Dutch National Food Consumption Survey Research Articles

Assessment of the prevalence of inadequate iron intakes in premenopausal females based on the reference values of the European Food Safety Authority using cross-sectional food consumption data

BackgroundThe iron intake requirement distribution for premenopausal females is not symmetric, which invalidates the EAR (Estimated Average Requirement) cut-point approach for assessing prevalence of iron inadequacy. Therefore, Beaton’s Full Probability Approach (PA) must be used. While the PA requires information on the entire iron intake requirement distribution, the European Food Safety Authority (EFSA) only provided the EAR (50th percentile), 90th, 95th (PRI) and 97.5th percentiles. ObjectiveThis study aimed to reliably estimate the prevalence of iron inadequacy in premenopausal females using the PA, based on the intake requirements established by EFSA and compare the results with those obtained from the EAR cut-point method. MethodsHabitual iron intakes were calculated using Statistical Program to Assess Dietary Exposure (SPADE) with data from 484 females (20-45 y) from the Dutch National Food Consumption Survey 2012-2016. Iron requirement of EFSA (including additionally obtained information) were applied. Results from the PA were compared to results obtained with the EAR cut-point method. Sensitivity analyses examined the impact of lower iron intake distributions on differences in estimated inadequate intakes between PA and EAR-cut point method. ResultsA twofold higher prevalence of iron inadequacy among Dutch premenopausal females was observed when employing the PA compared to the EAR cut-point method, using EFSA’s reference values. Sensitivity analysis showed that the EAR cut-point method could also result in large overestimations for populations with lower intake distributions. ConclusionsThis study provided an example for using the PA method by using additionally derived information on the full requirement distribution underlying EFSA’s reference values. Results showed once more the unsuitability of the EAR cut-point method to calculate the prevalence of iron inadequacy in premenopausal females. Hence, we recommend that institutions deriving dietary reference values provide all information needed to use the correct method to determine inadequate intakes in the population.

A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study.

In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3% men and n=107, 50.7% women) had plausible recording days. Of all recorded food items, 12.8% (114/894) were entered via food barcode scanning, and 18.9% (169/894) were searched at the brand level. For 31% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95% limits of agreement were 14 kcal (-1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients.

The Nutritional Benefit of UV-Exposed Mushrooms for the Dutch Population: Modeling the Addition of UV-Exposed Mushrooms to the Diet

BackgroundMushrooms are rich in fiber and vitamins B and vitamin D when exposed to UV light and are sometimes used as a meat substitute. A modeling study showed that adding a mushroom portion (84 g/d) to the diet of an American population caused a significant improvement in the intake of several nutrients. ObjectiveTo study the association between habitual intake of mushrooms and nutrient intake and to assess the change in micronutrient intake with the modeled addition of 60 or 84 grams of UV-exposed mushrooms to the diet of the Dutch population, with a subanalysis on subjects with a low animal: plant protein ratio. MethodsA modeling study was conducted in 3121 Dutch persons aged 9-80 y, using cross-sectional data from the Dutch National Food Consumption Survey 2012-2016. Linear regression was used to explore the association between habitual intake of mushrooms and nutrients. Habitual intake and nutritional adequacy were calculated before and after the modeled addition of mushrooms. ResultsA small association was observed between the habitual intake of mushrooms and the intake of copper, niacin, and vitamin B2 (beta ranging from 0.002 to 0.039). The modeled addition of UV-exposed mushrooms increased the intakes of plant protein (by 5–7%), fiber (4–6%), niacin (10–20%), vitamin D (176–388%), folate (11–17%), potassium (6–10%), and copper (29–48%). Nutritional adequacy also improved significantly. For subjects with a low animal:plant protein ratio, the added mushrooms increased the intakes of niacin (11–22%), potassium (6–11%), and vitamin D (190–445%). ConclusionsConsumption of mushrooms contributes to higher intakes of copper, niacin, and vitamin B2. Addition of UV-exposed mushrooms to the diet of the Dutch further improves nutrient intakes and, most notably, vitamin D, especially for people with low animal food consumption.

Prevalence of Undernutrition in Community-Dwelling Older Adults in The Netherlands: Application of the SNAQ65+ Screening Tool and GLIM Consensus Criteria.

The aim of this study was to provide recent data on the prevalence of undernutrition based on screening and diagnosis in Dutch community-dwelling older adults. The data from the 2021 to 2022 examination wave from the Longitudinal Aging Study Amsterdam (n = 1138) and the Dutch National Food Consumption Survey 2019-2021 (n = 607) on community-dwelling men and women aged 65 years and older were used. The prevalence of undernutrition was based on a positive score on the Short Nutritional Assessment Questionnaire 65+ (SNAQ65+) screening tool, a positive diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria and their combination. Of the combined sample (n = 1745), the mean age was 74 (SD 6) years, where 16.7% were aged 80 years or older, 50.5% was female, 56.9% had a high education level, and 30.3% lived alone. The prevalence of undernutrition based on the SNAQ65+ screening in the combined sample was 8.5% (95% CI 7.3-9.9%). In the subgroup of LASA participants with complete data on all GLIM criteria (n = 700), the prevalence of undernutrition was 5.4% based on SNAQ65+ and 7.1% based on GLIM. A positive SNAQ65+ screening followed by a positive GLIM diagnosis resulted in a lower prevalence (3.1%). Being female, older, living alone, receiving formal home care, and having poor self-rated health, poor appetite, or mobility limitations, they were all associated with a higher prevalence, with more than two-fold higher prevalence rates in some subgroups. The results show that currently one out of twelve community-dwelling adults aged 65 years and older is undernourished based on the SNAQ65+ screening, and one out of fourteen is undernourished based on the GLIM diagnosis criteria. Awareness is needed to increase early recognition and treatment in community and primary care, especially among the more vulnerable groups.

Micronutrient intakes in the Dutch diet: foods, fortified foods and supplements in a cross sectional study

PurposeThis study investigates intakes of risk micronutrients from non-fortified foods, fortified foods and food supplements in different age and gender sub-groups of the Dutch population.MethodsThis is a secondary analysis of the Dutch National Food Consumption Survey (DNFCS 2012–2016, N = 4313, 1–79 years). The proportion of the population with Habitual Intakes below the Estimated Average Requirement (EAR) and above the Upper Level (UL) for calcium, iron, zinc, vitamin A, vitamin B6, folate, vitamin D and vitamin E from non-fortified foods, fortified foods and total intake including food supplements was calculated using Statistical Program to Assess Dietary Exposure (SPADE).ResultsMore than 50% of the population had an intake below the EAR for calcium, iron, vitamin D and folate. Intakes were inadequate for certain sub-groups for the other vitamins and minerals. Adolescents and women were the population sub-groups most likely to have an intake below the EAR. For zinc, vitamin A and folic acid, more than 1% of toddlers exceeded the UL from the total intake. A negligible proportion exceeded the UL for the other vitamins and minerals.ConclusionInadequate intakes were found for several micronutrients in various population sub-groups despite an apparently well-nourished population. Intakes of zinc, folic acid and vitamin A from food supplements in toddlers and preschoolers should be investigated further to ensure they do not exceed recommended amounts. These results can be used to inform policy makers and to design nutritional interventions to improve micronutrient intakes in the Netherlands.

Shifting towards optimized healthy and sustainable Dutch diets: impact on protein quality

PurposeTo reduce the environmental impact of Western diets, a reduction of meat consumption and a substitution by plant-based protein sources is needed. This protein transition will affect the quantity and quality of dietary protein. Therefore, the aim of this study was to evaluate the protein adequacy of diets optimized for nutritional health and diet-related greenhouse gas emission (GHGE).MethodsData from 2150 adult participants of the Dutch National Food Consumption Survey were used, with diet assessed using two non-consecutive 24 h dietary recalls. Utilizable protein of current diets per day was based on meal composition and the Protein Digestibility-Corrected Amino Acid Score and was compared to protein requirements. Optimized diets were derived as linear combinations of current diets that minimized GHGE and maximized the Dutch Healthy Diet 2015 score, with/without constraints to keep dietary change within 33% of current consumption. Protein adequacy was evaluated in both current and optimized diets.ResultsIn all age and gender strata, the healthiest diets had higher GHGE, the most sustainable diets had the lowest dietary quality, though higher than current diets, and protein adequacy remained sufficient. When limiting dietary change to 33% of current consumption, in the most promising trade-off diet GHGE was reduced by 12–16%. The current diet provided 1.4–2.2 times the required amount of utilizable protein.ConclusionThese results suggest that a realistic aim for the next decade might be to reduce diet-related GHGE to 12–16% of the current levels without compromising protein adequacy and diet quality. To achieve global targets, upstream food system transformations are needed with subsequent dietary changes.

The cost of healthy versus current diets in the Netherlands for households with a low, middle and high education

The cost of food is an important driver of food choice and most evidence suggests that healthier diets are more costly than less healthy diets. However, current attempts to model the cost of healthy and current diets do not take into account the variation in diets or food prices. We calculated the differential cost between healthy and current diets for households with a low, medium and high education in the Netherlands using the DIETCOST program. The DIETCOST program accounts for variations in dietary patterns and allows for the calculation of the distribution of the cost of bi-weekly healthy and current household diets. Data from the Dutch National Food Consumption Survey 2012–2016 was used to construct commonly consumed food lists for the population as a whole and for households with a low, medium and high education and linked to a local food price database. The average cost of current household diets was €211/fortnight (SD 8.9) and the healthy household diet was on average €50 (24%) more expensive. For households with a low, medium and high education, healthy diets were on average 10% (€17), 26% (€50) and 36% (€72) more expensive compared to current diets, respectively. All healthy diets could be classified as affordable (i.e. requiring less than 30% of the average disposable income) as diets required around 20% of the income. To conclude, while healthy diets were found to be affordable, we found that these were more expensive than current diets, especially for those with a higher educational level. This suggests that individuals will need to spend more money on food if they aim to adhere to dietary guidelines under the assumption that they will minimally adjust their diet. Bridging the gap between the cost of healthy and less healthy foods could be an important strategy for improving population diets.

Clusters of lifestyle behaviours and their associations with socio-demographic characteristics in Dutch toddlers

PurposeThis study aimed to identify clusters of lifestyle behaviours in toddlers and assess associations with socio-demographic characteristics.MethodsWe used data from the Dutch National Food Consumption Survey 2012–2016 and included 646 children aged 1–3 years. Based on 24-h dietary recalls and a questionnaire, a two-step cluster analysis was conducted to identify clusters in the intake of fruit, vegetables, sugar-sweetened beverages and unhealthy snacks, physical activity and screen time. Logistic regression models assessed associations between socio-demographic characteristics and cluster allocation.ResultsThree clusters emerged from the data. The ‘relatively healthy cluster’ demonstrated a high intake of fruit and vegetables, low sugar-sweetened beverage and unhealthy snack intake and low screen time. The ‘active snacking cluster’ was characterised by high unhealthy snack intake and high physical activity, and the ‘sedentary sweet beverage cluster’ by high intake of sugar-sweetened beverages and high screen time. Children aged 1 year were most likely to be allocated to the ‘relatively healthy cluster’. Compared to children of parents with a high education level, children of parents with a low or middle education level were less likely to be in the ‘relatively healthy cluster’, but more likely to be in the ‘sedentary sweet beverage cluster’.ConclusionClusters of lifestyle behaviours can be distinguished already in children aged 1–3 years. To promote healthy lifestyle behaviour, efforts may focus on maintaining healthy behaviour in 1-year-olds and more on switching towards healthy behaviour in 2- and 3-year-olds.

Consumption of young child formulae in the Netherlands

PurposeAdequate micronutrient intakes are essential for young children. Special young child formulae (YCF) intended for children from 1 year old are available in the Dutch market. Since YCF are enriched with many micronutrients, it has the potential to have a beneficial effect on young children, or might pose a risk on excessive micronutrient intakes. The current study investigated the characteristics of YCF users, and the effect of YCF use on micronutrient intakes.MethodsData from the Dutch National Food Consumption Survey (2012–2016; n = 440 children aged 1–2 year old) and the Dutch Food Composition Database (NEVO version 2016) were used to assess micronutrient intakes. Habitual intakes of users and non-users of YCF were calculated using Statistical Program to Assess Dietary Exposure (SPADE) and compared.ResultsIn the Netherlands, YCF was consumed by 21% of the 1–2-year-olds. YCF contributed mostly to total vitamin D intake (76%) and between 0 and 50% for other micronutrients. Higher vitamin A, B1, C, D, E, total folate, iron and zinc intakes were observed among users, and higher potassium and phosphorus intakes were found among non-users. Risk of inadequate intake was low among both users and non-users for most nutrients, and the only elevated risk of excessive intake found was for zinc among YCF users.ConclusionYCF increased micronutrient intake, however, for most of the micronutrients there is already a low risk of inadequate intake. YCF increased the risk of excessive zinc intake. It is important that the addition of micronutrients to YCF is regulated, to prevent excessive intake.

Evaluation of foods, drinks and diets in the Netherlands according to the degree of processing for nutritional quality, environmental impact and food costs

ObjectiveThis study investigates nutritional quality, environmental impact and costs of foods and drinks and their consumption in daily diets according to the degree of processing across the Dutch population.DesignThe NOVA classification was used to classify the degree of processing (ultra-processed foods (UPF) and ultra-processed drinks (UPD)). Food consumption data were derived from the Dutch National Food Consumption Survey 2012–2016. Indicators assessed were nutritional quality (saturated fatty acids (SFA), sodium, mono and disaccharides (sugar), fibre and protein), environmental impact (greenhouse gas (GHG) emissions and blue water use) and food costs.SettingThe Netherlands.ParticipantsFour thousand three hundred thirteen Dutch participants aged 1 to 79 years.ResultsPer 100 g, UPF were more energy-dense and less healthy than unprocessed or minimally processed foods (MPF); UPF were associated with higher GHG emissions and lower blue water use, and were cheaper. The energy and sugar content of UPD were similar to those of unprocessed or minimally processed drinks (MPD); associated with similar GHG emissions but blue water use was less, and they were also more expensive. In the average Dutch diet, per 2000 kcal, ultra-processed foods and drinks (UPFD) covered 29% (456 g UPF and 437 g UPD) of daily consumption and 61% of energy intake. UPFD consumption was higher among children than adults, especially for UPD. UPFD consumption determined 45% of GHG emissions, 23% of blue water use and 39% of expenses for daily food consumption. UPFD consumption contributed 54% to 72% to daily sodium, sugar and SFA intake.ConclusionsCompared with unprocessed or minimally processed foods and drinks, UPF and UPD were found to be less healthy considering their high energy, SFA, sugar and sodium content. However, UPF were associated higher GHG emissions and with less blue water use and food costs. Therefore daily blue water use and food costs might increase if UPF are replaced by those unprocessed or minimally processed. As nutritional quality, environmental impacts and food costs relate differently to the NOVA classification, the classification is not directly applicable to identify win–win-wins of nutritional quality, environmental impact and costs of diets.

Low Meat Consumption in the Netherlands Is Associated With Higher Intake of Fish, Nuts, Seeds, Cheese, Sweets, and Snacks: Results From a Two-Part Model.

Studies on sustainable diets show a need for replacement of animal-based foods by plant-based foods, which is also called “the protein transition.” To gain insight into the acceptability of such diet shifts, this study evaluated which current food sources people consume at varying amounts of meat consumption. The study population consisted of 4,313 participants aged 1–79 years of the Dutch National Food Consumption Survey 2012–2016, which assessed diet using two nonconsecutive 24-h dietary recalls. A two-part statistical model was used that accounts for both repeated measures and the correlation between probability and amount of consumption. Results are presented for quartiles of low to high meat consumption, by age and sex. Depending on age and sex, a higher consumption of fish (>100%), nuts and seeds (73–156%), cheese (34–111%), and sweets and snacks (28–81%) is observed in the lowest quartile of meat consumption compared to the highest. For fish, nuts, seeds, and cheese, this increase is mainly due to probability of consumption (>100%, 61–93%, and 16–64%, respectively). For sweets and snacks, the increase is mainly due to the amount of consumption (26–72%). Probability of potato consumption is 29–51% lower at low meat consumption. Vegetable consumption is lower mainly due to amount of consumption (6–29%). The results from the two-part model suggest that shifting away from a traditional Dutch high meat-vegetable-potatoes pattern is associated with higher probability of consuming fish, nuts and seeds, and cheese, but also increased amounts of sweets and snacks. This illustrates that analyzing the probability and amount part separately in relation to behavioral or physiological determinants extends our understanding of the diet according to meat consumption. These insights are important when developing realistic and acceptable food-based dietary guidelines for meat reduction.

Contribution of fortified margarines and other plant-based fats to micronutrient intake in the Netherlands

PurposeIn the Netherlands, margarines and other plant-based fats (fortified fats) are encouraged to be fortified with vitamin A and D, by a covenant between the Ministry of Health and food manufacturers. Frequently, these types of fats are also voluntarily fortified with other micronutrients. The current study investigated the contribution of both encouraged as well as voluntary fortification of fortified fats on the micronutrient intakes in the Netherlands.MethodsData of the Dutch National Food Consumption Survey (2012–2016; N = 4, 314; 1–79 year.) and the Dutch Food Composition Database (NEVO version 2016) were used to estimate micronutrient intakes. Statistical Program to Assess Dietary Exposure (SPADE) was used to calculate habitual intakes and compared to dietary reference values, separate for users and non-users of fortified fats.ResultsOf the Dutch population, 84% could be considered as user of fortified fats. Users consumed mostly 1 fortified fat a day, and these fats contributed especially to the total micronutrient intake of the encouraged fortified micronutrients (vitamins D and A; 44% and 29%, respectively). The voluntary fortification also contributed to total micronutrient intakes: between 7 and 32%. Vitamin D and A intakes were up to almost double among users compared to non-users. Intakes were higher among users for almost all micronutrients voluntarily added to fats. Higher habitual intakes resulted into higher risks of excessive vitamin A-intakes among boys and adult women users.ConclusionConsumption of fortified fats in the Netherlands resulted into higher vitamin A and D-intakes among users, compared to non-users of these products.

Contribution of voluntary fortified foods to micronutrient intake in The Netherlands

PurposeIn the Netherlands, voluntary fortification of foods with micronutrients is allowed under strict regulations. This study investigates the impact of voluntary food fortification practices in the Netherlands on the frequency and type of fortified food consumption and on the micronutrient intakes of the Dutch population.MethodsData of the Dutch National Food Consumption Survey (2012–2016; N = 4314; 1–79 year) and the Dutch Food Composition Database (NEVO version 2016) was used. To determine if voluntary fortified foods could be classified as healthy foods, criteria of the Dutch Wheel of Five were used. Habitual intakes of users and non-users of voluntary food fortification were calculated using Statistical Program to Assess Dietary Exposure (SPADE) and compared.ResultsWithin the Dutch population, 75% could be classified as user of voluntary fortified foods. Consumed voluntary fortified foods were mostly within food groups ‘Fats and Oils’, ‘Non-alcoholic Beverages’ and ‘Dairy products and Substitutes’ and fell mostly outside the Wheel of Five. Voluntary foods contributed between 9 and 78% to total micronutrient intake of users. Users had up to 64% higher habitual micronutrient intakes, compared to non-users. These higher intakes resulted into lower risks on inadequate intakes, and did not contribute to increased risks of excessive intakes.ConclusionAlthough voluntary fortified foods increased micronutrient intakes, most of these foods cannot be classified as healthy foods. Future studies should study the association between higher micronutrient intakes and (potential) excessive intakes of e.g. saturated fat and sugar to better understand the role of voluntary fortified foods in a healthy food pattern.

The protein gap-increasing protein intake in the diet of community-dwelling older adults: a simulation study.

Approximately 50 % of Dutch community-dwelling older adults does not meet protein recommendations. This study assesses the effect of replacing low protein foods with protein-rich alternatives on the protein intake of Dutch community-dwelling older adults. The Dutch National Food Consumption Survey-Older Adults 2010-2012 (DNFCS-OA) was used for scenario modelling. Dietary intake was estimated based on two 24-h recalls. Commonly consumed products were replaced by comparable products rich in protein (scenario 1), foods enriched in protein (scenario 2) and a combination of both (scenario 3). Replacement scenarios were confined to participants whose dietary protein intake was < 1·0 g/kg BW/d (n 391). Habitual protein intake of all older adults was estimated, adjusting for effects of within-person variation in the 2-d intake data. A simulation study based on the DNFCS-OA. 727 Dutch community-dwelling older adults aged 70+. Mean protein intake of the total population increased from 1·0 to 1·2 g/kg BW/d (scenarios 1 and 2) and to 1·3 g/kg BW/d (scenario 3). The percentage of participants with intakes of ≥ 1·0 g/kg BW/d increased from 47·1 % to 91·4 %, 90·2 % and 94·6 %, respectively, in scenarios 1, 2 and 3. The largest increases in protein intake were due to replacements in food groups: yoghurt, cream desserts and pudding, potatoes, vegetables and legumes and non-alcoholic beverages and milk in scenario 1 and bread; yoghurt, cream desserts and pudding and soups in scenario 2. This simulation model shows that replacing low protein foods with comparable alternatives rich in protein can increase the protein intake of Dutch community-dwelling older adults considerably. Results can be used as a basis for nutritional counselling.

Dietary intake of protein and fat of 12- to 36-month-old children in a Dutch Total Diet Study

PurposeThis study attempted gaining insight into the intake of protein and fat of 12- to 36-month-old children in the Netherlands.MethodsIn 2017, a Total Diet Study (TDS) was carried out in the Netherlands including following three age groups: 12–17-, 18–23- and 24- to 36-month-old children. Protein and fat concentrations of 164 composite samples were analysed and combined with the consumption data from the Dutch National Food Consumption Survey 2012–2016 (DNFCS).ResultsMedian protein intake of the 12- to 35-month-old Dutch children based on the TDS was 35 g/day with main contributions from the food subgroups “milk and milk-based beverages”, “beef” and “yoghurts and desserts”. Median fat intake was 34 g/day with main contributions from the food subgroups “margarines”, “cheeses” and “milk and milk-based beverages”. For the youngest age group (12- to 18-month-old children), (ready to drink) follow-on formula was one of the main contributors to the fat intake.ConclusionCompared to the EFSA reference values, protein intake of the Dutch 12- to 36-month-old children is high, whereas fat intake follows the reference intake. A TDS is a suitable instrument to estimate macronutrient intakes.

Evaluation of Nutrient Intake and Food Consumption among Dutch Toddlers.

Improving dietary habits at a young age could prevent adverse health outcomes. The aim was to gain insight into the adequacy of the dietary intake of Dutch toddlers, which may provide valuable information for preventive measures. Data obtained from the Dutch National Food Consumption Survey 2012–2016 were used, which included 672 children aged one to three years. Habitual intakes of nutrients were evaluated according to recommendations set by the Dutch Health Council. Specific food groups were evaluated according to the Dutch food-based dietary guidelines. For most nutrients, intakes were estimated to be adequate. High intakes were found for saturated fatty acids, retinol, iodine, copper, zinc, and sodium. No statement could be provided on the adequacy of intakes of alpha-linoleic acids, N-3 fish fatty acids, fiber, and iron. 74% of the toddlers used dietary supplements, and 59% used vitamin D supplements specifically. Total median intakes of vegetables, bread, and milk products were sufficient. Consumption of bread, potatoes and cereals, milk products, fats, and drinks consisted largely of unhealthy products. Consumption of unfavorable products may have been the cause of the observed high and low intakes of several nutrients. Shifting towards a healthier diet that is more in line with the guidelines may positively affect the dietary intake of Dutch toddlers and prevent negative health impacts, also later in life.

Can Healthy and Sustainable Dietary Patterns That Fit within Current Dutch Food Habits Be Identified?

This study investigated major healthy and sustainable dietary patterns in the Dutch population. Two 24-hour dietary recalls were collected in 2078 participants aged 19–79 years in the Dutch National Food Consumption Survey 2012–2016. Dietary patterns were identified using reduced rank regression. Predictor variables were food groups and response variables were Dutch Healthy Diet index 2015 (DHD15-index) score, greenhouse gas emissions (GHGE), and blue water use. Three patterns were discovered, including a “high fruit and vegetable dietary pattern”, a “low meat dietary pattern”, and a “high dairy, low fruit juices dietary pattern”. Diets in the highest quartile of these patterns had higher DHD15-index score than the average population. However, diets of the “high fruit and vegetable dietary pattern” were associated with higher dietary GHGE (14%) and blue water use (69.2%) compared to the average population. Diets of the “low meat dietary pattern” were associated with lower GHGE (19.6%) and higher blue water use (7.7%). Concluding, the “low meat dietary pattern” was the most healthy and sustainable dietary pattern in this population. The addition of blue water use as an environmental impact indicator shows the difficulty of finding existing dietary patterns that have low environmental impact in all determinants.

Allergen risk assessment: Food intake levels of the general population represent those of food allergic patients

Unintentional intake of allergens through food products poses a daily risk for allergic patients. Models estimating the risk of reactions mostly use intake data from general population surveys. Our study evaluates the comparability of food intake levels in the general population to those in the food allergic population. Data were collected by a 24-h recall method on 2 non-consecutive days in 38 cow's milk and/or hen's egg and 35 peanut and/or tree nut allergic adult patients. All products were assigned to food groups previously developed for allergen risk assessment. Food intake distributions from the allergic populations and a matched sample from the Dutch National Food Consumption Survey were compared, and risk assessments were performed. Food intake data was obtained for 92% of the food groups. Comparison of the intake showed no statistically significant differences between either of the two allergic populations and the general population. Consequently, only small variations in estimated risks were found, that would not result in different risk management decisions. In conclusion, food intake data from the general population can be used for food allergen risk assessment and will not lead to a relevant under- or overestimation of the risk for the food allergic population.

A social cost-benefit analysis of meat taxation and a fruit and vegetables subsidy for a healthy and sustainable food consumption in the Netherlands

BackgroundImplementation of food taxes or subsidies may promote healthier and a more sustainable diet in a society. This study estimates the effects of a tax (15% or 30%) on meat and a subsidy (10%) on fruit and vegetables (F&V) consumption in the Netherlands using a social cost-benefit analysis with a 30-year time horizon.MethodsCalculations with the representative Dutch National Food Consumption Survey (2012–2014) served as the reference. Price elasticities were applied to calculate changes in consumption and consumer surplus. Future food consumption and health effects were estimated using the DYNAMO-HIA model and environmental impacts were estimated using Life Cycle Analysis. The time horizon of all calculations is 30 year. All effects were monetarized and discounted to 2018 euros.ResultsOver 30-years, a 15% or 30% meat tax or 10% F&V subsidy could result in reduced healthcare costs, increased quality of life, and higher productivity levels. Benefits to the environment of a meat tax are an estimated €3400 million or €6300 million in the 15% or 30% scenario respectively, whereas the increased F&V consumption could result in €100 million costs for the environment. While consumers benefit from a subsidy, a consumer surplus of €10,000 million, the tax scenarios demonstrate large experienced costs of respectively €21,000 and €41,000 million. Overall, a 15% or 30% price increase in meat could lead to a net benefit for society between €3100–7400 million or €4100–12,300 million over 30 years respectively. A 10% F&V subsidy could lead to a net benefit to society of €1800–3300 million. Sensitivity analyses did not change the main findings.ConclusionsThe studied meat taxes and F&V subsidy showed net total welfare benefits for the Dutch society over a 30-year time horizon.

Educational differences in healthy, environmentally sustainable and safe food consumption among adults in the Netherlands.

To assess the differences in healthy, environmentally sustainable and safe food consumption by education levels among adults aged 19-69 in the Netherlands. This study used data from the Dutch National Food Consumption Survey 2007-10. Food consumption data were obtained via two 24-h recalls. Food consumption data were linked to data on food composition, greenhouse gas emissions (GHGe) and concentrations of contaminants. The Dutch dietary guidelines (2015), dietary GHGe and dietary exposure to contaminants were used as indicators for healthy, environmentally sustainable and safe food consumption, respectively. The Netherlands. 2106 adults aged 19-69 years. High education groups consumed significantly more fruit (+28 g), vegetables (men +22 g; women +27 g) and fish (men +6 g; women +7 g), and significantly less meat (men -33 g; women -14 g) compared with low education groups. Overall, no educational differences were found in total GHGe, although its food sources differed. Exposure to contaminants showed some differences between education groups. The consumption patterns differed by education groups, resulting in a more healthy diet, but equally environmentally sustainable diet among high compared with low education groups. Exposure to food contaminants differed between education groups, but was not above safe levels, except for acrylamide and aflatoxin B1. For these substances, a health risk could not be excluded for all education groups. These insights may be used in policy measures focusing on the improvement of a healthy diet for all.