Equol, a microbial metabolite of daidzein, has been hypothesized as a clue to the effectiveness of soy and its isoflavones but is excreted by only 33% of Caucasians. Microbial and dietary factors associated with the ability to harbor equol-producing bacteria were studied in a randomized dietary intervention trial with 100 healthy postmenopausal women. After a 4-d baseline period, subjects delivered first-void urine, fecal, and breath samples. During the 5-d treatment period, 3 portions of either soymilk or soy germ containing 28.51 and 37.99 mg isoflavone aglycone equivalents/portion, respectively, were administered daily, and on the last day, 24-h urine samples were collected. The urinary recoveries of genistein and daidzein from soymilk were significantly higher than those from soy germ tablets. Because the proportion of equol:(daidzein + metabolites) in the urine did not differ between the treatment groups, subjects were pooled and classified into poor, moderate, and strong equol producers based on this criterion. The strong equol producer phenotype correlated negatively [in vivo, r = -0.478 (-0.256 to -0.893), P = 0.021; in vitro, r = -0.576 (-0.350 to -0.949), P = 0.030] with Clostridium coccoides-Eubacterium rectale counts and positively [in vivo, r = 1.158 (0.971-1.380), P = 0.048; in vitro, r = 1.156 (1.007-1.327), P = 0.039] with the abundance of sulfate-reducing bacteria. Furthermore, persons with a higher PUFA [in vivo, r = 2.150 (1.058-4.371), P = 0.034; in vitro, r = 2.131 (1.144-3.967), P = 0.017] and alcohol [in vivo, r = 1.166 (0.721-1.887), P = 0.050; in vitro, r = 1.850 (1.215-2.817), P = 0.004] intake were more likely to be strong equol producers. Finally, we validated the daidzein metabolism by fecal cultures as screening assay to identify equol producers without dietary intervention.

Objective: To evaluate the gap between food-based dietary guidelines (FBDG) and the usual food consumption in Belgium. Design and setting: Information on food intake was collected with two nonconsecutive 24 h recalls, using the validated software package EPIC-SOFT in combination with a self-administered FFQ. Habitual food intake was estimated by the Nusser method. Physical activity was evaluated according to the International Physical Activity Questionnaire. Subjects: A representative sample of the Belgian population aged 15 years and older was randomly selected from the National Register using a multistage stratified procedure. Dietary information was obtained from 3245 individuals. Results: Food intakes deviated significantly from the recommendations. In particular, fruit (118 g/d) and vegetable (138 g/d) consumption and intake of dairy and Ca-enriched soya products (159 g/d) were inadequate. Consumption of energy-dense, nutrient-poor foods (soft drinks, alcohol and snacks) was excessive (481 g/d). There were important age and gender differences. Fruit, vegetable and spreadable fat consumption was lowest, while consumption of dairy, starchy and energy-dense, nutrient-poor foods was highest among the youngest age group. Men consumed more animal and starchy foods than women, who consumed more fruits. There were only slight differences by education level. Conclusion: Food intakes differed substantially from the FBDG. Improvement of the Belgian food pattern, in particular among the youngest age group, is necessary for a better prevention of diet-related diseases. In addition, continuous or regular monitoring is crucial to permit trend analyses and to plan effective education or intervention strategies.

The objective of the present study was to assess animal and plant protein intakes in the Belgian population and to examine their relationship with overweight and obesity (OB). The subjects participated in the Belgian National Food Consumption Survey conducted in 2004. Food consumption was assessed by using two non-consecutive 24 h dietary recalls. About 3083 participants ($15 years of age; 1546 males, 1537 females) provided completed dietary information. Animal protein intake (47 g/d) contributed more to total protein intakes of 72 g/d than plant protein intake, which accounted for 25 g/d. Meat and meat products were the main contributors to total animal protein intakes (53 %), whereas cereals and cereal products contributed most to plant protein intake (54 %). Males had higher animal and plant protein intakes than females (P, 0·001). Legume and soya protein intakes were low in the whole population (0·101 and 0·174 g/d, respectively). In males, animal protein intake was positively associated with BMI (b ¼ 0·013; P¼0·001) and waist circumference (WC; b ¼ 0·041; P¼0·002). Both in males and females, plant protein intake was inversely associated with BMI (males: b ¼ 20·036; P, 0·001; females: b ¼ 20·046; P¼ 0·001) and WC (male: b ¼ 2 0·137; P,0·001; female: b ¼ 2 0·096; P¼0·024). In conclusion, plant protein intakes were lower than animal protein intakes among a representative sample of the Belgian population and decreased with age. Associations with anthropometric data indicated that plant proteins could offer a protective effect in the prevention of overweight and OB in the Belgian population. Key words: Animal protein: Plant protein: BMI: Waist circumference: ObesityIn recent decades, intakes of dietary protein have been associated with treating chronic diseases such as obesity (OB) and CVD besides improving health outcomes (1,2) . Evidence indicates that a high dietary protein intake decreases the risk of non-communicable diseases via the regulation of energy intake, increment of satiety, lowering of systolic and diastolic blood pressure, decrement of total cholesterol levels and presence of LDL-cholesterol and TAG (3 -5) . In addition, high protein intakes are associated with the prevention of the development of chronic diseases, including OB, the metabolic syndrome, CVD, type 2 diabetes, osteoporosis, and breast and prostate cancer (3,6 -10) .Findings from recent randomised controlled trials relate plant proteins to health benefits more than animal proteins (11 -19) , mainly due to factors affecting the level of hypercholesterolaemic amino acids present in plant proteins (20) . However, the debate on the potential health effects of animal protein-and plant protein-rich diets is * Corresponding author: Dr I. Huybrechts, fax þ32 9 332 4994, email inge.huybrechts@ugent.be Abbreviations: OB, obesity; OW, overweight; WC, waist circumference.

Objective: To assess the relationship(s) between overall and within-food group diversity and several indices of dietary quality, such as dietary adequacy, moderation and balance, in Belgian adults. Dietary quality indices were derived from the food-based dietary guidelines (FBDG). Design: Information on food intake was collected with two 24 h recalls. Setting: Average overall and within-food group diversity scores and dietary adequacy, moderation and balance scores were calculated. Subjects: A representative sample (n 3245) of the Belgian population at the age of 15 years and older was randomly selected from the National Register using a multistage stratified procedure. Results: For both men and women, total dietary diversity score increased with age and smokers had a significantly lower overall diversity score than non-or former smokers. A positive association was found between overall dietary diversity and both dietary adequacy and balance. For most food groups, especially bread and cereals, vegetables, dairy products and spreadable fats, within-food group dietary diversity was positively associated with the fulfilment of the specific recommendation for the intake of that food group. An inverse association was found between dietary diversity within the meat and the energy-dense, nutrient-poor food groups and dietary balance. Diversity within the dairy and spreadable fat group was responsible for the strongest increase in overall dietary adequacy and balance. Conclusions: Overall dietary diversity is a useful indicator of dietary quality in Belgium. For some food groups, within-food group dietary diversity is a useful indicator of compliance with the specific FBDG for intake of that food group.

The study provided representative data on cardiorespiratory fitness, BMI and total body fat percentage for Belgian firefighters. The findings suggest the need for a structural approach on healthy eating and regular physical exercise in firefighters.

The objectives of the present study were to assess total dietary fibre intake and the main contributors to fibre intake in the Belgian population by sex -age and sex -education groups and to investigate its relationship with BMI and waist circumference (WC). The participants of the Belgian food consumption survey (2004) were randomly selected. Information about food intake was collected using two repeated, non-consecutive 24 h recall interviews. A total of 3083 individuals ($15 years; 1546 men and 1537 women) completed both interviews. The main contributors to total fibre intake (17·8 g/d) were cereals and cereal products (34 %; 5·9 g/d), potatoes and other tubers (18·6 %; 3·3 g/d), fruits (14·7 %; 2·8 g/d) and vegetables (14·4 %; 2·6 g/d). Legume fibre intake was extremely low (0·672 %; 0·139 g/d). In all sex-age and sex -education groups, total fibre intake was below the recommendations of the Belgian Superior Health Council. Men (21 g/d) consumed significantly more fibre than women (17·3 g/d) (P,0·001). Lower educated men and higher educated women reported the highest fibre intake. A significant inverse association was found between total fibre intake and WC (b ¼ 20·118, P, 0·001). Fruit-derived fibre was positively associated with WC (b ¼ 0·731, P¼0·001). In summary, total fibre intake was inversely associated with WC, whereas fruit-derived fibre intake was positively associated with WC in the Belgian population.

Trilucent soybean oil-filled breast implants were initially announced as the ultimate prostheses for breast augmentation. However, after an increasing number of reports of local complications and hazardous metabolites attributable to lipid oxidation, first the United Kingdom Medical Devices Agency and later the Belgian National Ministry of Health urged all plastic surgeons to contact their patients and advise them to have the implants removed and, if desired, replaced with another type of prosthesis. In our plastic surgery department, 13 patients received bilateral implants with triglyceride-filled prostheses between February and July of 1996, for primary breast augmentation or replacement of previously implanted prostheses. For 12 of those 13 patients, the prostheses have been explanted, because of unilateral breast enlargement attributable to a ruptured prosthesis for five patients and following the recommendation of the Belgian National Ministry of Health for the other seven patients. Before explantation, all patients underwent standard clinical examinations, with assessments of breast shape, volume, and firmness. Blood analyses were performed, with a special focus on liver enzymes, as were urinalyses. Magnetic resonance imaging scans were obtained before explantation; for two patients, the scans revealed a fluid level separating two liquid layers in an intact prosthesis. This is the first report of such a finding. The removed implants were examined for any damage or shell deterioration and for changes in color and viscosity, the weights and volumes were measured and compared with the initial values for the implanted prostheses, and complete biochemical analyses of the accumulated fluid in cases of ruptured prostheses and of the filler material in cases of intact prostheses were performed. This small but well-documented series illustrates the multitude of problems associated with triglyceride-filled implants, including bleeding of the triglyceride filler; shell deterioration, as indicated by a loss of texture and extreme fragility of the implant (with rupture or delamination with a simple finger touch); an increase in osmotic pressure exerted by the degraded filler material; progressive weakening of the outer silicone shell, with influx of plasma proteins of up to 750 kDa, eventually resulting in rupture of the prosthesis; a lack of oxidative stability and the formation of toxic oxidation products; a lack of biocompatibility, with the formation of insoluble organic soap-like material; and a pronounced inflammatory reaction. It is concluded that the sequential and/or simultaneous occurrence of (1) implant bleeding, (2) lipid infiltration of the silicone elastomer, and (3) inflammation attributable to oxidation products provides an overall explanation or unifying hypothesis for the wide variety of adverse events related to soybean oil-filled implants.

This study aimed to explore the potential role of plant-based “dairy-like” products (PBDL) in sustainable diets. For each individual from a representative sample of French adults (INCA2 survey 2006–2007; n = 1816), a diet optimized to be more sustainable (nutritionally adequate while having a 30% reduced carbon impact with minimal change from the actual diet and isocaloric content) was modelled. The food content of the optimized diets was compared to actual diets, with a focus on PBDL and dairy products. The presented quantitative results focused on women. Optimized diets contained more plant-based products and less meats than actual diets. PBDL products were present in 7.3% and 55.7% of the subjects’ actual and optimized diets, respectively, increasing significantly from 7 to 48 g/day. Regarding dairy products, cheese decreased (−14 g/day), milk increased (+14 g/day), and yogurt remained constant (87 g/day) between the actual and optimized diets, such that the intake of this food group remained constant (214 g/day). Women for whom PBDL products were introduced as new foods in their optimized diets were found to be those with actual low energy intake (1755 kcal/d on average). As a complement to dairy products, fortified PBDL products may help to achieve more sustainable diets, especially for individuals with low energy intakes.