OBJECTIVE: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. SUBJECTS: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study. RESULTS: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. CONCLUSIONS: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.
OBJECTIVE: To evaluate dietary quality of European and American elderly subjects using different derivatives of dietary patterns (dietary scores and clusters) and to investigate the relationship of these approaches to nutritional and lifestyle factors. DESIGN: Data from the cross-sectional SENECA baseline study and Framingham Heart Study (original cohort and offspring) were used for data analysis. Food intake data were summarised into dietary clusters and into dietary scores (Healthy Diet Indicator and Mediterranean Diet Score). These measures of dietary quality were then tested for associations with lifestyle factors and measures of nutritional status. SUBJECTS/SETTING: The study population, aged 70-77 y, consisted of 828 subjects from Framingham, MA (USA) and 1282 subjects from the following European centres: Hamme, Belgium; Roskilde, Denmark; Padua, Italy; Culemborg, The Netherlands; Vila Franca de Xira, Portugal; Betanzos, Spain; and Yverdon, Burgdorf and Bellinzona, Switzerland. RESULTS: Dietary intake varied widely across the European and American research centres. In general, Southern European centres and Framingham had higher mean diet scores, indicating a higher dietary quality, than Northern European centres (MD-scores: 4.2-4.4 vs 2.7-3.5). Cluster analysis identified the following five dietary patterns characterised by: (1) sugar and sugar products; (2) fish and grain; (3) meat, eggs and fat; (4) milk and fruit; and (5) alcohol intake. The meat, eggs and fat pattern had significantly lower average dietary quality, as measured with all three diet scores than all other groups except the alcohol group. The fish and grain group had significantly better Mediterranean diet scores than all other groups. CONCLUSIONS: Dietary scores and dietary clusters are complementary measures to classify dietary quality. The associations with nutritional and lifestyle factors indicate the adequate categorisation into dietary quality groups. SPONSORSHIP: European Union, US Department of Agriculture, Agriculture Research Service, under agreement (58-1950-9-001), Haak Bastiaanse-Kuneman Foundation.
Dehydration is a common fluid disorder which occurs in residents, hospitalised and community-dwelling elderly people. In this study the intake of water and fluids of community-dwelling elderly Europeans is presented in relation to risk factors of dehydration: mental state, ability to perform activities of daily living (ADL), medicine use and body composition. As part of the SENECA-study of 1993, data were collected from a random age-stratified sample (birth cohorts 1913-1918) of inhabitants of small traditional towns in Europe. Food intake data were collected by using the dietary history method. The study population consisted of 629 men and 696 women of the following towns: Hamme/Belgium, Roskilde/Denmark, Haguenau/France, Romans/France, Padua/Italy, Culemborg/the Netherlands, Lisbon/Portugal, Yverdon/Switzerland, Marki/Poland and Ballymoney-Limavady-Portstewart/Northern Ireland/United Kingdom. Fluid intake of elderly people varied between the towns of Europe and between men and women. A high percentage of the female population had a water intake below the cut-off value of 1,700 g. In most towns about 70 percent of daily water intake came from the food groups 'Milk products', 'Alcoholic drinks', 'Juices' and 'Other non-alcoholic drinks'. The consumption of 'Other non-alcoholic drinks' contributed most to daily fluid intake. In the total female population, women with the lowest water intake (first tertile) scored negatively on factors influencing fluid intake (mental state, ADL) in comparison to women of the second and third tertile. However, in the distinct towns no unequivocal relationship emerged between those factors and fluid intake. Yet, women were found to be at higher risk of dehydration because of much lower water intakes than men and because of the overall relationship between a low fluid intake and a poor mental state and ADL problems.
As part of the Euronut SENECA study, food consumption has been assessed in 1217 men and 1241 women, born between 1913 and 1918 and living in 18 towns in 12 European countries. The method used was a standardized modified dietary history, including a 3-day estimated record and a food frequency list based on local food patterns. Intakes of energy, protein, fat, carbohydrate, fatty acids, cholesterol and alcohol are described in this paper. As expected, a difference between men and women in energy and nutrient intake was observed in all towns. There was a great variation between towns in mean dietary intakes of all dietary components. Mean energy intake of men ranged from 12.7 MJ in Marki (Poland) to 8.2 MJ in Yverdon (Switzerland) and Chateau Renault-Amboise (France). For women the range was from 10.9 MJ in Marki (Poland) to 6.3 MJ in Yverdon (Switzerland) and Vila Franca de Xira (Portugal). A geographical pattern can be detected for the intake of fatty acids. Intakes of saturated fat were lower in southern than in northern European towns. The calculated ratio for intakes of unsaturated and saturated fatty acids (polyunsaturated fatty acids plus monounsaturated fatty acids/saturated fatty acids) for all participants was higher in the southern European centres than in the northern centres and ranged from 2.7 in Markopoulo (Greece) to 1.2 in Elverum (Norway) and Marki (Poland). Alcohol consumption was considerable higher in men than in women. In men a north-south gradient in alcohol intake can be detected, with the highest intake in the two centres in Italy, where, on average 11% of energy intake was derived from alcohol.
OBJECTIVE: To assess longitudinal changes in intakes of energy and macronutrients in elderly Europeans. DESIGN: Longitudinal study including a dietary assessment in 1988/1989, which was repeated in 1993. SETTING: Serial data were collected in nine European towns: Belgium: Hamme (H/B); Denmark: Roskilde (R/DK); France: Haguenau (H/F) and Romans (R/F); Italy: Padua (P/I); the Netherlands: Culemborg (C/NL); Portugal: Vila Franca de Xira (V/P); Spain: Betanzos (B/E) and Switzerland: Yverdon (Y/CH). In other centres dietary intake data were collected in 1993 only: Portugal: Coimbra (C/P); Poland: Marki (M/PL); Northern Ireland: Ballymoney-Limavady-Portstewart (BLP/NI/UK) and United States: Mansfield (Connecticut) (M/CT/USA). SUBJECTS AND METHODS: Using standardized methodologies, data were collected from a random stratified sample of elderly men and women born between 1913 and 1918. In 1993 dietary intake data were collected from 1125 subjects by a modified validated dietary history method. RESULTS: Over the 4-year study period, a decline in mean energy intake of one MJ or less per day was observed in most towns, which was significant (P