OBJECTIVE:To study the effect of modified polyunsaturated fatty acid (PUFA) profiles of complementary food on long-chain (LC) PUFA composition in healthy infants.DESIGN:Double blinded, randomised, controlled intervention trial.SETTING:Dortmund, Germany.PATIENTS:Free-living sample of healthy term infants.METHODS:Participants were randomly assigned within the first 2 months of life. During the intervention period from 4 to 10 months, the control group (n = 53) received commercial complementary meals with corn oil (3.4 g/meal) rich in n-6 linoleic acid (LA), the intervention group (n = 49) received the same meals with rapeseed oil (1.6 g/meal) rich in n-3 alpha-linolenic acid (ALA). Fatty acid intake was assessed from dietary records throughout the intervention period. Fatty acid proportions (% of total fatty acid) in total plasma were analysed before and after the intervention.RESULTS:Plasma fatty acid profiles did not differ between the intervention and control groups before the intervention. During the intervention, the only difference in fatty acid intake between the intervention and control groups was a higher intake of ALA in the intervention group, 21% deriving from study food and a lower ratio of LA/ALA (10.7 vs 14.8). At the end of the intervention, the plasma proportions of total n-3 fatty acids and of n-3 LC-PUFA, but not of ALA, were higher and the ratios of n-6/n-3 fatty acids were lower in the intervention group.CONCLUSIONS:Feasible dietary modifications of the precursor fatty acid profile via n-3 PUFA-rich vegetable oil favoured n-3 LC-PUFA synthesis in the complementary feeding period when LC-PUFA intake from breast milk and formula is decreasing.

There is a lack of detailed data on fish consumption in European children and adolescents. We therefore investigated fish consumption patterns, portion sizes and estimated intakes of long-chain n-3 polyunsaturated fatty acids (PUFA; eicosapentaenoic acid, docosahexaenoic acid). From the Dortmund Nutritional and Anthropometric Longitudinally Designed study between 1985 and 2006, yearly 3-day weighed dietary records (N=7152) from 1024 subjects (2–18 years, 49% males) were evaluated. On 14% of total recorded days fish consumption from 33 different species was documented. In the total sample (in the subgroup with fish intake), mean fish intake almost doubled from 5 to 14 g per day (from 15 to 37 g per day) within the age range. Mean portions of fish increased from 40 to 89 g per portion, predominantly from low-fat fish species. In the total sample mean long-chain (LC) n-3 PUFA intake increased with age from 42 to 141 mg per day (100–324 mg per day in the subgroup with fish intake). Without any fish consumption in the recording period, n-3 LC PUFA intake ranged below 20 mg per day. Within the 20-year time frame, the frequency of fish consumption increased significantly (P<0.0282) from 35% at the start in 1985 to 40% in 2005. Fish consumption—even with low intakes as observed here—improves LC n-3 PUFA considerably. Owing to the very low preference for high-fat fish in our sample, the potential of fish intake as an LC n-3 PUFA source was not considered.

BACKGROUND AND OBJECTIVE:To provide an overview of methods used to assess food and nutrient intake, nutritional knowledge and diet-related attitudes in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS), with selected results from the feasibility study.MATERIAL AND METHODS:To assess food intake in 13- to 16-year-old adolescents, a previously developed computer-assisted and self-administered 24-h recall was adapted for international use. Food consumption data were linked to national food composition databases to calculate energy and nutrient intakes. To assess nutritional knowledge in pupils not having any special (trained) education concerning 'nutrition', a 23-item validated multiple choice questionnaire was adapted. To assess eating attitudes, behaviour and/or putative problems with body weight in adolescents, a validated inventory covering 60 questions or statements was adapted for the study. In a feasibility study, instruments, data collection and processing were tested in one school class in each of the 10 participating European cities.RESULTS AND CONCLUSIONS:The feasibility study provided plausible results, quite consistent between countries. Against this background and for the first time, standardized and uniform methodology was made available for the main study to assess and characterize dietary intake, nutritional knowledge and eating attitudes.

OBJECTIVE:Adolescents are an interesting but neglected target group in obesity prevention. We assessed the feasibility of using a diet optimization approach for computer-tailored nutrition interventions for adolescents.METHOD:Development of an optimization model based on the public health approach to diet optimization. On the basis of food frequency questionnaires (FFQ) of 48 adolescents (14-17 years) optimized diets were calculated.RESULTS:The optimization calculations for all cases resulted in individual advice. On a total of 137 items included in the FFQ, the individualized advice included changes in a minimum of 36 and a maximum of 88 items (mean: 61 items), recommendations for changes in the food items ranged from less than 1 g day(-1) up to 1660 g day(-1). In almost all cases a higher intake of fruit and vegetables was recommended; some unexpected advice was also generated (for example, to decrease the consumption of brown bread and to increase the consumption of pizza). The strengths and weaknesses of the optimized diets are discussed.CONCLUSION:Using the optimization approach is a step forward in nutrition tailoring interventions but the model used in the present feasibility study still needs to be refined.

Objective: To describe the development of a European computerized 24-h dietary recall method for adolescents, and to investigate the feasibility of self-administration (self report) by comparison with administration by a dietician (interview). Methods: Two hundred and thirty-six adolescents (mean age 14.6 years (s.d.=1.7)) of eight European cities completed the 24-h recall (Young Adolescents Nutrition Assessment on Computer (YANA-C)) twice (once by self-report and once by interview). Results: A small but significant underestimate in energy (61 (s.e.=31) kcal) and fat (4.2 (s.e.=1.7) g) intake was found in the self-reports in comparison with the interviews; no significant differences were found for the intake of carbohydrates, proteins, fibre, calcium, iron and ascorbic acid. Spearman's correlations were highly significant for all nutrients and energy ranging between 0.86 and 0.91. Agreement in categorizing the respondents as consumers and non-consumers for the 29 food groups was high (kappa statistics ⩾0.73). Percentage omissions were on average 3.7%; percentage intrusions: 2.0%. Spearman's correlations between both modes were high for all food groups, for the total sample (⩾0.76) as well as for the consumers only (⩾0.72). Analysing the consumer only, on an average 54% of the consumed amounts were exactly the same; nevertheless, only for one group ‘rice and pasta’ a significant difference in consumption was found. Conclusion: Adaptation, translation and standardization of YANA-C make it possible to assess the dietary intake of adolescents in a broad international context. In general, good agreement between the administration modes was found, the latter offering significant potential for large-scale surveys where the amount of resources to gather data is limited.

Effects of a Protein Optimized Diet Combined with Moderate Resistance Training on the Postoperative Course in Older Patients with Hip Fracture

Background. Nutritional counseling for infants has mostly been focused on breastfeeding, whereas other dietary components have been neglected. Methods. One hundred eighty-three mothers of full-term infants were randomized to three intervention groups (IG1, IG2; IG3) and one control group (IG0). The former were counseled based on the Dietary Schedule for the First Year of Life by three instruments and intensities: a telephone hotline (IG1), an additional booklet (IG2), and an additional personal telephone approach (IG3). For control, telephone interviews were conducted to evaluate the actual diet of the infants using complex dietary scores at the age of 2, 4, 6, 9 and 12 months. Results. Total diet during the 1st year of life was significantly closer to recommendations in the most intensively counseled group (IG3) than in the noncounseled group (IGO). Plausible but often not statistically significant associations between counseling intensity and compliance with recommendations were found at various age points. Conclusion. Dietary counseling during ordinary pediatric examinations in the 1st year of life is effective.

Trotz des steigenden Verzehrs von Convenience-Produkten fehlen bisher systematische Untersuchungen zu deren ernährungsphysiologischer Qualität. Aus diesem Grund wurde die seit 1985 am Forschungsinstitut für Kinderernährung Dortmund (FKE) durchgeführte DONALD-Studie (Dortmund Nutritional and Anthropometric Longitudinally Designed Study) hinsichtlich des Verzehrs von Convenience Food (CF) – hier definiert als vorgefertigte, pikante, üblicherweise warm verzehrte Produkte – bei Kindern und Jugendlichen ausgewertet. Berücksichtigt wurden 1158 Dreitage-Wiege-Ernährungsprotokolle von 514 Probanden (256 Jungen; 258 Mädchen) im Alter von 3–18 Jahren aus den Jahren 2003–2005. In 853 (74%) dieser Protokolle wurde mindestens 1 CF protokolliert. Von den 1845 CF-Produkten waren 473 (26%) Komplettmahlzeiten, 1381 (74%) Mahlzeitenkomponenten. Die 516 protokollierten CF-Produkte bestanden aus insgesamt 7367 Zutaten (durchschnittlich 14,3 Zutaten pro Produkt), darunter 1476 (20%) Aroma- oder Zusatzstoffe. Im Mittel lagen Energiedichte und Fettgehalt über den Empfehlungen für eine warme Mahlzeit in der optimierten Mischkost optimiX®.

Die Erfolgskontrolle von Beratung zur Säuglingsernährung galt bisher im Wesentlichen dem Stillen, weniger der sonstigen Ernährung.

Effects of a Protein Optimized Diet Combined with Moderate Resistance Training on the Postoperative Course in Older Patients with Hip Fracture

OBJECTIVE:To evaluate dietary fibre intake from infancy to adolescence against various reference standards expressed on a body weight, age or energy intake (EI) basis and to describe age and 15-year time trends. DESIGN AND SUBJECTS:The ongoing longitudinal (open cohort) Dortmund Nutritional and Anthropometric Longitudinally Designed Study with a total of 7810 3-day dietary records from 980 infants, children and adolescents aged 6 months to 18 years collected between 1990 and 2004. RESULTS:Absolute dietary fibre intakes (g/day) increased with age from infancy to adolescence; dietary fibre density (g/1000 kcal) reached a maximum at 1 year and remained constant after the transition to the family diet. Expressed as g/kg body weight, dietary fibre intake increased during infancy with a maximum at 1 year, but decreased thereafter during childhood and adolescence. Dietary fibre intake was low irrespective of the reference used and showed no time trends, with the exception of a small negative trend in 4-8-year olds and 9-13-year-old girls. CONCLUSION:As intake of dietary fibre in our sample was significantly associated with EI and fibre density remained constant after infancy, our data support an energy-based approach for establishing a reference value for children and adolescents.

Frequent consumption of supplements is a common behavior in adults, as well as children and adolescents. We report on vitamin intake from consuming supplements, taking into account the vitamin intake from fortified and usual foods. A total of 5990 3-d weighed dietary records from 931 German subjects (452 males, 479 females, 2-18 y of age) between 1986 and 2003 from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were evaluated. We identified 133 different vitamin-containing supplements in 451 records (7.5%). Slightly more males (8.0%) than females (7.1%) consumed supplements, with highest frequencies found between ages 15 and 18 y. For the majority (10 of 13) of vitamins (vitamin A, vitamin E, vitamin K, thiamin, riboflavin, vitamin B-6, vitamin B-12, niacin, biotin, and vitamin C), intake from usual and fortified food already reached or exceeded 80% of the recommended dietary allowances in all age groups. In the case of folate and pantothenic acid, intake from supplements was necessary to achieve at least 80% of recommended dietary allowances for half of the age groups, especially in females. Supplements with vitamin D considerably helped increase vitamin intake but failed to achieve 80% of references in almost all age groups. Intakes of vitamin A and folic acid exceeded the tolerable upper level most frequently in many age groups and were most pronounced in up to 32% and 13% of children aged 2-3 y. Intake of vitamin D, vitamin E, and vitamin C exceeded the tolerable upper level in single age groups only (<7% of subjects). For the other vitamins, no exceeded limits were identified. The ubiquitous availability of supplements might indicate that even healthy children and adolescents profit by taking them. However, it is difficult to evaluate whether consumers receive more benefits or risks from the unrestricted consumption of supplements as they are marketed today.

Overweight amongst children and adolescents is an ever increasing problem in today's society. In order to find appropriate, evidence-based solutions to this problem information on the origins and causes of this increase are required. Much of what we know today has come from observational, epidemiological studies. However, limitations inherent in the study design and data collection methodology specific to these studies, have resulted in gaps in our information, as well as in possible misinterpretations. It is methodologically very difficult to accurately measure energy consumption, especially in children and adolescents. The reasons for this lie, on the one hand, in the degree of intra- and inter-individual variability in eating behaviour, and on the other, in the negligible absolute differences in energy consumption between individuals who maintain a stable body weight and those who put on weight. The assumptions which often guide the interpretation of data appear to be inconclusive, and this fact, together with the aforementioned difficulties, creates the impression that nutrition has only a secondary role to play in the increasing prevalence of overweight. Using concrete data examples and well-known criticism of methodology we intend to show why/how the role of nutrition in the increasing prevalence of over-weight might be underestimated.

In Germany consumption of foods supplements is increasing. Results of the DONALD study have shown that about 10% of the children and adolescents consume vitamin supplements. To estimate the benefits of supplement intake, vitamins and minerals contained in conventional and fortified food are to be taken into account. Detailed recording of food intake in 3-day weighting protocols provides the necessary data. Comparable to nutrient- enriched food, supplements usually contain those vitamins, the supply of which is sufficient anyway. In 10 of 13 vitamins evaluated, no benefit of supplementation has been found. Supplemented folic acid and pantothenic acid, however, have been found beneficial especially for girls, while vitamin D supply, despite supplementation, remained below the reference values. However, intakes exceeding the tolerable upper intake levels have also been found e. g. for vitamin A and folic acids. The commercial supply of food supplements in Germany could prompt parents and adolescents to uncritically consume such products.

To determine the age at which dietary habits emerge, it is necessary to document the changes in dietary intake, beginning early in life and continuing through late adolescence, of an individual. We examined fat intake as a percentage of energy intake in 228 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study with at least ten 3-day dietary records collected yearly between 1985 and 2002 between the ages of 2 and 18 years. After defining a distance matrix with 3 criteria to measure similarity between individual fat intake trends during childhood and adolescence (=fat intake pattern), cluster analysis was used to identify groups with similar individual fat intake pattern. Cluster analysis resulted in 4 clusters consisting of 35 to 81 subjects with differences in (1) mean fat intake, (2) standard deviation of intraindividual fat intake, and (3) fat intake trends over time. No differences of sex, age, or study participation characteristics were found between clusters. Our analysis shows that cluster analysis is an appropriate tool to identify different fat intake patterns during childhood and adolescence, starting early in life.

AIM: This paper deals with some methodological aspects of data collection in the context of measuring dietary intake in individuals in their adolescence life stage.METHOD: Experiences from three partners of the HELENA project in dietary intake measurement in children and adolescents are presented in this paper with emphasis on characteristics of under-reporting, long-term diet measurement and food patterns (Dortmund DONALD group), influences of survey duration on under-reporting (Ghent group) and meal habits (Spanish AVENA group).RESULTS: Under-reporters in the DONALD Study, particularly female adolescents, had a significantly higher body mass index (BMI) than non-under-reporters; BMI could not be explained by different long-term dietary patterns during childhood and adolescence clustered according to fat consumption; consumers of fast food had higher BMI values than nonconsumers. In the Ghent experience, the decline in population mean energy intake as calculated over selected clusters of days is 184 kcal (6.5%) in boys and 116 (5.6%) in girls; the cluster of 1 recording day and the cluster of 3 recording days were not significantly different but they were both significantly different from the 7-day cluster; no significant interaction was observed between the effect of time and BMI. In the AVENA Study, the percentage of adolescents skipping breakfast was higher in females (8.6%) than in males (3.5%, P<0.001); higher BMI values were observed in those skipping breakfast than in those notskipping breakfast, but differences were statistically significant in males at 15 y and in females at 14 and 17 y; adolescents avoiding some food groups for breakfast had higher BMI values (carbohydrates, fruits and pastries in males and milk, fruits and pastries in females).CONCLUSION: Dietary and nutrient intake data in the HELENA project will be obtained by means of repeated 24-h dietary recalls. Data from HELENA might be a basis for developing complex approaches like Healthy Eating Indices.