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BACKGROUND/OBJECTIVES: Differences in the quality of complementary feeding between infants of obese and nonobese mothers have not been examined sufficiently. The aim of this paper was to compare dietary patterns, foods, nutrients and energy intakes of 9-month-old Danish infants in a cohort comprising obese mothers (SKOT II, n = 184;SKOT, Danish abbreviation of small children's diet and well-being) with a cohort consisting mainly of nonobese mothers (SKOT I, n = 329). SUBJECTS/METHODS: Dietary intake was assessed by 7-day records, and dietary patterns were identified by principal component analysis. RESULTS: SKOT I was characterized by a lower maternal body mass index (BMI) and a higher social class than SKOT II in relation to parental education and occupation. Infants in SKOT II had lower scores on a Health-Conscious Food pattern reflected at the food group level, for example, with lower intake of the food groups Fruit and Vegetable but higher intake of WheatBreadNoWholegrain in SKOT II compared with SKOT I. Moreover, SKOT II had shorter durations of breastfeeding, earlier introductions of complementary feeding, higher energy intake from protein but lower energy intakes from monounsaturated fatty acids and polyunsaturated fatty acids at 9 months. SKOT II had higher weight-for-age and length-for-age z-scores, but no differences in BMI z-scores, as compared with SKOT I at 9 months. CONCLUSIONS: Infants of obese mothers from a lower social class seem to have a less healthy diet and higher weight and length z-scores at 9 months. Therefore, the promotion of healthy complementary feeding might be beneficial for the prevention of health implications, such as obesity, later in life for these infants. European Journal of Clinical Nutrition (2015) 69, 668-675; doi: 10.1038/ejcn.2014.258; published online 3 December 2014, INTRODUCTION It is well established that maternal obesity is associated with early childhood obesity, and it seems that environmental factors such as the intrauterine nutrient environment (1) and breastfeeding practice, [...]

BACKGROUND/OBJECTIVES: To identify and describe dietary patterns in Danish adults and to examine which demographic and health-related lifestyle factors are associated with dietary patterns. SUBJECTS/METHODS: Data derived from the Danish national survey of diet and physical activity collected in 2003-2008 and included 1569 men and 1785 women. Diet was assessed by a 7-day pre-coded food diary. Information on age, gender, weight, height, physical activity, smoking habits, educational level and attitudes towards healthy eating habits was derived from face-to-face interviews. Principal component analysis was applied to explore dietary patterns. Associations with lifestyle factors were examined by means of multiple regression analyses. RESULTS: Three major dietary patterns were identified: a 'traditional' pattern correlated with intake of rye bread, white bread, fat on bread, cheese, jam, cold meat, minced meat, potatoes and gravy, and cake and biscuits;a 'health-conscious' pattern correlated with coarse bread, fruit, vegetables, low-fat dairy, nuts, water and tea; and a 'fast food' pattern correlated with pizza, hamburger/spring rolls, crisps, rice and pasta, sugar-sweetened soft drinks and sweets. The 'traditional' pattern was positively associated with male gender and age, whereas the 'health-conscious' pattern was positively associated with being female, increasing age and educational level. The 'fast food' pattern was inversely associated with age and smoking. CONCLUSIONS: Three distinct dietary patterns were identified, and associated lifestyle and demographic factors were characterised. The findings are valuable in targeting future nutrition education and will enable more focused strategies in communicating food-based dietary guidelines. European Journal of Clinical Nutrition (2014) 68, 736-740; doi:10.1038/ejcn.2014.38; published online 19 March 2014, INTRODUCTION Unhealthy diet may increase risk of non-communicable diseases, such as type 2 diabetes, obesity, ischaemic heart disease and cancer. (1,2) Changing dietary habits at a population level represents a [...]

BACKGROUND/OBJECTIVES: To determine seasonal variation in vitamin D status in healthy Caucasian adolescent girls and elderly community-dwelling women living in Denmark, and to quantify the impact of sun exposure and intake on the seasonal changes in vitamin D status. SUBJECTS/METHODS: A 1-year longitudinal observational study of 54 girls (11-13 years) and 52 women (70-75 years). The participants were examined three times (winter-summer-winter). Serum 25-hydroxyvitamin D (S-25OHD) concentration and vitamin D intake were measured at each visit. Sun exposure was measured during summer. RESULTS: S-25OHD concentrations (winter, summer, winter) were median (25, 75 percentiles) 23.4 (16.5, 36.4), 60.3 (42.7, 67.7), 29.5 (22.2, 40.4) and 47.2 (27.3, 61.1), 67.3 (35.1, 79.2), 50.5 (32.7, 65.5) nmol/l for girls and women, respectively. The usual sun habits were determinant (P = 0.002) for change in vitamin D status from winter to summer. Vitamin D intake from supplements (P CONCLUSIONS: Low vitamin D status among adolescent girls and elderly women during two consecutive winter seasons, improved vitamin D status during the summer and better vitamin D status in women than in girls was found. The estimations show that a summer S-25OHD concentration ~ 100 nmol/l is needed to achieve a concentration of ~50 nmol/l the following winter. European Journal of Clinical Nutrition (2013) 67, 270-274; doi: 10.1038/ejcn.2013.3 published online 6 February 2013 Keywords: vitamin D status and intake; sun exposure; UV; adolescent girls; elderly women; season, INTRODUCTION Vitamin D is obtained through synthesis in the skin by ultraviolet (UV)B radiation and by intake from food or supplements. In Northern Europe, vitamin D status is highest during [...]

Background/Objectives: To assess the validity of a 7-day pre-coded food record (PFR) method in 9-month-old infants against metabolizable energy intake ([ME.sub.DLW]) measured by doubly labeled water (DLW);additionally to compare PFR with a 7- day weighed food record (WFR) in 9-month-old infants and 36-month-old children. Subjects/Methods: The study population consisted of 36 infants (age: 9.03 ± 0.2 months) and 36 young children (age: 36.1 ± 0.3 months) enrolled in a cross-over design of 7 consecutive days PFR vs 7 consecutive days WFR. Children were randomly assigned to one method during week 1, crossing over to the alternative method in week 2. Total energy expenditure (TEE) and [MED.sub.LW] were obtained in the 9-month-old infants using the DLW technique for 7 days while recording with PFR. Results: For the 9-month-old group, PFR showed a mean bias of + 726 kJ/day, equivalent to 24%, (P< 0.0001) compared with [MED.sub.LW] (n = 29). Using WFR as the reference in this group no between-method differences were found for energy, fat and carbohydrate. Energy intake in the 36-month-old children was 12% higher in the PFR vs WFR (P< 0.0001), and protein plus total fat intake were overestimated with the PFR (P = 0.008, P< 0.0001, respectively). Conclusions: The study indicates that the PFR may be a valuable tool for measuring energy, energy-yielding nutrients and foods in groups of 9-month-olds infants and 36-month-olds young children. European journal of Clinical Nutrition (2012) 66, 91 -96; doi: 10.1038/ejcn.2011.133; published online 10 August 2011 Keywords: pre-coded food record; validation; energy intake; doubly labeled water; energy expenditure; dietary assessment, Introduction Detailed information regarding energy and nutrient requirements during infancy and early childhood is critical to the provision of sound nutritional advice consistent with growth and development plus the prevention [...]

Background/Objectives: To outline and discuss the main results and conclusions of the European Food Consumption Validation (EFCOVAL) Project. Subjects/Methods: The EFCOVAL Project was carried out within the EU Sixth Framework Program by researchers in 11 EU countries. The activities focused on (1) the further development of the EPIC-Soft software (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) and the validation of the 2-day non-consecutive 24-HDR method using EPIC-Soft, (2) defining and investigating the applicability of the most appropriate dietary assessment method to younger age groups and expanding the applicability of the software for use in exposure assessment of some potentially hazardous chemicals and (3) to improve the methodology and statistical methods that estimate usual intake distributions from short-term dietary intake information and develop a methodology to quantify uncertainty in usual intake distributions. Results: The preexisting EPIC-Soft application was reprogrammed into a Windows environment and more than 60 new specifications were implemented in the software. A validation study showed that two non-consecutive EPIC-Soft 24-HDRs are suitable to estimate the usual intake distributions of protein and potassium of European adult populations. The 2-day nonconsecutive 24-HDRs in combination with a food propensity questionnaire also appeared to be appropriate to rank individuals according to their fish and fruit and vegetable intake in a comparable way in five European centers. Dietary intake of (young) children can be assessed by the combination of EPIC-Soft 24-HDRs and food recording booklets. The EPIC-Soft- standardized method of describing foods is useful to estimate dietary exposure to potentially hazardous chemicals such as specific flavoring substances. With the developed Multiple Source Method, repeated non-consecutive 24-HDR data in combination with food propensity data can be used to estimate the population distribution of the usual intake by estimating the individual usual intakes. Conclusions: The findings provide sufficient evidence to conclude that the repeated 24-HDR using EPIC-Soft for standardization in combination with a food propensity questionnaire and modeling of usual intake is a suitable method for pan-European surveillance of nutritional adequacy and food safety among healthy adults and maybe in children aged 7 years and older. To facilitate this methodology in other European countries, the next step is to provide and standardize an implementation plan that accounts for maintenance and updates, sampling designs, national surveillance programs, tailored capacity building and training, and linkage to food composition and occurrence databases. European journal of Clinical Nutrition (2011) 65, S102-S107; doi: 10.1038/ejcn.2011.94 Keywords: EFCOVAL; food consumption survey; 24-h dietary recall; Europe; EPIC-Soft; validation, Introduction For effective formulation and evaluation of European health and food safety policy, standardized data are required on the food consumption of the European population. At present, many member states [...]

Background/Objectives: The aim of this study was to evaluate the estimated energy, nutrient and food intake from the suggested trans-European methodology for undertaking representative dietary surveys among schoolchildren: 2 x 24-h dietary recalls (24-HDRs) combined with a food-recording booklet (FRB), using EPIC-Soft pc-program (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study), against a 7-day food-record (7-dFR) method among Danish schoolchildren. Subjects/Methods: A total of 74 children aged 7-8 years and 70 children aged 12-13 years were recruited through the Civil Registration System in Denmark. Each child and one of their parents completed two face-to-face 24-HDRs, combined with optional use of a FRB, followed by a 7-day-estimated FR. Results: Energy intake was significantly higher with the 24-HDR method than with the 7-dFR method for both age groups. Mean energy intake was 6% higher for the youngest (P = 0.02) and 11% for the oldest children (P = 0.01);underreporting of energy occurs among the oldest children, being less present with the 24-HDR method. The intakes of carbohydrate and dietary fiber (absolute and related to energy) were significantly higher with the 24-HDR than with the 7-dFR for both age groups (P< 0.001). No significant differences between the two methods were observed for absolute intake of fat and added sugar between both age groups, and for intake of protein among the 7- to 8-year olds. The percentage of energy intake from fat from the 24- HDR, however, was significantly lower for both age groups and for energy intake from added sugar for the 12- to 13-year olds. Conclusions: The 2 x 24-HDR method compared with the 7-dFR yields relatively good values on the group level for many macronutrients and foods. However, some differences in estimated intakes of macronutrients suggest the need to carefully adapt the tools to be age and country specific. There is a tendency for parents and schoolchildren to report a healthier diet with the 24-HDR than with the FRs; this results in some concern about the method and has to be studied further. European Journal of Clinical Nutrition (2011) 65, S77-S83; doi: 10.1038/ejcn.2011.90 Keywords: children; dietary survey; nutrient intake; food intake; 24-h dietary recalls; food records, Introduction Representative data on children's diet is much demanded for risk assessment as well as for nutrition policy making both at national and EU level. The 'European Food Consumption Survey [...]

Background/Objectives: The aim of this study was to evaluate the feasibility of the suggested trans-European methodology for undertaking representative dietary surveys among schoolchildren: 2 x 24-h dietary recalls (24-HDRs) combined with a food-recording booklet, using EPIC-Soft (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) pc-program. Subjects/Methods: A total of 75 children aged 7-8 years and 70 children aged 12-13 years old were recruited through the Civil Registration System in Denmark, and 57 children aged 7-8 years and 47 children aged 12-13 years were recruited through schools in Spain. Each child with one parent completed two face-to-face 24-HDRs, combined with optional use of a food- recording booklet (FRB) to be filled in by the child, a parent or other proxy persons for preparing the recalls. Feasibility was evaluated by questionnaires completed by parents, children and interviewers, and by selected data from the 24-HDRs. Results: The face-to-face interviews with the child and a parent together are confirmed as feasible. The children participated actively in the interviews, the oldest children being most active. The children, parents and interviewers agreed that children needed help from the parents, and that parents were of help to the child. In both countries, other proxy persons, such as teachers or the school cafeteria staff, were involved before the interview, and the majority of the parents and children reported that the FRB had been a help for the child during the interview. Further results point at specific needed improvements of the tools. Conclusions: The evaluated method is shown feasible in two culturally diverse European populations. However, the feasibility study also points to specific improvements of tools and data collection protocol that are strongly recommended before implementation of the method in each country of a pan-European dietary survey. European Journal of Clinical Nutrition (2011) 65, S65-S76; doi: 10.1038/ejcn.2011.89 Keywords: children; dietary survey; pan-European; 24-h dietary recalls; food recording; feasibility, Introduction The recommendation from the 'European Food Consumption Survey Method' Project (Biro et al., 2002; Brussaard et al., 2002) for a harmonized method of food intake assessment was to use [...]

Background/Objectives: The main objective of European Food Consumption Validation (EFCOVAL)-child Project is to define and evaluate a trans-European methodology for undertaking national representative dietary surveys among children in the age group of 4-14 years. In the process of identifying the best dietary assessment methodologies, experts were brought together at a workshop. The paper presents the discussion of the best available method and the final recommendations for a trans- European dietary assessment method among 4- to 14-year-old children. Subjects/Methods: The starting point was to investigate whether the method (two non-consecutive 24-h dietary recalls (24-HDRs)) suggested for the adults in European Food Consumption Survey Method (EFCOSUM) would be usable for children in the age group between 4 and 14 years. However, all available dietary assessment methods were included in the discussion to ensure that the final recommendation would be based on the best evidence. Six criteria were defined and used as additional guidance in the process. Results: The literature does not give a clear recommendation on the dietary assessment methods that are most suitable for children in the age group of 4-14 years. Nevertheless, on the basis of the literature, the recommendations were separated for preschoolers (4-6 years) and schoolchildren (7-14 years). Conclusion: For preschoolers, two non-consecutive days of a structured food record are recommended, using a (for children adapted) picture booklet and household measures for portion-size estimation. For schoolchildren, repeated 24-HDRs are recommended, using a picture booklet and household measures for portion-size estimation. In addition, the child should bring a booklet to register what is eaten out of home. One parent should assist the schoolchild at the 24-HDR interview, and therefore face-to-face interviews are required. European journal of Clinical Nutrition (2011) 65, S58-S64; doi: 10.1038/ejcn.2011.88 Keywords: EFCOVAL; children; dietary assessment method, Introduction Of the many determinants of health, diet is the one that can be improved by interventions. To assess the need for intervention and to evaluate the effect of such [...]

Background/Objectives: The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies. Subjects/Methods: Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc 'EPIC-Soft specifications questionnaire' sent to past, current and possible future users of the software;(2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop;(3) development of a technical solution for each retained specification;(4) implementation of the specifications by software developers;(5) testing and amendment of bugs. Results: A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts. Conclusions: EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere. European Journal of Clinical Nutrition (2011) 65, S5-S15; doi: 10.1038/ejcn.2011.83 Keywords: EPIC-Soft; 24-h dietary recall; software; standardization; Europe; EFCOVAL, Introduction The European Union (EU) has a major interest in harmonizing nutritional and health monitoring and surveillance systems across its member states (http://ec.europa.eu/). Although national monitoring systems already exist in [...]

Background/Objectives: The overall objective of the European Food Consumption Validation (EFCOVAL) Project was to further develop and validate a trans-European food consumption method to be used for the evaluation of the intake of foods, nutrients and potentially hazardous chemicals within the European population. Subjects/Methods: The EFCOVAL Project was carried out by 13 institutes from 11 European countries. The main activities were centered on the three main objectives of the project organized in different sub-projects. Results: In EFCOVAL, EPIC-Soft (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was reprogrammed and adapted according to prioritized specifications, resulting in a software program working under the Windows operating system. In parallel of the EPIC-Soft development, the repeated 24-HDR method using EPIC-Soft and a food propensity questionnaire was evaluated against biomarkers in 24-h urine collections and in blood samples among adults from Belgium, the Czech Republic, (the South of) France, the Netherlands and Norway. As a result from an expert workshop on a proposed dietary assessment method for children (4-12 years), the suggested method was tested in a feasibility study in Denmark and Spain among children of 4-5, 7-8 and 12-13 years. To ensure that collected data had sufficient detail in food description for the assessment of additives and contaminants to foods the EPIC-Soft databases were adapted. Finally, the EFCOVAL Consortium developed a statistical tool (Multiple Source Method) for estimating the usual intake and distribution, which has been tested using real food consumption data and compared with three other statistical methods through a simulation study. In addition, a methodology was developed to quantify uncertainty due to portion-size estimation in usual intake distributions. Conclusion: The findings of EFCOVAL provide sufficient evidence to conclude that the repeated 24-HDR using EPIC-Soft for standardization in combination with a food propensity questionnaire and modeling of usual intake is a suitable method for pan-European surveillance of nutritional adequacy and food safety among healthy adults and maybe in children aged 7 years and older. European Journal of Clinical Nutrition (2011) 65, S1-S4; doi: 10.1038/ejcn.2011.82 Keywords: EFCOVAL; food consumption survey; 24-h dietary recall; Europe; EPIC-Soft; validation, Introduction Dietary monitoring data are essential to develop and evaluate policy measures for a healthier and safer diet. In Europe, most countries conduct national food consumption surveys. The methods and [...]

In a cross-sectional study, the primary objective was to assess the plasma concentration of 25-hydroxyvitamin D (25(OH)D) in healthy 9-month-old infants (n = 255). The secondary objective was to evaluate nutritional variables and season in relation to 25(OH)D. The concentration of 25(OH)D was 77.2 ± 22.7 nmol/l (mean ± s.d.), ranging from 12 to 151 nmol/l. During the first 9 months, 97% received vitamin D supplementation (10 µg/day) and 89% had sufficient levels of 25(OH)D (50-250 nmol/l). In multiple regression analysis, controlled for body mass index (BMI) and intake of infant formula, a longer period of exclusive breastfeeding (P = 0.026) and breastfeeding at 9 months (P = 0.001) were both associated with lower levels. Dietary vitamin D intake was 4.4 ± 3.1 µg/day and in multiple regression analysis, controlled for BMI, intake of infant formula and mean energy intake, it was positively associated with 25(OH)D (P = 0.001). There was a significant seasonal difference in 25(OH)D, with higher levels during summer--autumn compared with winter--spring (P = 0.021) after control for BMI. European journal of Clinical Nutrition (2011) 65, 657-660; doi: 10.1038/ejcn.2010.285; published online 19 January 2011 Keywords: 25(OH)D; infants; season; breastfeeding; supplementation; vitamin D, Introduction Vitamin D is important for growth and development during infancy. The Danish National Board of Health recommends that term infants should be given a vitamin D supplement (10 mg/day) [...]

Potential long-term negative effects of increased vitamin D consumption are not thoroughly examined. The aim of this study was to investigate possible negative effects of vitamin D supplementation on serum lipids and lipoproteins. A 1-year long randomised double-blinded placebo-controlled intervention study with two doses of vitamin D3 (10 and 20 [micro]g/day) was carried out among 89 women (18-53 years of age) and 84 men (18-64 years of age) of Pakistani origin living in Denmark with low vitamin D status. This study did not find changes in total cholesterol, LDL-cholesterol, HDL-cholesterol, LDL-cholesterol/ HDL-cholesterol ratio, VLDL-cholesterol and triacylglycerol after daily supplementation with 10 or 20 [micro]g vitamin D for 1 year. In conclusion, increasing the vitamin D intake by 10-20 [micro]g per day for 1 year is safe for Pakistani immigrants with regards to serum lipids and lipoproteins. doi:10.1038/ejcn.2009.18; published online 8 April 2009 Keywords: vitamin D supplementation; HDL-cholesterol; LDL-cholesterol; total cholesterol; triacylglycerol; Pakistani immigrants, Introduction Increasing vitamin D intake through fortification and/or supplementation to groups in risk of deficiency is topical in most European countries. Presently, the tolerable upper intake level is set to [...]

Background/Objectives: This study evaluates the feasibility among preschoolers of the 2 x 24-h dietary recalls (24- HDRs) method combined with a food-recording booklet (FRB), using EPIC-Soft pc-program for the 24-HDR (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study). Subjects/Methods: A total of 20 and 25 (4- to 5-year-old) children were recruited, as a convenience sample, through worksites or day or healthcare in Denmark and Spain, respectively. One parent (or both parents together) completed two face-to- face 24-HDR, combined with an optional use of a FRB. Feasibility was evaluated by evaluation questionnaires completed by parents and interviewers. Results: The face-to-face interviews were primarily conducted with the mothers. The FRB was used by 90% of the participants, and proxy persons, other than the parent, were also involved; involvement of proxy persons seems necessary in a majority of the recalls in both the countries. Conclusions: The results suggest that 2 x 24-HDR with one parent combined with a FRB is feasible for registering preschoolers' diet. An FRB and/or information from proxy persons, other than the parent, is needed for a majority of the parents. In future studies, it may be beneficial to develop the FRB more like a structured food record (FR), which might, in principle, change the method to a one-day FR method from more than a 24-HDR method. It is recommended then to further investigate the use of EPIC-Soft as a data-entry tool. European journal of Clinical Nutrition (2011) 65, S84-S86; doi: 10.1038/ejcn.2011.91 Keywords: children; dietary survey; pan-European; 24-h dietary recalls; food recording; feasibility, Introduction One of the main objectives of the European Food Consumption Validation (EFCOVAL)-child Project was to develop and evaluate a trans-European methodology for undertaking representative dietary surveys among children in [...]