Dutch Nutrition Surveillance System Research Articles

Nutrition assessment and dietary guidelines: experience from the Dutch Nutrition Surveillance System.

Nutrition assessment and dietary guidelines: experience from the Dutch Nutrition Surveillance System.

Combinations of low thiamin, riboflavin, vitamin B6 and vitamin C intake among Dutch adults. (Dutch Nutrition Surveillance System).

Clustering of low vitamin intake may entail a greater functional and/or health risk than the summation of separate low intakes may suggest. Therefore, the prevalence of combined low thiamin, riboflavin, vitamin B6 and vitamin C intake in various adult sex-age groups in The Netherlands was estimated. Nutritional risks were evaluated by comparing the calculated intakes with the recommendations for each vitamin. For this purpose the data of a subsample of 3353 adults of a nationwide food consumption survey were used, which had been collected in 1987-88 within the framework of the Dutch Nutrition Surveillance System. Food consumption data were obtained through 2-day dietary records. Respondents were segmented into tertiles based on their vitamin intake per 1000 kcal (4.2 MJ) to adjust for energy intake. As compared with the RDAs, mean overall intake was lowest for vitamin B6. Based on tertile analyses, the risk for inadequate intake was relatively high for vitamin C, small for riboflavin and intermediate for thiamin and vitamin B6. Low vitamin densities clustered somewhat since the prevalence of combined low intakes for all four vitamins was higher than expected from probability calculations. This interdependence was mainly the result of a higher consumption of alcoholic beverages and of other food products with a low vitamin density. In affluent societies nutritional risk assessment should not be based solely on single vitamins but should also be oriented at combined low intake levels.

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Diet and Cardiovascular Risk Factors Among Elderly People (Dutch Nutrition Surveillance System)

Vitamin C status in elderly women: A comparison between women living in a nursing home and women living independently

The vitamin C status in blood fractions in 135 elderly women aged 65 years and older was studied within the framework of the Dutch Nutrition Surveillance System. Mean (± standard deviation) vitamin C intake (mg/day) was lower among women living in a nursing home (54±27 mg/ day) than among women living in service flats (97±55 mg/ day) and women living independently (132 ± 44 mg/day). (Service flats are apartments in which the rent includes housekeeping and, when ordered, meal service.) Marginal vitamin C values (<23 μmol/L) in blood fractions and even levels as low as those found in clinical scurvy (<11 μmol/L) were frequently observed. In the nursing home, 35% of the women had plasma vitamin C values below 11 μmol/L, and 23% had values between 11 and 23 μmol/L. Blood levels were not significantly affected by age, smoking status, or use of particular drugs but were strongly ( r = .47 or, after logarithmic transformation, r = .64) associated with daily intake of vitamin C. Low intake of vitamin C resulted from an overall low food consumption and selective restriction of food products rich in vitamin C. Vitamin C losses caused by food preparation practices and distribution in the nursing home's catering system reduced actual vitamin C intake levels but these losses were not substantially greater than those that are assumed to occur as a result of preparation practices by women living independently.

Marginal nutritional status among institutionalized elderly women as compared to those living more independently (Dutch Nutrition Surveillance System).

The nutritional status (assessed by anthropometric indices, and biochemical and hematological variables in blood) of three groups of elderly women (aged > or = 65 years) was evaluated within the framework of the Dutch Nutrition Surveillance System. The groups were composed of women living in a nursing home (n = 51), women living in service flats and receiving their dinners from the nursing home kitchen (n = 29), and women living independently (n = 52). Mean blood levels of folate, pyridoxal 5'-phosphate, 25-hydroxyvitamin D, alpha-tocopherol, vitamin C, albumin, selenium and total cholesterol were significantly (p < 0.05) lower among nursing home women. Among these women a biochemical deficiency was frequently found for 25-hydroxyvitamin D (73%), pyridoxal 5'-phosphate (57%), vitamin C (38%), selenium (30%) and folate (28%). These nutritional risks were largely independent of each other. Since folate and pyridoxal 5'-phosphate were associated with several clinicochemical indicators, health status may be an important determining factor for this unfavorable situation. Low 25-hydroxyvitamin D concentrations were associated with limited exposure to ultraviolet radiation and nonusage of vitamin D supplements. We conclude that dietary intake variables are not the only determinants of a marginal nutritional status among nursing home women. Use of foods with a high nutrient density should be encouraged, whereas other preventive measures are needed to improve vitamin D status.

Nutritional status and food consumption in 10-11 year old Dutch boys (Dutch Nutrition Surveillance System).

As part of the Dutch Nutrition Surveillance System, cardiovascular risk factors and food consumption (24 h recall) as well as haematological, Fe and vitamin status (A, B6, C) were assessed in 126 Dutch boys aged 10-11 years (response 71%). Body mass index (BMI) and the sum of four skinfolds were strongly associated (r 0.85, P less than 0.01) and 8% of the boys were overweight (BMI greater than 20.1 kg/m2). Elevated serum total cholesterol levels (greater than 4.4 mmol/l) were observed in 38%; total cholesterol and low-density-lipoprotein-cholesterol levels were strongly associated (r 0.88, P less than 0.001). Intake of fat was high (38% of energy) and too much fat was saturated (polyunsaturated: saturated 0.44, guideline: 0.5-1.0), whereas intake of carbohydrate (49% of energy) and dietary fibre was low. About 12% of the boys had insufficient Fe stores (plasma ferritin less than 12.0 micrograms/l) and the mean Fe intake (9.0 mg/d) was below recommended daily allowance (10.0 mg/d). Plasma ferritin was, however, not associated with haematological indices and no frank anaemias were observed. No marginal values were observed for vitamins A, B6 and C status. In conclusion, the main nutritional risks in boys aged 10-11 years are cardiovascular risk factors and Fe nutrition.

The Dutch National Food Consumption Survey: design, methods and first results

The first Dutch National Food Consumption Survey (DNFCS) was conducted in 1987–1988. This report describes the design and methods of the Dutch nutrition surveillance system. The rationale for the use of an existing panel and a two-day record is given, and some potential pitfalls are discussed. The DNFCS data are compared with data from the Dutch national food balance sheets. Data from both individual and household levels are presented and discussed. An example regarding risk group identification is given.

Nutrition and blood pressure among elderly men and women (Dutch Nutrition Surveillance System).

Associations between blood pressure and nutrition-related variables (body mass index, dietary intake, and 24-hr excretion of sodium, potassium, magnesium, and calcium in the urine) were investigated in men (n = 138) and women (n = 117) 65-79 years old not using drugs known to affect blood pressure and not on a diet. Among men, body mass index was positively and creatinine clearance was inversely associated with systolic blood pressure, whereas body mass index and urinary sodium:potassium ratio were positively associated with diastolic blood pressure. Among women, both age and urinary calcium:creatinine ratio were positively associated with systolic as well as diastolic blood pressure. Coffee consumption was positively correlated with blood pressure and urinary calcium:creatinine ratio among the women. From the results it appears that, besides "normal" weight, increased potassium intake and urinary excretion may exert a protective effect among elderly men against hypertension when sodium exposure is relatively high. The positive association between urinary calcium:creatinine ratio and blood pressure among the women may be partly due to coffee consumption.

Nutrition and Serum Cholesterol Levels Among Elderly Men and Women (Dutch Nutrition Surveillance System)

Associations of serum cholesterol with relevant dietary intake variables (assessed with the dietary history method) and body mass index were investigated in elderly men (n = 199) and women (n = 180) 65-79 years old. All subjects were apparently healthy, nondiabetic, and not on a dietary regimen. The associations were studied separately for men and women using linear regression analysis and all possible subsets regression analysis. Among men, body mass index (kg/m2) and intake of monounsaturated fat and of alcohol were positively and consistently associated with serum total cholesterol. Among women, intake of alcohol and of saturated fat were positively associated, and intake of polysaccharides was inversely associated with serum total cholesterol. The intake of monounsaturated fatty acids was highly (r greater than .60) positively correlated with the intake of total fat and saturated fatty acids, and inversely with carbohydrates. HDL-cholesterol was positively associated with alcohol intake (significant for men only), and inversely with body mass index (women). The results indicate that the effect of dietary factors on serum cholesterol levels is probably not age-limited. Elderly people may potentially benefit from weight reduction or control, moderate alcohol consumption, and avoidance of too much dietary fat. These suggestions are in fair accordance with general population-based guidelines for a healthy diet. However, as our study was cross-sectional, causation as well as the public health impact remains to be proven.

Long-term effects of a vegetarian diet on the nutritional status of elderly people (Dutch Nutrition Surveillance System).

The health and nutritional status (anthropometry, and blood and urine biochemistry) of 44 Dutch apparently healthy vegetarians, aged 65-97 years, refraining from meat, fish, and poultry consumption, was assessed for insight into long-term consequences of ovo-lacto- or lacto-vegetarianism. The results indicate that in comparison to omnivorous elderly the vegetarian elderly (especially men) have aged successfully with respect to cardiovascular risk factors. In contrast, vegetarian elderly are at a higher risk for a marginal iron, zinc, and vitamin B12 status. Although several vegetarian elderly showed low levels of 25-hydroxyvitamin D in plasma and many had low values of 24-hr urine volume (per kg body weight), these values are not likely the result of a vegetarian diet per se. It is concluded that, although some nutrition-related risks are prevalent among vegetarian elderly, these risks can probably be prevented by lifestyle changes.

Dependence of Vitamin B-6 Status Assessment on Alcohol Intake Among Elderly Men and Women (Dutch Nutrition Surveillance System)

To obtain more insight into the effect of moderate alcohol intake on vitamin B-6 status indicators, we studied the associations of alcohol intake (unadjusted and adjusted for intake of vitamin B-6 and protein) with the erythrocyte aspartate aminotransferase activation coefficient (EAST-AC) and plasma pyridoxal 5'-phosphate (PLP) level. Data obtained from men (n = 224) and women (n = 217) aged 65-79 (nationwide sample in the Netherlands) were used for this purpose. Although alcohol intake (a maximum of 21% of the energy came from alcohol) tended to be positively associated with PLP, this association never reached statistical significance (p greater than or equal to 0.05). EAST-AC was inversely associated with alcohol intake, whether or not it was adjusted for vitamin B-6 and protein intake. Similar results were found for the total EAST activity (after adding PLP) or apoenzyme activity; the basal EAST activity (before adding PLP) or holoenzyme activity was not associated with the alcohol intake. These results indicate that caution is needed in the interpretation of the specificity of EAST-AC (i.e., the degree to which EAST-AC is unaffected by other factors) as an indicator of vitamin B-6 intake.

Adequacy of a vegetarian diet at old age (Dutch Nutrition Surveillance System).

To assess the adequacy of a vegetarian diet at old age, the dietary intake (assessed through dietary history with cross-check) of 44 apparently healthy lacto-(ovo-)vegetarians, aged 65-97 years, was evaluated. Adequacy was assessed by a comparison of nutrient intake with (Dutch) recommendations and by evaluating data on nutritional status. The results were also compared with data of elderly omnivores. In contrast to elderly omnivores, percentages of energy from protein (13%), fat (37%), and carbohydrates (50%) as well as P/S ratio (0.63) were close to or within the range of Dutch guidelines regarding a healthy diet (percentages of energy from protein, fat, and carbohydrates 10-15, 30-35, and 55%, respectively: P/S ratio 0.5-1.0). For most of the micronutrients studied intake was adequate, and nutrient density of the vegetarian diet was higher than of the omnivorous diet. However, the supply of zinc (average daily intake 8.5 and 7.6 mg for men and women, respectively), iron (because of lower bioavailability of nonheme iron), vitamin B12 (women only: intake 2.3 micrograms/day), and water (daily intake less than 1600 ml for 30% of the vegetarians) need special attention, considering the relatively high prevalence of a marginal status of these nutrients. In conclusion, a lacto-(ovo-)vegetarian diet can be adequate at old age, provided that it is carefully planned, especially with respect to the supply of iron, zinc, and vitamin B12.

Effect of dietary fiber on the vitamin B6 status among vegetarian and nonvegetarian elderly (Dutch nutrition surveillance system).

To obtain more insight into the effect of dietary fiber on vitamin B6 status among elderly people, we studied dietary interrelationships as well as associations between dietary intake and plasma pyridoxal-5'-phosphate (PLP) and cofactor stimulation of aspartate aminotransferase in erythrocytes (EAST-AC) among 441 nonvegetarian (aged 65-79) and 32 vegetarian elderly (aged 65-94). EAST-AC was found to be inversely related with intake of vitamin B6 and dietary fiber in bivariate regression analyses. After adjustment for age, intake of energy, protein, and fiber, the intake of vitamin B6 was still inversely related with EAST-AC. The association between EAST-AC and dietary fiber disappeared in the multivariate analysis, whereas total protein intake proved to be positively related with EAST-AC in the multivariate analysis only. The differences between bi- and multivariate analyses are most likely due to the observed interrelationships between intake of vitamin B6, fiber, and protein. It is concluded that dietary fiber does not have a significant impact on the vitamin B6 status among Dutch elderly people, since only protein (positively) and vitamin B6 (inversely) intake appeared to be related with EAST-AC in the multivariate analysis.

Nutrition and aging: nutritional status of “apparently healthy” elderly (Dutch nutrition surveillance system).

In a nationwide survey the nutritional status was assessed of 539 apparently healthy, independently living elderly aged 65-79 years. Anthropometric data showed no energy deficits. The prevalence of anemia was 4 and 1% among men and women, respectively. Many elderly showed a low level of 25-hydroxyvitamin D in plasma (less than 31 nmol/L: men 35%; women 43%), indicating a marginal status. Although the prevalence of low blood levels of folate, pyridoxal-5'-phosphate, and total carotenoids was higher among the elderly than among younger adults, clear (clinical) signs of nutritional deficiencies were not observed. Prevalence of obesity (13%), hypercholesterolemia (38%), and hypertension (63%) was found to be high, the percentages being higher for women than for men. Several indicators of the nutritional status appeared to differ among age groups. It is concluded that few differences can be considered as being due to physiological aging, which finding should be reflected in reference values for elderly people.

Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch nutrition surveillance system)

In 460 apparently healthy Dutch elderly, aged 65–79 years, serum uric acid correlates were studied by linear regression analyses, for men and women separately. Diuretic therapy, total serum cholesterol (women only) and creatinine clearance (in bivariate analysis only) were significantly associated with serum uric acid level. Positive associations of serum uric acid with body weight, body mass index, body fatness (men) and lean body mass (men) were observed, with and without adjustment for diuretic therapy, creatinine clearance and age. Serum uric acid levels, whether adjusted or not for these variables and for body mass index, were positively associated with alcohol intake (men) and consumption of meat and fish (women), and inversely with consumption of bread, margarine and milk products (women). These results indicate that limited medication with diuretics, weight control and restriction of alcohol use may help to prevent hyperuricemia in the elderly.

Nutrition and aging: dietary intake of "apparently healthy" elderly (Dutch Nutrition Surveillance System).

The dietary intake (assessed through dietary history) of 539 apparently healthy, independently living elderly aged 65-79 years, was evaluated in a nationwide random sample. Except for pyridoxine, the intake of vitamins, minerals, and water was adequate according to the Dutch recommended dietary allowances. Fat intake (40 energy%) as well as P/S ratio (0.41) was assessed as being unfavorable, whereas the intake of vitamin B6 was marginal. The prevalence of obesity was higher among the women, while food selection was healthier as reflected in the higher nutrient density than among the men. Food consumption of elderly men (26%) and women (33%) on a dietary regimen was more prudent and nutrient density higher than among the elderly not on a diet. Our results are in accordance with previous food consumption studies among elderly in The Netherlands, but differ substantially from dietary intake figures for American elderly. Although the intake of energy and nutrients was lower among elderly men than among younger men, we conclude that age per se is not an important determinant of dietary intake among Dutch apparently healthy elderly aged 65-79 years.

The Dutch nutrition surveillance system

The Dutch nutrition surveillance system provides information on the food consumption and nutrition status of the population in general and of high risk groups. It consists of a regular national food consumption survey and investigations on dietary intake and nutrition status. The choice of indicators on nutrition conditions in any survey is vital; the authors discuss the evaluation criteria used. Although there is a consensus on the outlines of the Dutch system, further refinements will have to be made. As an applied research activity, surveillance can never be finalized, since nutrition problems change with time and these changes need to be reflected in the surveillance system.