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Determinants of macronutrient intake in elderly people.

An understanding of the determinants of nutritional intake may be helpful in the early detection and prevention of malnutrition. A vast amount of literature exists on factors influencing daily energy or food intake. Although far less is known about population and subject characteristics influencing the macronutrient composition of the diet, associations appear to exist with cultural factors, snacking and disease. The literature does not provide sufficient evidence in support of relationships with other factors such as living situation, dentition, disability, depression and drug use, partly because information on determinants of macronutrient intake is scarce.

Aged↗

Evolution of meal patterns and food choices of Japanese-American females born in the United States.

OBJECTIVES: To examine trends in meal patterns and food choices across two generations of Japanese-American females born in the USA. DESIGN: Cross-sectional cohort study. SETTING: Gardena, a suburb of Los Angeles, California. SUBJECTS: One-hundred and seventy-six Japanese-American females, participating in a morning exercise class from December 1998 to January 1999. INTERVENTION: Eighty-eight Nisei (second generation) mothers and their Sansei (third generation) daughters completed a food frequency questionnaire, answering questions regarding meal patterns and consumption frequency of 51 food items. RESULTS: The Sansei ate fewer meals per day compared with the Nisei. Mean frequencies of takeout foods and eating out were higher in the Sansei vs the Nisei. Mean intake of meats and eggs were similar between the two groups. However, mean consumption of traditional Japanese complement foods including fish, vegetables and legumes was lower in the Sansei vs the Nisei. Intake of more 'Westernized' accessory foods, including salty snacks, regular soft drinks and alcoholic beverages, was higher in the Sansei vs the Nisei. CONCLUSION: Findings from this study indicate that meal patterns and food choices have changed in succeeding generations of Japanese-American females from traditional fare to a diet containing many complement and accessory foods that are higher in fat, sugar, sodium and calories. Health professionals should be advised to consider the whole diet in making nutrition recommendations to this population as well as providing information to this group on the nutritional benefits of many traditional foods. European Journal of Clinical Nutrition (2000) 54, 665-670.

Acculturation↗

The role of street foods in the dietary pattern of two low-income groups in Nairobi.

OBJECTIVES: To examine the frequency of street food consumption of people living in low-income settlements in Nairobi and the role of street foods in their daily diet and to reveal why people consume street foods rather than home-prepared foods. SETTING, SUBJECTS AND METHODS: A cross-sectional descriptive study was done with 1011 households and in-depth interviews with a subsample of 73 households in two selected areas in Nairobi: Korogocho, a low-income slum area and Dandora, a low-middle-income area. RESULTS: The frequency of street food consumption was higher in Korogocho than in Dandora (3.6 vs 2.0 days per week; P<0.001). Street food consumption did not differ between different types of households, with the exception of household size. Employment status of the household head and street food consumption were related (P<0.001): consumption frequency of 3.7 days per week when irregularly or unemployed, 2.9 days/week when self-employed and 2.1 days/week when regularly employed. Furthermore, where an adult woman with primarily a domestic role was present, street food consumption was less (2.55 days per week when present vs 2.95 when not present; P<0.05). CONCLUSIONS: Street foods play an important role in the diet of poor households in Nairobi, in particular for breakfast and snacks, because they are cheap and convenient. The frequency of street food consumption is determined by a combination of at least four factors: level of household income; regularity of income; household size; and time available to prepare meals. SPONSORSHIP: The project is financed by the Netherlands Foundation for the Advancement of Tropical Research (WOTRO), filenumber WV 96-153.

Adult↗

The impact on eating habits of temporary translocation from a Mediterranean to a Northern European environment.

OBJECTIVE: To assess the effect of temporary translocation from a Mediterranean to a Northern European environment on the eating habits of a group of foreign students. DESIGN: Cross-sectional survey of eating habits before and after moving from Greece to Glasgow, Scotland. SETTING: University of Glasgow. SUBJECTS: Eighty post-graduate Greek students. INTERVENTIONS: A self-administered questionnaire comprising of three major sections: (1) general eating habits; (2) frequency of eating selected food items; (3) opinion of food availability in Glasgow. RESULTS: After moving to Glasgow, significant decreases were reported in the frequency of consuming fresh fruit, raw vegetables, fish, legumes, meat, poultry and fresh fruit juice. The frequency of eating biscuits, savoury snacks, soft/fizzy drinks, alcoholic drinks and mayonnaise, dips and sauces increased. The estimated median daily consumption of fruit and vegetables decreased from 363 g in Greece to just 124 g in Glasgow, well below the Scottish and WHO dietary target of 400 g/day. The main perceived barriers to maintaining customary eating habits were the price of food, the lack of familiar tastes, the greater availability of convenience food and the limited variety of food available in Glasgow, when compared to Greece. CONCLUSIONS: These findings highlight the difficulties that migrant populations face in retaining traditional, often healthier, eating habits when migrating to a foreign country. Barriers of high cost, limited availability and poor quality of familiar foods, need to be addressed in order for migrants to maintain their customary eating patterns. Furthermore, these barriers need to be addressed before nutritionists can expect to see the widespread adoption of the Mediterranean diet by Western populations less familiar with this eating pattern.

Adult↗

Meal patterns and obesity in Swedish women-a simple instrument describing usual meal types, frequency and temporal distribution.

OBJECTIVE: To characterize meal patterns in relation to obesity in Swedish women using a simple instrument describing meal frequency, meal types and temporal distribution. DESIGN: Cross-sectional parallel group design. SUBJECTS: Eighty-three obese women from the Swedish Obese Subjects (SOS) study were compared with 94 reference women, randomly recruited from the population. METHOD: A new, simplified and self-instructing questionnaire was used to assess meal patterns. Usual meal pattern was reported as time and meal type for each intake episode during a typical day. RESULTS: The obese women consumed 6.1 meals/day compared with 5.2 meals/day among the reference women (P<0.0001). All types of meals except 'drink meals' were significantly more frequently consumed in the obese group. The obese women also displayed a different meal pattern across the day, consuming a larger number of meals later in the day. As a result a larger fraction of each obese woman's total meals were consumed in the afternoon and in the evening/night. There was no difference in the number of obese vs reference women consuming breakfast. Snack meals were positively associated with total energy intake in both groups. CONCLUSIONS: A new simplified method assessing meal pattern revealed that the number of reported intake occasions across a usual day was higher in obese women compared with controls and the timing was shifted to later in the day. These findings should be considered in the treatment of obesity.

Adult↗

The extent to which breakfast covers the morning energy expenditure of adolescents with varying levels of physical activity.

BACKGROUND: Energy intake at breakfast affects the performance of creativity tests, memory recall and voluntary physical endurance in children before lunch, and food craving during the whole day. OBJECTIVES: To assess the adequacy of breakfast energy supply (BES) and energy expenditure (EE) in adolescents during a schoolday without or with 2 h of physical education lesson (PEL) in the morning. DESIGN: Sixty adolescents (four groups of 14-16 boys and girls aged 12-16 y) participated in a cross-sectional study. Activity patterns and EE were determined by whole-body calorimetry during 36 h and in free-living conditions during 5 days using both a diary and the validated heart rate recording method. BES was determined by weighing individual foods. The pyloric energy flow was assessed using a model of fractional stomach emptying. RESULTS: BES averaged 24.9% (s.d.=6.1) of daily EE in the four groups of subjects. It covered the mean morning EE on a schoolday without PEL, but not in a schoolday with 2 h of PEL in any group. When PEL took place from 8-10 am the cumulative EE exceeded the cumulative pyloric energy flow after 105-150 min, that is during the PEL session, and the energy deficit increased until lunch. With a light breakfast (BES-1 s.d.) energy deficiency happened after 90 min. CONCLUSION: The results stress the need for a heavy breakfast for children and adolescents on the days with PEL in the morning, and a carbohydrate rich snack at 10 am to improve attention, memory and willing participation in physical activities.

Adolescent↗

Interaction of body mass index and attempt to lose weight in a national sample of US adults: association with reported food and nutrient intake, and biomarkers.

OBJECTIVE: This study examined the interaction between body mass index (BMI) and attempting to lose weight for reporting of: (1) macro- and micronutrient intake; (2) intake of low-nutrient-density foods; and (3) serum biomarkers of dietary exposure and cardiovascular disease risk. METHODS: Dietary, anthropometric and biochemical data were from the third National Health and Nutrition Examination Survey (1988-1994), n=13 095. Multiple regression methods were used to examine the independent associations of BMI, trying to lose weight, or the interaction of BMI-trying to lose weight with reported intakes of energy, nutrients, percentage energy from low-nutrient-density foods (sweeteners, baked and dairy desserts, visible fats and salty snacks), and serum concentrations of vitamins, carotenoids and lipids. RESULTS: BMI was an independent positive predictor (P<0.05) of percentage of energy from fat, saturated fat, but a negative predictor of the ratio of reported energy intake to estimated expenditure for basal needs (EI/BEE), percentage of energy from carbohydrate and alcohol (men only), and serum concentrations of folate, vitamin C, vitamin E and most carotenoids in both men and women. Trying to lose weight was a negative predictor (P<0.05) of EI/BEE, intake of energy, and energy density, but not micronutrient intake. Higher mean serum ascorbate, vitamin E, lutein/zeaxanthin, and other carotenoids (men only) concentrations were associated with trying to lose weight (P<0.05) in both men and women. Few adverse BMI-trying to lose weight interaction effects were noted. CONCLUSIONS: There was little evidence of increased nutritional risk in those reportedly trying to lose weight irrespective of weight status.

Adult↗

Short-term repeatability of a food frequency questionnaire in New Zealand children aged 1-14 y.

OBJECTIVE: To evaluate the repeatability of a children's food frequency questionnaire (FFQ) by gender, ethnicity, and age group. DESIGN: A 117-item FFQ asking about food intake patterns over the past 4 weeks was developed using food records from 428 children (204 boys and 224 girls) and the reproducibility on average 13 days apart was tested in 130 children (78 boys and 52 girls). Children were recruited using clustered probability sampling (n=103), and a convenience sample of 25 Maori children. SETTING: Children aged 1-14 y from Auckland, Feilding and Shannon, New Zealand. SUBJECTS: There were 71 Maori, 20 Pacific, and 39 Other children. RESULTS: Spearman correlations between the two FFQs ranged from 0.50 for bread to 0.82 for fruit, with a median of 0.76 for spreads and nonmilk drinks, and Cronbach's coefficient alpha's ranged from 0.59 for bread to 0.92 for nonmilk drinks, with a median of 0.85 for mixed meat dishes. There were no significant differences between the two administrations, apart from reporting higher intakes of vegetables and snacks & sweets in the first FFQ. Correlation coefficients tended to be slightly higher in boys than in girls, and in Other ethnic groups compared to Maori and Pacific children. Correlations were slightly higher for the 1-4 y age group, intermediate in the 10-14 y age group, and lowest in the 5-9 y-old age group. CONCLUSIONS: Overall, the FFQ described here shows similar or better repeatability in New Zealand children of all major ethnic groups compared to other child or adolescent FFQs.

Adolescent↗

Meal pattern, food choice, nutrient intake and lifestyle factors in The Göteborg Adolescence Study.

OBJECTIVE: To relate meal pattern of Swedish adolescents to food choice, nutrient intake and other lifestyle factors. DESIGN: Cross-sectional study including diet history and interview about smoking, ethnicity, social factors and retrospectively collected data of menarche and growth. SETTING: School setting, Göteborg, Sweden. SUBJECTS: A total of 611 boys and 634 girls in grade 9 (15-16 y). RESULTS: The majority of the students, 65% of the boys and 52% of the girls, consumed three main meals daily. The in-between meals, however, contributed the major part of the energy intake. The energy intake was 12.9+/-3.5 MJ (mean+/-s.d.) for boys and 9.0+/-2.5 MJ for girls. Irregular breakfast eating, 12% of the boys and 24% of the girls, was related to negative lifestyle factors where smoking was the strongest, odds ratio 3.8 (95% CI: 2.6-5.4) and to irregular intake of lunch and dinner. These boys and girls had a food choice including a higher percentage of energy from snack food (26% vs 20% and 19% in boys and girls respectively, all P<0.001), mostly consumed between the main meals. These groups had significantly lower intakes of micronutrients, but higher intakes of sucrose and alcohol compared to the groups with regular breakfast intake. Girls omitting breakfasts and lunches (8%) also had a less healthy food choice and the poorest nutrient intake. These girls had matured earlier, with menarche age of 12.2+/-1.1 y vs 12.9+/-1.0 y (P<0.001) in girls with regular main meal intake. CONCLUSIONS: Meal pattern with omission of breakfast or breakfast and lunch was related to a clustering of less healthy lifestyle factors and food choice leading to a poorer nutrient intake. SPONSORSHIP: The Swedish Medical Research Council (project B94-19X-04721-19A), the Swedish Mill Industry and the Wilhelm and Martina Lundgren Foundation.

Adolescent↗

Sociodemographic and lifestyle determinants of food patterns in Spanish children and adolescents: the enKid study.

OBJECTIVE: To analyse prevailing food patterns among Spanish children and young people and their relationship to sociodemographic and lifestyle factors. DESIGN: Cross-sectional population survey. SETTING: Population study. Data were collected at participants' home addresses. SUBJECTS: Random sample of the Spanish population aged 2-24 y (n=3534; 1629 boys and 1905 girls). INTERVENTIONS: Food consumption was assessed by means of a 24-h recall and a food frequency questionnaire. Sociodemographic and lifestyle related data were collected by specially designed questionnaires, previously pretested and validated. All the information was collected during a personal interview by trained dietitians. DATA COLLECTION: May 1998-April 2000. RESULTS: Average consumption of fruit and vegetables was low. The youngest age group (2-5 y) showed the lowest proportions of inadequacy for the dairy group (P<0,001; chi(2)=39.11 boys; chi(2)=49.60 girls). Factor analysis identified five main components of dietary patterns. The 'Snacky' pattern was characterised by more frequent and higher consumption of bakery products (buns, cakes and biscuits), sweets, salted snacks and soft drinks. Higher intakes of fruit, vegetables and fish were associated to the 'Healthy' pattern. Children whose mother had a low level of education and those who spent more than 2 h daily watching TV were more likely to follow the 'Snacky' pattern. Girls were more likely to follow the 'Healthy' pattern, while children and young people whose mother had a lower level of education were less likely. CONCLUSION: Results from this study highlight the importance of enhancing school-based and community-based actions to promote healthy eating and physical activity addressed to children and young people.

Adolescent↗

The effect of grape-seed extract on 24 h energy intake in humans.

OBJECTIVE: Since grape-seed extract has been shown to stimulate lipolysis in vitro and reduce food intake in rats, we assessed the efficacy of grape-seed extract with respect to energy intake (EI) and satiety. DESIGN: In a randomized, placebo-controlled, double-blind, cross-over study, 51 subjects (age 18-65 y, body mass index 22-30 kg/m2) ate an ad libitum lunch and dinner twice in the University Restaurant for 3 days. Standard breakfasts and snacks were provided. Supplements were taken 30-60 min prior to each meal. RESULTS: In the total study population, no difference in 24 h EI was found between the grape-seed extract and placebo. However, in the subgroup of subjects (n=23) with an energy requirement > or =the median of 7.5 MJ/day, EI was reduced by 4% (DeltaEI 352.1 kJ/24 h, P=0.05) after grape-seed extract compared to placebo treatment. Meanwhile, there were no significant differences in macronutrient composition, attitude towards eating, satiety, mood or tolerance. CONCLUSIONS: Grape seed reduced 24 h EI, with on average 4% in subjects who had an energy requirement > or =7.5 MJ/day, without further effects on satiety, mood or tolerance. These findings suggest that grape seed could be effective in reducing 24 h EI in normal to overweight dietary unrestrained subjects, and could, therefore, play a significant role in body-weight management.

Adult↗

Effect of moderate changes in dietary fatty acid profile on postprandial lipaemia, haemostatic and related CVD risk factors in healthy men.

OBJECTIVE: To investigate the effect of moderate changes in dietary fatty acid profile on postprandial risk factors for cardiovascular disease (CVD). DESIGN: Double-blind, randomised, crossover, intervention trial. SETTING: : University of Auckland Human Nutrition Unit, New Zealand. SUBJECTS: A total of 18 lean healthy men. INTERVENTION: A dairy butter fat modified to reduce the saturated:unsaturated fatty acid ratio and a conventional high saturated butter fat were given on two separate occasions as a high-fat test meal (59+/-4 g fat; 71 en% fat) at breakfast. A fat exclusion lunch, dinner and snacks were also given. Blood samples were collected at 0 (baseline), 1, 3, 6, 10 and 24 h. RESULTS: Maximum peak in total triacylglycerol (TAG) occurred 3 h postprandially and was highest on modified treatment (diet, P<0.05) due predominantly to increased TAG within the chylomicron-rich fraction. Transient peaks in total-, LDL- and HDL-cholesterol occurred postprandially, but did not differ between dietary treatments (P>0.05). There were no differential effects of diet on postprandial free fatty acids, apo A, apo B, glucose, insulin, amylin or haemostatic clotting factors (P>0.05). CONCLUSIONS: In a group of healthy young men, replacement of 16% of total saturated fatty acids by mono- and polyunsaturated fats within a dairy lipid did not induce postprandial changes in CVD risk that may be considered beneficial for health. SPONSORSHIP: Fonterra, Wellington; New Zealand.

Butter↗

School food policy at primary and secondary schools in Belgium-Flanders: does it influence young people's food habits?

OBJECTIVE: To describe the availability of food items at primary and secondary schools in Belgium-Flanders and to examine the influence of school food policy (availability of food items, school food rules, nutrition education programmes) and aggregated school socioeconomical status (AGG SES) on the consumption of fruit, soft drinks, crisps and sweets, using multilevel modelling. DESIGN, SETTING AND SUBJECTS: In spring 2002, 360 schools were invited to participate in the Health Behaviour in School-aged Children survey. In January 2003, the same schools were asked to complete a short school policy questionnaire. Pupils of 197 schools participated in the pupil survey (n=16560); 247 school principals completed the school questionnaire; for 157 schools data were available for both (n=12 360). RESULTS: Mineral water, fruit juice, chocolate milk, and soup were available in most schools. Whole fat milk was available in most primary schools; soft drinks, diet soft drinks and biscuits were available in most secondary schools. Fruit was available in 14% of primary and 26% of secondary schools. Assessment of the variation in the outcome variables revealed no significant between-school variation in primary schools, but considerable variation between secondary schools in the consumption of soft drinks, sweets and crisps (but not fruit). School characteristics explaining some of this school variance independent of pupil level characteristics were: for soft drinks: availability at the school, rules regarding the consumption of sweets and AGG SES; for sweets: AGG SES; and for crisps: rules regarding the consumption of savoury snacks and AGG SES. CONCLUSION: The results indicate that school food policy can have an impact on adolescents' food habits.

Adolescent↗

Malnutrition and associated factors among aged residents in all nursing homes in Helsinki.

OBJECTIVE: To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland. DESIGN: Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents' backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care. SETTING: All nursing homes in Helsinki community, the capital of Finland. SUBJECTS: Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82 y, were examined. RESULTS: One-third (29%) of the studied residents suffered from malnutrition (MNA < 17), and 60% were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patient-related factors predicted malnutrition: impaired functioning (OR 3.71, 95% CI 2.76-4.99), swallowing difficulties (OR 3.03, 95% CI 2.10-4.37), dementia (OR 2.06, 95% CI 1.45-2.93), constipation (OR 1.84, 95% CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95% CI 2.21-4.15). CONCLUSIONS: Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.

Activities of Daily Living↗

Effect of high-fat meals and fatty acid saturation on postprandial levels of the hormones ghrelin and leptin in healthy men.

OBJECTIVE: Ghrelin and leptin play a role in control of food intake and adiposity but mechanisms regulating these hormones in man are poorly defined and evidence that dietary fats may have adverse effects is inconclusive. We investigated whether high-fat meals, which differed in saturated fatty acid (SFA) content acutely modified these hormones. DESIGN: Randomised, double-blind, crossover trial. A high-fat (HF) test meal (59 +/- 4 g fat; 71% of energy as fat) was given for breakfast on two occasions. Meals comprised either high (approximately 70:30) or low (approximately 55:45) saturated:unsaturated fatty acid (SFA:USFA) ratio. Fasting and postprandial measurements of serum total ghrelin (RIA), leptin (enzyme-linked immunosorbent assay (ELISA)) and insulin (RIA) were made over 6 h. Postprandial measurements were also made at 10 and 24 h following a fat-exclusion lunch, snack and dinner. SUBJECTS: A total of 18 lean, healthy men. RESULTS: There was no significant effect of the fatty meal (time, P > 0.05), nor a differential effect of SFA:USFA ratio (treatment*time, P > 0.05) on ghrelin over 6h. Leptin decreased in response to both HF treatments (time, P < 0.001) but increased SFA content did not further inhibit hormone secretion (treatment*time, P > 0.05). There was no significant correlation between ghrelin or leptin and circulating insulin (P>0.05). CONCLUSION: We conclude that HF diets may adversely effect serum leptin, although the circadian decrease may account in part for this response. Increasing dietary SFAs had no deleterious effects on leptin or total ghrelin.

Adult↗

Lower limb fracture, cognitive impairment and risk of subsequent malnutrition: a prospective evaluation of dietary energy and protein intake on an orthopaedic ward.

OBJECTIVE: To report the dietary energy and protein intake of undernourished older adults (with and without cognitive impairment) admitted to hospital following a lower limb fracture and to determine whether dietary intakes met estimated requirements. DESIGN: An observational study of a sequential sample. SETTING: The orthopaedic ward of a South Australian metropolitan teaching hospital. SUBJECTS: Sixty-eight patients aged > or =70 years screened as undernourished and admitted to hospital following lower limb fracture (50% cognitively impaired) provided 3 to 5 days of dietary data. MAJOR OUTCOME METHODS: Dietary energy and protein intake. METHODS: Dietary assessment using plate waste methodology and snack record charts commenced within 6 days postinjury and continued for up to five consecutive days or until discharge. Estimated resting energy requirements were calculated and adjusted for activity equivalent to bed rest and physiological stress. Protein requirements were calculated as 1 g/kg/day. Cognition was assessed using the Short Portable Mental Status Questionnaire. RESULTS: Cognitively impaired participants and those without cognitive impairment consumed, mean (95% CI) respectively, 3661 kJ/day (3201, 4121) versus 4208 kJ/day (3798, 4619) and 38 g (33, 44) versus 47 g (41, 52) protein/day. Cognitively impaired participants consumed mean (95% CI) 48% (43, 53) of estimated total energy expenditure and 78% (69, 87) of estimated protein requirements. CONCLUSIONS: Orthopaedic fracture patients at greatest nutritional risk, including those with cognitive impairment, do not achieve estimated energy or protein requirements from diet alone. Effective methods of achieving requirements in this vulnerable group are needed before improvements in outcomes will be observed.

Aged↗

Trends of food intake in Portugal, 1987-1999: results from the National Health Surveys.

OBJECTIVE: To assess trends of food intake in Portugal. DESIGN: Analysis of three cross-sectional studies: 1987, 1995-1996 and 1998-1999. SETTING: Representative samples of free-living individuals. SUBJECTS: 64 734 men and 71 282 women. INTERVENTIONS: Food intake was assessed by questionnaires inquiring the number of meals and which foodstuffs (fish, meat, milk, rice/pasta/potatoes, soup, vegetables and fruit) had been consumed the day before. RESULTS: Age-adjusted average number of meals decreased from 3.3+/-0.1 in 1987 to 2.9+/-0.1 in 1998-1999 in both genders (P<0.001). In men, the percentage of subjects consuming meat, milk and potatoes/rice/pasta increased from 73, 66 and 91% in 1987 to 83, 74 and 95% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 56% in 1987 to 62 and 53% in 1998-1999, respectively. In women, the percentage of subjects consuming meat, milk, potatoes/rice/pasta and vegetable increased from 70, 66, 89 and 71% in 1987 to 78, 77, 93 and 83% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 55% in 1987 to 64 and 53% in 1998-1999, respectively. These trends were more pronounced in the younger age, which also displayed a higher frequency of snacking. Multivariate analysis adjusting for age group, region and educational level showed that the consumption of meat, milk and vegetables increased and the consumption of soup, fish and fruit decreased in 1998-1999 relative to 1995-1996. CONCLUSIONS: Within a decade, the Portuguese dietary pattern has changed considerably, shifting from a traditional, south European to a more Westernized, protein-rich diet. SPONSORSHIP: The Unidade de Nutrição e Metabolismo of the Instituto de Medicina Molecular is partially funded by a grant from the FCT (Fundação para a Ciência e a Tecnologia) ref. RUN 437.

Adolescent↗

Dieting, weight and health in adolescents in The Netherlands.

OBJECTIVE: To estimate the prevalence of dieting and the relationship between dieting, nutritional habits, and health among young adolescents in the Netherlands. METHODS: Out of 1359 secondary school children, aged 13 through 15 y, who were invited for a routine health assessment by school doctors or nurses as part of the Child Health Monitoring System, 1279 (94%) responded and data were analyzed. RESULTS: Among secondary school children 13% of girls and 5% of boys were dieting at the time of the health assessment. Half of the dieting pupils were at risk of overweight, while the other half were within the normal weight range. The mean preferred weight of the dieting pupils was not lower than the mean actual weight of the non-dieting pupils. Dieting pupils skipped meals more often and consumed less sweets and salty snacks, soft drinks and bread than non-dieting pupils. School absence due to illness was relatively high in dieting boys, and medicine use was high in dieting girls. CONCLUSION: As in other Western countries, dieting is a common practise among young adolescents in the Netherlands, especially in girls. "Unhealthy' dietary practices, like skipping breakfast, are already present at early age, therefore preventive programs should be targeted at young adolescents.

Absenteeism↗