Given the lack of consistent evidence of the relationship between Mediterranean dietary patterns and body fat, we assessed the cross-sectional association between adherence to a modified Mediterranean diet, BMI, and waist circumference (WC). A total of 497,308 individuals (70.7% women) aged 25-70 y from 10 European countries participated in this study. Diet was assessed at baseline using detailed validated country-specific questionnaires, and anthropometrical measurements were collected using standardized procedures. The association between the degree of adherence to the modified-Mediterranean Diet Score (mMDS) (including high consumption of vegetables, legumes, fruits and nuts, cereals, fish and seafood, and unsaturated:saturated fatty acids ratio; moderate alcohol intake; and low consumption of meat and meat products and dairy products) and BMI (kg.m(-2)) or WC (cm) was modeled through mixed-effects linear regression, controlling for potential confounders. Overall, the mMDS was not significantly associated with BMI. Higher adherence to the Mediterranean diet was significantly associated with lower WC, for a given BMI, in both men (-0.09; 95% CI -0.14 to -0.04) and women (-0.06; 95% CI -0.10 to -0.01). The association was stronger in men (-0.20; 95% CI -0.23 to -0.17) and women (-0.17; 95% CI -0.21 to -0.13) from Northern European countries. Despite the observed heterogeneity among regions, results of this study suggest that adherence to a modified Mediterranean diet, high in foods of vegetable origin and unsaturated fatty acids, is associated with lower abdominal adiposity measured by WC in European men and women.
Tree nuts, peanuts and seeds are nutrient dense foods whose intake has been shown to be associated with reduced risk of some chronic diseases. They are regularly consumed in European diets either as whole, in spreads or from hidden sources (e.g. commercial products). However, little is known about their intake profiles or differences in consumption between European countries or geographic regions. The objective of this study was to analyse the population mean intake and average portion sizes in subjects reporting intake of nuts and seeds consumed as whole, derived from hidden sources or from spreads. Data was obtained from standardised 24-hour dietary recalls collected from 36 994 subjects in 10 different countries that are part of the European Prospective Investigation into Cancer and Nutrition (EPIC). Overall, for nuts and seeds consumed as whole, the percentage of subjects reporting intake on the day of the recall was: tree nuts = 4·4%, peanuts = 2·3% and seeds = 1·3%. The data show a clear northern (Sweden: mean intake = 0·15 g/d, average portion size = 15·1 g/d) to southern (Spain: mean intake = 2·99 g/d, average portion size = 34·7 g/d) European gradient of whole tree nut intake. The three most popular tree nuts were walnuts, almonds and hazelnuts, respectively. In general, tree nuts were more widely consumed than peanuts or seeds. In subjects reporting intake, men consumed a significantly higher average portion size of tree nuts (28·5 v. 23·1 g/d, P<0·01) and peanuts (46·1 v. 35·1 g/d, P<0·01) per day than women. These data may be useful in devising research initiatives and health policy strategies based on the intake of this food group.
Socially-and culturally-patterned differences in food habits exist both between and within European populations. Daily individual food availability data, collected through the national household budget surveys (HBS) and harmonized in the context of the Data Food Networking (DAFNE) project, were used to assess disparities in food habits of seven European populations and to evaluate dietary changes within a 10-year interval. The availability of selected food items was further estimated according to the educational level of the household head and, based only on the Greek HBS data, according to quintiles of the household's food purchasing capacity. Results for overall food availability support the north-south differentiation in food habits. Generally, the availability of most food items, including foods such as vegetable fats, animal lipids and sugar products, has decreased over the 10 years. Households in which the head was in the higher education categories reported lower availability for most food items, with the exception of low-fat milk, fresh fruit, animal lipids and soft drinks; the latter showing a sharp increase even within southern European households. The household's food purchasing capacity can be used as an indicator of socio-economic status, with higher values being associated with lower status. Greek households of lower social class follow a healthier diet in terms of greater availability of vegetable oils, fresh vegetables, legumes, fish and seafood. Data from the DAFNE databank may serve as a tool for identifying and quantifying variation in food habits in Europe, as well as for providing information on the socio-economic determinants of food preferences.
Recasting the role of fruit and vegetables (F&V) in the diet, and planning national and international campaigns to enhance their consumption are major public health service objectives. The present study seeks to describe F&V availability patterns in ten European countries and examine compliance with current recommendations. The mean and median F&V availability (g/person per d) was estimated based on household budget survey data retrieved from the Data Food Networking (DAFNE) databank. Low F&V consumers were identified based on WHO international recommendations (minimum combined F&V intake of about 400 g/person per d) and current conservative guidelines of a minimum daily intake of three portions of vegetables and two portions of fruit. Considerable disparities in F&V availability were found among the surveyed European populations. Only in Mediterranean countries did the mean daily population intake clearly exceed combined F&V recommendations. Dietary patterns were positively skewed in all populations studied, on account of the presence of exceptionally high values among segments of the populations. Moreover, the correlation was unexpectedly weak between the proportion of low fruit and low vegetable consumers (Spearman's correlation coefficient +0·18). More than 50 % of the households in the surveyed populations are likely to consume less than the recommended daily vegetable intake of three portions, and this applies even to the two Mediterranean populations. The efficiency of F&V promoting strategies may be enhanced if F&V are addressed separately; furthermore, interventions that would specifically focus on vegetables are probably needed.
Guarantor: E Riboli. Contributors: ER is overall coordinator of the EPIC study, which he designed and implemented in collaboration with his team at IARC and the principal investigators in the collaborating centres. NS developed the 24-h recall system and the food consumption database in collaboration with the EPIC centres. WA, NS, PF and ER constituted the writing group in charge of conducting statistical data analyses and preparing the manuscript. ALvK and JPS were in charge of laboratory analyses of carotenoids in plasma samples. The other authors supervised the collection and analysis of dietary data and the collection of blood samples in the participating study centres, and provided comments and suggestions on the final manuscript. None of the authors have any conflict of interest in carrying out this study. 30 Objective: The aim of this study was to assess the ability of a single 24-h dietary recall (24HDR) and food questionnaires (FQ) to predict plasma carotenoid levels at the ecological level by assessing the relationship between mean plasma carotenoid levels and mean intake of fruit and vegetables measured by 24HDR and FQ across 16 European regions. Design: A random subsample of 3089 subjects was included, stratified by age and gender. They provided blood samples and dietary information between 1992 and 2000 as part of the European Prospective Investigation into Cancer and Nutrition. Results: Using Spearman's correlation coefficients, the correlations between mean regional 24HDR fruit and vegetable variables and corresponding mean plasma carotenoid levels were generally higher than the correlations using FQ means. The highest correlation was between the 24HDR citrus fruit variable and beta-cryptoxanthin (r ¼ 0.90). For 24HDR, total fruits and vegetables were highly correlated with lutein, zeaxanthin, and beta-cryptoxanthin (r ¼ 0.83-0.87), while vegetables were more closely related with lutein (r ¼ 0.69) and zeaxanthin (r ¼ 0.68), and fruits correlated with zeaxanthin (r ¼ 0.87) and betacryptoxanthin (r ¼ 0.84). Root vegetables (r ¼ 0.81) and total carrots (r ¼ 0.71) were well correlated with alpha-carotene. In the multivariate models adjusting for age, body mass index, and season, and using observations of means stratified by sex and region, the association was generally higher for 24HDR compared to FQ. Conclusion: Mean regional intakes of fruits and vegetables in several European countries were closely correlated with corresponding mean plasma levels of individual carotenoids. Fruits and vegetables measured by 24HDR were generally better able to predict plasma carotenoids at the ecological level.
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