Guarantor: N Slimani. Contributors: NS was the overall coordinator of the ENDB project and in charge of the preparation of the paper in collaboration with the other co-authors. GD, JV, GS, SS, MP, IU, DATS, NS were members of the 'task force group' involving specific managerial or technical tasks for the project and/or the preparation of reference ENDB guidelines. IU was also in charge of the development of the DBMS in collaboration with the coordinating centre. SS, MP, PG, AM, JI, WB, AF, SW, EV, JU, SC and AB were involved as the national compilers in charge of documenting, compiling and evaluating the subset of their national nutrient databases used in the ENDB project. AM, JI, WB and IU were also involved as members of the 'ENDB expert group' headed by DATS, in charge of revising the reference ENDB guidelines. MN, MCB-R, CS, AT, SN, IM, JR, HB, MO, PHMP, PJ, PA, DE, EL, MS de M, AT, KG, CS, SR, AW, SB were involved as local EPIC collaborators in the supervision and preparation of EPIC-specific databases relevant to the ENDB project (e.g. recipe files). CC and MvB, at the coordinating centre, were involved in tasks relevant to these EPIC databases. AFS has provided long-standing scientific collaboration and support for setting up the ENDB. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the manuscript. Objective: This paper describes the ad hoc methodological concepts and procedures developed to improve the comparability of Nutrient databases (NDBs) across the 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). This was required because there is currently no European reference NDB available. Design: A large network involving national compilers, nutritionists and experts on food chemistry and computer science was set up for the 'EPIC Nutrient DataBase' (ENDB) project. A total of 550-1500 foods derived from about 37 000 standardized EPIC 24-h dietary recalls (24-HDRS) were matched as closely as possible to foods available in the 10 national NDBs. The resulting national data sets (NDS) were then successively documented, standardized and evaluated according to common guidelines and using a DataBase Management System specifically designed for this project. The nutrient values of foods unavailable or not readily available in NDSs were approximated by recipe calculation, weighted averaging or adjustment for weight changes and vitamin/mineral losses, using common algorithms. Results: The final ENDB contains about 550-1500 foods depending on the country and 26 common components. Each component value was documented and standardized for unit, mode of expression, definition and chemical method of analysis, as far as possible. Furthermore, the overall completeness of NDSs was improved (X99%), particularly for b-carotene and vitamin E. Conclusion: The ENDB constitutes a first real attempt to improve the comparability of NDBs across European countries. This methodological work will provide a useful tool for nutri...

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Background: Dietary supplement use is increasing, but there are few comparable data on supplement intakes and how they affect the nutrition and health of European consumers. The aim of this study was to describe the use of dietary Correspondence: G Skeie, Institute of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway. E-mail: Guri.Skeie@uit.no Guarantor: G Skeie Contributors: GS performed statistical analyses and wrote the article. NS was the overall coordinator of this project and of the EPIC nutritional databases (ENDB) project. GS, ML, PA, PJ, VP, AP, EMN, KA, TP, MN, MT, KN, JH, LW, ES, AO, SN, VH, GD, CC, DE contributed to the reclassification of data from their respective countries, and gave input on statistical analyses, interpretation of results and drafting of the article. TB, AH, HV, PW, MCBR, PF, EL, NS gave input on the statistical analyses, interpretation of results and drafting of the manuscript. The other co-authors were local EPIC collaborators involved in the design of the study and data collection. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the article and approved the final version. Results: Between countries, the mean percentage of dietary supplement use varied almost 10-fold among women and even more among men. There was a clear north-south gradient in use, with a higher consumption in northern countries. The lowest crude mean percentage of use was found in Greece (2.0% among men, 6.7% among women), and the highest was in Denmark (51.0% among men, 65.8% among women). Use was higher in women than in men. Vitamins, minerals or combinations of them were the predominant types of supplements reported, but there were striking differences between countries. Conclusions: This study indicates that there are wide variations in supplement use in Europe, which may affect individual and population nutrient intakes. The results underline the need to monitor consumption of dietary supplements in Europe, as well as to evaluate the risks and benefits.

Objective: To compare the average out-of-home (OH) consumption of foods and beverages, as well as energy intake, among populations from 10 European countries and to describe the characteristics of substantial OH eaters, as defined for the purpose of the present study, in comparison to other individuals. Design: Cross-sectional study. Dietary data were collected through single 24-hour dietary recalls, in which the place of consumption was recorded. For the present study, substantial OH eaters were defined as those who consumed more than 25% of total daily energy intake at locations other than the household premises. Mean dietary intakes and the proportion of substantial OH eaters are presented by food group and country. Logistic regression analyses were used to estimate the odds of

and Sweden. They were compared from the point view of availability, de®nition, analytical methods, and mode of expression of the nutrients of interest for EPIC, and it was seen that most of the nutrients in the tables are analysed and expressed in a compatible way. For some nutrients, however, common methods and de®nitions (folate, dietary ®bre), or modes of expression (energy, protein, carbohydrates, carotenes, vitamin A and E) have not yet been agreed upon, so values are not comparable. For vitamin C a wide range of values are found due to the high natural variation in foods. For compiled tables, an additional problem is the use of several sources which may mean that the nutritional values are not comparable within the same table; and these values cannot be converted if the source is not stated. In addition, some tables were compiled using food composition values produced over 20 years ago with outdated analytical methods. In view of the inconsistent values for some nutrients and due to the large amount of foods reported within EPIC, it was concluded that standardised food composition tables have to be developed for the nine European countries involved in EPIC in order to provide comparable nutrient intake data.

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Until recently, the study of nutrient patterns was hampered at an international level by a lack of standardization of both dietary methods and nutrient databases. We aimed to describe the diversity of nutrient patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) study at population level as a starting point for future nutrient pattern analyses and their associations with chronic diseases in multi-center studies. In this cross-sectional study, 36,034 persons aged 35-74 y were administered a single, standardized 24-h dietary recall. Intake of 25 nutrients (excluding intake from dietary supplements) was estimated using a standardized nutrient database. We used a graphic presentation of mean nutrient intakes by region and sex relative to the overall EPIC means to contrast patterns within and between 10 European countries. In Mediterranean regions, including Greece, Italy, and the southern centers of Spain, the nutrient pattern was dominated by relatively high intakes of vitamin E and monounsaturated fatty acids (MUFA), whereas intakes of retinol and vitamin D were relatively low. In contrast, in Nordic countries, including Norway, Sweden, and Denmark, reported intake of these same nutrients resulted in almost the opposite pattern. Population groups in Germany, The Netherlands, and the UK shared a fatty acid pattern of relatively high intakes of PUFA and SFA and relatively low intakes of MUFA, in combination with a relatively high intake of sugar. We confirmed large variability in nutrient intakes across the EPIC study populations and identified 3 main region-specific patterns with a geographical gradient within and between European countries.

Objectives: To assess the contribution of out-of-home (OH) energy and nutrient intake to total dietary intake, and to compare out-versus in-home nutrient patterns among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 participants aged between 35-74 years completed a standardized 24-h dietary recall using a software programme (EPIC-Soft) that recorded the place of food/drink consumption. Eating OH was defined as the consumption of foods and beverages anywhere other than in household premises, irrespective of the place of purchase/ Correspondence: P Orfanos, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Mikras Asias 75, Goudi, Athens 11527, Greece. E-mail: orfanos@nut.uoa.gr Guarantor: A Trichopoulou. Contributors: PO was the coordinator for the analyses conducted in this paper and for drafting the article. NS was the overall coordinator of this project and of the EPIC nutritional databases (ENDB) project. AN, AT, SG, JMA-B, MvB and UE, as members of the working group on 'Eating out and nutrient intakes', gave input on statistical analyses, interpretation of results and drafting of the article. The other co-authors were local EPIC collaborators involved in data collection and documentation and in compiling and evaluating the subset of their national nutrient databases used in the ENDB. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the article and approved the final version. preparation. Nutrient intakes were estimated using a standardized nutrient database. Mean intakes were adjusted for age and weighted by season and day of recall. Results: Among women, OH eating contributed more to total fat intake than to intakes of protein and carbohydrates. Among both genders, and particularly in southern Europe, OH eating contributed more to sugar and starch intakes and less to total fibre intake. The contribution of OH eating was also lower for calcium and vitamin C intakes. The composition of diet at home was different from that consumed out of home in southern countries, but was relatively similar in the north. Conclusions: In northern Europe, OH and in-home eating are homogeneous, whereas southern Europeans consider OH eating as a distinctive occasion. In most centres, women selected more fat-rich items when eating out.