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The purpose of this work was to identify dietary patterns in the past using cluster analysis of reported diet in childhood, and to assess predictors for dietary patterns in relation to ethnicity in the population in the Sámi core areas in Norway. The Sámis are an indigenous population living in the border areas of Norway, Sweden, Finland and Russia.
Population-based, cross-sectional study, using self-administered questionnaires. A food-frequency questionnaire covering selected food items eaten in childhood was used. The questionnaire also provided data on ethnicity.
Subjects and setting
This study was based on data collected from 7614 subjects participating in The Population Based Study of Health and Living Conditions in Areas with a Mixed Sámi and Norwegian Population (the SAMINOR study) who grew up in the SAMINOR geographical areas, i.e. areas with mixed Sámi and Norwegian populations in Norway.
Four dietary clusters were identified: a reindeer meat cluster; a cluster with high intakes of fish, traditional fish products and mutton, in addition to food sources from the local environment; a Westernised food cluster with high intakes of meat balls and sausages; and a cluster with a high intake of fish, but not any other foods in the questionnaire. The cluster distribution differed by ethnicity, but the effect of ethnicity on diet differed by coastal and inland residence.
Our study has shown that data gathered through the limited questionnaire could be used to group the study sample into different dietary clusters, which we believe will be useful for further research on relationships between diet in childhood and health in the Sámi core areas in Norway.
To assess vitamin D status and the impact of three fish meals consisting of cod liver and fresh cod-liver oil on the plasma level of vitamin D metabolites in an area with high consumption of cod liver and cod-liver oil.
Experimental field study.
Thirty-two volunteers from the Skjervøy (70°N) municipality in northern Norway were recruited to consume three traditional mølje meals, consisting of cod, cod liver, fresh cod-liver oil and hard roe, in one week. The liver and fresh cod-liver oil consumed by the participants were weighed and recorded. Blood samples were collected before the first meal, and subsequently 12h and 4 days after the last meal. The blood samples were analysed for the vitamin D metabolites 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D). All participants answered a semi-quantitative food-frequency questionnaire, which was used to estimate usual daily nutrient intake. The study was carried out in the last part of March 2001.
The median daily vitamin D intake estimated from the questionnaire was 9.9μg. The proportion of subjects with baseline 25(OH)D level below 50nmoll−1 was 15.4% and none were below 37.5nmoll−1. Only ‘mølje consumption’ and ‘time spent in daylight’ were significantly associated with baseline log 25(OH)D. The mean total intake of vitamin D in the three servings was 272μg (standard deviation 94μg), ranging from 142 to 434μg. Relative to baseline plasma concentration, the mean level of 25(OH)D decreased slightly in both post-consumption samples (P≤0.03), while 1,25(OH)2D peaked 12h after the final meal (P = 0.03).
Three mølje meals provided, on average, an amount of vitamin D equal to 54 times the recommended daily dose. Subjects with food consumption habits that included frequent mølje meals during the winter sustained satisfactory vitamin D levels in their blood, in spite of the long ‘vitamin D winter’ (i.e. absence of ultraviolet-induced vitamin D production in the skin).
To determine the vitamin D status of middle-aged women living in the Norwegian arctic and its relationship with vitamin D intake and exposure to ultraviolet (UV) radiation.
Subjects and setting:
This study is based on measurements of 25-hydroxyvitamin D (25(OH)D) levels in a sub-sample of the Norwegian component of the EPIC biological bank, which consists of blood samples from a random selection of participants in the Norwegian Women and Cancer Study. From November 2001 until June 2002, 309 blood samples were collected from a total of 443 invited middle-aged women (44–59 years) in northern Norway (65–71°N) (crude response rate, 69.8%). Questionnaire data provided information on dietary sources of vitamin D and UV exposure.
Median plasma 25(OH)D concentration for the whole group was 55.0 nmol l−1 (range 8.1–142.8 nmol l−1). Vitamin D intake was a significant predictor of 25(OH)D status (P = 0.0003). The time of the year when the blood sample was collected significantly predicted plasma 25(OH)D level (P = 0.005). Levels of 25(OH)D were positively associated (P = 0.0002) with estimated hours per day of exposure to UV-B radiation. Residing in northern Norway during the summer prior to blood sampling was negatively associated with 25(OH)D concentration (P = 0.001). The prevalence of moderate hypovitaminosis D was highest in January–February, when a quarter of the participants had 25(OH)D concentrations ≤37.5 nmol l−1.
Increased ingestion of marine food items that provide vitamin D should be promoted and further studies should be carried out to investigate vitamin D status in arctic populations in relation to both UV exposure and traditional food sources.
To describe and compare the consumption of total fish (marine foods) and the fish sub-groups – white fish, fatty fish, very fatty fish, fish products and crustacea, in participants from the European Investigation into Cancer and Nutrition (EPIC) study.
Cross-sectional analysis of dietary intake using a computerised standardised 24-hour recall interview. Crude means, means and standard errors adjusted by age, season and day of the week were calculated, stratified by centre and gender.
Twenty-seven redefined centres in the 10 European countries participating in the EPIC study.
In total, 35 955 subjects (13 031 men and 22 924 women), aged 35–74 years, selected from the main EPIC cohort.
A six- to sevenfold variation in total fish consumption exists in women and men, between the lowest consumption in Germany and the highest in Spain. Overall, white fish represented 49% and 45% of the intake of total fish in women and men, respectively, with the greatest consumption in centres in Spain and Greece and the least in the German and Dutch centres. Consumption of fatty fish reflected that of total fish. However, the greatest intake of very fatty fish was in the coastal areas of northern Europe (Denmark, Sweden and Norway) and in Germany. Consumption of fish products was greater in northern than in southern Europe, with white fish products predominating in centres in France, Italy, Spain, The Netherlands and Norway. Intake of roe and roe products was low. The highest consumption of crustacea was found in the French, Spanish and Italian centres. The number of fish types consumed was greater in southern than in northern Europe. The greatest variability in consumption by day of the week was found in the countries with the lowest fish intake.
Throughout Europe, substantial geographic variation exists in total fish intake, fish sub-groups and the number of types consumed. Day-to-day variability in consumption is also high.
To evaluate under- and overreporting and their determinants in the EPIC 24-hour diet recall (24-HDR) measurements collected in the European Prospective Investigation into Cancer and Nutrition (EPIC).
Cross-sectional analysis. 24-HDR measurements were obtained by means of a standardised computerised interview program (EPIC-SOFT). The ratio of reported energy intake (EI) to estimated basal metabolic rate (BMR) was used to ascertain the magnitude, impact and determinants of misreporting. Goldberg's cut-off points were used to identify participants with physiologically extreme low or high energy intake. At the aggregate level the value of 1.55 for physical activity level (PAL) was chosen as reference. At the individual level we used multivariate statistical techniques to identify factors that could explain EI/BMR variability. Analyses were performed by adjusting for weight, height, age at recall, special diet, smoking status, day of recall (weekday vs. weekend day) and physical activity.
Twenty-seven redefined centres in the 10 countries participating in the EPIC project.
In total, 35955 men and women, aged 35–74 years, participating in the nested EPIC calibration sub-studies.
While overreporting has only a minor impact, the percentage of subjects identified as extreme underreporters was 13.8% and 10.3% in women and men, respectively. Mean EI/BMR values in men and women were 1.44 and 1.36 including all subjects, and 1.50 and 1.44 after exclusion of misreporters. After exclusion of misreporters, adjusted EI/BMR means were consistently less than 10% different from the expected value of 1.55 for PAL (except for women in Greece and in the UK), with overall differences equal to 4.0% and 7.4% for men and women, respectively. We modelled the probability of being an underreporter in association with several individual characteristics. After adjustment for age, height, special diet, smoking status, day of recall and physical activity at work, logistic regression analyses resulted in an odds ratio (OR) of being an underreporter for the highest vs. the lowest quartile of body mass index (BMI) of 3-52 (95% confidence interval (CD 2.91–4.26) in men and 4.80 (95% CI 4.11–5.6l) in women, indicating that overweight subjects are significantly more likely to underestimate energy intake than subjects in the bottom BMI category. Older people were less likely to underestimate energy intake: ORs were 0.58 (95% CI 0.45–0.77) and 0.74 (95% CI 0.63–0.88) for age (≥ 65 years vs. < 50 years). Special diet and day of the week showed strong effects.
EI tends to be underestimated in the vast majority of the EPIC centres, although to varying degrees; at the aggregate level most centres were below the expected reference value of 1.55. Underreporting seems to be more prevalent among women than men in the EPIC calibration sample. The hypothesis that BMI (or weight) and age are causally related to underreporting seems to be confirmed in the present work. This introduces further complexity in the within-group (centre or country) and between-group calibration of dietary questionnaire measurements to deattenuate the diet—disease relationship.
To describe the trends of self-reported past consumption of alcoholic beverages and ethanol intake from 1950 to 1995 within the European Prospective Investigation into Cancer and Nutrition (EPIC).
Data on consumption of beer/cider, wine and liqueur/spirits were obtained retrospectively at age 20, 30 and 40 years to calculate average consumption and ethanol intake for the time periods 1950–1975 (at age 20), 1960–1985 (at age 30) and 1970–1995 (at age 40). Regression analysis was conducted with the time period data to assess trends in past alcoholic beverage consumption and ethanol intake with time.
The EPIC project.
In total, 392 064 EPIC participants (275 249 women and 116 815 men) from 21 study centres in eight European countries.
Generally, increases in beer/cider consumption were observed for most EPIC centres for 1950–1975, 1960–1985 and 1970–1995. Trends in wine consumption differed according to geographical location: downward trends with time were observed for men in southern European EPIC centres, upward trends for those in middle/northern European study centres. For women, similar but less pronounced trends were observed. Because wine consumption was the major contributor to ethanol intake for both men and women in most study centres, time trends for ethanol intake showed a similar geographical pattern to that of wine consumption.
The different trends in alcoholic beverage consumption and ethanol intake suggest that information depicting lifetime history of ethanol intake should be included in analyses of the relationship between ethanol and chronic diseases, particularly in multi-centre studies such as EPIC.
The aim of this study was to compare the quantities of alcohol and types of alcoholic beverages consumed, and the timing of consumption, in centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). These centres, in 10 European countries, are characterised by widely differing drinking habits and frequencies of alcohol-related diseases.
We collected a single standardised 24-hour dietary recall per subject from a random sample of the EPIC cohort (36 900 persons initially and 35 955 after exclusion of subjects under 35 and over 74 years of age). This provided detailed information on the distribution of alcohol consumption during the day in relation to main meals, and was used to determine weekly consumption patterns. The crude and adjusted (by age, day of week and season) means of total ethanol consumption and consumption according to type of beverage were stratified by centre and sex.
Sex was a strong determinant of drinking patterns in all 10 countries. The highest total alcohol consumption was observed in the Spanish centres (San Sebastian, 41.4 g day−1) for men and in Danish centres (Copenhagen, 20.9 g day−1) for women. The lowest total alcohol intake was in the Swedish centres (Umeå, 10.2 g day−1) in men and in Greek women (3.4 g day−1). Among men, the main contributor to total alcohol intake was wine in Mediterranean countries and beer in the Dutch, German, Swedish and Danish centres. In most centres, the main source of alcohol for women was wine except for Murcia (Spain), where it was beer. Alcohol consumption, particularly by women, increased markedly during the weekend in nearly all centres. The German, Dutch, UK (general population) and Danish centres were characterised by the highest percentages of alcohol consumption outside mealtimes.
The large variation in drinking patterns among the EPIC centres provides an opportunity to better understand the relationship between alcohol and alcohol-related diseases.
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.
In total, 35 955 men and women, aged 35–74 years, participating in the EPIC nested calibration study.
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.
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.
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