Can a normal European diet provide all the micronutrients children need? Artur Mazur Medical Faculty University of Rzeszow, Poland European Childhood Obesity Group
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
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
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
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
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)
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.
G.B.M Mensink et al. British Journal of Nutrition 2013
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 4 6 3-day dietary record 3-day dietary record 2008 2008 554 713 yes yes Kyttala et al., 2008 Denmark 4 6 7-day dietary record 2000 2002 233 no Fagt et al., 2008; Lyhne et al., 2005 Ireland 5 6 7-day weighed dietary records Sweden 4 6 4-day dietary record (open) Greece 1 5 3 days overall,combination of weighed food records and 24-hourrecall or food diaries (3-day) 2003/2004 148 yes National Children s Food Survey, 2005 2006 590 no Becker et al., 2008 2003/2004 2,374 no Manios et al., 2006 Poland 4 6 24-hour recall 2000 166 no Szponar et al., 2000
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 5 120 15-45 North Male 687-1,103 1,042-1,284 7.8-8.6 9.8-9.1 173-223 26-45 Female 673-991 966-1,137 6.9-7.7 7.1-8.2 151-197 24-39 South Male 793-1,024 1,085 8.8-10.00 8.4-9.2 N.A. 29 Female 701-1,024 1,063 10.0-10.1 8.4-8.9 N.A. 28 Central-East Male 604-900 882-1,183 8.0-10.6 6.8-7.7 69-87 27-61 Female 606-809 877-1,183 7.4-10.6 6.4-7.3 69-82 29-61 West Male 813-856 933-1,067 6.0 142 23-27 Female 750-794 904-950 6.8-7.8 5.3-5.6 137 23-24 European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa
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 7 140 20-50 North Male 936 1,207 1,300 1,455 8.9 10.3 10.3 10.4 203 34 365 Female 756 1,094 1,155 1,288 7.7 9.2 8.9 9.3 179 30 32 South Male 904-1,174 1,253 11.1 10.9 N.A. 41 Female 715-1,126 1,091 9.8 9.4 N.A. 33 Central-East Male 628-900 960-1,295 9.2-11.8 8.0-8.7 73-143 34-58 Female 548-882 851-1,295 8.2-11.8 7.1-8.0 73-128 31-58 West Male 855-943 1,098-1,273 7.0-7.5 165 27-34 Female 857-901 991-1,185 7.8-8.9 6.4-7.0 137 26-30
Intake of selected minerals (min. max.) in children aged 10-14 years in the four European regions Region/sex Calcium, mg Phosphorus, mg Iron, mg Zinc, Iodine, Selenium, References 1.200mg 1.250mg 15mg 7 180-200g 25-60 North South Male 936-1,193 1,259-1,472 9.2-11.5 10.5-10.8 209 33-36 Female 785-1,003 1,079-1,184 7.7-10.3 8.6-8.8 171 28-30 Male 879-959 1,395-1,458 12.8-13.3 10.1-12.4 N.A. 42 Female 769-849 1,169-1,297 10.5-11.3 8.7-10.7 N.A. 36 Central-East West Male 686-1,381 964-1,615 9.2-17.9 8.3-13.8 89-134 42 Female 593-1,238 807-1,324 8.1-14,8 7.1-11.3 85-123 34 Male 852-1,023 1,118-1,493 7.0-9.3 154-168 29-40 Female 743-905 977-1,298 8.3-9,1 6,1-7.7 129-137 27-34 European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa
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 10 150 30-70 North Male 1,209-1,447 1,525 10.2-15.1 11.7 221 39 Female 1,025-1,040 1,194 7,8-12,7 8.9 175 31 South Male 941-1,001 1,596-1,605 13.4-14.7 10.8-14.5 N.A. 50 Female 803-810 1,208-1,272 10.8-10.9 8.5-11.0 N.A. 38 Central-East West Male 806-1,283 1,646-1,75 12.6-19.0 12.2-15.2 93-196 59 Female 678-1,021 1,124-1,265 9.6-14.0 9.1-10.8 78-182 37 Male 869-1,086 1,413-1,697 9.3-10.4 185-196 44-49 Female 645-911 962-1,356 8.3-10.7 6.4-8.4 115-126 30-36 European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa
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 300 1.8 5 North Male 1.1-1.6 135-256 4.2-5.3 2.3-6.8 Female 1.0-1.5 132-235 4.2-4.7 2.0-6.5 South Male 1.6 198 N.A. 2.3 Female 1.6 199 N.A. 2.2 Central-East Male 1.5-1.8 190-214 4.2-5.0 1.8-2.3 Female 1.2-1.9 164-190 2.9-5.0 1.5-2.3 West Male 1.3-1.8 120-225 2.2-2.4 Female 1.2-1.7 109-196 2.6-4.3 1.9 European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa
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 300 1.8 5 Male 1.3-2.5 204-290 5.4-5.5 2.5-6.4 Female 1.2-1.6 187-264 4.7-4.8 2.2-5.1 South Male 1.8 242 N.A. 2.8 Female 1.7 211 N.A. 2.1 Central-East Male 1.2-1.8 154-229 3.6-5.3 1.5-2.8 Female 1.1-1.8 145-212 2.8-5.3 1.5-2.7 West Male 1.3-2.2 144-256 2.2-2.9 Female 1.2-1.9 133-226 4.2 2.4-2.8 European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa
North Region/sex Intake of selected vitamins (min.-max.) in children aged 10-14 years in the four European regions Vitamin B6 mg Folate Cobalamin Vitamin D References 1-1.4mg 400 2-3 5 Male 1.4-1.8 191-298 4.9-5.2 2.6-4.8 Female 1.1-1.5 174-238 4.0 2.2-4.4 South Male 2.0-2.8 236-428 4.7-11.8 1.7-4.8 Female 1.8-2.7 207-412 2.9-11.1 1.6-4.5 Central-East Male 1.2-3.1 149-380 3.2-6.4 1.5-3.9 Female 1.1-2.5 138-360 2.2-4.9 1.2-2.9 West Male 1.5-2.4 170-271 2.1-3.8 Female 1.3-2.3 156-217 3.9-4.1 1.9-3.2 European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa
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 400 3 5 Male 1.5 306 5.1 2.6-7.5 Female 1.2 262 3.8 2.1-7.1 South Male 2.2-2.3 237-336 4.9 1.8-3.3 Female 1.7-1.9 196-254 4.0 1.5-3.0 Central-East Male 2.3-3.1 195-365 5.3-7.5 2.0-5.5 Female 1.7-2.4 154-298 3.5-5.2 1.7-3.0 West Male 1.8-3.1 190-320 3.0-4.4 Female 1.4-2.5 166-230 3.6-4.2 2.0-3.3 European nutrition and health report.karger 2009 / volume editor, Ibrahim Elmadfa
Retinol intake from the base diet A Flynn et al. Food & Nutrition Research Supplement 1, 2009
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
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.
Thank you!