German National Nutrition Survey Research Articles

Optimization of a Food List for Food Frequency Questionnaires Using Mixed Integer Linear Programming: A Proof of Concept Based on Data from the Second German National Nutrition Survey.

Food Frequency Questionnaires (FFQs) are important instruments to assess dietary intake in large epidemiological studies. To determine dietary intake correctly, food lists need to be adapted depending on the study aim and the target population. The present work compiles food lists for an FFQ with Mixed Integer Linear Programming (MILP) to minimize the number of foods in the food list. The optimized food lists were compared with the validated eNutri FFQ. The constraints of the MILP aimed to identify food items with a high nutrient coverage in a population and with a high interindividual variability. The optimization was based on data from the second German National Nutrition Survey. The resulting food lists were shorter than the one used in the validated eNutri FFQ.

Association between body mass index and macronutrients differs along the body mass index range of German adults: results from the German National Nutrition Survey II.

The aim of the present study was to determine whether the association between body mass index (BMI) and the intake of macronutrients varies along the BMI distribution of German adults. Based on a sample of 9214 men and women aged 18-80 years from the representative cross-sectional German National Nutrition Survey (NVS) II, quantile regression was used to investigate the association between BMI and the intake of macronutrients independent of energy intake and other predictors. In both sexes, BMI was positively associated with the intake of total protein and animal protein over its entire range and negatively associated with vegetable protein. A negative association between BMI and the intake of polysaccharides was found along the entire range of BMI in men. There was a weak negative association between BMI and the intake of total fat and saturated fatty acids observed in normal-weight-range women only. In conclusion, the association between BMI and the intake of macronutrients varies along the BMI range. Animal protein intake is positively associated with BMI independent of energy intake in both sexes whereas only in men an inverse association of polysaccharide intake with BMI was shown.

Front-of-Package Food Labeling to Reduce Caries: Economic Evaluation

Front-of-package food labeling (FoPFL) is increasingly advocated as an effective intervention to facilitate behavior changes toward healthier food purchasing and consumption, particularly in relation to products with added sugar. The present study assessed the potential caries-related impacts of FoPFL, using Germany as an example. The outcomes of interest were caries lesions prevented, dental treatment costs avoided, productivity loss reductions, and disability-adjusted life years (DALYs) averted. The baseline consumption of added sugar was derived from the German National Nutrition Survey. The reduction in sugar intake due to FoPFL was modeled according to estimates from a recent meta-analysis. Microsimulations were performed for 500,000 individuals and over a time horizon of 10 y. Deterministic and probabilistic sensitivity analyses were performed to check the robustness of results. For the period from 2017 to 2027, FoPFL was identified to prevent 2,370,715 (95% confidence interval [CI], 2,062,730–2,678,700) caries lesions and avert 677.62 (95% CI, 589.59–765.65) DALYs. Treatment cost savings amounted to €175.67 million (95% CI, €152.85–€198.49), and productivity losses reduced by €27.33 million (95% CI, €23.78–€30.88). Sensitivity analyses showed that the magnitude of the effects is highly dependent on consumers’ response to FoPFL. Our findings suggest that FoPFL has the potential to substantially reduce caries increment, caries-related morbidity, and economic burden. In addition, our study allows for the inclusion of oral health estimates in overall health estimates for sugar-related food labeling. Before prioritizing a strategy to tackle sugar consumption, decision makers should carefully consider all relevant context-specific factors and implementation costs.

Vitamin Substitution Beyond Childhood—Requirements and Risks

Vitamins are vitally important, but they are not always adequately supplied with the diet. In this review, we present the advantages and disadvantages of vitamin supplementation and the indications for it in various life situations. This review is based on pertinent publications retrieved by a selective search of the literature. The German National Nutrition Survey II (Nationale Verzehrsstudie II) showed that most people in Germany consume adequate amounts of vitamins in their diet, with the exception of vitamin D and folate. Supplements are often taken by adults who already consume a balanced diet. Depending on the vitamin, 3-13% of survey respondents took vitamin supplements; the ones most often taken were vitamins C and E. No convincing evidence has yet demonstrated a health benefit from vitamin supplementation in addition to a balanced diet for the primary prevention of nutrition-associated diseases. Vitamin supplementation is indicated in certain specific life situations, e.g., pregnancy, but otherwise unnecessary, unless a deficiency has been diagnosed or the individual is at elevated risk. Vitamin supplementation is recommended for certain population groups: folic acid for pregnant women, vitamin B12 for vegans and persons with resorption disorders, vitamin D for persons with insufficient endogenous synthesis. In all other cases, it should first be tested whether the individual might be substantially helped by dietary changes alone. In general, the potential adverse effects of vitamin supplementation need to be considered, and its benefits weighed against its risks.

Fruit and vegetable consumption assessed by three dietary assessment methods in regard to sex, age, BMI and socio economic status

AbstractIntroductionA comparison of means of food consumption assessed by three different dietary assessment methods (diet history interviews [DHI], 24h-recalls [24HR] and weighing food records [WR]) used in the German National Nutrition Survey (NVS) II showed higher consumption means in 7 out of 18 food groups for DHI compared to 24HR and WR. Especially for food groups perceived as socially desirable such as fruit and vegetable means were highest for DHI. In the following, it is examined whether differences in fruit and vegetable consumption assessed by three different dietary assessment methods are related to sex, age, body mass index (BMI) or socio economic status (SES).MethodsA subgroup of 677 participants of the NVS II (2005–2007, 14–80 years of age) completed all three dietary assessment methods. DHI covered the food consumption of the past month, 24HR of the previous day and WR two times four days. Body height and weight were measured. SES was defined as an index based on the household income, employment status of the household's principle earner, and education level of the participant. The Multiple Source Method was applied to estimate population distributions of usual intakes based on two 24HR. Confidence intervals were calculated on basis of bootstrapping samples. Differences are considered to be significant if confidence intervals do not overlap.ResultsFor vegetable consumption, all subgroups regarding sex (male, female), age (14–18 years, 19–24 years, 25–34 years, 51–64 years, 65 years and older), body mass index (< 25 kg/m2, 25–30 kg/m2, > 30 kg/m2) and SES (5 groups from 1 = lower to 5 = upper SES) showed higher means for DHI compared to 24HR and WR. For fruit consumption, in almost all subgroups higher means for DHI compared to 24HR and WR could be found, except for the age group 19–24 years and the lowest SES group.DiscussionThe results show that higher means in fruit and vegetable consumption assessed by DHI compared to 24HR and WR are independent of sex, age, BMI and SES. A reason why socially desirable foods like fruit or vegetables are stated in higher amounts by DHI may be the enormous cognitive task of participants necessary to estimate quantities and frequencies over the long period of time covered by DHI.

Dietary assessment in the German National Cohort (GNC)

AbstractWe describe a novel dietary assessment strategy to estimate usual food intake in the ongoing large-scale multi-center German National Cohort (GNC). The dietary assessment is based on three 24 h food lists (24h-FL) and a food frequency questionnaire (FFQ) enriched by information from the representative German National Nutrition Survey II (NVS II). The novelty of this dietary assessment strategy is based on separating the probability of food intake from daily consumption amounts. The probability of consumption is estimated from 24h-FLs used in the GNC. To estimate daily consumption amounts, the already collected data of the NVS II are used. The 24h-FL simplifies the question on food consumption for all foods asked to consumption or not and so the questionnaire can be completed in about 10 minutes, reducing the burden on study participants. As proof of concept, we applied the assessment strategy to pretest data collected in 2012 to 2013 to assess the feasibility of the instruments. In brief, the novel dietary assessment strategy comprises three steps. First, the individuals’ consumption probability is estimated by three 24h-FLs and one FFQ applying a logistic linear mixed model adjusted for characteristics of the participants. Second, person-specific daily consumption amounts are estimated from the NVS II applying a linear mixed model taking the characteristics of the participants into account. Third, usual food intake is estimated by the consumption probability multiplied by person-specific daily amounts. Usual intake of 41 food groups in 318 men and 377 women were estimated. Of those participants who completed the first 24h-FL, 84.4, and 68.5% completed the second and third 24h-FL, respectively. No associations were observed between probability to participate and lifestyle factors. The estimated usual food intake distributions were in a plausible range as shown by comparing the estimated energy intake to the energy needs approximated by estimated total energy expenditure. Total energy was estimated to be 2,707 kcal/day for men and 2,103 kcal/day for women. With a few exceptions, the estimated food-based consumption probabilities did not differ considerably between men and women. The differences in energy intake between men and women were mainly due to their differences in the estimated person-specific daily amounts. As a conclusion, plausible but not validated values for usual food intake were derived in the pretest study, so that the combination of three repeated 24h-FLs, an FFQ and person-specific daily amounts from an external source is a feasible strategy for dietary assessment.

Dietary exposure assessment of aluminium and cadmium from cocoa in relation to cocoa origin.

Cocoa contains aluminium and cadmium as environmental contaminants while concentrations are supposed to be country of origin-related. Integrating origin in dietary exposure assessment could refine calculations. Averages or higher percentiles of concentrations in cocoa powder from German Food Monitoring (GFM) and cocoa consumption from the German National Nutrition Survey II (NVS II) were combined in standard scenarios. Additional origin-related scenarios used concentration data grouped into origin A (lower concentrations) and origin B (higher concentrations) as plausible origin information was rare. The most conservative standard scenario resulted in the highest intake estimates for aluminium and cadmium with 0.152 mg/week/kg BW and 0.363 μg/week/kg BW and covered the origin influence calculated in origin-related scenarios. Having plausible origin information would help to refine exposure assessment as it is exemplarily shown here that origin-related lower intake estimates are possible. Using the Eurostat database and the Mintel Global New Product Database (GNPD) generated more origin information for products available on the German market. For Germany, cocoa beans, cocoa powder and cocoa mass were mainly sourced in Côte d'Ivoire, while the Netherlands was the main distributor. Packages of cocoa powders were sourced from different origins.

Refinement of dietary exposure assessment using origin-related scenarios

Global sourcing of food may lead to variability in concentrations of contaminants or pesticide residues. It would be important to incorporate origin influences in dietary exposure assessment. To characterise uncertainties, substance concentrations from GFM (German Food Monitoring), chosen based on the highest CV (coefficient of variation), and food consumption from NVS II (German National Nutrition Survey II) were combined in standard scenarios. Averages or higher percentiles of non-grouped concentrations were used. Additional origin-related scenarios used concentrations grouped by origin. For bromide in tomatoes the most conservative origin-related scenario for Italian tomatoes resulted in the highest exposure of 0.015 mg/d/kg BW. The impact of origin was not covered by the conservative standard scenario (0.006 mg/d/kg BW). For ethephon in pineapples and aluminium in kiwifruits, the highest intake estimates were obtained with the conservative standard scenario resulting in 0.895 μg/d/kg BW and 0.023 mg/week/kg BW, respectively. In these two cases, standard scenarios cover origin influences but the conservative origin-related scenario based on origins with higher concentrations identifies lower exposures of 0.835 μg/d/kg BW for ethephon from African pineapples and 0.014 mg/week/kg BW for aluminium from non-EU kiwifruits. Hence, the inclusion of origin information can refine exposure assessment.

Design and characterization of dietary assessment in the German National Cohort.

The aim of the study was to describe a novel dietary assessment strategy based on two instruments complemented by information from an external population applied to estimate usual food intake in the large-scale multicenter German National Cohort (GNC). As proof of concept, we applied the assessment strategy to data from a pretest study (2012-2013) to assess the feasibility of the novel assessment strategy. First, the consumption probability for each individual was modeled using three 24 h food lists (24h-FLs) and frequencies from one food frequency questionnaire (FFQ). Second, daily consumed food amounts were estimated from the representative German National Nutrition Survey II (NVS II) taking the characteristics of the participants into account. Usual food intake was estimated using the product of consumption probability and amounts. We estimated usual intake of 41 food groups in 318 men and 377 women. The participation proportion was 100, 84.4, and 68.5% for the first, second, and third 24h-FL, respectively. We observed no associations between the probability of participating and lifestyle factors. The estimated distributions of usual food intakes were plausible and total energy was estimated to be 2707 kcal/day for men and 2103 kcal/day for women. The estimated consumption frequencies did not differ substantially between men and women with only few exceptions. The differences in energy intake between men and women were mostly due to differences in estimated daily amounts. The combination of repeated 24h-FLs, a FFQ, and consumption-day amounts from a reference population represents a user-friendly dietary assessment approach having generated plausible, but not yet validated, food intake values in the pretest study.

Meat consumers and non-meat consumers in Germany: a characterisation based on results of the German National Nutrition Survey II.

Meat consumption in high-income countries is increasingly discussed due to its impact on environment and health as well as ethical considerations. The present paper aims to provide information on meat consumption behaviour, sociodemographic factors related to meat consumption and its associations with health and nutritional behaviour, based on the German National Nutrition Survey II. For 12 915 participants aged 18-80 years, food consumption was assessed by two 24-h recalls and further data by interviews. Participants were distinguished in non-meat consumers and meat consumers; meat consumers were further differentiated as low and high meat consumers (<86 g/d and ≥86 g/d). Group differences were analysed using binary logistic and linear regression models. More non-meat consumers were found among women, young and more educated persons. They showed equal or more preferable health characteristics, had a similar energy intake but ate more plant-based foods compared with meat consumers. More high meat consumers were found among men, young and middle-aged and lower-educated persons. Compared with low meat consumers, they showed equal or less preferable health characteristics, had a higher energy intake and ate more potatoes and sauces/spices and less of most other food groups in relation to their energy intake. To conclude, sociodemographic groups differ in their meat consumption and differences in meat consumption go together with differences in health behaviour and other food consumption.

Comparison of food consumption and nutrient intake assessed with three dietary assessment methods: results of the German National Nutrition Survey II

PurposeComparison of food consumption, nutrient intake and underreporting of diet history interviews, 24-h recalls and weighed food records to gain further insight into specific strength and limitations of each method and to support the choice of the adequate dietary assessment method.MethodsFor 677 participants (14–80 years) of the German National Nutrition Survey II confidence intervals for food consumption and nutrient intake were calculated on basis of bootstrapping samples, Cohen’s d for the relevance of differences, and intraclass correlation coefficients for the degree of agreement of dietary assessment methods. Low energy reporters were identified with Goldberg cut-offs.ResultsIn 7 of 18 food groups diet history interviews showed higher consumption means than 24-h recalls and weighed food records. Especially mean values of food groups perceived as socially desirable, such as fruit and vegetables, were highest for diet history interviews. For “raw” and “cooked vegetables”, the diet history interviews showed a mean consumption of 144 and 109 g/day in comparison with 68 and 70 g/day in 24-h recalls and 76 and 75 g/day in weighed food records, respectively. For “fruit”, diet history interviews showed a mean consumption of 256 g/day in comparison with 164 g/day in 24-h recalls and 147 g/day in weighed food records. No major differences regarding underreporting of energy intake were found between dietary assessment methods.ConclusionsWith regard to estimating food consumption and nutrient intake, 24-h recalls and weighed food records showed smaller differences and better agreement than pairwise comparisons with diet history interviews.

Dietary quality among the elderly in Germany: a retirement-nutrition puzzle?

We test the hypothesis of a retirement-nutrition puzzle with data from the German National Nutrition Survey II, starting from the economic debate on whether a retirement-consumption puzzle actually exists. The major question is whether unexpected income changes following retirement cause a reduced consumption of nutrients and/or a lower dietary quality. Three indices of dietary quality are computed for 6,504 individuals in the 50+ generation. Descriptive and inductive statistics are used first to compare retired and working people with regard to the consumption of foods and nutrients as well as their dietary quality. Then, multiple regression models are utilized in order to analyse the influence of retirement on dietary quality under ceteris-paribus conditions. The empirical findings do not support the hypothesis of a retirement-nutrition puzzle. Although retired people consume fewer nutrients than their working counterparts, their dietary quality is not worse. When income and age effects are controlled in a multivariate analysis, none of the three dietary quality indicators is significantly affected by retirement. The multivariate analysis reveals highly significant influences of other sociodemographic and personal characteristics on dietary quality within the 50+ generation. The analysis suggests there is no general need to target nutrition policy at a retirement-nutrition puzzle. However, pensioners are a very diverse group, and it remains a task for future research to disaggregate the findings for different clusters of retired persons.

Carbon footprints and land use of conventional and organic diets in Germany

Organically produced food is often considered more environmentally friendly than conventionally produced food, and Germany is one of the most important and rapidly growing markets for organic food in Europe. However, the carbon footprints and land use of organic diets, and how they compare to conventional diets, have not yet been quantified. Using food consumption data from the German National Nutrition Survey II, and carbon footprint and land-use data from life cycle assessment studies of conventional and organic food products, carbon footprints and land use of conventional and organic diets in Germany were calculated for three consumer categories: men, women and their combined unweighted average. Conventional diets are defined as the average diet of consumers who do not buy organic food products; organic diets are the average diets of consumers whose food purchases include a large share of organic food products. Greenhouse gas emissions associated with land use change are not included. The carbon footprints of the average conventional and organic diets are essentially equal (ca. 1250 CO2-eq cap−1 year−1), while the land use to provide food is ca. 40% greater in the organic diet (ca. 1900 and 2750 m2 of land cap−1 year−1 in the conventional and organic diets, respectively). The average conventional diet contains 45% more meat than the average organic diet, which on the other hand contains 40% more vegetables, fruits, and legumes (combined). Animal-based food products dominate the carbon footprints and land use (ca. 70–75%) in both diets. The organic diet, in particular that of women, is more aligned with health-based dietary guidelines. Diet-related carbon footprints and land use can be reduced by shifting toward diets with less animal-based food products (other measures are also discussed). General conclusions about the overall performance of conventional and organic agriculture are not supported by this study since only carbon footprints and land use were assessed, while other important issues, such as biodiversity, ecotoxicity impacts and animal welfare, were not considered.

Energy and macronutrient intake over the course of the day of German adults: A DEDIPAC-study

The aim of the study was to analyze the energy and macronutrient intake over the course of the day of selected population groups in Germany defined by sex, age, BMI, SES, and diet quality. The study was based on food consumption data from the German National Nutrition Survey II (2005–2007) assessed by two 4-day dietary weighing records of 662 women and men aged between 18 and 80 years. Energy and macronutrient intake were calculated using the German Nutrient Database 3.02 and summarized for the periods ‘morning’, ‘midday’, ‘afternoon’, ‘evening’, and ‘night’. Generalized estimating equation models were used to examine differences in energy and macronutrient intake. For women and men, a three-main-meal pattern (‘morning’, ‘midday’, and ‘evening’) was observed, indicated as peaks in energy intake at 08:00 to 09:00, 13:00 and 19:00 o'clock. The distributions of carbohydrate, protein, and fat intake mirror the distribution of energy intake over the course of the day. The highest energy intake was found in the ‘evening’ period, especially in young adults, overweight persons, persons with a high SES, and men with a low diet quality. Women of the oldest age group showed a similar energy intake across the three-main-meals in contrast to young adults, who had lower peaks in the ‘morning’ and ’midday’ periods as well as a shift to later meal times. Young adults seem to have a higher variability in energy intake and a less distinct meal pattern, while seniors have a more structured day. Because a high energy intake in the ‘evening’ period is associated with negative health-related factors, the distribution of energy intake should be considered by recommendations for a healthy nutritional behavior.

Predictors of BMI Vary along the BMI Range of German Adults - Results of the German National Nutrition Survey II

Objective: The objective of the study was to identify predictors of BMI in German adults by considering the BMI distribution and to determine whether the association between BMI and its predictors varies along the BMI distribution. Methods: The sample included 9,214 adults aged 18-80 years from the German National Nutrition Survey II (NVS II). Quantile regression analyses were conducted to examine the association between BMI and the following predictors: age, sports activities, socio-economic status (SES), healthy eating index-NVS II (HEI-NVS II), dietary knowledge, sleeping duration and energy intake as well as status of smoking, partner relationship and self-reported health. Results: Age, SES, self-reported health status, sports activities and energy intake were the strongest predictors of BMI. The important outcome of this study is that the association between BMI and its predictors varies along the BMI distribution. Especially, energy intake, health status and SES were marginally associated with BMI in normal-weight subjects; this relationships became stronger in the range of overweight, and were strongest in the range of obesity. Conclusions: Predictors of BMI and the strength of these associations vary across the BMI distribution in German adults. Consequently, to identify predictors of BMI, the entire BMI distribution should be considered.

Trends in food consumption and nutrient intake in Germany between 2006 and 2012: results of the German National Nutrition Monitoring (NEMONIT).

The German National Nutrition Monitoring (NEMONIT) is a longitudinal and nationwide study to assess changes in food consumption and nutrient intake in Germany. A sample of 1840 participants (baseline age: 14-80 years) was drawn from the nationally representative German National Nutrition Survey (NVS) II (2005-2007). The participants have been interviewed by telephone annually since 2008. Food consumption was assessed by two 24-h recalls in the NVS II and the 4 years of NEMONIT (2008-2012/2013), respectively. Energy and nutrient intakes were calculated using the German Nutrient Database 3.02. Diet quality was evaluated using the Healthy Eating Index-NVS (HEI-NVS) II. Time trends were analysed by generalised estimating equation. Consumption of fruit/fruit products and fruit juice/nectar among men and women decreased, whereas consumption of water, soft drinks and coffee/tea increased over the 6-year period. Furthermore, increased consumption of confectionery and animal fats was observed among women. HEI-NVS II did not change since NVS II in both sexes. There were no changes in energy and protein intakes, but carbohydrate intake declined while fat intake increased over time. Regarding micronutrients, a decreasing intake of thiamin, riboflavin and vitamin B6 was observed in both sexes, but intake of Mg, Fe and niacin increased among women over time. In conclusion, food consumption and nutrient intake remained relatively stable between 2005-2007 and 2012/2013 within this German cohort. A few favourable and unfavourable changes were observed. Compared with national dietary guidelines, consumption of food of plant origin remained too low and consumption of meat/meat products remained too high in Germany.

Determinants of consumption-day amounts applicable for the estimation of usual dietary intake with a short 24-h food list.

Next to the information on frequency of food consumption, information on consumption-day amounts is important to estimate usual dietary intake in epidemiological studies. Our objective was to identify determinants of consumption-day amounts to derive person-specific standard consumption-day amounts applicable for the estimation of usual dietary intake using separate sources to assesss information on consumption probability and amount consumed. 24-h Dietary recall data from the German National Nutrition Survey II (n=8522; aged 20-80 years) conducted between 2005 and 2007 were analysed for determinants of consumption-day amounts of thirty-eight food and beverage groups using LASSO variable selection for linear mixed-effects models. Determinants included sex, age, BMI, smoking status, years of education, household net income, living status and employment status. Most often, sex, age and smoking status were selected as predictors for consumption-day amounts across thirty-eight food groups. In contrast, living with a partner, employment status and household net income were less frequently chosen. Overall, different determinants were of relevance for different food groups. The number of selected determinants ranged from eight for coffee and juice to zero for cabbage, tea, root vegetables, leafy vegetables, fruit vegetables, legumes, offal, vegetable oils, and other fats. For the estimation of usual dietary intake in a combined approach with a 24-h food list, person-specific standard consumption-day amounts could be used. Sex, age and smoking status were shown to be the most relevant predictors in our analysis. Their impact on the estimation of usual dietary intake needs to be evaluated in future studies.

The German Nutrient Database: Effect of different versions on the calculated energy and nutrient intake of the German population

The effects of altered data on the nutrient content of food items in a food composition database can be described by calculating and comparing the energy and nutrient intake of a population group with different database versions. To examine the effect of the differences between the German Nutrient Database (BLS) versions II.3, II.4, and 3.02 (generated in 1999, 2006, and 2014), the energy and nutrient intake of a representative sample of the German population (German National Nutrition Survey II (NVS II)) were compared. This comparison reveals that the median intake for most of the studied nutrients differed significantly between the three BLS versions for both sexes, in approximately one fourth of the comparisons more than 10%. The differences are largest for calcium (men: −21.5%; women: −22.5%), magnesium (men: −19.3%; women: −22.1%), and iodine (women: −20.2%) in the comparison of BLS version 3.02 and II.3. In particular changes of nutrient data of food items with high consumption, like milk, tea, and water, have strong effects on the calculated nutrient intake. Since the present study reveals a strong impact of the applied versions of a food composition database on the nutrient intake of food consumption studies, the knowledge of the version differences is of significant importance.

Customers Purchasing Organic Food - Do They Live Healthier? Results of the German National Nutrition Survey II

Aims: Using national food consumption data this paper addresses issues whether buyers of organic food make healthier food choices and pursue a healthy lifestyle concerning smoking, physical exercise and body weight compared to non-buyers. Study Design: The German National Nutrition Survey II (NVS II) is a nationwide food consumption study providing additional information on social demographics, health, and lifestyle aspects as well as anthropometric measurements. Using data of several assessment tools, a comparison was conducted between buyers and non-buyers of organic food. Place and Duration of the Study: From November 2005 to November 2006, data collection took place in about 500 randomly chosen sample points across Germany. Methodology: 13,074 participants aged 18-80 years were divided into groups of buyers (44.9%) and non-buyers (55.1%) of organic food. According to their purchase frequency, the organic food buyers were further differentiated into intensive, occasional or infrequent purchase groups. A diet history method was applied to assess food consumption, trained staff measured BMI while questionnaires were used for social demographic description and healthy lifestyle factors. Original Research Article Eisinger-Watzl et al.; EJNFS, 5(1): 59-71, 2015; Article no.EJNFS.2015.003 60 Results: Buyers of organic food consumed 17% more fruit and 23% more vegetables as well as less meat/sausages (25%) and soft drinks (58%) than non-buyers did (P< .001, resp.). These results are more pronounced for women and for intensive buyers. Additionally, buyers of organic food exhibit healthier lifestyle characteristics in respect to smoking behaviour, physical activity, and body weight compared to non-buyers. Conclusion: German buyers of organic food demonstrate health behaviours complying better with the recommendations for a healthy lifestyle compared with non-buyers. Independent of the discussion whether organically produced food exerts additional health effects, buyers of organic food make healthier food choices than non-buyers, thereby benefiting for their overall health.

Intake of dietary folate and folic acid in Germany based on different scenarios for food fortification with folic acid.

PurposeBesides the adverse health effects of a low folate intake, the risks of high intakes of folic acid have moved into the focus. The aim of this study was to investigate the potential range of folate and folic acid intake of the German population under consideration of different fortification scenarios.Methods Food consumption data of 13,926 participants of the German National Nutrition Survey II (NVS II), collected with two 24-h recalls, were used to calculate the nutrient intake. The nutrient data are based on the German Nutrient Database (BLS), information from a market survey and analyses of multivitamin juices. The scenarios were modelled without, as well as with low and high fortification levels of folic acid.ResultsThe median intake of dietary folate equivalents ranged from 191 µg/d (men) and 168 µg/d (women) without fortification to 425 µg/d (men) and 334 µg/d (women) in the highest fortification scenario. Thus, 12.4–68.2 % (men) and 5.9–56.1 % (women) met the 300 µg/d recommended by the nutrition societies of Germany, Austria and Switzerland. In the highest fortification scenario, 1.9 % (men) and 0.8 % (women) exceeded the tolerable upper intake level (UL) of 1,000 µg/d folic acid given by the European Food Safety Authority. For supplement users, this proportion was 5.2 and 5.4 %.ConclusionsOnly a high fortification of several foods leads to a marked increase of the proportion of population reaching the recommendation. Simultaneously, with a high fortification a higher proportion exceeds the UL, especially in combination with supplements.