Can a normal European diet provide all the micronutrients children need? Artur Mazur

Transcription

1 Can a normal European diet provide all the micronutrients children need? Artur Mazur Medical Faculty University of Rzeszow, Poland European Childhood Obesity Group

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3 Dietary Assessment Methods Food Record Methods - Weighed food intake - 24 hr. recall - Estimated Food intake (household measures; photos; food models) Food diaries - Food Frequency Questionnaire (FFQ) - Diet History - New methods e.g. computer-based, mobile phone technologies NO CONSENSUS ON BEST METHOD OF DIETARY ASSESSMENT IN CHILDREN

4 Methodological issues Childhood Dietary Habits Rapidly changing but (more) structured patterns More in-home eating Supervised by adults Parental influence important Psychological Food satisfies hunger Adolescence Rapidly changing food habits but unstructured eating patterns More out of home eating Less supervision by adults Peer influence important Food means of self-expression

5 Errors! Under-reporting (missing foods) Increases as overall no of foods or number of eating occasions increases Over-reporting (phantom foods) Incorrect identification foods Distraction/inattention

6 Nutritional recommendations and reference values for children and adolescents methods used to formulate nutritional guidelines for children are not homogeneous across Europe diverse population age ranges and different yardsticks of adequate intake such as the proportion of children with intakes below the recommended nutrient intake, estimated average requirement (EAR) or dietary reference value

7 Cut of points Average Requirement (AR): intake to meet the average physiological requirement Population Reference Intake (PRI): intake to meet the needs of nearly all healthy people in the population or group (mean + 2SD=97.5centile) Lowest Threshold Intake (LTI): 2.5th centile (mean ± 2SD), intake below which nearly all individuals in the population or group will be unable to maintain metabolic integrity according to the criterion chosen (mean - 2SD=2.5 centile)

8 Different concepts of nutritional recommendations and reference values-cut off points Estimated Average Requirement (EAR) as the average daily nutrient intake level estimated to meet the nutrient requirement of half the healthy individuals in a particular life stage and gender group Recommended Dietary Allowance (RDA) as the average daily nutrient intake level estimated to meet the nutrient requirement of nearly all (97 to 98 per cent) healthy individuals in a particular life stage and gender group.

9 G.B.M Mensink et al. British Journal of Nutrition 2013

10 Methods and period of dietary assessment in children aged 4 6 years of the various countries-example Country Age group years Method Year of survey n Survey included supplements Reference Finland day dietary record 3-day dietary record yes yes Kyttala et al., 2008 Denmark day dietary record no Fagt et al., 2008; Lyhne et al., 2005 Ireland day weighed dietary records Sweden day dietary record (open) Greece days overall,combination of weighed food records and 24-hourrecall or food diaries (3-day) 2003/ yes National Children s Food Survey, no Becker et al., /2004 2,374 no Manios et al., 2006 Poland hour recall no Szponar et al., 2000

11 Intake of selected minerals (min. max.) in 4-6 years in the four European regions Region/sex Calcium, mg Phosphorus, mg Iron, mg Zinc, Iodine, Selenium, References 700mg 800mg 8mg North Male 687-1,103 1,042-1, Female , South Male 793-1,024 1, N.A. 29 Female 701-1,024 1, N.A. 28 Central-East Male , Female , West Male , Female European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa

12 Intake of selected minerals (min. max.) in children aged 7-9 years in the four European Regions Region/sex Calcium, mg Phosphorus, mg Iron, mg Zinc, Iodine, Selenium, References 900mg 800mg 10mg North Male 936 1,207 1,300 1, Female 756 1,094 1,155 1, South Male 904-1,174 1, N.A. 41 Female 715-1,126 1, N.A. 33 Central-East Male , Female , West Male ,098-1, Female ,

13 Intake of selected minerals (min. max.) in children aged years in the four European regions Region/sex Calcium, mg Phosphorus, mg Iron, mg Zinc, Iodine, Selenium, References 1.200mg 1.250mg 15mg g North South Male 936-1,193 1,259-1, Female 785-1,003 1,079-1, Male ,395-1, N.A. 42 Female ,169-1, N.A. 36 Central-East West Male 686-1, , Female 593-1, , , Male 852-1,023 1,118-1, Female , ,1 6, European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa

14 Intake of selected minerals (min. max.) in adolescents in the four European regions Region/sex Calcium, mg Phosphorus, mg Iron, mg Zinc, Iodine, Selenium, References 1.200mg 1.250mg 12mg North Male 1,209-1,447 1, Female 1,025-1,040 1,194 7,8-12, South Male 941-1,001 1,596-1, N.A. 50 Female ,208-1, N.A. 38 Central-East West Male 806-1,283 1,646-1, Female 678-1,021 1,124-1, Male 869-1,086 1,413-1, Female , European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa

15 Region/sex Intake of selected vitamins (min.-max.) in children aged 4 6 years in the four European regions Vitamin B6 mg Folate Cobalamin Vitamin D References 0,7mg North Male Female South Male N.A. 2.3 Female N.A. 2.2 Central-East Male Female West Male Female European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa

16 North Region/sex Intake of selected vitamins (min.-max.) in children aged 7 9 years in the four European regions Vitamin B6 mg Folate Cobalamin Vitamin D References 0,7mg Male Female South Male N.A. 2.8 Female N.A. 2.1 Central-East Male Female West Male Female European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa

17 North Region/sex Intake of selected vitamins (min.-max.) in children aged years in the four European regions Vitamin B6 mg Folate Cobalamin Vitamin D References 1-1.4mg Male Female South Male Female Central-East Male Female West Male Female European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa

18 North Region/sex Intake of selected vitamins (min.-max.) in adolescents in the four European regions Vitamin B6 mg Folate Cobalamin Vitamin D References 1.2mg Male Female South Male Female Central-East Male Female West Male Female European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa

19 Retinol intake from the base diet A Flynn et al. Food & Nutrition Research Supplement 1, 2009

20 A Flynn et al. Food & Nutrition Research Supplement 1, 2009 Fortification practices in Europe-examples Country Denmark Finland Fortification practice Mandatory fortification of household salt and salt used in bread Permission needed for voluntary fortification Optional fortification permitted for vitamin A and β-carotene to margarine and fat spreads; calcium, phosphorous, iron, vitamin B1, B2 and niacin to certain flours and breakfast cereals and vitamin C to juices No mandatory fortification Common practice (consensus between authorities and food industry) fortification: iodine in salt, vitamin D in milk and margarines, vitamin A in margarines Large voluntary fortification (permission needed): e.g. vitamins A, E and C and calcium in fruit juices, Permission granted on safety aspects only Germany No mandatory fortification Voluntary fortification permitted for water-soluble vitamins and vitamin E. Vitamin A and vitamin D (milk products and margarine) in other products permission is needed for fortification: relatively difficult to obtain, especially for products that are not already sold in EU Iodisation of salt is encouraged

21 Conclusions The major contributor to intakes for all nutrients and in all countries is from foods in the base diet. Each country used different methodologies to estimate food and supplement intake. In some regions of Europe depend on age and gender -vit D,retinol,folate, iron, zinc, iodine intake in some children are below recommendations and could requiret supplementation. The application of more precise of food intake methods estimation may be required for the future, to enable the estimation of nutrient intakes from base diet, food supplements and fortified foods.

22 Thank you!