What consumers eat 11 2.3.2 Household budget surveys The household budget surveys(HBSs) are periodically conducted by the National Statistical Offices of most European countries in nationally representative samples of households. By recording the values and quantities of household food purchases, the HBSs can adequately depict the dietary patterns prevailing in rep resentative population samples. Moreover, the concurrent recording of demo- graphic and socio-economic characteristics of the household members may allow exploratory analyses on the evaluation of their effects on dietary choices. One of the main advantages of the multi-purpose HBSs is their periodic undertaking by Governmental Services, making them a readily available and thus an afford- able source of dietary information in developed and developing countries lou,1992) The HBSs can be thought of as occupying a position between the FBSs and the specially designed individual food consumption surveys. Like food balance sheets, the HBSs allow intercountry comparisons on a regular basis but, moving from total population to household level, they further allow the calculation of both the mean and the distribution of food availability within the population and specific subgroups(Trichopoulou et al, 1999) Issues of comparability can be raised when using HBS data for international omparisons. The data collection methodology is uniform enough to allow such comparisons, but the food information recorded in the various countries may be of different forms and levels of detail. The methodology, however, for address ing these discrepancies has been developed in the context of the DAta Food NE yorking ( DAFNE) project(Lagiou et al, 2001; Friel et al, 2001). However, since HBSs are not primarily designed to collect nutritional information, the food data bear limitations, which need to be considered when they are used for nutritional purposes(van Staveren et al, 1991; Southgate, 1991; Trichopoulou, 1992). The its should be bor In most cases, no records are collected on the type and quantity of food items ind beverages consumed outside the home Information on food losses and waste, food given to pets, meals offered to guests, use of vitamin and mineral supplements and the presence of pregnant or lactating women is not consistently collected Data are collected at household level and estimation of the individuals intake requires the application of stochastic statistical models Information on nutrient intake is not readily available. Nevertheless, appro- priate conversion factors based on food composition tables are developed for converting quantity data into nutrients Despite their limitations, the HBSs provide a resource for the conduct of a vide range of nutritional analyses. They also constitute a reasonable alternative to specially designed individual-based nutrition surveys for most Mediterranean and central/eastern European countries. HBS data could help highlight issues uch as differences in dietary patterns(Byrd-Bredbenner et al, 2000), high risk population groups on account of their nutritional habits, relationships between
2.3.2 Household budget surveys The household budget surveys (HBSs) are periodically conducted by the National Statistical Offices of most European countries in nationally representative samples of households. By recording the values and quantities of household food purchases, the HBSs can adequately depict the dietary patterns prevailing in representative population samples. Moreover, the concurrent recording of demographic and socio-economic characteristics of the household members may allow exploratory analyses on the evaluation of their effects on dietary choices. One of the main advantages of the multi-purpose HBSs is their periodic undertaking by Governmental Services, making them a readily available and thus an affordable source of dietary information in developed and developing countries (Trichopoulou, 1992). The HBSs can be thought of as occupying a position between the FBSs and the specially designed individual food consumption surveys. Like food balance sheets, the HBSs allow intercountry comparisons on a regular basis but, moving from total population to household level, they further allow the calculation of both the mean and the distribution of food availability within the population and specific subgroups (Trichopoulou et al, 1999). Issues of comparability can be raised when using HBS data for international comparisons. The data collection methodology is uniform enough to allow such comparisons, but the food information recorded in the various countries may be of different forms and levels of detail. The methodology, however, for addressing these discrepancies has been developed in the context of the DAta Food NEtworking (DAFNE) project (Lagiou et al, 2001; Friel et al, 2001). However, since HBSs are not primarily designed to collect nutritional information, the food data bear limitations, which need to be considered when they are used for nutritional purposes (van Staveren et al, 1991; Southgate, 1991; Trichopoulou, 1992). The following points should be borne in mind: • In most cases, no records are collected on the type and quantity of food items and beverages consumed outside the home. • Information on food losses and waste, food given to pets, meals offered to guests, use of vitamin and mineral supplements and the presence of pregnant or lactating women is not consistently collected. • Data are collected at household level and estimation of the individuals’ intake requires the application of stochastic statistical models. • Information on nutrient intake is not readily available. Nevertheless, appropriate conversion factors based on food composition tables are developed for converting quantity data into nutrients. Despite their limitations, the HBSs provide a resource for the conduct of a wide range of nutritional analyses. They also constitute a reasonable alternative to specially designed individual-based nutrition surveys for most Mediterranean and central/eastern European countries. HBS data could help highlight issues such as differences in dietary patterns (Byrd-Bredbenner et al, 2000), high risk population groups on account of their nutritional habits, relationships between What consumers eat 11
12 The nutrition handbook for food processors diet and morbidity/mortality data Lagiou et al, 1999)and dietary intakes of addi tives and contaminants 2.3.3 Individual dietary surveys The specially designed individual dietary surveys (IDSs) primarily aim at the col- lection of information on the food intake of free-living individuals over a speci fied period. The individual surveys, when intakes of the subject are recorded as dequately as possible, are expected to provide evidence on the food quantities consumed and to allow the calculation of both the mean and the distribution of food and nutrient intake among the whole or segments of the population The methods used to assess individual intake can be broadly divided into two generic categories(Willett, 1998): Recall methods of sporadic or habitual diet. They can be limited to the pre vious 24 hours(24-hour dietary recall), where subjects are asked to recall everything they consumed the previous day, or to a diet history referring to a broader and less precisely defined time period using food frequency methods Record methods of daily intake, where subjects are required to keep records of everything they eat and drink for one(24-hour food record) or more days The 7-day weighed record is the one commonly used The quantification of foods consumed and the selection of items to be included in the food list, in the case of closed lists, are critical components of data col lection. standard. natural and household units three-dimensional food model photographs, drawings of foods and geometric shapes are often used for docu henting portion sIzes. Recall methods, in comparison to the record ones, do not require literacy; they re not expected to cause alterations in the eating behaviour of the subject, since the information is collected after the fact; and they have minimal respondent burden. Nevertheless, recall methods are subject to respondents'memory, a limi- tation not present in food records. In recent surveys, dietary recalls are collected using computer software programmes that allow data to be uniformly collected by prompting interviewers to ask all the necessary questions, and may further reduce the cost of data collection and processing. The food records and the 24-hour recall may be used to estimate the absolute intake of energy, macronutrients and some vitamins and minerals that are com- monly found in the food supply. Both methods are frequently used in describing the mean intake of aggregated food groups and in validating food frequency ques tionnaires. These short-term methods are completely open ended, they accom- modate any food or food combination reported by the subject and they allow recording information at various levels of detail including the type of food, the food source, the food processing and preparation methods. They are therefore particularly useful for estimating intakes of culturally diverse populations. One gle day of intake, however, is highly unlikely to be representative of usual
diet and morbidity/mortality data (Lagiou et al, 1999) and dietary intakes of additives and contaminants. 2.3.3 Individual dietary surveys The specially designed individual dietary surveys (IDSs) primarily aim at the collection of information on the food intake of free-living individuals over a speci- fied period. The individual surveys, when intakes of the subject are recorded as adequately as possible, are expected to provide evidence on the food quantities consumed and to allow the calculation of both the mean and the distribution of food and nutrient intake among the whole or segments of the population. The methods used to assess individual intake can be broadly divided into two generic categories (Willett, 1998): • Recall methods of sporadic or habitual diet. They can be limited to the previous 24 hours (24-hour dietary recall), where subjects are asked to recall everything they consumed the previous day, or to a diet history referring to a broader and less precisely defined time period using food frequency methods. • Record methods of daily intake, where subjects are required to keep records of everything they eat and drink for one (24-hour food record) or more days. The 7-day weighed record is the one commonly used. The quantification of foods consumed and the selection of items to be included in the food list, in the case of closed lists, are critical components of data collection. Standard, natural and household units, three-dimensional food models, photographs, drawings of foods and geometric shapes are often used for documenting portion sizes. Recall methods, in comparison to the record ones, do not require literacy; they are not expected to cause alterations in the eating behaviour of the subject, since the information is collected after the fact; and they have minimal respondent burden. Nevertheless, recall methods are subject to respondents’ memory, a limitation not present in food records. In recent surveys, dietary recalls are collected using computer software programmes that allow data to be uniformly collected, by prompting interviewers to ask all the necessary questions, and may further reduce the cost of data collection and processing. The food records and the 24-hour recall may be used to estimate the absolute intake of energy, macronutrients and some vitamins and minerals that are commonly found in the food supply. Both methods are frequently used in describing the mean intake of aggregated food groups and in validating food frequency questionnaires. These short-term methods are completely open ended, they accommodate any food or food combination reported by the subject and they allow recording information at various levels of detail including the type of food, the food source, the food processing and preparation methods. They are therefore particularly useful for estimating intakes of culturally diverse populations. One single day of intake, however, is highly unlikely to be representative of usual 12 The nutrition handbook for food processors
What consumers eat 13 intake. For this reason the collection of multiple days of intake is required in rder to estimate as adequately as possible the subjects' usual intake Food frequency questionnaires are food lists of differing length and the infor- mation collected can refer either to the frequency of consuming certain foods and beverages, or to both the frequency and estimates of the portions consumed. The underlying principle of the food frequency method is that the average long-term diet reflects the conceptually important exposure, and therefore makes the food frequency questionnaires the method of choice for measuring dietary exposures in epidemiological studies. In constructing a food frequency questionnaire. careful attention must be given to the format of the food frequency section, the selection of foods that will be included in the food list and the clarity of the ques tions. Food frequency questionnaires can be administered to large population groups; they can be applied as interviews or in a self-administered form and are relatively easy and less time consuming to complete when compared to other dietary assessment methods. It should, however, be borne in mind that food fre- quency questionnaires including a restricted food list may result in reducing the true variance of intake For most investigations of nutritional epidemiology, the relative ranking of individuals according to their food and nutrient intakes is adequate for deter mining correlations of relative risks. In such cases, food frequency questionnaires constitute the primarily selected dietary assessment method. In situations however, when the aim is to compare the nutrient intakes of various population or to evaluate compliance with dietary recommendations, estimates of the absolute energy and macronutrient intakes may be required In such instances, records or 24-hour recalls are generally the methods of choice(Willett, 1998) 2.4 Dietary data in Europe: national surveys A number of European countries have carried out national dietary surveys. Table 2.1 summarises basic information on the various ldss that have been undertaken in 20 European countries during the last 20 years. The surveys are often designed to document the dietary patterns of the genera population or segments of it and possibly to identify groups at nutritional risk. In other instances, the primary aim is to address country-specific objectives. The selection of the dietary survey method depends on a number of different factors and investigators may frequently have to compromise according to the specific objectives of the survey and the inherent cost of setting it up When the option of running international comparisons using these data is raised, a number of methodological constraints emerge. It can directly be noted that a variety of dietary assessment methods are used, making it difficult to accomplish comparability at the international level ( Friedenreich, 1994). The dif- ferences in the data collection methodology are reflected in the type and accu racy of the data collected. Some dietary surveys, usually those conducted with food frequency questionnaires, collect data on the intake of particular food
intake. For this reason the collection of multiple days of intake is required in order to estimate as adequately as possible the subjects’ usual intake. Food frequency questionnaires are food lists of differing length and the information collected can refer either to the frequency of consuming certain foods and beverages, or to both the frequency and estimates of the portions consumed. The underlying principle of the food frequency method is that the average long-term diet reflects the conceptually important exposure, and therefore makes the food frequency questionnaires the method of choice for measuring dietary exposures in epidemiological studies. In constructing a food frequency questionnaire, careful attention must be given to the format of the food frequency section, the selection of foods that will be included in the food list and the clarity of the questions. Food frequency questionnaires can be administered to large population groups; they can be applied as interviews or in a self-administered form and are relatively easy and less time consuming to complete when compared to other dietary assessment methods. It should, however, be borne in mind that food frequency questionnaires including a restricted food list may result in reducing the true variance of intake. For most investigations of nutritional epidemiology, the relative ranking of individuals according to their food and nutrient intakes is adequate for determining correlations of relative risks. In such cases, food frequency questionnaires constitute the primarily selected dietary assessment method. In situations, however, when the aim is to compare the nutrient intakes of various populations or to evaluate compliance with dietary recommendations, estimates of the absolute energy and macronutrient intakes may be required. In such instances, records or 24-hour recalls are generally the methods of choice (Willett, 1998). 2.4 Dietary data in Europe: national surveys A number of European countries have carried out national dietary surveys. Table 2.1 summarises basic information on the various IDSs that have been undertaken in 20 European countries during the last 20 years. The surveys are often designed to document the dietary patterns of the general population or segments of it and possibly to identify groups at nutritional risk. In other instances, the primary aim is to address country-specific objectives. The selection of the dietary survey method depends on a number of different factors and investigators may frequently have to compromise according to the specific objectives of the survey and the inherent cost of setting it up. When the option of running international comparisons using these data is raised, a number of methodological constraints emerge. It can directly be noted that a variety of dietary assessment methods are used, making it difficult to accomplish comparability at the international level (Friedenreich, 1994). The differences in the data collection methodology are reflected in the type and accuracy of the data collected. Some dietary surveys, usually those conducted with food frequency questionnaires, collect data on the intake of particular foods, What consumers eat 13
Table 2.1 Specially designed dietary surveys undertaken in the general population of 20 European countries during the last 20 years. Sample size Survey Population Dietary Countr Name of the survey Years of data collection (number of assessment individuals) Gender Age(yrs) Austrian Study on 1991-1994 2173 F+M 6-18 7 day record Nutritional Status 1993-1997 2065 F+M19-65 (ASNS diet history 1995,1998 F+m elde 7 day record Belgium Belgian Interuniversity 1980-1985 10971 F+M I day recor Research on Nutrition and health ( BIRNH Croati Croatian Study on 1997-1998 348 F+M12-14 recall and Schoolchildren’s Nutrition Dietary Habits in Denmark 303 F+M 15-80 diet history National Dietary Survey 1995 F+M 1-80 7 day record National Continuous 2000-2002 1500( F+M 4-75 7 day record Dietary Survey Finland Dietary Survey of Finnish 1992 186 25-64 3 day record 1997 25-64 24 hour recall (FINDIET National Food diet history Consumption Survey 993-1994 7 day record (ASPCC) 1993-1994 7 day record Individual National Food 1998-1999 7 day record Consumption Surveys 1985 F+M15+ (INCA
14 The nutrition handbook for food processors Table 2.1 Specially designed dietary surveys undertaken in the general population of 20 European countries during the last 20 years. Sample size Survey Population Dietary Country Name of the survey Years of data collection (number of Gender Age (yrs) assessment individuals) method Austria Austrian Study on 1991–1994 2 173 F + M 6–18 7 day record Nutritional Status 1993–1997 2 065 F + M 19–65 24 hour recall, (ASNS) diet history 1995, 1998 78 F + M Elderly 7 day record Belgium Belgian Interuniversity 1980–1985 10 971 F + M 25–74 1 day record Research on Nutrition and Health (BIRNH) Croatia Croatian Study on 1997–1998 348 F + M 12–14 24 hour recall and Schoolchildren’s food frequency Nutrition questionnaire Denmark Dietary Habits in Denmark 1985 2 242 F + M 15–80 diet history National Dietary Survey 1995 3 098 F + M 1–80 7 day record National Continuous 2000–2002 1 500 (2000) F + M 4–75 7 day record Dietary Survey Finland Dietary Survey of Finnish 1992 1 861 F + M 25–64 3 day record Adults 1997 2 862 F + M 25–64 24 hour recall (FINDIET) 290 F + M 65–74 France National Food 1985–1995 1 778 F + M 18–62 diet history Consumption Survey 1993–1994 1 229 F + M 18+ 7 day record (ASPCC) 1993–1994 1 500 F + M 2–85 7 day record Individual National Food 1998–1999 1 018 F + M 3–14 7 day record Consumption Surveys 1 985 F + M 15+ (INCA)
Table 2.1 Continued Sample size Survey Population Dietary Name of the survey Years of data collection (number of individuals) Gender Age(yrs) method Germany National Nutrition Survey 1985-1989 24632 F+M 4-70+ in former West germany National Health Survey in 1991-1992 1897 F+ former East Germany German Nutrition Survey 199 4030 F+M 18-79 First hungarian 1985-1988 16641 +M15-60+ Two 24 hour recalls Representative Nutrition and food frequency Hungarian Randomised 1992-1994 F+M1860+ Three 24 hour recalls and food frequency Iceland Icelandic National 1990 1240 F+M15-80 diet history Ireland Irish National Nutrition 1990 1214 F+M 8-18 North-South food 1998 1379 F+M18-64 7 day record Italy INN-CA 1994-1996 3600 F+M0-94 7 day record Lithuania Baltic Nutrition and Health 1997 2183 20-65 24 hour recall and food frequency Netherlands Dutch National Food 1987-1988 5898 F+M 1-79 2 day record 1992 6218 F+M 192 2 day record 1997-1998 6250 F+M1-97 2 day record Norway National Dietary Survey 1993-1994 31 F+M food frequency NORKOST 1997 F+M food frequency National Dietary Survey 1993 1705 F+M food frequency 1564 18 1999 2400 F+M 6 and 12 food frequency month 1999 2010 F+M
What consumers eat 15 Germany National Nutrition Survey 1985–1989 24 632 F + M 4–70 + 7 day record in former West Germany National Health Survey in 1991–1992 1 897 F + M 18–79 diet history former East Germany German Nutrition Survey 1998 4 030 F + M 18–79 diet history Hungary First Hungarian 1985–1988 16 641 F + M 15–60 + Two 24 hour recalls Representative Nutrition and food frequency Survey questionnaire Hungarian Randomised 1992–1994 2 559 F + M 18–60 + Three 24 hour recalls Nutrition Survey and food frequency questionnaire Iceland Icelandic National 1990 1 240 F + M 15–80 diet history Nutrition Survey Ireland Irish National Nutrition 1990 1 214 F + M 8–18 + diet history Survey North-South Food 1998 1 379 F + M 18–64 7 day record Consumption Survey Italy INN-CA 1994–1996 3 600 F + M 0–94 7 day record Lithuania Baltic Nutrition and Health 1997 2 183 F + M 20–65 24 hour recall and Survey food frequency questionnaire Netherlands Dutch National Food 1987–1988 5 898 F + M 1–79 2 day record Consumption Survey 1992 6 218 F + M 1–92 2 day record 1997–1998 6 250 F + M 1–97 2 day record Norway National Dietary Survey 1993–1994 3 144 F + M 16–79 food frequency among Adults questionnaire (NORKOST) 1997 2 672 F + M 16–79 food frequency questionnaire National Dietary Survey 1993 1 705 F + M 13 food frequency 1 564 18 questionnaire 1999 2 400 F + M 6 and 12 food frequency months questionnaire 1999 2 010 F + M 2 food frequency questionnaire Table 2.1 Continued Sample size Survey Population Dietary Country Name of the survey Years of data collection (number of Gender Age (yrs) assessment individuals) method