), as did unesterified cholesterol (from 1.80 to 2.00 mmol/L). The esterified cholesterol to total cholesterol ratio and apo E level significantly decreased between the beginning and the end of the experiment. Esterified cholesterol and apo B levels remained unchanged. The levels of apo AI or unesterified cholesterol were not correlated to the alcoholic calories or to total or lipid energy. Dietary soyabean lecithin contributed to stimulation of the reverse cholesterol transport by increasing apo AI system and decreasing apo AII and apo E systems. Thus, soyabean lecithin could be considered an effective nutrient useful in the dietary treatment of mild hypercholesterolemia.
Two cardiovascular risk factor surveys were carried out in 1984/1985 and 1989/1990 in the Augsburg study region of the international World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) project. Independent random samples o f the 25- to 64-year-old population were examined at each survey. Five-year changes in blood pressure (BP) and hypertension parameters were monitored in a population not targeted by any formal intervention program. Response rates in both surveys ranged close to 80%. Evaluation of selected quality indicators confirmed comparability of the two surveys in terms of BP measurement quality. Small but consistent decreases in mean systolic and diastolic BP were observed, particularly for women 35 years and older, whereas BP changes in men were less pronounced and inconsistent. Likewise, downward shifts of the 10th, 50th, and 90th percentiles of systolic and diastolic BP occurred in women and their slopes of BP rise with age decreased while such changes were less clear in men. The age-standardized prevalenceof men and women with hypertensive BP () decreased slightly. This contrasted with rises in the prevalence of actual hypertension (those with HBP plus those taking antihypertensive drugs) for 45- to 64-year-old men, which originated from changes in hypertension management involving a more frequent drug treatment of borderline-hypertensive men (140 to to 94 mm Hg) in 1989/1990. There were notable overall increases in the awareness, treatment, and control of men and women with hypertension. In summary, based on a monitoring of the Augsburg population, prevention efforts in Germany between 1984/1985 and 1989/1990 appear to have been particularly successful for high-risk hypertensive individuals from both sexes. In the male population, no clear changes of BP distribution parameters could be detected while changes observed in women above 35 years old may be cautiously interpreted to indicate the onset of a downward shift of the entire BP distribution independent from antihypertensive medication use.
Antioxidants are crucial components of fruit/vegetable-rich diets preventing cardiovascular disease (CVD) and cancer:
—plasma vitamins C, E, carotenoids from diet correlate prevalence of CVD and cancer inversely, low levels predict an increased risk of individuals which is potentiated by combined inadequacy (e.g., vitamins C+E, C+carotene, A+carotene);
—self-prescribed rectification of vitamins C and E at adequacy of other micronutrients reduce forthcoming CVD, of vitamins A, C, E, carotene and conutrients also cancer;
—randomized exclusive supplementation of β-carotene±vitamin A or E lack benefits except prostate cancer reduction by vitamin E, and overall cancer reduction by selenium;
—randomized intervention with synchronous rectification of vitamins A+C+E+B+minerals reduces CVD and counteracts precancerous lesions;
—high vitamin E supplements reveal potentials in secondary CVD prevention.
Plasma values desirable for primary prevention: ≥30μmol/l lipid-standardized vitamin E (α-tocopherol/cholesterol ≥5.0μmol/mmol); ≥50μmol/l vitamin C aiming at vitamin C/vitamin E ratio >1.3–1.5; ≥0.4μmol/l β- (≥0.5μmol/l α+β-) carotene.
Conclusions:
—in CVD vitamin E acts as first risk discriminator, vitamin C as second one;
—optimal health requires synchronously optimized vitamins C+E, A, carotenoids and vegetable conutrients.
The European diet is characterized by a wide variation in every aspect of eating from the timing of meals to the composition of meals. In general, there is a tendency in terms of dietary advice towards lower fat intakes in order to reduce saturated fatty acid intake and to reduce the risk of obesity. Such diets are most successful and yield the most favourable metabolic profile when there is an adequate level of physical activity.
The aim of the present paper was to explore how the composition of dietary fat changes across the EU with low- and high-fat diets and to explore levels of physical activity and attitudes to physical activity across the EU.
The paper draws on data contained in reports and supplements of the Institute of European Food Studies in the EU.
There is a clear trend for southern EU states to have higher MUFA intakes and lower SFA intakes than northern ELJ states. However, for both geographic regions, the fatty acid composition of dietary fat was similar in groups with lower or higher dietary fat intakes. Physical activity was ranked low by consumers (n= 15,000) for its importance in relation to health and the prevention of weight-gain. Some 47% agreed that their present level of physical activity is sufficient. 78% agreed that being 13 kg heavier would not be detrimental to health and 30% agreed that the main benefit of physical activity was to relieve stress.
(i) The present strategy of lowering dietary fat intake does not alter dietary fat composition and (ii) there is a high level of ignorance among consumers of the benefits of physical activity and the adverse effects of excess body-weight.
Findings of the Nationale Verzehrstudie and Verbundstudie, Ernährungserhebung und Risikofaktorenanalytik studies are discussed in light of their clinical significance. Obesity increases the statistical risk of developing a number of diseases, of which the most important are cardiovascular morbidity and mortality. Obesity causes insulin resistance and plays a part in the development of the metabolic syndrome. The Verbundstudie, Ernährungserhebung und Risikofaktorenanalytik survey shows that in the mid-1980s roughly one third of the German population was overweight. However, criteria for defining the overweight condition are variable. Overall data in Germany are comparable to those of several other population surveys, but regional increases are observed. Analysis of dietary intakes shows a marked deviation from recommended nutritional standards, especially in the distribution of total caloric intake as carbohydrate (42.8%) and fat (38.4%). Almost 9% of the population derived more than 20% of their energy intake from snacks. The data cannot provide a full explanation as to why people become fat. This may be due to the well-known problem of underrating and underreporting intakes, particularly by obese subjects.
The antioxidant effects of vitamin E may protect low density lipoproteins from peroxidation and thus inhibit the development of arteriosclerosis. Inverse associations between vitamin E levels and coronary heart disease have been reported from cross-sectional and ecologic studies. In the population-based MONICA Augsburg cohort (2023 men, 1999 women, age 25-64 years at baseline in 1984, 93% of whom were reexamined in 1987/88) we investigated the relationship between serum vitamin E concentrations and the risk of subsequent myocardial infarction (MI). Between 1984 and 1991, 46 cases of fatal and non-fatal myocardial infarction from this cohort were recruited for a nested case-control study. Four controls were sampled from the cohort for each case of MI with matching for age, sex, and total cholesterol. There were no marked differences between cases and their matched controls in the means of vitamin E concentrations (33.9 mumol/l vs. 32.8 mumol/l, P = 0.37) or in the mean vitamin E/total cholesterol ratios (4.89 mumol/mmol vs. 4.82 mumol/mmol, P = 0.75). The covariate adjusted relative risk (RR) for fatal plus non-fatal MI in the lowest tertile of vitamin E relative to the upper two tertiles was 0.72 (90% confidence interval: 0.33-1.57). Likewise, for the lowest tertile of the ratio (vitamin E/total cholesterol) the RR was 0.81 (0.42-1.56). The association was not modified by history of previous coronary heart disease, fatality of MI, temporal distance of MI onset from vitamin E determinations, or season.(ABSTRACT TRUNCATED AT 250 WORDS)
Of the highest priority for preventive medicine in Europe is to achieve a major reduction in coronary heart disease (CHD) and other manifestations of atherosclerosis. To this end a policy based upon reduction of risk factors has been formulated by experts from 19 countries: it employs complementary strategies directed to CHD-prone populations as a whole and to individuals at particular risk. The population strategy includes improved nutrition, avoidance of smoking, blood pressure reduction and promotion of suitable exercise. These should be based upon health education for all age groups and actions by governmental and supranational agencies (including implementation of food labelling, smoking control measures and wide provision of exercise facilities). Only measures directed to the population can reach the large proportion of people at mild to moderate risk of CHD.
To provide care for individuals at particular risk of CHD, case finding requires that risk factor assessment, including measurement of plasma cholesterol and blood pressure, be included in full medical examinations. The relative merits of other modes of case finding, including selective screening and general screening, are discussed. Decisions concerning management of elevated lipid levels should be influenced by overall cardiovascular risk, by a family history of CHD and by age. Lipid lowering dietary and drug therapy should take these variables into account in addition to the extent and type of the hyperlipidaemia. Cholesterol levels exceeding about 5.2 mmol 1⁻¹ (200 mg dl⁻¹) deserve consideration, and the goal of therapy should be to reduce levels towards this value. For most persons with levels of 5.2–6.5 mmol 1⁻¹ (200–250 mg dl⁻¹) dietary advice and correction of other risk factors are appropriate, i.e. management comprises reinforcement of population strategy. Dietary recommendations for the control of hyperlipidaemia are reviewed, and indications for drug therapy are presented. Non-pharmacological methods for reducing mildly elevated blood pressure are discussed, and reduction of CHD risk in diabetes is reviewed.
Implementation of these recommendations will be furthered by their endorsement by cardiologists and other physicians.
The British tables of Paul and Southgate provide by far the most extensive introductory and explanatory material with the tables. As it is a resource which is often utilized, we thought it important to mention here. Since, however, the introduction is 52 pages long and is already in the English language we refer you to the original. A sample page is presented (see Table 1).
Diet records of the WHO MONICA Augsburg dietary survey 1984/85 sample of 899 men aged 45-64 were used to derive quantitative data about food intake and the contribution of food groups to energy intake and the intake of those nutrients relevant to the discussion about nutrition and cardiovascular disease: protein, fat, saturated, mono- and polyunsaturated fatty acids, cholesterol, carbohydrate, polysaccharides and total fiber. The present lists of nutrient sources should be helpful for the development of acceptable dietary advises, which make allowance for actual eating patterns as well as for developing improved instruments of dietary assessment.
In the WHO MONICA Augsburg survey of 1984/85 dietary intake was assessed in an age-stratified cluster sample of 899 men aged 45-64 years by 7-day records. The mean energy intake was 2,609 kcal (10.9 MJ), 15.9% of which came from protein, 38.1% from fat, and 36.6% from carbohydrate. A remarkably high proportion of 9.4% was derived from alcohol. Saturated fatty acids accounted for 14.6% of total energy, monounsaturated fatty acids for 13.2% and polyunsaturated fatty acids for 5.2%. The results showed that current dietary habits do not conform with the national nutritional guidelines.
The Belfast MONICA Project carried out the joint European Economic Community WHO MONICA Project nutrition study (EURONUT) in 1985-1986 in 401 males subjects (45-64 years) using 3-day weighed records. This resulted in 356 reliable records which were analysed. The mean energy intake was 2369 Kcals (9.9 MJ) with 38% of energy (including alcohol) derived from fat (16.5% from saturated fat, 14.0% from monounsaturated fat, 4.8% from polyunsaturated fat), 14.2% from protein, 43.2% from carbohydrate and 4.0% from alcohol. The mean total fat was 100.3 g (saturated fat 43.5 g, monounsaturated fat 36.9 g, polyunsaturated fat 12.5 g), with a P:S ratio of 0.32. The sources of the different kinds of fat and cholesterol are presented as cumulative percentages of the total. This is a useful way of identifying those foods which contribute chiefly to fat in the diet, and it should have important implications for the monitoring of progress towards meeting dietary guidelines.
Starting from large differences in rates and trends of mortality between European countries, an ecological type of comparative study was launched between five population samples in so-called Eastern European countries: Krakow, Warsaw, Novosibirsk, Kaunas, and the German Democratic Republic (GDR). The purpose was to look into dietary data as a possible explanation for varying risk factor and mortality data. It was found that high energy and fat consumption but low carbohydrate intake are common in these populations. The sources of energy and fat however vary markedly. An association was found between diet-related cardiovascular risk factors like the mean total cholesterol value and excess energy or fat intake both in males and in females. It was concluded that changes in diet might be the most important prerequisite for a number of lifestyle changes in these communities, and that those diet changes need to be monitored on a regular basis as part of the national health reports.