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The bioavailability and urinary excretion of three dietary flavonoids, quercetin, hesperetin and naringenin, were investigated. Ten healthy men were asked to consume a 'juice mix' containing equal amounts of the three flavonoids, and their urine and plasma samples were collected. The resulting mean plasma area under the curve (AUC)(0-48 h) and C(max) values for quercetin and hesperetin were similar, whereas the AUC(0-48 h) of naringenin and, thus, the relative bioavailability were higher after consumption of the same dose. The study consolidates a significantly lower urinary excretion of quercetin (1.5+/-1%) compared with hesperetin (14.2+/-9.1%) and naringenin (22.6+/-11.5%) and shows that this is not due to a lower bioavailability of quercetin, but rather reflects different clearance mechanisms.

Background/Aims: An adequate fruit and vegetable intake provides essential nutrients and nutritive compounds and is considered an important part of a healthy lifestyle. No simple instrument has been available for the assessment of fruit and vegetable intake as well as its determinants in school-aged children applicable in different European countries. Within the Pro Children Project, such an instrument has been developed. This paper describes the cross-sectional survey in 11-year-olds in 9 countries. Methods: The cross-sectional survey used nationally, and in 2 countries regionally, representative samples of schools and classes. The questionnaires, including a precoded 24-hour recall component and a food frequency part, were completed in the classroom. Data were treated using common syntax files for portion sizes and for merging of vegetable types into four subgroups. Results: The results show that the fruit and vegetable intake in amounts and choice were highly diverse in the 9 participating countries. Vegetable intake was in general lower than fruit intake, boys consumed less fruit and vegetables than girls did. The highest total intake according to the 24-hour recall was found in Austria and Portugal, the lowest in Spain and Iceland. Conclusion: The fruit and vegetable intake in 11-year-old children was in all countries far from reaching population goals and food-based dietary guidelines on national and international levels.

In a previous paper we reported an inverse relationship between fitness and serum lipids in this group of young subjects. The present study investigates whether a higher fitness level was associated with a more prudent diet and whether this contributed to the observed relationship between fitness and serum lipids.The study sample, comprising 70 women and 49 men ages 23-27 years, was a subgroup of a large random sample. Aerobic fitness was measured directly as maximal oxygen uptake (ml O2 min-1 kg-1) and dietary intake as 7-day food records.The highest fitness tertile had an intake of dietary fiber higher than that of the lowest tertile (25.2 g/10 MJ vs 21.9 g/10 MJ, P0.05) and a lower intake of sucrose (7.2 E% vs 9.8 E%, P0.01), whereas total fat intake and the ratio between polyunsaturated and saturated fatty acids were similar (35.4 E% vs 36.5 E%, P0.05, 0.39 vs 0.34, P0.05, respectively). No differences were observed in intake of alcohol, protein, and total carbohydrate. Multiple regression analyses showed no impact of dietary variables upon the relationship between serum lipids and fitness.Better fitness was associated with a better dietary composition with respect to dietary fiber and sucrose, but not to fat. The observed inverse relationship between fitness and serum lipids was not related to diet.

Background Dietary surveys often rely upon subjects' ability to estimate their portion sizes instead of weighing them, but information on the validity of such estimates is lacking. This study investigated the validity of estimated portion sizes from a self-administered food frequency questionnaire including photos. Methods Validity was evaluated by comparison with portion sizes from 14-day weighed food records. Eight sets of photos were included in the study (three meat dishes, one fish dish, three vegetables, potatoes), each set with four options. Subjects (59 men, 85 women) were 40-64 years. Results The majority of subjects (85-95%) selected the most correct photo or a neighbouring photo. However, regression analyses showed that the relationship between the estimated and the measured portion sizes was relatively weak for most of the foods tested, and correlations were only significant for three of the eight foods. This apparent contradiction was partly due to the pattern of the error: subjects selecting small portions had underestimated their actual portions while subjects selecting large portions had overestimated them. This error pattern could not be explained by the theoretical error resulting from the use of four discrete portion sizes instead of continuous weights, neither was it a simple consequence of the unidirectional errors at the extreme ends. Actual portion sizes varied from day to day, with intra-individual coefficients of variation of 34-40%. Conclusions The photos used in the present study were of limited value for ranking individuals correctly according to their actual portion sizes. Whether this is a common feature of photos used in food frequency questionnaires remains to be answered.

Foods to be included in a Danish self-administered semiquantitative food frequency questionnaire were identified from food tables developed, together with data collected, for the survey 'Dietary habits in Denmark, 1985'. The questionnaire was to be used in a prospective study on diet, cancer and health, and the aim was to rank individuals with regard to intake of 19 different nutrients considered of prime importance in human carcinogenesis. The questionnaire for the dietary survey included 247 foods and recipes. From stepwise multiple regression analyses with the intake of each of the 19 nutrients as the dependent variable and the intake of the 247 foods and recipes as independent variables, the foods in the models explaining 90% of the between-person variability were considered for the final questionnaire. All relevant analyses were performed for the study group as a whole, for men and women separately, and in each gender for subgroups of energy intake. Taken together, the models explaining 90% of the between-person variability identified a total of 74 foods or recipes, which were important predictors of the intake of one or more of the nutrients considered. A few foods were excluded and a few foods were added to the final questionnaire based on common biological background information, and on information on foods providing important amounts of given nutrients, but which failed to contribute to regression analyses. The 92 foods and recipes, which were included in the final questionnaire provided altogether 81% of the average total supply of the nutrients.(ABSTRACT TRUNCATED AT 250 WORDS)

Background/Aims: Validity and reproducibility were evaluated of a new questionnaire to assess fruit and vegetable intakes in 11- to 12-year-old children. Methods: The precoded teacher-assisted self-administered questionnaire included two sections: a 24-hour recall part and a food frequency part. Validity was tested in 4 countries (Denmark, Iceland, Norway, Portugal; n = 43–60 per country) using a 1-day weighed food record and 7-day food records as reference methods. Test-retest (7–12 days apart) reproducibility was assessed in 6 countries (Belgium, Denmark, Iceland, Norway, Portugal, Spain; n = 60–74 per country). Results: Spearman rank correlations for fruit and vegetable intake according to the frequency part and the 7-day food record ranged between r = 0.40–0.53. Between 25–50% were classified into the same quartile and 70–88% into the same or adjacent quartile. Test-retest Spearman rank correlations for the food frequency part were r = 0.47–0.84. Three countries showed no significant difference between fruit intake as assessed with the 24-hour recall part and the 1-day weighed food record, and 2 countries showed no significant difference for vegetables. In the other countries, the 24-hour recall part resulted in substantially higher mean intake levels. Conclusion: Validity and reproducibility as to ranking of subjects were regarded to be satisfactory in all countries. Group mean intake, based on the original 24-hour part, was valid for fruit in 3 countries and for vegetables in 2 countries, and this part was subsequently adjusted to avoid overestimation, before the questionnaire was used in the Pro Children study.

Background/Aims: The Pro Children Project was designed to assess fruit and vegetable consumption in European schoolchildren and their parents, as well as determinants of the children’s consumption patterns. A second objective was to develop and test strategies, applicable across Europe, for promoting consumption of fruits and vegetables among schoolchildren and their parents. In this paper, the rationale, theoretical background, overall design and implementation of the project is presented. Methods: Surveys of national, representative samples of 11-year-old schoolchildren and their parents were conducted in 9 countries, i.e. in Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden. Comprehensive school-based educational programmes have been developed and tested in three settings, i.e. in Spain, the Netherlands and in Norway. A precoded 24-hour recall form combined with a set of food frequency questions assessing regular intake were used to assess fruit and vegetable consumption. Determinants were assessed employing a comprehensive theoretical framework including personal, social and environmental factors related to fruit and vegetable consumption. The intervention programmes have been tested employing a group-randomized trial design where schools have been randomly allocated to an intervention arm and a delayed intervention arm. Surveys among all participating children and their parents were conducted prior to the initiation of the intervention, immediately after the end of the intervention and at the end of the subsequent school year. Conclusion: The project is expected to provide new information of great importance for improving our understanding of consumption patterns of fruits and vegetables and for guiding future efforts to promote increased consumption patterns across Europe.

Objectives:To describe the use of dietary supplements in a group of Danish adults and to investigate the differences between users and non-users with respect to age, gender, health and lifestyle factors.Design:Cross-sectional study in two Danish cities.Setting:The Danish Investigation on Iodine Intake and Thyroid Diseases, 1997–1998.Subjects:Participants were 3707 women (selected age groups between 18 and 65 years) and 942 men (60–65 years). Participation rate was 50%. Supplement data were collected in a personal interview. Data on education, smoking, alcohol intake, physical activity, use of medication and self-perceived health were derived from a self-administered questionnaire. Multiple logistic regression was used for the statistical analysis.Results:Participants were asked about all kinds of supplements, ranging from products containing vitamins and minerals, to fish oils and products of herbal origin. On average 59% reported use of some kind of dietary supplement. Most common were combined multivitamin/mineral products (48%) followed by single vitamin C products (10%). Twelve per cent used three or more different supplements. Supplement use was strongly associated with age and gender, being highest among elderly women (78%). Ex-smokers were more likely to use supplements than subjects who had never smoked (odds ratio (OR) 1.36, 95% confidence interval (CI) 1.09–1.76). Supplement use was more likely among subjects who had many days of illness (OR = 1.37, 95% CI 1.12–1.66) and among users of medication (OR = 1.22, 95% CI 1.04–1.42). Subjects who perceived their health as poor were more likely to use supplements other than just a multivitamin/mineral tablet (OR = 2.2, 95% CI 1.31–3.77).Conclusions:Use of dietary supplements was related to age, gender and smoking, but also to poor self-perceived health status and absence from work. This indicates that a group of people use supplements as a form of self-medication.

The aim of the study was to describe trends in food habits in Denmark derived from a food frequency survey conducted by the Danish Nutrition Council in 2001 and compare it to similar surveys from 1995 and 1998.A random population sample of 1000 men and women (aged 15-91 years) were interviewed by telephone. They were asked 13 food frequency questions about nutritionally important foods (yoghurt, milk, cheese, rye bread, wheat bread, sandwiches with fish, fish as the main meal, meat as the main meal, potatoes, rice/pasta, vegetables (two questions) fruit) and about the type of milk and fat spreads most often used.Several of the changes seen from 1995 to 1998 had continued into the 1998-2001 period. The results showed increased frequencies for shredded salad/raw vegetables and rice/pasta, but reduced frequencies for meat as the main meal and potatoes. Fruit consumption had also increased between 1998 and 2001. Average frequencies differed by 13-28%. Another pronounced trend was the increased use of low-fat milk (or = 0.5% fat) instead of whole milk (42% drinking low-fat milk in 2001 versus 28% in 1998) and the greater numbers who did not spread any kind of fat on their bread (40% versus 22% in 1995, for rye bread).In general the observed trends point in the right direction in respect of food-based dietary guidelines and other recommendations. This indicates that the Danish population has been influenced by the nutritional messages and campaigns stressing fat reduction and increased intake of fruit and vegetables. An important factor in this context is the increasing availability of low-fat milk products on the Danish market. Whether or not the positive trends for foods included are supported by the rest of the diet remains to be answered.

Gentofte Hospital, Niels Andersensvej 65, DK-2900Hellerup, Copenhagen, DenmarkSubmitted 5 January 2001: Accepted 26 March 2001AbstractObjectives: To monitor trends in Danish food habits with respect to selected keyelements, from 1995 to 1998, and to evaluate the appropriateness of the methoddeveloped for that purpose.Design and method: Two cross-sectional population surveys, in 1995 and 1998. Datacollection by computer-assisted telephone interviews including 10 food-frequencyquestions,questionsontypeoffatusedon sandwichesanddrinkingmilk,andcheckquestions on theprevious day. Reproducibility was tested ina subgroup –n ‹222ƒinthe 1998 survey.Setting: The Danish Nutrition Council initiated the survey.Subjects: Men and women aged 15–90 years, 1007 in 1995 and 1024 in 1998. Samplesof private telephone numbers were drawn from regional telephone registers,geographically stratified. Participation rates were 62%.Results: Significant differences were observed between 1995 and 1998, some of thesein accordance with dietary guidelines (decreased use of whole milk and fat spreadon bread, increased use of skimmed milk, salad vegetables, rice/pasta and fish).Other changes were opposite to dietary guidelines (increased use of soft butter,decreased use of soft margarine and low-fat spreads, potatoes, and fresh fruit).Differences in average consumption frequency amounted to 4–13%. Several resultswere confirmed by comparison with other data, and the reproducibility of themethod was acceptable. Data were suitable for analysis of food use patterns, arelevant approach when assessing food habits in a lifestyle context.Conclusions: The changes observed illustrate the dynamics of food habits and theneed for frequent monitoring. This simple telephone method may be a valuable toolfor that purpose, as a supplement to national dietary surveys, also in a public healthcontext.KeywordsFood habitsDietary changesTelephone interviewsFood frequenciesPopulation surveillanceDietary habits are in a constant process of change. Publichealth authorities, food authorities, the food industry andothers working within this field need up-to-date data onthe dietary habits of the population as a basis for theirinitiatives. Up until now the availability of such data hasbeen limited in Denmark. Only two national dietarysurveys have been carried out, in 1985 and 1995

Background Critical evaluation of energy intake data from dietary studies is difficult but important. A simple approach has been suggested using minimum cutoff limits for the ratio of energy intake to basal metabolic rate as predicted from body weight (EI/BMR(est.)). This study investigates the potential of this particular approach in young subjects. Methods Energy intake during strictly controlled dietary intervention studies (2-6 weeks or 8 months) was compared with reported intake before the study started (7 days' weighed food records). Participants were 48 men and 22 women, 20-30 years. Results Mean EI/BMR(est.) values during the intervention study were 1.92 for men and 1.77 for women. Reported intakes before the study were only slightly lower (women 8%, P 0.05). Two EI/BMR(est.) limits were tested. Smaller underestimations could be detected by applying calculated cutoff limits based on average EI/BMR(est.) values from the intervention studies instead of published limits assuming a low physical activity level (6% versus 22% underestimation of group intake). Conclusions These results suggest that for the evaluation of energy intake of young adults it is more meaningful to use EI/BMR(est.) cutoff limits which assume a moderate, instead of a low, average physical activity level.

In a randomly selected sample of 88 men and 115 women, aged 23-27 years from Denmark, maximal oxygen uptake (VO2max), maximal voluntary isometric contraction (MVC) in four muscle groups and physical activity were studied. The VO2max was 48.0 ml.min-1.kg-1 and 39.6 ml.min-1.kg-1 for the men and the women, respectively. The MVC was 10% lower than in a comparable group of Danes of the same age and height studied 35 years ago. Only in men was sports activity directly related to VO2max (ml.min-1.kg-1; r = 0.31, P < 0.01). The MVC of the knee extensors was related to VO2max in the men (r = 0.31, P < 0.01), but there was no relationship between the other measurements of MVC and VO2max. In the women VO2max (ml.min-1.kg-1) was only related to body size, i.e. body mass index, percentage body fat and body mass [(r = -0.47, -0.48 (both P < 0.001) and -0.34 (P < 0.01), respectively)]. There were differences in VO2max in the men, according to education and occupation. Blue collar workers and subjects attending vocational or trade schools in 1983 had lower VO2max, and more of them were physically inactive. In the women differences were also found, but there was no clear pattern among the groups. More of the women participated regularly in sports activity, but more of the men were very active compared to the women.

Using data from a Danish dietary validity study, we evaluated the influence of including individually estimated portion size data on the validity of a semiquantitative food frequency questionnaire. A total of 144 subjects, aged 40-64 years were included. Correlation coefficients and classification of subjects into quintiles according to their intake of foods and nutrients were used to compare questionnaire data, with and without individually estimated portion size data, with data obtained by 2 x 7 days weighed diet records. For men, the mean correlation coefficient for food group comparisons was 0.47 when information about individually estimated portion sizes for food items that do not come in natural units was included in the analysis. Using a common average portion size reduced the mean correlation coefficient to 0.45. For women, similar changes were observed (0.36 to 0.35). For nutrients the mean values for the comparison changed from 0.51 to 0.49 and from 0.39 to 0.40 for men and women, respectively. For both men and women the classification into quintiles according to their intake of foods and nutrients showed only minor differences. We conclude that little extra information was gained by including individual portion size information for food items that do not come in natural units. This may reflect that portion sizes are of minor importance compared with frequencies or that the relevant individual portion sizes were not estimated correctly.

Background Epidemiologic studies suggest that foods rich in flavonoids might reduce the risk of cardiovascular disease. Objective Our objective was to investigate the effect of intake of flavonoid-containing black currant and apple juice on urinary excretion of quercetin and on markers of oxidative status. Design This was a crossover study with 3 doses of juice (750, 1000, and 1500 mL) consumed for 1 wk by 4 women and 1 man corresponding to an intake of 4.8, 6.4, and 9.6 mg quercetin/d. Results Urinary excretion of quercetin increased significantly with dose and with time. The fraction excreted in urine was 0.29-0.47%. Plasma quercetin did not change with juice intervention. Plasma ascorbate increased during intervention because of the ascorbate in the juice. Total plasma malondialdehyde decreased with time during the 1500-mL juice intervention, indicating reduced lipid oxidation in plasma. Plasma 2-amino-adipic semialdehyde residues increased with time and dose, indicating a prooxidant effect of the juice, whereas erythrocyte 2-aminoadipic semialdehyde and gamma-glutamyl semialdehyde concentrations, Trolox-equivalent antioxidant capacity, and ferric reducing ability of plasma did not change. Glutathione peroxidase activity increased significantly with juice dose. Conclusions Urinary excretion of quercetin seemed to be a small but constant function of quercetin intake. Short-term, high intake of black currant and apple juices had a prooxidant effect on plasma proteins and increased glutathione peroxidase activity, whereas lipid oxidation in plasma seemed to decrease. These effects might be related to several components of the juice and cannot be attributed solely to its quercetin content.

Objectives: To investigate whether a modest number of food frequency questions are sufficient to describe sociodemographic differences in dietary habits, and to identify sociodemographic characteristics of subjects adhering to food-based dietary guidelines operationalised in a ‘healthy-diet index’. Design: Cross-sectional population survey. Subjects: A total of 480 men, 515 women, aged 15–90 y. Random sample of private telephone numbers drawn from regional telephone records, geographically stratified. Participation rate 62%. Methods: Computer-assisted telephone interviews, including six food frequency questions, a question on type of fat spreads used on bread, questions on seven sociodemographic variables. Results: The summary of the healthy-diet index showed that the subjects who adhered to food-based dietary guidelines (top quintile) compared to those who did not (bottom quintile) were most often women (odds ratio (OR)=6.07; confidence interval (CI): 3.91–9.43, women vs men), of older age (OR=9.72; CI: 3.02–31.31, old age vs young), highly educated (OR=3.69; CI: 1.53–8.92, high education vs low) and living in multiperson households including children (OR=4.66; CI: 2.47–8.80, multiperson household vs single household). The results also showed that gender difference in dietary habits is associated with other sociodemographic variables. Conclusions: The selected food frequency questions proved sufficient to describe sociodemographic differences in dietary habits, and this method may be a valuable supplement to traditional quantitative dietary surveys in monitoring sociodemographic changes in eating patterns. The results also underline the influence of sociodemographic status on dietary habits. Sponsorship: The Danish Nutrition Council funded the study.