Chapter 9 - Current Food Intake and Food Variety CHAPTER 9 CURRENT FOOD INTAKE AND FOOD VARIETY CONTENTS

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1 CHAPTER 9 CURRENT FOOD INTAKE AND FOOD VARIETY CONTENTS 9.0 INTRODUCTION TOTAL FOOD INTAKE TOTAL FOOD INTAKE ANIMAL FOOD INTAKE PLANT FOOD INTAKE PLANT TO ANIMAL FOOD RATIO ANIMAL FOODS MEAT, CHICKEN, PORK FISH & SEAFOOD MILK AND MILK PRODUCTS EGGS, SOUPS, DIPS PLANT FOODS VEGETABLES LEGUMES CEREALS FRUIT FATS/OILS SUGAR PRODUCTS ALCOHOLIC BEVERAGES WATER, TEA, COFFEE DIETARY ADEQUACY AND FOOD VARIETY RECOMDED SERVINGS FROM 5 FOOD GROUPS FOOD VARIETY Food group variety Total food variety Total food variety, food & nutrient intake DISCUSSION SUMMARY page - 490

2 CHAPTER 9 CURRENT FOOD INTAKE AND FOOD VARIETY 9.0 INTRODUCTION In this study, estimated intake of food items and food groups was of interest for the following reasons: 1) To describe or define the food culture of the populations surveyed, in food terms (see also chapter 8) 2) To determine the degree of acculturation to traditional diets on migration (see also chapter 8) 3) To assess dietary adequacy 4) To examine the inter-relationships between food, health and lifestyle (see chapter 12). There are many cultures around the world, all of which have their distinct cuisine and usage of particular foods. Dietary advice to individuals and groups may be about a particular nutrient, but the advice must ultimately relate to foods they eat. This can only be done if the food culture of the target population has been quantified and defined (see also Chapter 8). There has been a great deal of interest in the Mediterranean diet ever since the Seven Countries study in the 1950's and 60's (Keys et al, 1966, 1971, 1986.) which showed that coronary artery disease was lower in Southern European countries. Nevertheless, there have been few attempts to define the food composition of the Greek diet. Most of these attempts have not relied on actual food intake but on indirect measures, such as food balance sheets or from case control studies (Trichopoulou et al, 1993a,b). Recently, the food intake of elderly Greeks was described in the Euronut study (Trichopoulou et al., unpublished data, Appendix 13). More data is clearly needed on the composition of the Greek diet and changes on migration. The most common method for assessing dietary adequacy is by comparing estimated nutrient intake against the recommended dietary intakes (RDIs). Alternatives to this traditional method have been used which involve the actual intake of specific foods and/or food groups. These include comparisons with the recommended servings per day page - 491

3 from the different food groups (Kohrs et al., 1978; Reid and Miles, 1977). Variety scores based on the number of food and beverage items consumed during a specific period have also been computed (Reid and Miles, 1977; Krondl et al., 1982; Davis et al., 1985; Horwath, 1987; Hsu-Hage, 1992). Significant positive correlations have been reported between variety scores and dietary adequacy as assessed by comparison with RDIs (Reid and Miles, 1977; Horwath, 1987). In the current study, foods are grouped firstly into broad groups e.g animal and plant food groups and then into more specific groups e.g meat, fish, dairy. The absolute intake of individual food items or dishes which relate to the traditional Greek diet (e.g olives, feta cheese, olive oil, mousaka) are presented in Chapter 8. They will be referred to in this chapter with reference to their broad grouping (e.g feta cheese and the cheese group). Some mixed dishes are classified or grouped according to the major ingredient in the dish. For example, the main ingredient in spinach pie is spinach so it is grouped with leafy green vegetables (see also Methods and Appendix 9). Due to the large number of certain types of mixed dishes, separate categories were created for mixed vegetable dishes and vegetable and rice dishes. The frequency of consumption of most food items is also reported in Chapter 8. The objectives of this chapter include: 1. Descriptive statistics by age group and gender for foods that constitute the diets of elderly Greeks (including traditional and non-traditional foods). 2. The determine the degree of acculturation to the diets on migration by comparing Melbourne elderly with elderly Anglo-Celtic Australians. 3. Dietary adequacy and food variety of elderly Greeks The amount consumed from each food group is presented as follows: a) in absolute amounts (grams/day); statistics performed and presented. b) as a percentage of total food intake (shown in brackets); this effectively controls for total food intake - statistics performed but not presented in tables (see text). c) energy contribution of major food groups to total energy intake. page - 492

4 Data on Spata Greeks was compared to: a) Euronut-Seneca study (de Groot et al., 1991) - food intake of rural Greeks aged 75 from Markopoulo, near Spata, (M 33, F 27) and Anogia/Archanes, Crete (M 31, F 45); interviewer administered quantitative diet history (unpublished data, see Appendix 13). b) Keys et al., country study, Crete and Corfu, 69 men aged 40-59; weighed 7 day food records. c) Kafatos et al., (M 256, F 131) Cretan bank employees aged years and compared to the cohort of the 7 country study; interviewer administered 24 hour recall. e) FAO Standardized food balance sheets Data on elderly Greek Australians was not available for comparison. Data was therefore compared to: a) Department of Community Services, National Dietary Survey of Adults, food intakes of Southern European Australians aged (M 203, F 172); interviewer administered 24 hour recall. b) Kosmidis et al., food frequency of 472 Greeks in Melbourne aged below 70; self administered 24 hour recall. c) Wahlqvist et al., in press (IUNS) - food intakes of Anglo-Celtic Australians aged from Melbourne (M 50, F 49); self administered quantitative FFQ. d) Baghurst et al., 1987 Victorian Nutrition Survey - food intakes of 525 (M 240, F 285) Anglo-Celtic Australians aged 60+; self administered semi-quantitative FFQ. e) Horwath, Anglo-Celtic elderly Australians aged >70 yrs from Adelaide (M 901 men, F 1072); semiquantitative food frequency questionnaire. f) Powles J et al., 1990b. Household expenditure patterns in selected migrant groups in Australia. g) FAO Standardised Food balance sheets (food availability in Greece & Australia, not actual food consumed. Due to limited available data on energy contribution from various food groups, Food Balance Sheets were used. It is important to note the different dietary methods used in these studies, because differences in food intakes can often exist as a result of the method chosen. For example, 24 hour recall is known to markedly underestimate habitual nutrient intake when compared to food frequency methods which assess long term intake. In the Euronut study, usual intake of food was obtained using an interviewer administered modified diet history for the previous month. Portion sizes were recorded for page - 493

5 each subject in household measures and checked by weighing. In the National Dietary Survey of Australian adults 1983 the interviewer administered 24 hour recall method was used and portion sizes estimated in household measures. In the Anglo-Celtic Australian study in Melbourne the same method was used as in the current study i.e interviewer administered quantitative FFQ over the past year, potion sizes estimated in household measures and with the aid of food photographs. In the Anglo-Celtic Australian study in Adelaide a self administered semiquantitative FFQ over the past year was used. Subjects were not asked to indicate portion size, but rather a standard or typical serving was used in data analysis. Furthermore, many of these studies were done prior to 1988 and thus changes in food and nutrient intakes may have occurred since then. Since the current study was carried out between , there are limitations in comparing with studies done earlier. 9.1 TOTAL FOOD INTAKE Calculation of total food intake included mainly solid foods with high nutrient density. Fats, sugar products and most fluids (e.g water, coffee, fruit juice - except milk and soups) were not included (Hsu-Hage, in press). Fats and sugar products would have added another 50g/day and the fluids another 1200g/day Total food intake Results: Total food intake in Spata was 1180g/day (M 1280g/ day, F 1070g/day) and in Melbourne 1450g/day (M 1610g/day, F 1290g/day). The men within centres consumed significantly more food than the women. Food intake did not change with age. Melbourne men and women consumed significantly more food than Spata elderly (see table 9.1.1). page - 494

6 Table Total food intake g/day Mean ai bj ci dj SD Minimum % % % % % Maximum WO Mean ak bl ck dl SD Minimum % % % % % Maximum Same pair of letters show significant differences, Wilcoxon p<0.05: Gender differences: Spata and 80+; Melbourne and 80+. Age group differences: nil. Centre differences: men and 80+; women and Animal foods Results: Melbourne men consumed markedly more animal foods (575g/day) than Spata men (410g/day). Differences did not reach significance for the women (Melbourne 420g/day, Spata 360g/day). The Melbourne men also consumed more animal foods than the women (see table 9.1.2). page - 495

7 Table Animal foods g/day (% of total food intake) Mean i (28) j (35) ci (32) dj (38) SD (10) (13) (8) (13) Minimum (11) (12) (14) (20) 5% % % % % Maximum (56) (66) (56) (69) WO Mean (32) (36) c (32) d (34) SD (11) (9) (11) (9) Minimum 77.0 (34) (24) (11) (13) 5% % % % % Maximum (88) (53) (63) (54) Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata nil; Melbourne and 80+. Age group differences: nil. Centre differences: Men and Plant food Results: Melbourne men (1040g/day) and women (860g/day) consumed significantly more plant foods than Spata men (870g/day) and women (710g/day). The men in both centres consumed more plant food than the women (see table 9.1.3). page - 496

8 Table Plant foods g/day (% of total food intake) Mean aei (72) ej (65) cfi (68) 960 dfj (62) SD (10) (13) (8) (13) Minimum (44) (34) (44) (30) 5% % % % % Maximum (89) (88) (86) (80) WO Mean ak (68) l (64) ck (68) dl (65) SD (11) (9) (11) (9) Minimum (34) (47) (37) (46) 5% % % % % Maximum (88) (76) (89) (87) Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata 70-79; Melbourne and 80+. Age group differences: Spata men; Melbourne men. Centre differences: Men and 80+; Women and Plant to animal food ratio Results: When total food intake was taken into account (i.e % plant and animal foods) differences were no longer significant either within or between centres. Average 'total food intake' was made up of the following proportions: Spata: Men - 31% animal & 69% plant foods; Women - 33% animal & 67% plant foods. Melbourne: Men - 35% animal & 65% plant foods; Women - 33% animal & 67% plant foods. See table for the plant to animal food ratio. Gender and age group differences within centres were not significant - the average ratio in Spata and Melbourne was 2.6. Only men aged in Spata were found to have a significantly higher ratio (3.2) than the men in Melbourne (2.6). Even though Melbourne page - 497

9 men eat a greater quantity of plant foods than Spata men, they also eat more animal foods, making their ratio significantly lower (see table 9.1.4). Table Plant to animal food ratio Mean 3.2 i i 2.2 SD Minimum % % % % % Maximum WO Mean SD Minimum % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: nil. Age group differences: nil. Centre differences: Men Comparisons with reported data: Limited studies are available on the food intake of Greeks, especially on the elderly and on migrant Greeks. A study in Crete (Kafatos et al., 1991) on 387 (256 males, 131 females) Cretan bank employees aged between years had similar total food intakes (1247g/day) to Spata elderly (1180g/day). The proportion of total food intake contributed by plant (72%, 897g/day) and animal foods (28%, 350g/day) in Crete was also similar to Spata elderly (69%, 795g/day; 31%, 385g/day respectively). Consequently, the plant/animal ratio was also 2.6 in Crete. In the Euronut study (de Groot et al., 1991), elderly Greeks also had total food intakes (1220g/day) similar to Spata elderly, including the proportions contributed by plant (73%, 895g/day) and animal foods (27%, 322g/day). However, the ratio of plant/animal was slightly greater (2.8). In the National Dietary survey of adults aged 25-65, mean total food page - 498

10 intake of Southern European Australians (1420 g/day) was similar to Melbourne elderly Greeks (1450g/day). However, the proportion of total food intake contributed by plant food was lower (55%, 788g/day), and from animal foods higher (45%, 629g/day) than Melbourne Greeks (65%, 950g/day; 35%, 500g/day respectively) - consequently, the plant/animal ratio was also significantly lower (1.25). Webb and Manderson (1990) indicate that plant food intake by Southern Europeans was under-reported in the National Survey - especially the consumption of plant foods from vegetable gardens which are commonplace in Greek households. The dietary method used (24 hour recall) may not have captured the variety of vegetables and fruits eaten. Furthermore, under-reporting of cooked vegetables is common (Karvetti and Knuts 1985); this may have occurred more frequently among immigrants with limited fluency in English. The Anglo-Celtic Australians in the National Dietary Survey (1983) consumed 1393g/day total food/day, of which 50% was plant (691g/day) and 50% animal foods (702g/day). In contrast, in the elderly Anglo-Celtic study in Melbourne where the food frequency questionnaire was used, total food intake was slightly higher 1468g/day (M 1433g/day, F 1508g/day), as was the proportion of plant food (60%, 886g/day); animal food intake was lower (40%, 582g/day). Elderly Anglo-Celtic Australians consume significantly more of their total food intake as animals foods (M 41%, F 38%) and less as plant foods (M 59%, F 62%) compared with elderly Greeks. 9.2 ANIMAL FOODS For absolute intake of animal foods see table a) Calories from animal foods Results: For absolute intake of total animal foods see table In Spata, animal foods provided 530kcal/day (M 580kcal/day, F 470kcal/day) and in Melbourne 680kcal/day (M 765kcal/day, F 580kcal/day). Gender and age group differences were not seen within centres. Although the proportion of animal to total food intake was not different between centres, the proportion of calories from animal food to total energy intake was significantly higher in Melbourne (32%) than Spata (27%) (see tale 9.2.a). This can be explained by the types of animal foods selected. In Melbourne, a greater proportion of total energy intake was obtained from energy dense meat and chicken (16%) compared page - 499

11 with Spata (10%). Furthermore, there was a tendency in Melbourne to consume animal foods as 'dry' dishes (e.g grilled, barbecued) than as 'wet' dishes (casseroles). Table 9.2a Kcal from animal foods (and % of total energy intake) Mean (24 i ) 600.5(29) 758.0(31 i ) (33) SD (6) (10) (7) (88) Minimum (11) (13) (15) (18) 5% (12) (13) (21) (23) 25% (20) (21) (27) (27) 50% (23) (26) (31) (32) 75% (27) (35) (36) (39) 95% (36) (58) (44) (45) Maximum (37) (58) (52) (60) WO Mean (26 k ) (29) (32 k ) 566.8(31.0) SD (9) (7) (9) (7.3) Minimum (9) (17) (12) (13.3) 5% (14) (20) (20) (18.4) 25% (19) (24) (26) (25.8) 50% (26) (26) (31) (30.6) 75% (31) (34) (38) (36.4) 95% (37) (45) (48) (42.2) Maximum (58) (47) (54) (43.9) Same pair of letters show significant differences, Wilcoxon p<0.05: Gender differences: nil. Age group differences: nil. Centre differences: men 70-79; women Comparisons with reported data: Food Balance Sheets (FAO, 1988) for Greece and Australia were used to compare results. The proportion of calories from animal food to total food calories available from the FBS for Greece was similar (25%) to Spata (27%); the proportion of energy from animal foods for Australia was similar (30.5%) to Melbourne Greeks (32%). The FBS highlight the greater availability of animal foods in Australia compared with Greece. page - 500

12 b) Animal food groups The animal food group included meat, poultry, organ meats, fish, dairy, eggs, soups, dips and eggs but not sugar products, fats/oils or alcohol. Results: Foods comprising the animal food group, for both men and women, in order of decreasing consumption were as follows: Spata: 50% dairy, 20% red meat, 15% fish, 6% poultry, 5% soups, 3% eggs, 0.5% organ meats, 0.5% dips. Melbourne: 40% dairy, 25% red meat, 12% fish, 11% soups, 9% poultry, 2% eggs, 0.5% organ meats, 0.5% dips. The higher animal food intake in Melbourne appears to be contributed evenly from all animal foods,with a slightly higher intake of poultry and soups compared to Spata elderly MEAT, CHICKEN, PORK This group included the following sub-groups: lamb, goat, beef and beef dishes, chicken, chicken dishes, pork, rabbit/birds, processed meat and organ meats. Casseroled meat dishes or wet meat dishes were included with dry meat dishes (e.g rissoles, steak). In the Greek cuisine, casseroled meat is mainly meat with a little tomato and oil based sauce. Therefore, the weight of casseroles was very similar to dry meat dishes. a) Absolute Intake of meat group Results: Average intake in Spata was 90g/day (M 105±68g/day, F 78±37g/day) and in Melbourne 130g/day (M 150±63g/day, F 105±53 g/day) (see table 9.2.1a). Average intake from the meat group was made up of the following foods: Spata: 44% beef, 28% chicken, 20% lamb, 3% offal, 2% processed meat, 1% goat and 1% pork, 1% rabbit/bird. Melbourne: 46% beef, 36% chicken, 12% lamb, 3% processed meat, 2% rabbit/bird, 2% pork, 1% goat, 1% offal. In Melbourne and Spata, men in both age groups consumed about 40% more meat than the women; however, consumption did not change with age. Centre differences were observed for men in both age groups and women aged Melbourne elderly consumed more meat than Spata elderly. When total food intake was taken into account, the Melbourne men and women aged were still consuming proportionally more meat (9%) than Spata elderly (7.5%). The gender differences were no longer significant in Spata but still significant in Melbourne elderly aged page - 501

13 Comparisons with reported data: Comparisons are fraught with difficulties due to differences in the grouping of foods. The study in Crete on 387 (M 256, F 131) Cretan bank employees aged between years had similar mean intakes of meat (91±117g/day) to Spata elderly (90±53g/day). In the Euronut study (de Groot et al., 1991, Appendix 13), elderly Greeks also had meat intakes (M 104±38g/day, F 73±25g/day) similar to Spata elderly (M 105±68g/day, F 78±37g/day), including the percentage of total food intake (7.2%). In the elderly Anglo-Celtic study in Melbourne (Wahlqvist et al., in press) mean meat intake was greater (M 165g/day, F 152g/day) than Melbourne Greeks, particularly for women (M 158g/day, F 109g/day). Percentage of total food intake from meat was 11% compared to 9% in Melbourne Greeks. In the Australian National Dietary survey of adults aged 25-65, meat intake was greater in Southern European Australians (187 g/day; M 228g/day, F 147g/day) compared with elderly Melbourne Greeks. Table 9.2.1a Meat, chicken, pork group (soups excluded) g/day (% of total food intake) Mean 97.7 ai (7) bj (10) ci (10) dj (9) SD 51.3 (3) 86.5 (6) 61.6 (4) 64.9 (4) Minimum 40.5 (3) 20.9 (2) 43.2 (2) 48.3 (2) 5% % % % % Maximum (16) (21) (26) (25) WO Mean 71.0 ak (7) 85.9 b (8) ck (8) 98.7 d (8) SD 40.0 (4) 34.5 (3) 52.4 (3) 53.4 (3) Minimum 6.9 (1) 30.0 (4) 23.6 (2) 8.6 (1) 5% % % % % Maximum (17) (16) (18) (15) Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata and 80+; Melbourne and 80+. Age group differences: Spata nil; Melbourne nil. Centre differences: Men and 80+; Women page - 502

14 b) Calories from meat group Results: The meat group provided 200kcal/day in Spata and 325kcal/day in Melbourne. This represented 12% of total energy intake in Spata and 15% in Melbourne. Gender and age group differences were not seen within centres. Centre differences were significant for men aged and 80+ and women aged Melbourne elderly had a greater percentage of their total energy intake from meat compared to Spata elderly (see table 9.2.1b). Table 9.2.1b Kcal from meat, chicken, pork group (soups excluded) (% of total energy intake) Mean 218.1(9.7 i ) 246.9(11.9 j ) 383.1(15.9 i ) (16.9 j ) SD (4.4) (7.3) (5.7) (6.1) Minimum 85.7 (4.0) 94.3 (4.3) 88.0 (4.1) (4.3) 5% (4.1) 94.3 (4.3) (7.6) (9.2) 25% (6.2) (5.9) 269.6(11.9) (13.1) 50% (8.6) (9.9) 364.4(15.1) (15.8) 75% 283.0(12.1) 306.6(15.6) 469.1(18.6) (20.3) 95% 492.2(19.3) 782.8(33.5) 651.6(25.3) (28.3) Maximum 514.2(23.6) 782.8(33.5) 939.9(35.2) (30.4) WO Mean 155.0(8.9 k ) 188.9(11.8) 275.5(14.7 k ) (14.2) SD 79.1 (4.0) 57.3 (4.6) (6.4) (5.5) Minimum 22.2 (1.9) 94.2 (5.0) 49.7 (2.2) 58.5 (4.2) 5% 37.3 (3.1) (7.3) 91.6 (4.5) 81.3 (5.6) 25% (5.8) (8.7) 179.8(10.8) (9.9) 50% (8.4) 186.8(11.0) 282.5(14.6) (13.9) 75% 195.1(12.0) 231.7(13.7) 345.8(17.6) (17.5) 95% 325.5(15.7) 286.7(20.9) 492.5(30.1) (23.8) Maximum 342.2(19.0) 314.4(25.1) 864.3(35.1) (24.8) Same pair of letters show significant differences, Wilcoxon p<0.05: Gender differences: nil. Age group differences: nil. Centre differences: men and 80+; women page - 503

15 Comparisons with reported data: Food Balance Sheets (FBS) (FAO, 1988) or food availability for Greece and Australia were used to compare results. The FBS from Greece indicate that the proportion of total available energy from meat was similar (14%) to Spata (12%). In contrast, the FBS from Australia indicate that the proportion of total available energy from meat (18.5%) was greater than values for Melbourne Greeks (15%), but similar to values on 3097 Anglo-Celtic Australians aged 18+ (M 20.5%, F 18.4%) (Victorian Nutrition Survey, Baghurst et al., 1988c) Specific Meats Consumption of specific meats (i.e beef, lamb, chicken etc) is scanty for Greeks in Greece and Australia, therefore comparisons could only be made with food intake data on Anglo-Celtic Australians. Frequency of intake is reported in Chapter 8. a) Lamb This group included mutton roast, mutton casserole and lamb roast. Souvlaki and takeaway 'giro - lamb on spit' were rarely eaten by all subjects. Results: Average intake of lamb was similar in both Spata (23g/day; M 26.5g/day, F 20g/day) and Melbourne (20g/day; M 23.5g/day, F 16g/day). The median values (50th percentile) were almost half that of the mean values, indicating that intake was skewed to the right, with a large proportion of elderly (25%) reporting to be non-consumers (see also chapter 8). In Spata, men aged consumed twice as much lamb than the women. However, lamb appeared to be more popular amongst the 80+ women in Spata, consuming three times more than the younger women (see table a). In Melbourne, gender and age group differences were not observed. Spata women aged 80+ consumed twice as much lamb (30g/day) as Melbourne women 80+ (13g/day) (see table a). Comparisons with reported data: In the Australian National Dietary survey of adults aged 25-65, mean intake of lamb by Southern European Australians was significantly lower (M 11g/day, F 11g/day) than elderly Greeks in Melbourne (M 23.5g/day, F 16g/day). In the Victorian Nutrition Survey (Baghurst et al., 1987), mean intake of Anglo- Celtic Australians aged 60+ (22g/day; M 23g/day, F 21g/day) was similar to elderly Greeks in Melbourne. page - 504

16 Table a Lamb g/day (+ non-consumers) Mean 26.1 a SD % % % % % Maximum WO Mean 10.9 ag 29.2 gl l SD % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata 70-79; Melbourne nil. Age group differences: Spata women; Melbourne nil. Centre differences: Women 80+. b) Goat Results: Goat intake averaged 1.2g±2.3/day in Spata and 1.5g±6/day in Melbourne. Similarly to lamb, the median values (50th percentile) were almost half that of the mean values, indicating that intake was skewed to the right, with a large proportion of elderly reporting to be non-consumers (50%) (see also chapter 8). Gender and age group differences were not significant within centres. Melbourne elderly consumed more goat than Spata elderly (except women 80+). Comparisons with reported data: Anglo-Celtic Australians rarely consume goat (Victorian Nutrition Survey, 1987). page - 505

17 c) Beef & Beef dishes The beef and beef dishes group included roast beef, boiled beef, casseroled beef (mainly meat with a little sauce), veal and mince meat (mainly as rissoles or meat balls in sauce 'giouvarlakia'). Meat pies and hamburgers were rarely eaten by the study subjects. Dishes such as pastichio (spaghetti pie) and mousaka (egg plant pie) were not included in this group since mince meat was not their major ingredient. Results: Average intake in Spata was 37g/day (M 41g/day, F 34g/day) and in Melbourne 50g/day (M 60g/day, F 40g/day). In Spata, gender and age group differences were not significant. In Melbourne, more beef was consumed by men (60g/day) in both age groups compared to the women (40g/day) and intake did not appear to change with age. Table c Beef & Beef dishes g/day (soups excluded) (+ non-consumers) Mean 35.9 i ci 61.4 d SD Minimum % % % % % Maximum WO Mean c 39.5 d SD Minimum % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata nil; Melbourne and 80+. Age group differences: Spata nil; Melbourne nil. Centre differences: Men page - 506

18 Centre differences were significant for men only aged Melbourne men consumed more beef than Spata men (see table c). In Spata, mince meat accounted for 50% of intake, followed by casseroles (30%) and roasts (20%). Beef in Greece is not as tender as Australian meat. The mincing and casseroling of such meat would help make it more chewable and palatable for consumption by elderly Greeks. In Melbourne, roasts/boiled/grilled/fried meat was more popular, which accounted for 50% of intake, followed by casseroles (30%) and mince meat (20%). Comparisons with reported data: In the Australian National Dietary survey of adults aged 25-65, mean intake of Southern European Australians was significantly greater (M 110g/day, F 76g/day) than intake of elderly Greeks in Melbourne (M 60g/day, F 40g/day). This data suggests that meat intake decreases markedly with age. Elderly Anglo-Celtic Australians consume less beef (M 38g/day, F 30g/day) than elderly Greeks in Melbourne (Victorian Nutrition Survey, 1987). From the 1984 Household Expenditure Survey (Powles et al., 1990b) Greek Australians were found to have the highest expenditure on red meat compared with Australian-born. d) Pork Results: Pork consumption averaged only 1g±3/day in Spata and 2.5g±5/day in Melbourne. Gender differences and age group differences were not significant within centres. The median values (50th percentile) were zero, indicating that intake was skewed to the far right, with a large proportion of elderly (80%) reporting to be nonconsumers (see also chapter 8). Comparisons with reported data: In the Australian National Dietary survey of adults aged 25-65, mean pork intake of Southern European Australians was significantly greater (M 28g/day, F 14g/day) than pork intake of elderly Greeks in Melbourne (M 3.5g/day, F 2g/day). Elderly Anglo-Celtic Australians consumed more pork (M 6g/day, F 5g/day) than Melbourne Greeks (Victorian Nutrition Survey, 1987). In contrast, the recent survey of Anglo-Celtic Australians in Melbourne (Wahlqvist et al., 1993) showed a mean intake of 18g/day for men and women. This increased intake is probably in response to the recent marketing of lean pork in Australia. page - 507

19 e) Chicken & Chicken dishes Chicken and chicken dishes included roast chicken, boiled chicken, chicken casserole, fried chicken and turkey. Turkey and fried chicken were rarely consumed by study subjects. Results: Average intake in Spata was 25g/day (M 27g/day, F 20g/day) and 45g/day (M 50g/day, F 38g/day) in Melbourne. Gender and age group differences were not significant in Spata. In Melbourne, men aged consumed more chicken than the women, but chicken consumption did not change with age. Twice as much chicken was consumed by men and women in both age groups in Melbourne compared with Spata (see table e). Table e Chicken & Chicken dishes g/day (soups excluded) (+ non-consumers) Mean 26.8 i 28.3 j 54.5 ci 48.5 j SD % % % % % Maximum WO Mean 22.2 k 17.3 l 38.0 ck 37.4 l SD % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata nil; Melbourne Age group differences: Spata nil; Melbourne nil. Centre differences: Men and 80+; Women and 80+. page - 508

20 Comparisons with reported data: In the Euronut study, elderly Greeks aged 75 had chicken intakes (M 23±17g/day, F 23±20g/day) similar to Spata elderly aged (M 27±23g/day, F 22±24g/day). In the Australian National Dietary survey of adults aged 25-65, chicken intake of Southern European Australians was lower (M 23g/day, F 26g/day) than elderly Greeks in Melbourne (45g/day). Elderly Anglo-Celtic Australians (Victorian Nutrition Survey, 1987) consumed slightly less chicken (15g/day) than elderly Greeks. A recent study of elderly Anglo-Celtic Australians in Melbourne (Wahlqvist et al., 1993) also reported lower intakes of chicken (M 17g/day, F 22g/day) compared with elderly Greeks. f) Rabbit & Bird Results: Rabbit and game bird included quail and other birds and rabbit casserole (a traditional Greek dish called 'stifado'). Average intake in Spata was 1g±2/day and 3±6g/day in Melbourne - mainly accounted for by rabbit casserole. Gender, age group and centre differences were not significant. The median values were zero, indicating that intake was skewed to the right, with a large proportion of elderly (80%) reporting to be non-consumers (see also chapter 8). Comparisons with reported data: Consumption of specific foods is scanty for Greeks in Greece and Australia. Elderly Anglo-Celtic Australians in Melbourne (Wahlqvist et al., in press) rarely consume rabbit (0.6g/day). Rabbit used to be very popular in Australia about years ago. g) Processed meat Results: Processed meat included ham, salami, mortadella, sausages, corned beef and bacon. Average intake in Spata was 2g/day (mainly mortadella) and in Melbourne 6g/day (mainly ham). Gender and age group differences were not seen in Spata or Melbourne. Centre differences were significant only for the men aged Melbourne men consumed more than Spata men (see table g). The median values were zero, indicating that intake was skewed to the right, with a large proportion of elderly (80%) reporting to be non-consumers (see also chapter 8). Comparisons with reported data: In the Australian National Dietary survey of adults aged 25-65, processed meat intake of Southern European Australians was significantly greater (M 16g/day, F 8g/day) than intake of elderly Greeks in Melbourne (M 8g/day F 3g/day). It appears that consumption of such meats decreases with age. Elderly Anglo- Celtic Australians consumed slightly more processed meat (M 14g/day, F 8g/day) than page - 509

21 elderly Greeks (Victorian Nutrition Survey, 1987). In a recent study of elderly Anglo-Celtic Australians in Melbourne (Wahlqvist et al., in press) mean intakes were about 10g/day for both men and women. Table g Processed meat g/day (+ non-consumers) Mean 0.2 k k 6.8 SD % % % % % Maximum WO Mean SD % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: nil. Age group differences: nil. Centre differences: Men h) Organ meats Results: Intake in Melbourne averaged about 2g/day and in Spata 3.5g/day. In Spata, liver accounted for 40% of intake, followed by tripe (36%) and brains (24%). In Melbourne, liver accounted for 60% of intake, followed by tripe (37%) and brains (3%). In Spata, the men aged consumed more organ meats, (5.3g/day) than the women (1.3g/day). Spata men also consumed more organ meats (mainly tripe) than Melbourne men (see table h). page - 510

22 Table h Organ meats g/day (+ non-consumers) Mean 5.3 ai i 2.2 SD % % % % % Maximum WO Mean 1.3 a SD % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata 70-79; Melbourne nil. Age group differences: nil. Centre differences: Men Comparisons with reported data: In the Australian National Dietary survey of adults aged 25-65, organ meat intake of Southern European Australian men was lower (0g/day) to intake of elderly Greek men in Melbourne (2.4g/day). In contrast, Southern European women had significantly greater intakes (6g/day) than Melbourne women (2g/day). Elderly Anglo-Celtic Australians in Melbourne had lower mean intakes (M 1.3g/day, F 1g/day) than Melbourne Greeks. page - 511

23 9.2.2 FISH & SEAFOOD The fish group included fish and fish dishes, shellfish, and fish roe dip (taramosalata). a) Absolute Intake of fish/shellfish group Results: Mean intake in Spata and Melbourne was about 50g/day, of which 94% was consumed as fish, 5% shellfish and 1% fish roe dip. The fish group represented 3.8% of total food intake for both centres. Gender, age group and centre differences were not significant, even after controlling for total food intake (see table 9.2.2a). Comparisons with reported data: A study in Crete (Kafatos et al., 1991) on 387 Cretan bank employees aged between years had lower intakes of fish (37g/day) compared with Spata elderly (50g/day). In the Euronut study (see Appendix 13), mean fish intakes of elderly Greeks were also significantly lower (M 31.5±23g/day, F 23±10g/day) than Spata Greeks, including the percentage of total food intake (2.1%). In the National Dietary survey of adults aged 25-65, fish intake was significantly lower in Southern European Australians (M 22g/day, F 18g/day) compared with elderly Melbourne Greeks, suggesting increased fish consumption with age. In the elderly Anglo-Celtic study in Melbourne (Wahlqvist et al., 1993) mean fish intake was significantly lower for men and women (15±11g/day) compared with Melbourne Greeks, including the percentage of total food intake (1%). Similar mean intakes were also reported in the Victorian Nutrition survey (M 16g/day, F 17g/day). From the 1984 Household Expenditure Survey (Powles et al., 1990b) Greek Australians were found to have a significantly higher expenditure on fish compared with Australian-born. page - 512

24 Table 9.2.2a Fish/shellfish group g/day (soups excluded) (% total food intake) Mean 60.2 (4.6) 48.7 (3.9) 63.5 (3.9) 48.5 (3.1) SD 40.1 (3.3) 29.8 (2.4) 40.7 (2.2) 34.7 (2.5) Minimum 0.0 (0) 0.0 (0) 1.8 (0.1) 4.3 (0.4) 5% % % % % Maximum 171.8(13.2) (8.8) (9.5) (12.5) WO Mean 47.6 (4.3) 39.6 (3.8) 48.8 (3.8) 41.0 (3.2) SD 42.3 (3.2) 37.1 (3.7) 36.7 (2.7) 33.9 (2.7) Minimum 4.1 (0.4) 0.0 (0) 0.0 (0) 0.0 (0) 5% % % % % Maximum 223.8(15.9) 127.9(13.7) (12) (12) Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: nil. Age group differences: nil. Centre differences: nil. b) Calories from fish/shellfish group Results: Fish and seafood provided 70kcal/day in Spata and Melbourne (3.5% of total energy intake). Gender, age group and centre differences were not significant (see table 9.2.2b). Comparisons with reported data: The FBS from Greece and Australia indicate that the proportion of total available energy from fish was only 0.9% compared to 3.5% of energy consumed as fish by Spata and Melbourne Greeks. Similarly, in the Victorian Nutrition Survey (Baghurst et al., 1988c) of 3000 adults aged 18+, fish contributed more energy to total intake (1.4%) than indicated from the FBS (0.9%). page - 513

25 Table 9.2.2b Kcal from fish/shellfish group (and % of total energy intake) Mean 88.0 (3.9) 70.3 (3.2) 90.3 (3.7) 68.8 (2.9) SD 56.0 (2.6) 44.2 (2.1) 54.4 (2.1) 48.4 (2.1) Minimum 0.0 (0.0) 0.0 (0.0) 3.0 (0.1) 6.5 (0.4) 5% 4.6 (0.4) 0.0 (0.0) 19.2 (0.8) 9.6 (0.4) 25% 49.0 (2.3) 37.3 (1.8) 56.5 (2.2) 34.4 (1.2) 50% 83.2 (3.5) 71.7 (3.0) 77.1 (3.6) 61.4 (2.8) 75% (5.3) 93.4 (4.9) (4.6) 91.0 (4.2) 95% (9.8) (8.6) (7.4) (5.8) Maximum 251.1(11.4) (8.6) 243.0(11.0) (10.6) WO Mean 68.2 (3.7) 57.1 (3.3) 70.8 (3.8) 60.8 (3.3) SD 61.9 (2.9) 52.6 (2.8) 49.1 (2.5) 49.9 (2.8) Minimum 5.5 (0.4) 0.0 (0.0) 0.0 (0.0) 0.0 (0.0) 5% 5.8 (0.5) 0.0 (0.0) 12.7 (0.7) 0.0 (0.0) 25% 24.4 (1.8) 21.4 (1.4) 35.9 (1.8) 26.3 (1.3) 50% 69.3 (3.4) 36.2 (2.4) 64.3 (3.0) 48.3 (2.7) 75% 88.4 (4.7) 75.3 (5.0) 86.7 (5.2) 78.2 (3.9) 95% (7.3) (8.7) (8.9) (8.5) Maximum 331.8(15.4) 176.9(10.8) 215.4(11.9) (13.8) Same pair of letters show significant differences, Wilcoxon p<0.05: Gender differences: nil. Age group differences: nil. Centre differences: nil Specific fish Foods Consumption of specific fish foods (i.e sardines, tuna, cod etc) is scanty for Greeks in Greece and Australia, therefore comparisons could only be made with food intake data on Anglo-Celtic Australians. Frequency of intake is reported in Chapter 8. a) Fish & Fish dishes Fish and fish dishes included fried fish, baked fish, salted cod, salted herring, fried whitebait/fresh sardines, tinned sardines, tuna and salmon. Results: In both Spata and Melbourne, fish intake averaged about 45g/day. Gender and age group differences were not seen in Spata. In Melbourne, men aged consumed page - 514

26 more fish (60g/day) than the women (45g/day), but intake did not change with age. Centre differences were not significant. In Melbourne, 94% of fish intake was accounted by fresh fish (of which 2% was white bait 'marida'), followed by tinned tuna (3%), tinned sardines (1%), salted cod (1%) and salted herring (0.5%). In Spata, 98% of fish intake was accounted by fresh fish (of which 11% was white bait 'marida'), followed by salted cod (1%), tinned tuna (0.5%) and salted herring (0.5%) (see table a). Table a Fish & Fish dishes g/day (soups excluded) (+ non-consumers) Mean c 46.4 SD Minimum % % % % % Maximum WO Mean c 37.7 SD Minimum % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: Spata nil; Melbourne Age group differences: nil. Centre differences: nil. page - 515

27 b) Shellfish Results: Shellfish and crustaceans included prawns, oysters, squid, octopus, caviar, crab and crayfish. Average intake in Spata and Melbourne was 3g/day. Gender, age group or centre differences were not significant (see table b). Comparisons with reported data: In the National Dietary survey of adults aged 25-65, shellfish intake was significantly greater in Southern European Australians (M 8g/day, F 6g/day) than elderly Melbourne Greeks, suggesting decreased shellfish consumption with age. In elderly Anglo-Celtic Australians mean shellfish intake is less than 1g/day (Baghurst et al., 1987, Wahlqvist et al., in press). Table b Shellfish & Crustaceans g/day (+ non-consumers) Mean SD % % % % % Maximum WO Mean SD % % % % % Maximum Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: nil. Age group differences: nil. Centre differences: nil. page - 516

28 9.2.3 MILK AND MILK PRODUCTS The milk group included the following sub-groups: milk, yoghurt, and yoghurt dip (tzatziki), cheese and cheese pie and desserts/puddings/custards. This group represented about 16% of total food intake in Spata and Melbourne. a) Absolute Intake of milk & milk products Results: Average intake in Spata was 186g/day and 250g/day for Melbourne. Average intake from the milk products group was made up of the following sub-group proportions, in order of decreasing consumption: Spata: 55% milk, 22% cheese, 19% yoghurt, 4% milk desserts, 0.2% yoghurt dip. Melbourne: 68% milk, 16% cheese, 12% yoghurt, 4% milk desserts, 0.1% yoghurt dip. Table 9.2.3a Milk and milk products g/day (% of total food intake) Mean (13) j (15) f (13) fj (20) SD (9) 99.9 (7) (8) (13) Minimum 22.9 (2) 45.5 (4) 19.9 (1) 28.6 (2) 5% % % % % Maximum (47) (26) (39) (56) WO Mean (16) (18) (15) (17) SD (10) (9) (9) (8) Minimum 0.0 (0) 24.1 (4) 10.0 (1) 11.9 (1) 5% % % % % Maximum (47) (37) (45) (34) Same pair of letters show significant differences,wilcoxon p<0.05: Gender differences: nil. Age group differences: Spata nil; Melbourne men. Centre differences: Men 80+. page - 517

29 Gender and age group differences were not significant in Spata. In Melbourne, gender differences were not seen but men aged 80+ consumed significantly more milk and milk products than the men aged Centre differences were seen for men only aged 80+- Melbourne men consumed more milk and milk products than Spata men 80+, even after controlling for total food intake (see table 9.2.3a). Comparisons with reported data: Cretan bank employees aged between years (M 256, F 131) had significantly lower mean intake of milk and milk products (120g/day) than Spata elderly (186g/day). In the Euronut study (de Groot et al., 1991), mean intake of milk products of elderly Greeks was similar (M 220±150g/day, F 178±120g/day) to Spata Greeks (M 186±138g/day, F 186±107g/day), including the percentage of total food intake (16%). In the National Dietary survey of adults aged 25-65, milk product consumption was significantly greater in Southern European Australians (M 350g/day, F 460g/day) than elderly Melbourne Greeks, suggesting that milk product consumption decreases with age. In the elderly Anglo-Celtic study in Melbourne (Wahlqvist et al., in press) mean intake of the men was similar (270±167g/day) to Greek men in Melbourne (280±168g/day) whereas Anglo-Celtic women had higher intakes (280±176g/day) than Greek women (210±107g/day). Similar mean intakes to Anglo-Celtic Melbournians were also reported in the Victorian Nutrition survey (M 284g/day, F 310g/day). The higher intake of Anglo-Celtics is mainly contributed by a greater intake of milk. b) Calories from milk & milk products Results: Milk and milk products provided 250kcal/day in Spata and Melbourne (12% of total energy intake). In Spata, gender differences reached significance in the age group - women had a greater percentage of their energy intake from milk products compared to the men. Age group differences were also seen for the men only - men aged 80+ consumed more milk products than their younger counterparts. Gender and age group differences were not seen in Melbourne. Centre differences were not significant (see table 9.2.3b). Comparisons with reported data: The proportion of total available energy (FBS) from dairy products for Greece and Australia (10%) was similar to the proportion of total energy intake actually consumed by Spata and Melbourne Greeks (12%). In the Victorian Nutrition Survey (Baghurst et al., 1988c) of 3000 adults aged 18+, milk products contributed 14% to total energy intake. page - 518

30 Table 9.2.3b Kcal from milk & milk products (and % of total energy intake) Mean 228.8(9.9 ae ) 261.6(12.8 e ) 267.1(11.0) 300.3(13.0) SD 155.5(5.2) 108.2(5.4) 147.9(5.2) 188.1(6.9) Minimum 62.1(2.9) 117.2(4.8) 42.2(1.7) 80.5(3.6) 5% 85.2(3.3) 117.2(4.8) 61.5(3.4) 104.1(3.9) 25% 148.6(6.3) 173.6(7.5) 147.6(7.1) 168.8(8.5) 50% 188.7(9.3) 250.6(12.6) 236.7(10.8) 265.2(12.4) 75% 282.1(12.1) 369.7(17.8) 375.9(14.0) 371.9(16.1) 95% 522.5(18.4) 507.8(21.8) 456.3(18.8) 572.6(20.9) Maximum 887.3(27.3) 507.8(21.8) 789.8(28.6) (37.4) WO Mean 219.7(13.1 a ) 232.2(13.4) 240.7(12.8) 227.5(12.5) SD 126.3(7.8) 145.0(5.4) 116.5(5.9) 98.1(5.0) Minimum 0.0(0.0) 56.4(5.5) 31.7(2.3) 44.1(2.0) 5% 57.2(4.3) 117.2(5.9) 74.0(4.5) 79.5(4.5) 25% 133.8(8.8) 134.2(10.0) 160.8(8.5) 155.7(9.2) 50% 213.0(11.6) 207.9(11.9) 233.7(12.1) 224.4(12.0) 75% 281.6(15.8) 273.4(16.1) 292.9(16.7) 300.5(16.5) 95% 383.2(34.1) 410.1(21.2) 499.3(24.5) 398.5(19.9) Maximum 701.6(40.3) 763.1(27.2) 606.4(28.9) 423.4(24.9) Same pair of letters show significant differences, Wilcoxon p<0.05: Gender differences: Spata Age group differences: Spata men. Centre differences: nil Specific milk and milk products Consumption of specific milk products (i.e cheese, yoghurt etc) is scanty for Greeks in Greece and Australia, therefore comparisons could only be made with food intake data on Anglo-Celtic Australians. Frequency of intake is reported in Chapter 8. a) Milk Milk group included cow's milk (full cream, reduced fat and skim), sheep's milk, goats milk, buttermilk, flavoured milk (milo) and evaporated milk, sweetened and unsweetened (made up/diluted). page - 519