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Background: Early applications of metabolomics in nutrition and health research identified associations between dietary patterns and metabolomic profiles. Twin studies show that diet-related phenotypes and diet-associated metabolites are influenced by genes. However, studies have not examined whether diet-metabolite associations are explained by genetic or environmental factors and whether these associations are reproducible over multiple time points., Objective: This research aims to examine the genetic and environmental factors influencing covariation in diet-metabolite associations that are reproducible over time in healthy twins., Methods: The UCD Twin Study is a semi-longitudinal classic twin study that collected repeated dietary, anthropometric, and urinary data over 2 months. Correlation analysis identified associations between diet quality measured using the Healthy Eating Index (HEI) and urinary metabolomic profiles at 3 time points. Diet-associated metabolites were examined using linear regression to identify those significantly influenced by familial factors between twins and those significantly influenced by unique factors. Cholesky decomposition modeling quantified the genetic and environmental path coefficients through associated dietary components onto the metabolites., Results: The HEI was associated with 14 urinary metabolites across 3 metabolomic profiles (r: ±0.15-0.49). For 8 diet-metabolite associations, genetic or shared environmental factors influencing HEI component scores significantly influenced variation in metabolites (β: 0.40-0.52). A significant relation was observed between dietary intakes of whole grain and acetoacetate (β: -0.50, P < 0.001) and β-hydroxybutyrate (β: -0.46, P < 0.001), as well as intakes of saturated fat and acetoacetate (β: 0.47, P < 0.001) and β-hydroxybutyrate (β: 0.52, P < 0.001). For these diet-metabolite associations a common shared environmental factor explained 66-69% of variance in the metabolites., Conclusions: This study shows that diet-metabolite associations are reproducible in 3 urinary metabolomic profiles. Components of the HEI covary with metabolites, and covariation is largely due to the shared environment., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Diet-quality scores (DQS), which are developed across the globe, are used to define adherence to specific eating patterns and have been associated with risk of coronary heart disease and type-II diabetes. We explored the association between five diet-quality scores (Healthy Eating Index, HEI; Alternate Healthy Eating Index, AHEI; MedDietScore, MDS; PREDIMED Mediterranean Diet Score, P-MDS; Dutch Healthy Diet-Index, DHDI) and markers of metabolic health (anthropometry, objective physical activity levels (PAL), and dried blood spot total cholesterol (TC), total carotenoids, and omega-3 index) in the Food4Me cohort, using regression analysis. Dietary intake was assessed using a validated Food Frequency Questionnaire. Participants ( n = 1480) were adults recruited from seven European Union (EU) countries. Overall, women had higher HEI and AHEI than men ( p < 0.05), and scores varied significantly between countries. For all DQS, higher scores were associated with lower body mass index, lower waist-to-height ratio and waist circumference, and higher total carotenoids and omega-3-index ( p trends < 0.05). Higher HEI, AHEI, DHDI, and P-MDS scores were associated with increased daily PAL, moderate and vigorous activity, and reduced sedentary behaviour ( p trend < 0.05). We observed no association between DQS and TC. To conclude, higher DQS, which reflect better dietary patterns, were associated with markers of better nutritional status and metabolic health., Competing Interests: T.E.G. is founder, stockowner and C.E.O. of Vitas; C.A.D. is founder, board member, stockowner, and consultant for Vitas Ltd. None of the other authors reports a conflict of interest.

The NOVA classification of foods proposes 4 categories: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods and drinks (UPFDs). It is argued that the latter relies heavily on modifications to foods, resulting in enhanced amounts of salt, added sugar, and fat as well as the use of additives in an attempt to make this food category highly palatable. It further argues that controlling food processing, rather than examining nutrients, should be foremost in shaping nutrition policy. This commentary challenges many of the basic arguments of using the NOVA food classification system to examine the link between food and health. We believe that there is no evidence to uphold the view that UPFDs give rise to hyperpalatable foods associated with a quasi-addictive effect and that the prevailing European Union and US data fail to uphold the assertion that UPFDs, which dominate energy intake, give rise to dietary patterns that are low in micronutrients. With regard to the use of the NOVA food classification in the development of food-based dietary guidelines, we show that the very broad definition of UPFDs makes this impossible. Finally, the available evidence does not support the view that the globalization of food is the driver of increased intakes of UPFDs in low- to middle-income countries but rather that this is driven by small indigenous companies. On balance, therefore, there seems to be little advantage from the use of the NOVA classification compared with the current epidemiologic approach, which relies on the linkage of nutrient intakes to chronic disease with subsequent identification of foods that merit consideration in public health nutrition strategies., (© 2017 American Society for Nutrition.)

I is an important mineral for health, required for the production of key thyroid hormones, which are essential for cellular metabolism, growth and physical development. Hence, adequate I is crucial at all stages of life, but imperative during pregnancy for fetal brain development and during a child's early life for neurodevelopment. Within Ireland, limited information exists on population I intakes and status. Therefore, the purposes of the present analysis were to estimate dietary I intakes and to analyse urinary iodine (UI) status using the cross-sectional National Adult Nutrition Survey 2008-2010 and the most recent Irish Total Diet Study. Median I intakes in the total population (n 1106) were adequate with only 26 % of the population being classified as below the estimated average requirement (EAR). Milk consumption was the major source of I in the diet, contributing 45 % to total intake. Likewise, median UI concentrations (107 µg/l) indicated 'optimal' I nutrition according to the WHO cut-off points. In our cohort, 77 % of women of childbearing age (18-50 years) did not meet the EAR recommendation set for pregnant women. Although I is deemed to be sufficient in the majority of adult populations resident in Ireland, any changes to the current dairy practices could significantly impact intake and status. Continued monitoring should be of priority to ensure that all subgroups of the population are I sufficient.

Childhood obesity is an issue of public health concern globally. This review reports on levels of overweight and obesity in Irish children and examines some aspects of their diet and lifestyle proposed to promote or protect against increasing body fatness in children. While there is still some debate with regard to the most appropriate cut-off points to use when assessing body fatness in children, approximately one in five Irish children (aged 2-17 years) have been classified as overweight (including obese) according to two generally accepted approaches. Furthermore, comparison with previous data has shown an increase in mean body weight and BMI over time. On examining dietary patterns for Irish children, there was a noticeable transition from a less energy dense diet in pre-school children to a more energy dense diet in older children and teenagers, associated with a change to less favourable dietary intakes for fibre, fat, fruit and vegetables, confectionery and snacks and sugar-sweetened beverages as children got older. A significant proportion of school-aged children and teenagers reported watching more than 2 h television per day (35% on school-days and 65% on week-ends) compared with 13% of pre-school children. For children aged 5-12 years, eating out of the home contributed just 9% of energy intake but food eaten from outside the home was shown to contribute a higher proportion of energy from fat and to be less fibre-dense than food prepared at home. Improvements in dietary lifestyle are needed to control increasing levels of overweight and obesity in children in Ireland.

A growing body of evidence supports the inclusion of whole grain foods in the diet to help prevent certain chronic diseases. Although much of the research has been conducted in adult cohorts, it is thought that younger populations may also benefit from whole-grain-rich diets. The aim of the present study was to quantify the intake of whole grain in Irish children and teenagers, and assess the major sources of intake. Data used in the present study were from the National Children's Food Survey and the National Teens' Food Survey, which used 7 d food diaries to collect data on habitual food and beverage consumption in representative samples of Irish children and teenagers. Results showed that over 90 % of children (5-12 years) and over 86 % of teenagers (13-17 years) are consumers of whole grain, with mean daily intakes of 18·5 and 23·2 g/d, respectively. Ready-to-eat breakfast cereals made the greatest contribution to whole grain intakes for both children and teenagers (59·3 and 44·3 %), followed by bread (14·4 and 26·5 %), with wheat being the major source of intake, accounting for over 65 % of all whole grains consumed. Whole grain consumers had significantly higher intakes of fibre, P and Mg in comparison with non-consumers of whole grain, even though whole grain intakes in this sample were well below the recommendation of three servings or 48 g/d. The present study characterises, for the first time, the patterns of whole grain consumption in Irish children and teenagers and shows whole grain intake to be low.

Objective: Pattern analysis of adolescent diets may provide an important basis for nutritional health promotion. The aims of the present study were to examine and compare dietary patterns in adolescents using cluster analysis and principal component analysis (PCA) and to examine the impact of the format of the dietary variables on the solutions., Design: Analysis was based on the Irish National Teens Food Survey, in which food intake data were collected using a semi-quantitative 7 d food diary. Thirty-two food groups were created and were expressed as either g/d or percentage contribution to total energy. Dietary patterns were identified using cluster analysis (k-means) and PCA., Setting: Republic of Ireland, 2005-2006., Subjects: A representative sample of 441 adolescents aged 13-17 years., Results: Five clusters based on percentage contribution to total energy were identified, 'Healthy', 'Unhealthy', 'Rice/Pasta dishes', 'Sandwich' and 'Breakfast cereal & Main meal-type foods'. Four principal components based on g/d were identified which explained 28 % of total variance: 'Healthy foods', 'Traditional foods', 'Sandwich foods' and 'Unhealthy foods'., Conclusions: A 'Sandwich' and an 'Unhealthy' pattern are the main dietary patterns in this sample. Patterns derived from either cluster analysis or PCA were comparable, although it appears that cluster analysis also identifies dietary patterns not identified through PCA, such as a 'Breakfast cereal & Main meal-type foods' pattern. Consideration of the format of the dietary variable is important as it can directly impact on the patterns obtained for both cluster analysis and PCA.

Over the last three decades, dietary pattern analysis has come to the forefront of nutritional epidemiology, where the combined effects of total diet on health can be examined. Two analytical approaches are commonly used: a priori and a posteriori. Cluster analysis is a commonly used a posteriori approach, where dietary patterns are derived based on differences in mean dietary intake separating individuals into mutually exclusive, non-overlapping groups. This review examines the literature on dietary patterns derived by cluster analysis in adult population groups, focusing, in particular, on methodological considerations, reproducibility, validity and the effect of energy mis-reporting. There is a wealth of research suggesting that the human diet can be described in terms of a limited number of eating patterns in healthy population groups using cluster analysis, where studies have accounted for differences in sex, age, socio-economic status, geographical area and weight status. Furthermore, patterns have been used to explore relationships with health and chronic diseases and more recently with nutritional biomarkers, suggesting that these patterns are biologically meaningful. Overall, it is apparent that consistent trends emerge when using cluster analysis to derive dietary patterns; however, future studies should focus on the inconsistencies in methodology and the effect of energy mis-reporting.

Background: Excessive energy intake and obesity lead to the metabolic syndrome (MetS). Dietary saturated fatty acids (SFAs) may be particularly detrimental on insulin sensitivity (SI) and on other components of the MetS., Objective: This study determined the relative efficacy of reducing dietary SFA, by isoenergetic alteration of the quality and quantity of dietary fat, on risk factors associated with MetS., Design: A free-living, single-blinded dietary intervention study., Subjects and Methods: MetS subjects (n = 417) from eight European countries completed the randomized dietary intervention study with four isoenergetic diets distinct in fat quantity and quality: high-SFA; high-monounsaturated fatty acids and two low-fat, high-complex carbohydrate (LFHCC) diets, supplemented with long chain n-3 polyunsaturated fatty acids (LC n-3 PUFAs) (1.2 g per day) or placebo for 12 weeks. SI estimated from an intravenous glucose tolerance test (IVGTT) was the primary outcome measure. Lipid and inflammatory markers associated with MetS were also determined., Results: In weight-stable subjects, reducing dietary SFA intake had no effect on SI, total and low-density lipoprotein cholesterol concentration, inflammation or blood pressure in the entire cohort. The LFHCC n-3 PUFA diet reduced plasma triacylglycerol (TAG) and non-esterified fatty acid concentrations (P < 0.01), particularly in men., Conclusion: There was no effect of reducing SFA on SI in weight-stable obese MetS subjects. LC n-3 PUFA supplementation, in association with a low-fat diet, improved TAG-related MetS risk profiles.

A WHO report on diet, nutrition and the prevention of chronic diseases recommended that frequency of consumption of foods and/or drinks containing free sugars should be limited to a maximum of four times per d. In addition, they recommended a reduction in the intake of free sugars to a maximum of no more than 10 % of energy intake. These recommendations were developed with the aim of reducing the prevalence of dental caries. The aim of the present study was to establish if there is a quantitative relationship between energy from added sugars and frequency of added sugars intakes in Irish children, teenagers and adults. In addition, the intake of added and total sugars and main contributors to added sugar intakes were examined. Data for the present analysis were based on the North/South Ireland Food Consumption Survey (n 1379; aged 18-64 years), the National Children's Food Survey (n 594; aged 5-12 years) and the National Teen Food Survey (n 441; aged 13-17 years) which used 7 d food diaries to collect food and beverage intake data in representative samples of Irish adults, children and teenagers respectively. Results showed that in adults, frequency of intake of added sugar intake of four times per d corresponded to a mean added sugar intake of 9 %, which was similar to the WHO recommendation. In children and teenagers, a frequency of intake of four times per d corresponded to a mean added sugar intake of 14.6 and 12.4 % respectively and was therefore not in agreement with the WHO recommendation.

Objective: To assess fat intake with particular focus on trans unsaturated fatty acid (TUFA) intake and the major sources of TUFA among Irish individuals using a Fat Intake Questionnaire (FIQ), designed specifically for an Irish context., Subjects and Methods: A total of 105 healthy volunteers (43 females, 62 males; aged 23-63 years) were recruited from Dublin Airport Medical centre, Republic of Ireland. Dietary intake was assessed using an 88 food item/food group semi-quantitative FIQ, which was developed and validated for the Irish population., Results: Mean energy intake was 10.6 MJ day(-1), and 34% was provided by fat. Saturated, monounsaturated, polyunsaturated, trans unsaturated fatty acids and linoleic acid contributed 13%, 10%, 6%, 2% and 5% of energy respectively. Mean TUFA intake was 5.4 g day(-1) (range 0.3-26). Margarine spreads provided the majority of TUFAs (1.93 g day(-1)), but the contribution was significantly greater for men compared with women (2.35 g day(-1) versus 1.33 g day(-1); P = 0.024). Milk and meat also contributed more to TUFA intake for men compared with women, but confectionery was a significantly greater contributor for women (8.6% versus 3.1% respectively, P = 0.01)., Conclusions: Although the mean TUFA intake of the total group was 5.4 g day(-1) and was within current dietary recommendations (2% energy intake), some individuals had intakes as high as 26 g day(-1). Public health efforts are therefore required to reduce TUFA intake in those individuals with high intakes.

Objectives: To estimate the intakes of cereal and dairy products and their contribution to nutrient intakes in men and women from the Republic of Ireland with a view to formulating food-based dietary guidelines., Design: The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. From this database all cereal and dairy products from recipes and identifiable sources were identified and a new database was generated from which analysis of the role of cereal and dairy products in the diet was carried out., Results: Almost 100% of the population consumed cereal and dairy products over the course of the survey week. In general, men consumed significantly more cereal and dairy products than did women (P<0.05). Cereal products made an important contribution to the mean daily intakes of energy (26%), protein (21%), fat (13%), carbohydrate (41%), fibre (45%), iron (43%) and folate (27%). Dairy products also contributed largely to the mean daily intakes of energy (11%), protein (14%), fat (17%), calcium (48%), phosphorus (24%) and vitamin A (27%). Analysis of nutrient intakes across tertiles of cereal and dairy consumption showed that high consumers of wholemeal bread, breakfast cereals, reduced-fat milk and yoghurt had lower fat and higher carbohydrate, fibre and micronutrient intakes than low consumers of these foods., Conclusions: Findings from the present study could be used to develop effective health strategies to implement changes in cereal and dairy consumption that could alter fat, fibre and micronutrient intakes in the diet.

Objectives: To analyse the temporal distribution of the intake of cereal and dairy products in the Republic of Ireland., Design: The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. The database also recorded the time and day of food consumption. Mean intakes of cereal and dairy products were calculated for time of the day and day of the week., Results: At the weekend, the percentage of consumers decreased for nearly all cereal and dairy products. White bread, total cereals, full-fat milk and total dairy intakes were significantly lower at the weekend (P<0.01) compared with weekdays. Intakes of cereal and dairy products over time of the day showed clear mealtime or snacking patterns when the number of consumers was controlled for. White bread, wholemeal bread, total cereals, full-fat milk, reduced-fat milk and total dairy intakes showed mealtime peaks for morning, afternoon and evening. When examined by tertile of intake, tertile of percentage energy from fat and tertile of fibre intake, intakes of cereal and dairy products over time of the day and day of the week were similar to trends described above, regardless of the tertile., Conclusions: Temporal analysis of the intakes of cereal and dairy products did not reveal any unusual trends in this population. However, the significant methodological issues raised in this paper will be of benefit to other aspects of research in this area.

Objectives: To examine the temporal pattern of the number of eating occasions that occurred at home, at work and outside the home, and to examine the contribution of fat to energy and the contribution of 26 food groups to fat at home and outside the home., Design and Setting: Food intake data were collected using a 7-day food diary from a random sample of 18-64-year-old adults from the Republic of Ireland (n=958). Respondents recorded the day, time and location of every eating occasion., Results: The number of eating occasions was constant across the days of the week for meals consumed at home, whereas the number of eating occasions increased at weekends for meals outside the home. The contribution of fat to energy approximated the 35% recommendation at home from Monday to Friday, but increased above this on Saturday and Sunday. The contribution of fat to energy outside the home was always above the recommendation. The food groups that contributed most to fat were similar at home and outside the home. These included butter and full-fat spreads, fresh meat, meat products, meat dishes, biscuits, cakes and pastries, whole milk, and chips and processed potatoes., Conclusion: The contribution of fat to energy was above the recommendations when eating outside the home, regardless of day of the week. A number of food groups have been identified that contributed most to fat intake outside the home and these might be targeted in developing public health nutrition strategies to reduce fat intake.

Objective: To examine energy intakes (EI), their ratio to estimated basal metabolic rate (BMR(est) and the contribution of food groups to energy intake in the North/South Ireland Food Consumption Survey., Design and Setting: Random sample of adults from the populations of Northern Ireland and the Republic of Ireland. Food intake data were collected using a 7-day food diary. Body weight and height were measured and EI/BMR(est) was calculated from reported energy intake and estimated basal metabolic rate. Dieting practices were assessed as part of a self-administered questionnaire., Results: Mean energy intake in men was 11.0 MJ and in women was 7.6 MJ, which is comparable to reported energy intakes in Northern Ireland and the Republic of Ireland over a decade ago. Mean EI/BMR(est) was 1.38. This increased to 1.42 after the exclusion of dieters and those who were unwell, but still remained less than the established cut-off of 1.53. EI/BMR(est) was significantly (P<0.05) higher in men than in women and decreased significantly (P<0.05) with increasing BMI in both sexes. The four food groups that contributed 50% of energy in men and women were meat and meat products, breads and rolls, potatoes and potato products, and biscuits, cakes, pastries and puddings., Conclusions: Energy intakes have not changed remarkably in Northern Ireland or the Republic of Ireland in the last 10 years, but the mean EI/BMR(est) of 1.38 suggests that energy underreporting occurred. EI/BMR(est) was lower in women and in the overweight/obese. Additional multivariate analysis of the data is needed to identify more clearly subgroups of the population reporting lower than expected energy intakes and to evaluate the effect of low energy reporting on the consumption of various foods and food groups.

Objective: The purpose of this survey was to establish a database of habitual food and drink consumption in a representative sample of Irish adults aged 18-64 years., Design: A cross-sectional food consumption survey was carried out. Food intake data were collected using a 7-day estimated food diary. Anthropometric data included measurements of weight, height, waist and hip circumferences and body composition using bioelectrical impedance analysis. Questionnaire data included assessments of health, lifestyle and socio-demographic status, levels of physical activity, attitudes to diet and health and restrained eating., Setting: Northern Ireland and Republic of Ireland between 1997 and 1999., Results: In total, 1379 adults aged 18-64 years participated in the survey and completed the 7-day food diary. This paper gives details of the methods used to carry out the survey. Sampling, respondent recruitment, dietary assessment, collection of anthropometric and questionnaire data and data management and analysis are described., Conclusion: The North/South Ireland Food Consumption Survey is unique in being the first food consumption survey ever to be carried out in the Republic of Ireland and Northern Ireland concurrently using the same methodology.

Objective: To describe macronutrient intakes and food sources of the adult population in the Republic of Ireland and Northern Ireland and to assess adherence of this population to current dietary recommendations., Design: A cross-sectional food consumption survey collected food intake data using a 7-day food diary., Setting: Northern Ireland and the Republic of Ireland between October 1997 and October 1999., Subjects: One thousand three hundred and seventy-nine adults aged 18-64 years (662 males and 717 females)., Results: Mean daily energy intakes in men were 11 MJ per day, 15.5% was derived from protein, 34.8% from fat, 43.5% from carbohydrate and 5.9% from alcohol. Corresponding figures for women were 7.6 MJ per day, 15.6%, 35.6%, 45.1% and 3.5%. When alcohol energy was excluded the contribution of fat and carbohydrate to energy did not differ between men and women. When compared with existing dietary recommendations, 93% of men and 86% of women had protein intakes above the Population Reference Intake. Two approaches were used to assess adherence to the fat and carbohydrate dietary recommendations: (1) the proportion of individuals in the population attaining these dietary targets and (2) the proportion of the population that was included in a 'compliers' group which had a group mean equal to these dietary targets. Thirty-three per cent of men and 34% of women met the target of 35% of food energy from fat and 78% of men and 80% of women comprised the 'compliers' group having a group mean of 35% of food energy from fat. Twenty-three per cent of men and 27% of women met the target of 50% of food energy from carbohydrate and 56% of men and 62% of women made up the 'compliers' group. Meat and meat products were the main source of fat (23%) and protein (37%), and bread and rolls (25%) were the main source of carbohydrate., Conclusion: A reduction in dietary fat intake remains an important public health issue in the Republic of Ireland and Northern Ireland. An increase in carbohydrate intake and attention to the rise in alcohol intake is also warranted.

Objectives: For effective healthy eating promotion, it is necessary to understand the attitudes towards and beliefs about nutrition of the general public. The objective of this study was to provide data on attitudes towards eating a healthy diet and the perceived need to alter eating habits from a random sample of adults in the Republic of Ireland and in Northern Ireland, using a self-administered questionnaire., Design: Cross-sectional survey using a self-administered attitudinal questionnaire on beliefs and attitudes to healthy eating., Setting: The survey was carried out between October 1997 and October 1999 in the Republic of Ireland and in Northern Ireland., Subjects: A randomly selected sample of 1256 adults from the Republic of Ireland and Northern Ireland completed the attitudinal questionnaire., Results: A majority of subjects (62%) perceived that they make conscious efforts to eat a healthy diet either most of the time or quite often, while just over half (52%) agreed that they do not need to make changes to their diet as it is healthy enough. Subjects most likely to make conscious efforts to try to eat a healthy diet were females, older subjects (51-64 years) and those with the highest intakes of fruit and vegetables and lowest quartile of fat (% food energy). When self-assessed adequacy of fruit and vegetables was examined, two-thirds of the total sample felt they ate too little fruit while just one-third felt they ate too little vegetables., Conclusion: Results of the present study, in general, revealed good agreement between attitude and behaviour with respect to healthy eating. This suggests that people appear to be reasonably accurate at evaluating their own diet in terms of how healthy it is. In terms of the two food groups examined in this study, some optimistic bias was evident for vegetables but not for fruit. It may be useful therefore to assess attitudes and beliefs about healthy eating by way of examining attitudes to such food groups individually.

Objective: A consideration of eating patterns in the general population is necessary when deriving food-based dietary guidelines (FBDG) as promoting the intake of one food may indirectly result in the increased consumption of another, which may not always be desirable. A number of issues that influence meal patterns such as temporal distribution of food intake (using data from the Netherlands), converging and diverging foods (using data from Ireland) and meals eaten inside and outside of the home (using data from the UK) are examined and discussed in the context of developing FBDG., Setting: Food intake databases from three EU countries: The Netherlands, Ireland and the UK., Results: The hot meal (dinner) was found to be the main contributor to the intake of energy and macro-nutrients in the Dutch population. It was also the main contributor to the intake of all micro-nutrients with the exception of calcium where the bread meal contributed a similar proportion as the hot meal to the intake of this micronutrient. Furthermore, fruit intake showed a very different temporal distribution to vegetable intake. Exploring the convergence of certain foods in the Irish population also revealed differences between fruit and vegetables. A low correlation was shown for consumers of fruit and vegetables indicating that being a high fruit consumer did not suggest being also a high vegetable consumer. An examination of where meals were consumed among British adults showed that 71% of all meals were consumed inside the home while 29% were consumed outside. 27% of food energy and 45% of alcohol energy was consumed out of home by the total population. In addition, those eating less of their foods out of home obtained a lower proportion of their food energy from fat and protein and a higher proportion from carbohydrate. A different demographic profile was associated with eating out compared to eating in, comprising more males and younger individuals., Conclusions: Information on patterns of food intake and food habits, specifically temporal distribution, the convergence and divergence of foods and foods consumed inside and outside of the home, give a culturally specific picture of food consumption practices within a population. This should enable the development of more culturally acceptable and realistic FBDG.

Background: The promotion of healthy eating is more likely to be effective if based on the understanding of how the elderly perceive their own diets and healthy eating., Objectives: The objectives of this study were to identify in the elderly European population, the attitudes to food, nutrition and health, in order to define adequate strategies of health promotion., Design: Cross-sectional survey using a face-to-face interview-assisted questionnaire. This project belongs to the multicentric Pan-EU Survey on Consumer Attitudes to Food, Nutrition and Health under the leadership of the Institute of European Food Studies - Dublin with the cooperation of members from all EU countries. 1843 European citizens, aged > or = 65, were interviewed. The data's descriptive analysis, was followed by univariate analysis to characterise the study's sample according to the defined objectives., Results: The most important factors influencing elderly's food choice were quality and freshness (54%), trying to eat healthy and price (8%). Healthy eating was defined as "less fat" (37%) "more fresh vegetables and fruit" (34%), and "natural foods" (11%). To stay healthy (36%), to prevent disease (26%) and to promote quality of life (10%) were the major benefits associated to healthy eating. However several barriers to the adoption of healthy eating were identified, namely self-control (27%), the resistance to change (23%) and price (15%). 86% of the elderly people believe they don't need to change their eating habits as they already eat healthily., Conclusion: Results of this study will help to improve eating habits in the elderly, as health professionals will be able to choose the most appropriate strategies for the different groups and settings, and provide a base for future interventions in European countries for this growing age group.

Objective: To determine the factors which are perceived to be important barriers to healthy eating among European adults., Design: A cross sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire., Setting: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union., Subjects: 14,331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state., Results: The study demonstrates a great variability in the perceived barriers to healthy eating between different EU countries. Lack of time was the most frequently mentioned difficulty among EU subjects for not following nutritional advice (24% of total EU sample). This barrier was frequently reported by the younger and the higher education people. Other frequently reported barriers were giving up favourite foods (23%) and willpower (18%). Thus healthy diets do not appear to be viewed as an easy or attractive alternative to current diets. There was wide geographical variation in the number of subjects mentioning price as an important barrier to healthy eating (15% in overall EU sample) ranging from less than 10% in Germany and Italy to 23% in the UK and 24% in Luxembourg.

Objective: To examine the perceived need to alter eating habits among nationally-representative samples from each member state of the European Union (EU)., Design: A cross-sectional study in which quota-controlled, nationally-representative samples of approximately 1000 adults from each country completed a face-to-face interview-assisted questionnaire., Setting: The survey was conducted between October 1995 and February 1996 in the 15 member states of the European Union., Subjects: 14,331 subjects (aged 15 y upwards) completed the questionnaire. Data were weighted by population size for each country and by sex, age and regional distribution within each member state., Results: 71% of EU subjects agreed with the statement 'I do not need to make changes to the food I eat, as it is already healthy enough'. There was wide variation between the member states ranging from 47% in Finland to 87% in Italy indicating agreement. Overall there was little difference between the sexes except in Austria, Belgium, Germany, Greece and Ireland, but the proportions of subjects agreeing with the statement generally increased with advancing age and decreased with higher levels of education. The effects of demographics were not consistent across member states. A total of 49% of EU subjects agreed with the statement 'I usually do not think of the nutritional aspects of the food I eat'. Significantly more females than males disagreed with the statement in all countries except Portugal. In all member states there were widespread beliefs that people in general should decrease their consumption of savoury snacks and increase their consumption of fruit and vegetables., Conclusions: The results of this study demonstrate that dietary advice may not be perceived as personally relevant among EU subjects. In addition important target groups for the promotion of healthy eating have been identified for example, males or subjects with low levels of education. Because of the variation in attitudes a single pan-EU healthy eating programme is unlikely to be effective for all countries or for different demographic groups.

Objective: To examine how women's dietary data can be used to formulate food based dietary guidelines for fat., Design: Dietary intake data was assessed cross-sectionally using the 7 d diet history method. Subjects were divided into quartiles on the basis of their intakes of total fat and saturated fatty acids (% energy) and the diets of those in the lowest and highest quartiles were compared., Subjects and Setting: Subjects studied were socially advantaged and disadvantaged women (n = 83, mean age 35 years) recruited from their workplaces., Results: The inverse relationship between intakes of sugar and total fat (P < 0.0001) found in this study also extended to saturated fatty acids (P = 0.0007). Women in the lowest quartile of total fat, in common with those in the lowest quartile of saturated fatty acids, were found to have higher intakes of fibre (P < 0.005), vitamin C (P < 0.01), folate (P < 0.005) and vitamin B6 (P < 0.05) while their intakes of vitamin A were lower (P = 0.01). Most (76%) of the differences in sugars intake between women of low and high total fat consumption were accounted for by added sugars, particularly non-fat containing confectionery/drink food sources where median daily intake values were 15 g vs 7 g sugars (P = 0.05) respectively. The finding that at best only 62% of the women had total fat and saturated fatty acids intake in similar quartiles, together with the differences that emerged in their food intake patterns, indicate that the goals for these nutrients may be separately achieved., Conclusion: Existing dietary data can be useful for the formulation of specific food based dietary guidelines and diets higher in sugar are not necessarily more dilute in micronutrients.

Objective: To determine whether eating patterns differ between patients with endoscopically determined functional dyspepsia and non-dyspeptic controls., Design: Case-control study (50 per group). A seven-day record of food consumption with time of food consumption was determined., Setting: Endoscopy clinic, St. James' Hospital and the Clinical Nutrition Laboratory at the Trinity College Medical School., Main Outcome Measures: Meal eating pattern and their temporal distribution; consumption of food categories and their temporal distribution; data for all subjects and for employed vs unemployed subjects., Results: There was no evidence to suggest that the pattern of food and meal intake throughout the day was in any way influenced by endoscopically determined functional dyspepsia., Conclusion: The widely held belief that patients with functional dyspepsia eat differently to healthy controls to relieve or prevent symptoms of dyspepsia is not supported by these findings.

Objective: To examine the effects of modifying meal consumption frequency on blood lipids in free-living healthy male volunteers on self-selected diets., Design: Cross-over study of snacking to non-snacking and non-snacking to snacking patterns., Setting: Civic Offices, Dublin., Subjects: 12 men with a mean (SD) eating frequency of 6.0 +/- 0.8 times per day ('snacking') and 11 men with a frequency of 3.1 +/- 0.1 meals per day ('non-snackers')., Intervention: The 'snackers' moved from 6.0 to 3.3 +/- 0.3 meal-eating occasions per day while the 'non-snackers' moved from 3.1 to 5.9 +/- 0.9 times per day. It was intended that these modifications of eating frequency would not be the cause of modified nutrient intake in the cross-over period., Main Outcome Measures: Nutrient intake, plasma total, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, plasma triglyceride and apoproteins A-I and B., Results: There was a significant treatment (cross-over) effect on plasma total cholesterol (P = 0.038), LDL cholesterol (P = 0.038), HDL/LDL cholesterol ratio (P = 0.013) and apo A-I/B (P = 0.029). There were no significant nutrient changes on moving from meal-eating to snacking but on moving from snacking to meal-eating there were significant changes (P < 0.005) in the % energy from protein, fat, saturated fatty acids and alcohol. These changes accounted for all the changes in blood cholesterol in this group. When the data for meal-eating to snacking were analysed separately, given that nutrient intakes did not change, a significant effect of altered meal-eating frequency was found for total cholesterol (P = 0.027) and HDL/LDL (P = 0.015)., Conclusion: These data on free-living subjects following normal self-selected diets support the hypothesis and the substantial related literature that more frequent meal consumption has a favourable effect on lowering plasma cholesterol and raising the HDL/LDL cholesterol ratio.