PubMed Health⌕ Search

Biomedical subjects

M C Ocké

Publications and source records attributed to M C Ocké.

At least 19 recordsLinked to original sources
PubMed2006

[Folic acid fortification: prevention as well as promotion of cancer].

In many countries foods are fortified with folic acid to prevent neural-tube defects. Beneficial effects on cancer, cardiovascular diseases and dementia are also assumed. Fortification with folic acid is not allowed in The Netherlands, although exemption can be granted. As well as beneficial effects, harmful effects may also occur. In addition to masking vitamin-B12 deficiency, there is some evidence that folic acid may promote progression of established tumours in laboratory animals and humans. In addition, it has been hypothesized that fortification with folic acid may have further negative effects on cancer through genetic selection. Given the high prevalence of cancer, these potentially harmful effects should also be taken into account in the Dutch debate on the advantages and disadvantages of folic acid fortification.

Animals↗
PubMed2005

Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC).

OBJECTIVE: The aim in this study was to assess the association between individual plasma carotenoid levels (alpha-carotene, beta-carotene, lycopene, beta-cryptoxanthin, lutein, zeaxanthin) and fruit and vegetable intakes recorded by a calibrated food questionnaire (FQ) and 24-h dietary recall records (24HDR) in nine different European countries with diverse populations and widely varying intakes of plant foods. DESIGN: A stratified random subsample of 3089 men and women from nine countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had provided blood samples and dietary and other lifestyle information between 1992 and 2000, were included. RESULTS: beta-Cryptoxanthin was most strongly correlated with total fruits (FQ r = 0.52, 24HDR r = 0.39), lycopene with tomato and tomato products (FQ r = 0.38, 24HDR r = 0.25), and alpha-carotene with intake of root vegetables (r = 0.39) and of total carrots (r = 0.38) for FQ only. Based on diet measured by FQ and adjusting for possible confounding by body mass index (BMI), age, gender, smoking status, alcohol intake, and energy intake, the strongest predictors of individual plasma carotenoid levels were fruits (R(partial)(2) = 17.2%) for beta-cryptoxanthin, total carrots ((partial)(2) = 13.4%) and root vegetables (R(partial)(2) = 13.3%) for alpha-carotene, and tomato products (R(partial)(2) = 13.8%) for lycopene. For 24HDR, the highest R(partial)(2) was for fruits in relation to beta-cryptoxanthin (7.9%). CONCLUSIONS: Intakes of specific fruits and vegetables as measured by food questionnaires are good predictors of certain individual plasma carotenoid levels in our multicentre European study. At individual subject levels, FQ measurements of fruits, root vegetables and carrots, and tomato products are, respectively, good predictors of beta-cryptoxanthin, alpha-carotene, and lycopene in plasma.

Alcohol Drinking↗
PubMed2005

Plasma carotenoids as biomarkers of intake of fruits and vegetables: ecological-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC).

OBJECTIVE: The aim of this study was to assess the ability of a single 24-h dietary recall (24HDR) and food questionnaires (FQ) to predict plasma carotenoid levels at the ecological level by assessing the relationship between mean plasma carotenoid levels and mean intake of fruit and vegetables measured by 24HDR and FQ across 16 European regions. DESIGN: A random subsample of 3089 subjects was included, stratified by age and gender. They provided blood samples and dietary information between 1992 and 2000 as part of the European Prospective Investigation into Cancer and Nutrition. RESULTS: Using Spearman's correlation coefficients, the correlations between mean regional 24HDR fruit and vegetable variables and corresponding mean plasma carotenoid levels were generally higher than the correlations using FQ means. The highest correlation was between the 24HDR citrus fruit variable and beta-cryptoxanthin (r = 0.90). For 24HDR, total fruits and vegetables were highly correlated with lutein, zeaxanthin, and beta-cryptoxanthin (r = 0.83-0.87), while vegetables were more closely related with lutein (r = 0.69) and zeaxanthin (r = 0.68), and fruits correlated with zeaxanthin (r = 0.87) and beta-cryptoxanthin (r = 0.84). Root vegetables (r = 0.81) and total carrots (r = 0.71) were well correlated with alpha-carotene. In the multivariate models adjusting for age, body mass index, and season, and using observations of means stratified by sex and region, the association was generally higher for 24HDR compared to FQ. CONCLUSION: Mean regional intakes of fruits and vegetables in several European countries were closely correlated with corresponding mean plasma levels of individual carotenoids. Fruits and vegetables measured by 24HDR were generally better able to predict plasma carotenoids at the ecological level.

Antioxidants↗
PubMed2004

Potential intake of phytosterols/-stanols: results of a simulation study.

BACKGROUND: Different doses of phytosterols/-stanols up to a maximum of 4.0 g/day have been used in human safety studies, whereas only one small-scale study investigated some detailed clinical information about consumption levels exceeding 8.6 g/day. OBJECTIVE: To determine which population groups are likely to be at risk of excessive intakes if liberal enrichment of foods with phytosterols/-stanols will be allowed. DESIGN AND SUBJECTS: Cross-sectional study among a representative sample (n=23 106) of the Dutch population, aged 20-60 y (MORGEN-project, 1993-1997). Phytosterol/-stanol intake was assessed with virtual replacement of one to four ordinary foods in the diet with enriched products. Percentile values were used to describe the distribution in simulated intake for different groups in the population, varying in sociodemographic and health characteristics. Multiple linear regression was used to describe the contribution of the different population characteristics to the simulated phytosterol/-stanol intake. RESULTS: If three commonly consumed products (margarine, cheese, yoghurt) were completely replaced, the median daily phytosterol/-stanol intake will be about 5.5 g in men and 4.6 g in women. In males, the intake above the 90th percentile will exceed 8.6 g/day. Women will approach this level. Especially, age, body mass index, socioeconomic status, subjective health, smoking behaviour, alcohol consumption, pregnancy (women) and high cholesterol level (men) contributed to the variance in the simulated intake (P<0.05), although the total explained variance was low (1-3%). CONCLUSIONS: If liberal phytosterol/-stanol fortification is allowed, the daily intake might exceed the recommended intake level as well as our 'cutoff' level of 8.6 g/day. Postlaunch monitoring to identify consumers and real intake levels, refinement of scenario buiding, as well as human safety studies for levels above 8.6 g/day are necessary.

Adult↗
PubMed2004

Plasma carotenoid levels in Dutch men and women, and the relation with vegetable and fruit consumption.

OBJECTIVE: Fruit and vegetable intake is inversely associated with cancer risk in many epidemiological studies. Accurate assessment of consumption of these foods is difficult, and biomarkers of intake would overcome several drawbacks of currently used dietary assessment methods. Therefore, we investigated the relation between plasma carotenoids and usual vegetable and fruit intake. DESIGN: Plasma carotenoid concentrations were measured and vegetable, fruit and juice consumption was assessed by a food frequency questionnaire (FFQ) in a random sample of 591 Dutch men and women aged 20-59 y from the MORGEN-project, one of the contributions to the European Prospective Investigation into Cancer and Nutrition (EPIC)-study. RESULTS: In this sample of the general Dutch population, in both genders, relative to the other carotenoids, plasma beta-cryptoxanthin was the best indicator for fruit intake, and for the sum of vegetable, fruit and juice intake, while lutein concentrations best reflected intake of vegetables, although quartiles of intake were not consistently separated. Since levels of lycopene were not associated with any of the main food groups examined, associations with total carotenoids improved when excluding lycopene, and monotonously increasing plasma levels were seen for intakes of vegetables, of fruits, and of the sum of vegetables, fruits and juices. Several vegetable types and orange/grapefruit juice were associated with plasma levels of one of the carotenoids. CONCLUSION: Plasma carotenoids were only crude indicators of vegetable and fruit intake as assessed by a FFQ; beta-cryptoxanthin for fruit intake and lutein for vegetable intake. None of the plasma carotenoids could distinguish all four quartiles of vegetables, fruit and/or juice intake.

Adult↗
PubMed2004

The opinion of Dutch dietitians about functional foods.

OBJECTIVE: To obtain information about Dutch dietitian's attitudes, perceived knowledge, training preferences, counselling procedures, opinions about post-launch monitoring, and personal consumption of functional foods. DESIGN: A self-administered, 62-item, postal survey in 2002. SUBJECTS: Five hundred randomly selected registered dietitians. The response rate was 49% (n = 238). RESULTS: The responders (mean age +/- SD: 40 +/- 9 years) had regular contact with clients (90%), and many (71% of 90%) advised about functional food use. Sixty-nine per cent hardly consumed any functional food themselves. Eighty-seven per cent of the responders would greatly appreciate courses given by scientists. Confusion existed about usage practices, target groups, safety, efficacy, and claims: between 42 and 89% agreed with the statements about uncertainties. Nonetheless, 69% felt that functional foods could theoretically contribute to good bodily functioning. Ninety per cent thought post-launch monitoring (PLM) important, but ideas about a common dietetic contribution to PLM did not emerge. CONCLUSIONS: Although functional foods potentially contribute to a healthful diet, there is still confusion among dietitians about claims, safety, efficacy and product-handling aspects. It is time to meet dietitians' repeated requests to provide education by noncommercial experts. In the meantime, dietitians themselves should have more say in the PLM debate because they should and could play an important role.

Adult↗
PubMed2002

European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics.

The European Prospective Investigation into Cancer and Nutrition (EPIC), which covers a large cohort of half a million men and women from 23 European centres in 10 Western European countries, was designed to study the relationship between diet and the risk of chronic diseases, particularly cancer. Information on usual individual dietary intake was assessed using different validated dietary assessment methods across participating countries. In order to adjust for possible systematic over- or underestimation in dietary intake measurements and correct for attenuation bias in relative risk estimates, a calibration approach was developed. This approach involved an additional dietary assessment common across study populations to re-express individual dietary intakes according to the same reference scale. A single 24-hour diet recall was therefore collected, as the EPIC reference calibration method, from a stratified random sample of 36 900 subjects from the entire EPIC cohort, using a software program (EPIC-SOFT) specifically designed to standardise the dietary measurements across study populations. This paper describes the design and populations of the calibration sub-studies set up in the EPIC centres. In addition, to assess whether the calibration sub-samples were representative of the entire group of EPIC cohorts, a series of subjects' characteristics known possibly to influence dietary intakes was compared in both population groups. This was the first time that calibration sub-studies had been set up in a large multi-centre European study. These studies showed that, despite certain inherent methodological and logistic constraints, a study design such as this one works relatively well in practice. The average response in the calibration study was 78.3% and ranged from 46.5% to 92.5%. The calibration population differed slightly from the overall cohort but the differences were small for most characteristics and centres. The overall results suggest that, after adjustment for age, dietary intakes estimated from calibration samples can reasonably be interpreted as representative of the main cohorts in most of the EPIC centres.

Adult↗
PubMed2002

Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries.

OBJECTIVE: To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN: Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis. SETTING: Twenty-seven centres in 10 European countries participating in the EPIC project. SUBJECTS: In total, 35 955 subjects (13 031 men and 22 924 women), aged 35-74 years, randomly selected from each EPIC cohort. RESULTS: The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both genders. These differences were more evident for fruits, particularly citrus. However, slightly different patterns arose for some sub-groups of vegetables, such as root vegetables and cabbage. Adjustment for body mass index, physical activity, smoking habits and education did not substantially modify the mean intakes of vegetables and fruits. CONCLUSIONS: Total vegetable and fruit intake follows a south-north gradient in both genders, whereas for several sub-groups of vegetables a different geographic distribution exists. Differences in mean intake of V&F by centre were not explained by lifestyle factors associated with V&F intake.

Adult↗
PubMed2002

Consumption of added fats and oils in the European Prospective Investigation into Cancer and Nutrition (EPIC) centres across 10 European countries as assessed by 24-hour dietary recalls.

OBJECTIVE: To evaluate the consumption of added fats and oils across the European centres and countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: 24-Hour dietary recalls were collected by means of standardised computer-guided interviews in 27 redefined EPIC centres across 10 European countries. SUBJECTS: From an initial number of 36 900 subjects, single dietary recalls from 22 924 women and 13 031 men in the age range of 35-74 years were included. RESULTS: Mean daily intake of added fats and oils varied between 16.2 g (Varese, Italy) and 41.1 g (Malmö, Sweden) in women and between 24.7 g (Ragusa, Italy) and 66.0 g (Potsdam, Germany) in men. Total mean lipid intake by consumption of added fats and oils, including those used for sauce preparation, ranged between 18.3 (Norway) and 37.2 g day-1 (Greece) in women and 28.4 (Heidelberg, Germany) and 51.2 g day-1 (Greece) in men. The Mediterranean EPIC centres with high olive oil consumption combined with low animal fat intake contrasted with the central and northern European centres where fewer vegetable oils, more animal fats and a high proportion of margarine were consumed. The consumption of added fats and oils of animal origin was highest in the German EPIC centres, followed by the French. The contribution of added fats and oils to total energy intake ranged from 8% in Norway to 22% in Greece. CONCLUSIONS: The results demonstrate a high variation in dietary intake of added fats and oils in EPIC, providing a good opportunity to elucidate the role of dietary fats in cancer aetiology.

Adult↗
PubMed2002

Meat consumption in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts: results from 24-hour dietary recalls.

OBJECTIVE: To evaluate meat intake patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts. DESIGN AND SETTING: 24-Hour dietary recalls were assessed within the framework of a prospective cohort study in 27 centres across 10 European countries by means of standardised computer-assisted interviews. SUBJECTS: In total, 22 924 women and 13 031 men aged 35-74 years. RESULTS: Mean total meat intake was lowest in the 'health-conscious' cohort in the UK (15 and 21 g day-1 in women and men, respectively) and highest in the north of Spain, especially in San Sebastian (124 and 234 g day-1, respectively). In the southern Spanish centres and in Naples (Italy), meat consumption was distinctly lower than in the north of these countries. Central and northern European centres/countries showed rather similar meat consumption patterns, except for the British and French cohorts. Differences in the intake of meat sub-groups (e.g. red meat, processed meat) across EPIC were even higher than found for total meat intake. With a few exceptions, the Mediterranean EPIC centres revealed a higher proportion of beef/veal and poultry and less pork or processed meat than observed in central or northern European centres. The highest sausage consumption was observed for the German EPIC participants, followed by the Norwegians, Swedish, Danish and Dutch. CONCLUSIONS: The results demonstrate distinct differences in meat consumption patterns between EPIC centres across Europe. This is an important prerequisite for obtaining further insight into the relationship between meat intake and the development of chronic diseases.

Adult↗
PubMed2002

Consumption of dairy products in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort: data from 35 955 24-hour dietary recalls in 10 European countries.

OBJECTIVES: To describe and compare the consumption of dairy products in cohorts included in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Data from single 24-hour dietary recall interviews collected through a highly standardised computer-based program (EPIC-SOFT) in 27 redefined centres in 10 European countries between 1995 and 2000. From a total random sample of 36 900, 22 924 women and 13 031 men were selected after exclusion of subjects under 35 and over 74 years of age. RESULTS: A high total consumption of dairy products was reported in most of the centres in Spain and in the UK cohort sampled from the general population, as well as in the Dutch, Swedish and Danish centres. A somewhat low consumption was reported in the Greek centre and in some of the Italian centres (Ragusa and Turin). In all centres and for both sexes, milk constituted the dairy sub-group with the largest proportion (in grams) of total dairy consumption, followed by yoghurt and other fermented milk products, and cheese. Still, there was a wide range in the contributions of the different dairy sub-groups between centres. The Spanish and Nordic centres generally reported a high consumption of milk, the Swedish and Dutch centres reported a high consumption of yoghurt and other fermented milk products, whereas the highest consumption of cheese was reported in the French centres. CONCLUSION: The results demonstrate both quantitative and qualitative disparities in dairy product consumption among the EPIC centres. This offers a sound starting point for analyses of associations between dairy intake and chronic diseases such as cancer.

Adult↗
PubMed2002

Variability of fish consumption within the 10 European countries participating in the European Investigation into Cancer and Nutrition (EPIC) study.

OBJECTIVE: To describe and compare the consumption of total fish (marine foods) and the fish sub-groups - white fish, fatty fish, very fatty fish, fish products and crustacea, in participants from the European Investigation into Cancer and Nutrition (EPIC) study. DESIGN: Cross-sectional analysis of dietary intake using a computerised standardised 24-hour recall interview. Crude means, means and standard errors adjusted by age, season and day of the week were calculated, stratified by centre and gender. SETTING: Twenty-seven redefined centres in the 10 European countries participating in the EPIC study. SUBJECTS: In total, 35 955 subjects (13 031 men and 22 924 women), aged 35-74 years, selected from the main EPIC cohort. RESULTS: A six- to sevenfold variation in total fish consumption exists in women and men, between the lowest consumption in Germany and the highest in Spain. Overall, white fish represented 49% and 45% of the intake of total fish in women and men, respectively, with the greatest consumption in centres in Spain and Greece and the least in the German and Dutch centres. Consumption of fatty fish reflected that of total fish. However, the greatest intake of very fatty fish was in the coastal areas of northern Europe (Denmark, Sweden and Norway) and in Germany. Consumption of fish products was greater in northern than in southern Europe, with white fish products predominating in centres in France, Italy, Spain, The Netherlands and Norway. Intake of roe and roe products was low. The highest consumption of crustacea was found in the French, Spanish and Italian centres. The number of fish types consumed was greater in southern than in northern Europe. The greatest variability in consumption by day of the week was found in the countries with the lowest fish intake. CONCLUSIONS: Throughout Europe, substantial geographic variation exists in total fish intake, fish sub-groups and the number of types consumed. Day-to-day variability in consumption is also high.

Adult↗
PubMed2002

Patterns of alcohol consumption in 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) project.

OBJECTIVE: The aim of this study was to compare the quantities of alcohol and types of alcoholic beverages consumed, and the timing of consumption, in centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). These centres, in 10 European countries, are characterised by widely differing drinking habits and frequencies of alcohol-related diseases. METHODS: We collected a single standardised 24-hour dietary recall per subject from a random sample of the EPIC cohort (36 900 persons initially and 35 955 after exclusion of subjects under 35 and over 74 years of age). This provided detailed information on the distribution of alcohol consumption during the day in relation to main meals, and was used to determine weekly consumption patterns. The crude and adjusted (by age, day of week and season) means of total ethanol consumption and consumption according to type of beverage were stratified by centre and sex. RESULTS: Sex was a strong determinant of drinking patterns in all 10 countries. The highest total alcohol consumption was observed in the Spanish centres (San Sebastian, 41.4 g day-1) for men and in Danish centres (Copenhagen, 20.9 g day-1) for women. The lowest total alcohol intake was in the Swedish centres (Umeå, 10.2 g day-1) in men and in Greek women (3.4 g day-1). Among men, the main contributor to total alcohol intake was wine in Mediterranean countries and beer in the Dutch, German, Swedish and Danish centres. In most centres, the main source of alcohol for women was wine except for Murcia (Spain), where it was beer. Alcohol consumption, particularly by women, increased markedly during the weekend in nearly all centres. The German, Dutch, UK (general population) and Danish centres were characterised by the highest percentages of alcohol consumption outside mealtimes. CONCLUSIONS: The large variation in drinking patterns among the EPIC centres provides an opportunity to better understand the relationship between alcohol and alcohol-related diseases.

Adult↗
PubMed2002

Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project.

OBJECTIVE: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. SUBJECTS: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study. RESULTS: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. CONCLUSIONS: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.

Adult↗
PubMed2002

Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC).

OBJECTIVE: To evaluate under- and overreporting and their determinants in the EPIC 24-hour diet recall (24-HDR) measurements collected in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN: Cross-sectional analysis. 24-HDR measurements were obtained by means of a standardised computerised interview program (EPIC-SOFT). The ratio of reported energy intake (EI) to estimated basal metabolic rate (BMR) was used to ascertain the magnitude, impact and determinants of misreporting. Goldberg's cut-off points were used to identify participants with physiologically extreme low or high energy intake. At the aggregate level the value of 1.55 for physical activity level (PAL) was chosen as reference. At the individual level we used multivariate statistical techniques to identify factors that could explain EI/BMR variability. Analyses were performed by adjusting for weight, height, age at recall, special diet, smoking status, day of recall (weekday vs. weekend day) and physical activity. SETTING: Twenty-seven redefined centres in the 10 countries participating in the EPIC project. SUBJECTS: In total, 35 955 men and women, aged 35-74 years, participating in the nested EPIC calibration sub-studies. RESULTS: While overreporting has only a minor impact, the percentage of subjects identified as extreme underreporters was 13.8% and 10.3% in women and men, respectively. Mean EI/BMR values in men and women were 1.44 and 1.36 including all subjects, and 1.50 and 1.44 after exclusion of misreporters. After exclusion of misreporters, adjusted EI/BMR means were consistently less than 10% different from the expected value of 1.55 for PAL (except for women in Greece and in the UK), with overall differences equal to 4.0% and 7.4% for men and women, respectively. We modelled the probability of being an underreporter in association with several individual characteristics. After adjustment for age, height, special diet, smoking status, day of recall and physical activity at work, logistic regression analyses resulted in an odds ratio (OR) of being an underreporter for the highest vs. the lowest quartile of body mass index (BMI) of 3.52 (95% confidence interval (CI) 2.91-4.26) in men and 4.80 (95% CI 4.11-5.61) in women, indicating that overweight subjects are significantly more likely to underestimate energy intake than subjects in the bottom BMI category. Older people were less likely to underestimate energy intake: ORs were 0.58 (95% CI 0.45-0.77) and 0.74 (95% CI 0.63-0.88) for age (> or =65 years vs. <50 years). Special diet and day of the week showed strong effects. CONCLUSION: EI tends to be underestimated in the vast majority of the EPIC centres, although to varying degrees; at the aggregate level most centres were below the expected reference value of 1.55. Underreporting seems to be more prevalent among women than men in the EPIC calibration sample. The hypothesis that BMI (or weight) and age are causally related to underreporting seems to be confirmed in the present work. This introduces further complexity in the within-group (centre or country) and between-group calibration of dietary questionnaire measurements to deattenuate the diet-disease relationship.

Adult↗
PubMed2001

Association between trans fatty acid intake and 10-year risk of coronary heart disease in the Zutphen Elderly Study: a prospective population-based study.

BACKGROUND: Evidence on the relation between trans fatty acid intake and coronary heart disease is limited. We investigated this relation in a Dutch population with a fairly high trans fatty acid intake, including trans fatty acids from partly hydrogenated fish oils. METHODS: We prospectively studied 667 men of the Zutphen Elderly Study aged 64-84 years and free of coronary heart disease at baseline. We used dietary surveys to establish the participants' food consumption patterns. Information on risk factors and diet was obtained in 1985, 1990, and 1995. After 10 years of follow-up from 1985-95, there were 98 cases of fatal or non-fatal coronary heart disease. FINDINGS: Between 1985 and 1995, average trans fatty acid intake decreased from 4.3% to 1.9% of energy. After adjustment for age, body mass index, smoking, and dietary covariates, trans fatty acid intake at baseline was positively associated with the 10-year risk of coronary heart disease. The relative risk for a difference of 2% of energy in trans fatty acid intake at baseline was 1.28 (95% CI 1.01-1.61). INTERPRETATION: A high intake of trans fatty acids (all types of isomers) contributes to the risk of coronary heart disease. The substantial decrease in trans fatty acid intake, mainly due to industrial lowering of trans contents in Dutch edible fats, could therefore have had a large public-health impact.

Aged↗
PubMed2001

Diet and chronic obstructive pulmonary disease: independent beneficial effects of fruits, whole grains, and alcohol (the MORGEN study).

BACKGROUND: In recent years antioxidants, foods rich in antioxidants (e.g. fruits, vegetables) and fish have been suggested to protect against chronic obstructive pulmonary disease (COPD). There are also indications for a protective effect of whole grain intake and of consuming moderate amounts of alcohol. It is, however, not clear whether the effects of the different dietary factors on COPD are independent of each other and if so, whether their effects are additive. OBJECTIVE: To gain more insight into the potential protective effect of diet on COPD, we studied fruit, vegetable, fish, alcohol and whole grain consumption simultaneously in relation to pulmonary function and COPD symptoms. METHODS: Analysed were cross-sectional data collected in 13 651 men and women aged 20-59 years participating between 1994 and 1997 in the MORGEN study (monitoring project on risk factors and health in The Netherlands). Regression models were adjusted for age, gender, height (for pulmonary function only), smoking, BMI and energy intake. RESULTS: Fruit and whole grain intake showed independent beneficial associations with COPD (P-trend < 0.001). Furthermore, in subjects with low alcohol consumption (1-30 g/day) the forced expiratory volume in 1 s (FEV1) was higher and the prevalence of COPD symptoms lower than in non-drinkers (P < 0.001). The effects of a favourable intake of fruits (> 180 g/day), whole grains (> 45 g/day) and alcohol (1-30 g/day) were largely additive. In the 2998 subjects with a favourable intake of the three foods, the FEV1 was 139 mL higher and the prevalence of COPD symptoms lower (odds ratio (OR) = 0.44) than in subjects (n = 1406) with unfavourable intakes of fruits, whole grains and alcohol (P < 0.001). A similar effect was observed in those who had never smoked. Fish and vegetable intake did not show independent beneficial associations with COPD. CONCLUSIONS: Our results suggest independent beneficial effects of fruits, whole grains and alcohol on COPD that are largely additive and cannot be explained by smoking habits.

Adult↗