Dietary intake and nutritional status of children and adolescents …€¦ · Dietary intake and...

Dietary intake and nutritional status of children and adolescentsin Europe

Janet Lambert1 Carlo Agostoni2 Ibrahim Elmadfa3 Karin Hulshof4 Edburga Krause5Barbara Livingstone6 Piotr Socha7 Daphne Pannemans8 and Sonia Samartın81Lambert Nutrition Consultancy Ltd 5 Britwell Road Watlington OX49 5JS UK2San Paolo Hospital Department of Pediatrics Via A di Rudini 8 I-20142 Milan Italy3University of Vienna Institute of Nutritional Sciences Althanstrasse 14 A-1090 Vienna Austria4TNO Nutrition and Food Research Institute Department of Nutritional Epidemiology Utrechtseweg 48 NL-3700 AJ Zeist

The Netherlands5Procter amp Gamble Service GmbH Sulzbacher Strasse 40 D-65824 Schwalbach am Taunus Germany6University of Ulster School of Biomedical Sciences Cromore Road Coleraine BT52 1SA UK7The Childrenrsquos Memorial Health Institute Department of Gastroenterology Hepatology and Nutrition

Al Dzieci Polskich 20 PL-04736 Warsaw Poland8ILSI Europe Av E Mounier 83 Box 6 B-1200 Brussels Belgium

The objective of this project was to collect and evaluate data on nutrient intake and status across Europe and to ascertain whether anytrends could be identified Surveys of dietary intake and status were collected from across Europe by literature search and personal contactwith country experts Surveys that satisfied a defined set of criteria ndash published based on individual intakes post-1987 adequate infor-mation provided to enable its quality to be assessed small age bands data for sexes separated above 12 years sample size over 25 andsubjects representative of the population ndash were selected for further analysis In a small number of cases where no other data for a countrywere available or where status data were given exceptions were made Seventy-nine surveys from 23 countries were included and fromthem data on energy protein fats carbohydrates alcohol vitamins minerals and trace elements were collected and tabulated Data onenergy protein total fat and carbohydrate were given in a large number of surveys but information was very limited for some micronu-trients No surveys gave information on fluid intake and insufficient gave data on food patterns to be of value to this project A variety ofcollection methods were used there was no consistency in the ages of children surveyed or the age cut-off points but most surveys gavedata for males and females separately at all ages Just under half of the surveys were nationally representative and most of the remainderwere regional Only a small number of local surveys could be included Apart from anthropometric measurements status data were col-lected in only seven countries Males had higher energy intakes than females energy intake increased with age but levelled off in ado-lescent girls Intakes of other nutrients generally related to energy intakes Some northndashsouth geographical trends were noted in fat andcarbohydrate intakes but these were not apparent for other nutrients Some other trends between countries were noted but there were alsowide variations within countries A number of validation studies have shown that misreporting is a major problem in dietary surveys ofchildren and adolescents and so all the dietary data collected for this project should be interpreted and evaluated with caution In additiondietary studies rely on food composition tables for the conversion of food intake data to estimated nutrient intakes and each country uses adifferent set of food composition data which differ in definitions analytical methods units and modes of expression This can makecomparisons between countries difficult and inaccurate Methods of measuring food intake are not standardised across Europe andintake data are generally poor so there are uncertainties over the true nutrient intakes of children and adolescents across EuropeThere are insufficient data on status to be able to be able to draw any conclusions about the nutritional quality of the diets of Europeanchildren and adolescents

Dietary intake Nutritional Status Children Adolescents Diet surveys

Introduction

There is little good evidence-based information on thenutritional needs of healthy children and adolescents overthe age of 2 years Numerous dietary surveys to assess

nutrient intake have been conducted across Europe atboth national and local level which could help establishnutrient needs especially if measurements of status arealso carried out However estimation of dietary intake isfraught with difficulties (Biro et al 2002) and it is now

Corresponding author ILSI Europe 83 Avenue E Mounier Box 6 B-1200 Brussels fax thorn32 2 762 00 44 email publicationsilsieuropebe

Abbreviations RE retinol equivalents SFA saturated fatty acids

British Journal of Nutrition (2004) 92 Suppl 2 S147ndashS211 DOI 101079BJN20041160q ILSI 2004

httpswwwcambridgeorgcoreterms httpsdoiorg101079BJN20041160Downloaded from httpswwwcambridgeorgcore IP address 541914080 on 02 Apr 2017 at 125230 subject to the Cambridge Core terms of use available at

accepted that many published surveys do not accuratelyreflect true intakes For this report as part of an exerciseto review data available in Europe that could be used tohelp develop dietary guidelines information on nutrientintake and status across Europe was collected and evalu-ated to ascertain whether any trends could be identified

Methodology

To gain insight into the dietary intake and nutritional statusof children and adolescents the first step was to collectdata and to highlight the measurement tools used and bio-logical parameters investigated for each data set individu-ally before a final selection of the most relevant surveysfor further analysis was made For this purpose the infor-mation listed below was collected for each survey

Quality of the document and whether published

Dietary assessment method used

Range of intakes (mean values standard deviations orother distribution characteristics)

Food composition databases used for the conversion offood intakes to estimated nutrient intakes (national foodcomposition databases other country databases andormanufacturerrsquos database duplicate portion techniquewith chemical analysis data nutrient calculationsinclusive or exclusive of the contribution of food sup-plements)

Year and type of the survey eg longitudinal or cross-sectional

Age ranges and cut-off ages sex and sample size

Assessment of status anthropometric data (measured orself-reported) and biochemical parameters

Geographical distribution national regional or localstudy rural or urban

Next each member of the Working Group looked for theabove-defined survey information and data on the energyand nutrients listed in Table 1 from their specifiedcountries Surveys to be assessed were collected betweenApril and December 2001 by literature search andor bycontacting experts in this field Once the available surveyswere collected and related information was incorporatedinto the template by country a selection of relevant sur-veys was made according to the criteria listed in Table 2

Originally we aimed to focus also on fluid intake (egwater other fluids juices soda) and meal pattern How-ever only a few studies provided information about the

intake of water and other fluids Sometimes these figureswere related to total water (including water from food)whereas in other studies figures seemed to refer only todrinks including or excluding tap water Furthermorealthough some information on meal pattern was availablethe kind of information was difficult to compare Since theinformation on fluids and meal pattern could not be inter-preted unequivocally we decided not to include this typeof data

In a final stage the results of the selected surveys wereincorporated in tables by nutrient using units accordingto the SI system and each nutrient was reviewed

The age group classification of the EU was used as gui-dance 1ndash3 years 4ndash6 years 7ndash10 years 11ndash14 years and15ndash17 years (Reports of the Scientific Committee on Food1993) Data were collapsed if relevant (weighted meanswhen only a small amount of data was available) Whenage categories were combined this was clearly indicatedData of specific groups within countries eg urbanruralwere collapsed in the case of minor differences

For describing regional trends in dietary intake of chil-dren and adolescents Europe was divided into fourregions Northern countries (Denmark Finland NorwaySweden) Western countries (Austria Belgium FranceGermany Ireland The Netherlands Switzerland theUK) Central and Eastern countries (Bulgaria CzechRepublic Estonia Hungary Poland Russia Yugoslavia)and Southern countries (Greece Italy Portugal Spain)

Results

Eighty surveys from twenty-three countries which satisfiedthe selection criteria were selected for inclusion in thereview These are listed by country in Table 3 Only sur-veys from the UK used 7 d weighed records Most surveysgave data for males and females separately for all ages

Table 2 Inclusion and exclusion criteria

Unpublished surveys were included only if relevant(eg no published documents were available)

Control groups from studies of children with medical conditionswere not used even for rare nutrients or for nutrients for whichno other data were available in the country

To assess nutrient intake only surveys based on theindividual level were included Therefore only dataobtained with a record method (weighed or estimated)24 h recall food frequency questionnaire andor dietaryhistory method were included

Surveys before 1987 were excluded unless specific information onfood status was available

If too much information was missing in a document the survey wasexcluded except if there was only a small number of surveysavailable for a specific country or a specific nutrient

Nutritional status data were included only if they could be linked todietary intake data in the same or a similar study In thisparticular case a randomised selection of children shouldbe ensured

Surveys with too broad age categories (eg 2ndash24 years) wereexcluded

Data were excluded when genders were mixed in children above12 years of age

Surveys with a very small sample size (n frac14 10ndash25) were excluded

Table 1 Nutrients included in the inventory

EnergyCarbohydrates (total sugars sucrose starches total available

carbohydrates) and NSPfibreLipids (total fat saturated fatty acids MUFA PUFA trans fatty

acids polyunsaturated fatssaturated fats cholesterol)ProteinAlcoholVitamins (biotin folic acid niacin pantothenic acid retinol

equivalents riboflavin thiamin vitamin B12 vitamin B6vitamin C vitamin D vitamin E vitamin K)

Minerals and trace elements (Ca Mg P K Na chloride iron CrCu fluoride I Mn Mo Se Zn)

J Lambert et alS148


Tab

le3

Surv

eys

inclu

ded

inth

edie

tary

inta

ke

and

sta

tus

revie

w

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)S

am

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

Austr

iaA

12002

Elm

adfa

ampW

ass

erb

uch

er

(2002)

7d

record

1pound

24

hre

call

mthorn

f4

ndash18

4ndash

6

7ndash

9

10

ndash12

13

ndash15

15

ndash18

2234

national

Belg

ium

B1

1992

Guill

aum

eet

al

(1998)

3d

record

mthorn

f6

ndash12

8

10

1028

regio

nal

B2

1991

De

Henauw

et

al

(1997)

FF

Qm

thornf

6ndash

12

ndash1321

local

B3

1995

Paulu

set

al

(2001)

1d

record

mthorn

f12

ndash17

ndash1526

regio

nal

B4

1997

De

Henauw

ampM

att

hys

(1998)

De

Henauw

et

al

(2001)

7d

record

mthorn

f13

ndash18

ndash341

local

urb

anr

ura

lB

ulg

aria

BG

11998

Petr

ova

et

al

(2000)

1pound

24

hre

call

mix

1

ndash10

mthorn

f11thorn

1ndash

18

3

6

10

14

362

national

Czech

Republic

CZ

11998

Bra

zdova

et

al

(2000)

1pound

24

hre

call

FF

Qf

6ndash

9

11

ndash15

ndash1564

national

CZ

2N

AB

razdova

et

al

(1992)

1pound

24

hre

call

mix

3ndash

6

9ndash

11

ndash100

local

Denm

ark

DK

11995

Anders

en

et

al

(1996)

7d

record

mthorn

f1

ndash18

3

6

10

14

1413

national

DK

21995

Lyhne

(1998)

7d

record

mthorn

f14

ndash19

ndash245

national

Est

onia

EE

11993

ndash95

Gru

nberg

et

al

(1997)

1pound

24

hre

call

FF

Q

OC

Dm

thornf

11

ndash12

14

ndash15

ndash341

regio

nal

Fin

land

SF

11996

Rasanen

et

al

(1991)

2pound

24

hre

call

mthorn

f9

ndash24

12

15

18

902

regio

nal

SF

2N

AR

ankin

en

et

al

(1995)

4d

record

mthorn

f9

ndash12

ndash170

local

SF

31989

Ylo

nen

et

al

(1996)

3d

record

mix

1ndash

73

77

regio

nal

SF

419969

7Lehto

nen-V

ero

maa

et

al

(1999)

4d

record

f9

ndash15

ndash191

national

Fra

nce

F1

1988

Herc

berg

et

al

(1991a)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F2

1988

Herc

berg

et

al

(1991b)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F3

1988

Herc

berg

et

al

(1994)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F4

1988

Pre

zio

siet

al

(1994)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F5

19939

4R

igaud

et

al

(1997)

1d

WR

mthorn

f2

ndash20

6

12

17

271

national

F6

19939

4C

ouet

et

al

(2000)

1d

WR

mthorn

f2

ndash20

6

12

17

271

national

F7

19899

0V

ola

tier

(2000)

1d

WR

mthorn

f3

ndash14

6

8

11

1018

national

F8

1985

ndash93

Deheeger

et

al

(1994)

DH

mthorn

f2

ndash20

4

6

82781

12

local

F9

1985

ndash93

Deheeger

et

al

(1996)

DH

mthorn

f2

ndash20

4

6

82781

12

local

Germ

any

D1

1998

Deuts

che

Gesells

chaft

fur

Ern

ahru

ng

eV

(2000)

1d

WR

D

Hm

thornf

4ndash

19

7

10

13

15

38

924

national

D2

1985

ndash88

Adolf

et

al

(1995)

7d

record

mthorn

f4

ndash18

6

9

12

14

24

632

national

D3

1985

ndash95

Kers

ting

et

al

(2000)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

D4

1985

Kers

ting

et

al

(1998a)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

D5

1985

Kers

ting

et

al

(1998b)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

Gre

ece

GR

119939

4R

om

a-G

iannik

ou

et

al

(1997)

1d

WR

O

CD

mthorn

f2

ndash14

3

5

7

9

11

1936

national

GR

21994

Kafa

tos

et

al

(2000)

1pound

24

hre

call

OC

Dm

12

ndash98

regio

nal

GR

31999

Moschandre

as

ampK

afa

tos

(2002)

1pound

24

hre

call

mthorn

f9

ndash16

9ndash

12

14

ndash16

10547

99

regio

nal

GR

41997

Hassapid

ou

et

al

(2001)

3d

WR

1pound

24

hre

call

OC

D

FF

Qm

thornf

11

ndash14

ndash582

regio

nal

GR

51987

ndash88

Hassapid

ou

et

al

(1996)

3d

WR

mthorn

f13

ndash14

ndash20

local

Hungary

H1

1995

Gabor

(1998)

3pound

24

hre

call

mthorn

f13

ndash14

13

ndash14

414

regio

nal

Irela

nd

IRL1

1988

Lee

ampC

unnin

gham

(1990)

DH

O

CD

mthorn

f8

ndash25

12

15

18

643

national

Dietary intake and nutritional status of children and adolescents in Europe S149


Tab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

Italy

IT1

1996

Bellu

et

al

(1996)

FF

Qm

thornf

7

mix

10

7

10

ndash35

072

national

IT2

1992

Rats

ch

et

al

(1992)

4d

record

mix

3

7

10

ndash93

national

IT3

1991

Lecle

rcq

ampF

err

o-L

uzzi(1

991)

1pound

24

hre

call

mix

10

ndash11

ndash178

national

IT4

1988

Agosto

niet

al

(1998)

1pound

24

hre

call

mthorn

f11

mix

15

11

15

ndash120

local

The

Neth

er-

lands

NL1

19979

8H

uls

hof

et

al

(1998)

2d

record

mthorn

f2

ndash19

3

6

9

12

15

1538

national

NL2

1984

Meulm

eeste

r(1

989)

1pound

24

hre

call

mthorn

f8

ndash135

local

NL3

1999

Bru

ssaard

et

al

(1999)

1pound

24

hre

call

mthorn

f7

ndash9

ndash202

local

Norw

ay

N1

NA

Fro

st

Anders

on

et

al

(1995)

1d

WR

F

FQ

mthorn

f18

ndash1564

national

N2

NA

Fro

st

Anders

on

et

al

(1997)

FF

Qm

thornf

13

ndash1705

national

N3

NA

Johanss

on

et

al

(1997)

1d

WR

mthorn

f16

ndash29

ndash845

national

Pola

nd

PL1

1991

ndash94

Szponar

ampR

ychlik

(1996a)

1pound

24

hre

call

m11

ndash14

11

12

13

14

401

national

PL2

1991

ndash94

Szponar

ampR

ychlik

(1996b)

1pound

24

hre

call

f11

ndash14

11

12

13

14

725

national

PL3

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(2000)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL4

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(1999)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL5

19969

7H

am

ułk

aet

al

(1998)

1pound

24

hre

call

FF

Qm

thornf

13

ndash15

13

15

104

urb

an

rura

lP

L6

NA

Ham

ułk

aet

al

(2000)

1pound

24

hre

call

m17

ndash18

17

18

215

local

PL7

NA

Sm

igie

let

al

(1994)

1pound

24

hre

call

m17

ndash18

17

18

236

local

PL8

19909

1R

ogals

ka-N

iedzw

iedz

et

al

(1992)

1pound

24

hre

call

mthorn

f11

ndash15

11

15

7562

local

PL9

NA

Czeczele

wskiet

al

(1995)

1pound

24

hre

call

mthorn

f13

ndash15

13

15

76

local

PL10

NA

Ilow

et

al

(1999)

1pound

24

hre

call

mix

3ndash

73

7822

national

PL11

NA

Werk

er

(2000)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL12

NA

Sto

pnic

ka

et

al

(1998)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL13

NA

Charz

ew

ska

et

al

(1992)

FF

Qm

thornf

9ndash

14

9

14

672

regio

nal

Port

ugal

P1

1995

Am

orim

Cru

z(2

000)

1pound

24

hre

call

mthorn

f13

ndash18

ndash78

local

Russia

Rus1

2000

BP

opki

n(u

npublis

hed

results

)1pound

24

hre

call

mthorn

f1

ndash20

2

3

4

etc

2779

national

Spain

E1

19899

2A

guile

raet

al

(1994)

FF

Qm

ix2

ndash7

3

6264

local

E2

NA

Gonzale

zet

al

(1994)

1pound

24

hre

call

OC

Dm

thornf

6ndash

14

7

8

9

etc

2608

local

E3

1988

Vazquez

et

al

(1996)

1pound

24

hre

call

mthorn

f6

ndash16

7

12

164

local

E9

Ara

nce

taamp

Pere

z(1

996)

Sw

eden

S1

19899

0B

erg

stro

met

al

(1993)

7d

record

mthorn

f14

ndash17

17

731

regio

nal

S2

19939

4S

am

uels

on

et

al

(1996a)

7d

record

mthorn

f15

ndash398

regio

nal

S3

19939

4S

am

uels

on

et

al

(1996b)

7d

record

mthorn

f15

ndash398

regio

nal

S4

NA

Sam

uels

on

et

al

(2001)

7d

record

mthorn

f15

ndash93

regio

nal

Sw

itzerland

CH

119949

5S

ocie

teS

uis

se

de

laN

utr

itio

n(1

998)

7d

record

mthorn

f13

ndash21

15

19

1862

regio

nal

UK

UK

11988

Nels

on

et

al

(1990)

7d

WR

mthorn

f7

ndash12

11

227

local

UK

21989

McN

eil

et

al

(1991)

7d

WR

mthorn

f12

ndash61

local

UK

31990

Adam

son

et

al

(1992)

2pound

3d

record

mthorn

f11

ndash12

ndash379

local

UK

419889

0P

ayne

ampB

elto

n(1

992a)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

519889

0P

ayne

ampB

elto

n(1

992b)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

619868

7C

raw

ley

(1993)

4d

record

mthorn

f16

ndash17

ndash4760

national

J Lambert et alS150


There was no consistency in the ages of the children sur-veyed or the age cut-off points Thirty-four of the selectedsurveys were nationally representative and most of theremainder were regional Only a small number of local sur-veys could be included Thirteen (16 ) surveys provideddata on children and adolescents living in Northerncountries of Europe fourteen (18 ) provided dataon those living in Southern Europe twenty-nine (37 )on those in Western Europe and twenty-three (29 ) onthose living in Central and Eastern Europe althoughmany of the surveys from the latter region were local sur-veys or surveys using 1 d records or 24 h recalls All intakedata are presented as a mean daily intake unless otherwisestated In some surveys only a daily median was provided

Apart from anthropometric data some surveys providedadditional information on status Data from the UK weregiven for individuals for age groups between 1middot5 and 18years and for Austria for 6ndash18 years For France andThe Netherlands status data were available only for thenutrients folic acid vitamins A E and C b-carotene ribo-flavin thiamin pyridoxine and Fe Status data for vitaminB12 and some lipid parameters were also available for TheNetherlands but these data related only to a small agegroup Greece discussed status data on lipids and vitaminE only Sweden provided status data for Fe and cholesteroland Finland for vitamin D

Appendix B tabulates the intake data by nutrient for chil-dren and adolescents across Europe For brevity in theappendix tables the surveys reviewed are given a surveynumber Table 3 links the survey numbers and sourcesThe latter are given in the reference list of the presentpaper

Energy

Data were obtained from sixty-seven surveys for males andfifty-nine for females Most surveys provided data onenergy intakes for a number of age categories Makingallowances for the different age categories used in the sur-veys the intake of energy was consistent within the Euro-pean countries Approximately half the surveys provideddata on children and adolescents living in WesternEurope while a further third reported on the intakes ofthose living in Southern Europe Children (2ndash10 years)and adolescents (11ndash18 years) were equally representedin terms of the number of surveys

There were fewer data sets available on the energyintakes of 2- to 3-year-olds compared with the other agecategories

When expressed in absolute terms reported energyintakes (kJd) increased with increasing age in bothmales and females when the data were expressed relativeto body weight (kJkg per d) the opposite trend wasapparent Within each age category there was a widerange in reported energy intake (kJd) and this variabilityincreased in magnitude with increasing age Energy intakesof males were in the following ranges 4200ndash6900 kJd(2ndash3 years) 5300ndash7700 kJd (4ndash6 years) 7000ndash10 100 kJd (7ndash10 years) 7740ndash15 000 kJd (11ndash14years) and 9000ndash16 500 kJd (15ndash18 years) The corre-sponding intakes for females were 4100ndash5400 kJd (2ndash3T

ab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

UK

71989

Davie

set

al

(1994)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

81

local

UK

81990

Str

ain

et

al

(1994)

DH

mthorn

f12

15

ndash1015

regio

nal

UK

919868

7C

raw

ley

ampW

hite

(1995)

4d

record

mthorn

f16

ndash17

ndash3288

national

UK

10

19929

3G

regory

et

al

(1995)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

1675

national

UK

11

1990

McN

ulty

et

al

(1996)

DH

mthorn

f12

ndash15

ndash1015

regio

nal

UK

12

19919

2R

uxto

net

al

(1996)

7d

WR

mthorn

f7

ndash8

ndash136

local

UK

13

1997

Gre

gory

ampLow

e(2

000)

7d

WR

mthorn

f4

ndash18

6

10

14

1701

national

Yugosla

via

YU

11998

Pavlo

vic

et

al

(2001)

1d

record

mix

10

9

11

5834

national

YU

21998

Pavlo

vic

et

al

(1999)

1d

record

mix

9ndash

10

9

11

492

local

YU

319949

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avlo

vic

(1999)

1d

record

mix

4ndash

64

6123

local

YU

4

YU

4b

1998

Pavlo

vic

(2000)

1d

record

mix

9ndash

10

9

11

375

local

NA

not

availa

ble

F

FQ

fo

od

frequency

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oth

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yfo

od

com

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ndata

base

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die

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R

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m

m

ale

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ix

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not

separa

ted



years) 5100ndash9600 kJd (4ndash6 years) 6700ndash9600 kJd(7ndash10 years) 6800ndash 10 900 kJd (11ndash14 years) and6800ndash10 600 kJd (15ndash18 years) Overall while energyintakes appeared to increase during adolescence in malesno further increases were apparent from the age of 11years in females

On the other hand the magnitude of the variability inenergy intakes decreased with increasing age when intakeswere expressed relative to body weight In children (2ndash10years) relative energy intakes were similar in males andfemales and typically these were in the range of 315ndash480 kJkg per d (2ndash3 years) 250ndash380 kJkg per d (4ndash6years) and 210ndash340 kJkg per d (7ndash10 years) In adoles-cents there was greater divergence between males andfemales in relative intakes The range of values for maleswas 175ndash290 kJkg per d in 11- to 14-year-olds and140ndash255 kJkg per d in 15- to 18-year olds The corre-sponding values for females were 150ndash225 kJkg per d(11ndash14 years) and 115ndash190 kJkg per d (15ndash18 years)In general the variability in energy intakes was greatestin children and adolescents from Western Europe but thismay simply be a reflection of the greater number of datasets available Otherwise there were no clear differencesin intake across the different regions of Europe

Carbohydrate and dietary fibre

Data for absolute intakes (gd) and percentage of totalenergy were collected for total carbohydrate total sugarssucrose and starch Only the percentage energy fromeach is presented as this corrects for any differences dueto total energy intake and to some extent for misreportingassuming misreporting is not macronutrient-specific

Where the percentage energy was not provided it wascalculated from the absolute intake and total energy perday The energy value used for 1 g carbohydrate waseither 16 or 17 kJ depending on which provided the nearestto 100 when added to the percentage energy from fat(37 kJg) and protein (17 kJg) This calculation wasrequired for most of the surveys and hence only a limitednumber of values for standard deviations are availableThe surveys provided data on fibre intakes as g dietaryfibred or in the case of most UK surveys NSP Thiswas converted to gMJ

Boys ate more carbohydrate and fibre than did girls inabsolute amounts but relative to energy intakes theywere very similar Data for both are given but the descrip-tions below refer to data for males unless specified forsimplicity Within surveys there were large differencesbetween individuals in absolute intakes but much of thiscan be explained by variations in energy intake

Total carbohydrate Data were obtained from sixty-four surveys for males and sixty-three for females Carbo-hydrate energy ranged from 40middot3 to 61middot6 of total energyfor males and from 39 to 60 for females In both casesthe lowest values were from a Spanish survey (Gonzalezet al 1994) and the highest from the Russian survey (BPopkin unpublished results) These represented the geo-graphical trend The lowest intakes tended to be in theSouthern European countries ranging from 40middot3 ofenergy in Spanish 8-year-olds to 53 in Italian 11- to

12-year-olds (Agostini et al 1998) and the highest in theCentral and Eastern countries ranging from 44middot6 ofenergy in Yugoslavian 9- to 10-year-olds (Pavlovic2000) to 61middot6 in Russian 8-year-olds In Northerncountries intakes ranged from 46middot1 of energy in Finnish12-year-olds (Rankinen et al 1995) to 55middot1 in Norwe-gian 13- to 15-year-olds (Frost Anderson et al 1997)Intakes in Western countries were from 42middot7 of energyin German 10- to 12-year-olds (Adolf et al 1995) to55 in Dutch 2- to 3-year-olds (Hulshof et al 1998)

In the surveys where a number of age groups wereincluded the majority demonstrated a decline in percen-tage energy from carbohydrate with age However inRussia where intakes were the greatest the survey indi-cated that the lowest intakes were in the under-sevensand over-sixteens A reduction with age was also lesslikely in Southern European countries where intakes werealready low at a young age

Total sugar Data were available from twenty surveysfor males and females Some UK surveys could not beincluded as they provided only non-milk extrinsic sugarswhich excludes lactose and sugars in fruits and vegetablesand therefore are not comparable with the data from therest of Europe There were no data for Scandinaviancountries

Intakes tended to be lowest in Southern Europeancountries There was a clear trend of declining intakewith age except in Spain (Aranceta amp Perez 1996)where intakes were mostly less than 12 of energyIntakes in 2- to 3-year-olds ranged from 22middot9 ofenergy in Greece (Roma-Giannikou et al 1997) to33middot2 in The Netherlands (Hulshof et al 1998) Intakesamong older children ranged from 10middot9 of energy inSpanish 6- to 7-year-olds to 27 and 24middot9 of energy inDutch adolescents aged 13ndash15 and 16ndash19 years respect-ively (Hulshof et al 1998)

Sucrose Data were provided by fifteen surveys formales and females As with total sugars the lowest intakeswere found in Southern European countries but there wereno obvious geographical trends amongst the other regionsSimilarly there was a decline in intake with age Thesmallest intakes were 6 of energy by a group of UK 7-to 8-year-olds (Ruxton et al 1996) and 7middot1 by Italian7-year-olds (Leclercq amp Ferro-Luzzi 1991) However itshould be noted that of the many UK surveys includedin this review this was the only one that provided dataon sucrose Other UK surveys only provided non-milkextrinsic sugars which include glucose and fructosefound in fruit juices Greatest sucrose intakes were 19 of energy by 4- to 6-year-old Austrians (Elmadfa amp Was-serbacher 2002) and 17middot6 of energy amongst Finnish 4-to 7-year-olds (Ylonen et al 1996)

Starch Data for males came from twenty-one surveysand for females from twenty surveys Intakes were greatestin the Spanish Russian and Polish surveys and smallest inthe Finnish surveys There was a clear trend of increasingintake with age except in the Spanish survey (Aranceta ampPerez 1996) In younger children intakes ranged from18 of energy in Finnish 2- to 3-year-olds (Ylonen et al1996) to 28 and 28middot8 in Russian 2- and 3-year-oldsrespectively and 35 in Spanish 4- to 5-year-olds

J Lambert et alS152


For the older children they ranged between 22middot8 and34middot6 of energy in Finnish (Rasanen et al 1991) and Rus-sian 18-year-olds respectively There were no clear differ-ences in intakes between those Southern and WesternEuropean countries that reported intakes

Fibre Data were obtained from fifty-four surveys formales and fifty-two for females Intakes ranged from 0middot9to 3middot5 g dietary fibreMJ with no discernible trendsbetween countries or ages Differences in methodologyfor determining fibre may partly explain why regionaldifferences were not apparent Values for NSP within theUK surveys ranged from 1middot1 to 2middot2 gMJ

Fat

Total fat Data originated from sixty surveys for malesand females Malesrsquo and femalesrsquo intakes of fat whenexpressed as percentage of total energy were similaralthough some values were lower in females when com-pared with their male counterparts from the same surveyThe lowest fat intakes were recorded in the Norwegianand Swedish surveys Mediterranean countries particularlySpain and Greece and some surveys from the UK recordedthe highest fat intakes that is more than 40 of energyFat intake and age of children did not seem to be associated

Saturated fatty acids Data were provided for malesand females by twenty-nine surveys Reported consump-tion of saturated fatty acids (SFA) in Belgium andFrance was quite high (about 17 of energy) whileFinland reported the highest intake ie 20 of energySouthern Mediterranean countries (Greece Spain andItaly) reported intakes of 12ndash13 Yugoslavia reportedthe lowest SFA intakes at 10 of total energy and similarvalues were found in Poland (10ndash11 )

MUFA Data for the intake of MUFA were availablefrom thirty surveys for males and twenty-nine surveys forfemales In Southern European countries where intakes ofSFA were low the reported consumption of MUFA wasgreatest Reported consumption in Spain was 16ndash17 and in Greece up to 18 of total energy For the othercountries 11ndash13 of energy seemed to be the mostcommon range of consumption Low intakes of MUFAwere found in Denmark Norway and Sweden and alsoin Hungary where the intake of MUFA was 10 ofenergy

PUFA Data for males were obtained from thirty sur-veys and for females from twenty-nine surveys In mostcountries intakes of PUFA ranged from 4 to 6 ofenergy Poland showed some peculiarities since two sur-veys (Smigiel et al 1994 Hamułka et al 2000) reportedhigh intakes of PUFA (9 of energy) while others (Szpo-nar amp Rychlik 1996ab) reported the lowest of all the sur-veys (3 of energy) Yugoslavian surveys also reported awide range of PUFA intakes (5ndash8 of energy) On thewhole surveys from Central and Eastern Europe reportedthe greatest intakes of PUFA for example the reportedconsumption of PUFA in Estonia was almost 10 ofenergy

Some differences in the composition of high-fat dietsbetween Mediterranean countries and other regions wereevident Hyperlipidic diets in Mediterranean countries

were associated in general with high intakes of both SFAand MUFA while high-fat diets in Central and Easternand Northern Europe showed quite high levels of SFAwith relatively lower levels of both MUFA and PUFA

Cholesterol Data were reported in thirty-one surveysfor males twenty-four for females and eight for malesand females together There was a relatively homogeneouspattern of cholesterol consumption within all Europeancountries Within both Northern and Southern Europethere are countries with dietary intakes in the higher andlower ranges Some surveys reported an intake of up to400 mgd for males in Northern Central and Eastern andSouthern European countries The highest intakes werereported for Spain (Aranceta amp Perez 1996 Vazquezet al 1996) Lower intakes were reported in surveysfrom The Netherlands Poland the UK and Denmark

Status data for cholesterol were available from fivecountries (Austria Greece The Netherlands Sweden andthe UK) Lipid status data were given as the parametersplasma total cholesterol HDL-cholesterol LDL-choles-terol triacylglycerols and more for different age groups

Protein

Data for protein intake were available from sixty-four sur-veys for males and fifty-eight surveys for females Mostsurveys provided data on protein intakes for a number ofage categories Approximately half of the surveys provideddata on children and adolescents living in Western Europewhile a further third reported on the intakes of childrenliving in Southern Europe Although children (2ndash10years) and adolescents (11ndash18 years) were equally rep-resented in terms of the number of surveys there werefewer data sets available on the protein intakes of 2- to3-year-olds compared with the other age categories North-ern countries (especially Sweden) and some surveys fromFrance and Spain showed the highest protein intakesmore than 16 of energy Otherwise protein intake (per-centage energy) was generally very similar within eachcountry

There was an approximately twofold difference betweenthe reported protein intakes of both males and females in theyoungest age categories (2ndash6 years) and of males in the olderage groups (7ndash18 years) The magnitude of the variability inintake decreased slightly in females in the older age groupsIn absolute terms the range in protein intakes (gd) wasbroadly similar in both males and females aged 2ndash10years Typically the range was 32ndash64 gd in 2- to 3-year-olds 38ndash72 gd in 4- to 6-year-olds and 53ndash85 gd in 7-to 10-year-olds Thereafter intakes increased with age inmales from 61ndash118 gd (11ndash14 years) to 71ndash127 gd(15ndash18 years) However the intake ranges in femalesaged 7ndash18 years were similar (53ndash88 gd)

When expressed relative to body weight protein intakesdecreased from 2middot3ndash4middot5 gkg per d in 2- to 3-year-olds to1ndash1middot9 gkg per d in 15- to 18-year-olds In all age cat-egories the range in protein intakes (gkg per d) wasbroadly similar in males and females Protein rangedfrom 11 to 16middot6 of energy and from 11 to 17middot8 forenergy in males and females respectively In general thelowest intakes of protein were reported in the German



and UK studies while the Spanish studies reported thehighest intakes particularly in the youngest age categories

Alcohol

Alcohol intakes were reported in sixteen studies of whichthe majority were from countries in Western Europe(eleven studies) and the remainder from countries in Scan-dinavia (four studies) and Central Europe (one study) Thesurveys provided data on alcohol intakes for a number ofage categories Overall alcohol intakes were highly vari-able both within and between studies The only cleartrends were an increase in alcohol intakes from 11 yearswith males consuming more alcohol than females Typi-cally alcohol intakes increased from 1middot5 gd (0middot5 ofenergy) in 11-year-old males and females to 10 gd(3middot3 of energy) in 15- to 18-year-old males and 6 gd(1middot8 of energy) in 15- to 18-year-old females In generalthe highest intakes were reported in studies from GermanyThe Netherlands and the UK while studies from Norwayand Sweden reported the lowest intakes

Water-soluble vitamins

Biotin Intake data were obtained from five surveys formales and six surveys for females No status data wereavailable In general biotin intake increased with age andwas very similar within a country Highest biotin intakeswere observed in Austria and Germany in comparisonintakes in UK and Yugoslavian boys and girls wereapproximately 40 less

Intakes in 2- and 3-year-old boys were 17mgd (UK)while intakes in 4- to 14-year-old boys ranged from 15to 40mgd The three surveys in the age category15ndash18 years reported intakes of between 29 and 45mgdIntakes of girls in all age categories ranged from 12 to39mgd The biotin intake of Austrian girls in the age cat-egory of 15ndash18 years was the lowest observed in thecountry survey for Austria and thus presented an exceptionthat biotin intakes increase with age

Folic acid Intake data for male and female childrenand adolescents were obtained from twenty-eight surveysIntake data refer to free folic acid (older surveys) as wellas to dietary folate in the more recent surveys of Austriaand Germany The dietary folate (and folic acid) equivalent(DFE) was developed to take into account the differencesin absorption of naturally occurring dietary folate and themore bioavailable synthetic folic acid 1mg DFE frac14 1mgdietary folate frac14 0middot5mg synthetic folic acid Accordinglyintake data and recommended daily allowances for dietaryfolate are twice as high as for folic acid As most of the lit-erature gives values for free folic acid the following narra-tive refers to free folic acid

There were no clear geographical trends in folic acidintake The greatest intakes were observed in DanishIrish and some UK surveys whereas the lowest intakeswere reported for Bulgaria Spain Sweden and also forsome UK surveys

In general folic acid intake increased with age Intakes in2- and 3-year-old boys ranged from 95 to 190mgd Intakesin 4- to 6-year-olds ranged from 120 to 200mgd Among

boys aged 7ndash10 years intakes of 100ndash250mgd werereported For 11- to 14-year-old boys intakes varied from105 to 300mgd In 15- to 18-year-olds low intakes ofabout 140mgd were reported for Germany Sweden andHungary The highest intakes of 300mgd were reportedin Denmark Ireland and the UK

Folic acid intakes of 2- to 6-year-old girls rangedfrom 100 to 200mgd In 7- to 10-year-old girls intakesranged from 130 to 250mgd For girls aged 11ndash14ndashyearsthe lowest levels of 100mgd were reported in the UKSweden and Hungary Other surveys reported intakesfrom about 140mgd in Spain and the UK (Nelson et al1990) to about 250mgd in Denmark (Andersen et al1996) and France (Volatier 2000) In 15- to 18-year-oldslow intakes of 105ndash120mgd were reported for SwedenHungary and one UK survey (Crawley 1993) Most sur-veys report intakes of 200ndash240mgd The greatest intakesof about 260mgd were reported in Denmark (Andersenet al 1996) and the UK (Gregory et al 1995)

Status data from four countries (Austria France UK andThe Netherlands) for folic acid were also available Moststatus data were in the range of 3middot8ndash6middot8 ng serum folateml (Austria) and 2middot3ndash23middot4 ng serum folateml (France)and about 11 nmol folic acidl (The Netherlands)Status data for the UK were given as red-cell folate(573 (SD 203middot9) nmoll for females and 626 (SD 209middot5)nmoll for males) and serum folate (20middot6 (SD 8middot16) nmollfor females and 21middot7 (SD 7middot64) nmoll for males)

Niacin Intake data for male and female children andadolescents were obtained from thirty-eight surveys Nostatus data were available There were no obvious geo-graphical trends The highest niacin intakes were reportedin Ireland and Spain whereas the lowest intakes werereported in Belgium France The Netherlands Polandand Russia In general niacin intake increased with age

Intakes in 2- and 3-year-old boys and girls ranged from 7to 20 mgd and in 4- to 6-year-old boys and girls fromabout 10 to 25 mgd For boys and girls aged 7ndash10 yearsthe lowest intakes of about 6ndash10 mg niacind were reportedin Belgium The Netherlands Poland and Russia Mostreported intakes were in the range of 20 to 25 mg niacind Intakes of about 35 mgd were reported for Ireland andYugoslavia (Pavlovic 2000)

In 11- to 18-year-olds a difference between genders wasnoticeable which is probably a reflection of an overallincrease in food and energy intake Intakes among 11- to14-year-old boys varied from 12 to 49 mg niacind Mostintakes were in the range of 25ndash33 mgd In boys aged15ndash18 years the lowest intakes were reported for Belgium(8 mgd) and Russia (13ndash16 mgd) The highest intakes of52 mgd were observed in Ireland Most intakes in 15- to18-year-olds were between 30 and 40 mg niacind Intakesin 11- to 14-year-old girls varied from 10 mgd (Russia) to36 mgd (Spain) Most intakes were in the range of24ndash27 mgd In girls aged 15ndash18 years the lowest intakeswere reported for Belgium (6 mgd) and Russia (10ndash11 mgd) The greatest intakes of 32ndash34 mgd were observed inthe UK and Ireland Most intakes in this age group werebetween 23 and 27 mg niacind

Pantothenic acid Data for male and female childrenand adolescents were obtained from eight surveys No

J Lambert et alS154


status data were available Highest intakes were observedin Yugoslavia whereas lowest intakes were reported inFrance and Germany In general intakes increased withage (except Austria) and were very similar within acountry There was no obvious geographical trend betweenthe European regions

Intakes among 2- and 3-year-old boys and girls wereinvestigated in only one UK survey which reportedmean intakes of 2middot7 mgd Intakes in 4- to 6-year-oldfemale and male children ranged from 2middot7 to 5 mgd In7- to 10-year-old-girls and boys the lowest intakes ofabout 3middot3 mgd were observed in Germany Most reportedintakes were in the range of 4ndash4middot8 mgd The highestintakes of 5middot1 and 6middot9 mgd were reported for Yugoslavia(Pavlovic 2000)

Among boys aged 11ndash14 years intakes varied from 4 to5middot8 mgd In 15- to 18-year-old male adolescents intakeswere between 4middot9 mgd in Germany (Deutsche Gesellscahftfur Ernahrung eV 2000) and 6 mgd in Austria (Elmadfa ampWasserbacher 2002) Intakes among 11- to 14-year-oldfemales varied from 3middot5 to 5 mgd One Polish surveyreported the highest intake for girls of this age categoryof about 10 mgd In girls aged 15ndash18 years intakeswere in the range of 4 mgd in one UK survey (McNultyet al 1996) to 4middot4 mgd in Austria

Riboflavin Data were obtained from forty-two surveysfor males and forty-four surveys for females In seven sur-veys the data for boys and girls were combined The highestriboflavin intakes were recorded in Ireland and the lowestin Russia In general riboflavin intake increased with ageThe data were very homogeneous within a survey and acountry There were no obvious geographical trends

Intakes in 2- and 3-year-old boys and girls ranged fromabout 0middot8 to 1middot7 mgd Intakes among 4- to 6-year-oldsranged from about 1middot0 to 1middot9 mgd Most intakes were inthe range of 1middot0ndash1middot7 mg riboflavind For girls and boysaged 7ndash10 years the lowest reported intakes were about1 mgd Most reported intakes were in the range of 1middot2ndash1middot8 mgd The highest intakes of 2middot6 mgd were reportedfor Irish males and in Yugoslavia (Pavlovic 2000)

Intakes in 11- to 14-year-old boys varied from 1 mgd inRussia to 2middot9 mgd in Norway Most reported intakes werein the range of 1middot3ndash1middot9 mgd In 15- to 18-year-old boysthe lowest intakes were reported for Greece and Russia(1middot3 mgd) The highest intakes of about 3 mgd wereobserved in Ireland Norway and Sweden Most intakesin this age group were between 1middot6 and 2middot3 mgd

Riboflavin intakes in girls aged 11ndash14 years varied from0middot9 mgd in Russia to 1middot9 mgd for Finland Ireland andSweden Most intakes were in the range of 1middot2ndash1middot7 mgdIn 15- to 18-year-old females the lowest intakes werereported for Greece and Russia (1 mgd) The highestintakes of about 2 mgd were observed in Norway Mostintakes in this age group were between 1middot3 and 1middot8 mgd

Status data from four countries (Austria France TheNetherlands UK) for riboflavin were available Moststatus data were in the range 1middot1ndash1middot5 erythrocyte gluta-thione reductase activation coefficient

Thiamin Data were obtained from forty-one surveysfor males and forty-three surveys for females Seven sur-veys included data for males and females combined

There were no clear geographical trends in intakes betweenthose Southern Northern and Western European countrieswith reported intakes The highest thiamin intakes wereobserved in Norway Poland Estonia and Ireland whereasthe lowest intakes were reported for Bulgaria In generalthiamin intake increased with age

Intakes among 2- and 3-year-old girls and boys rangedfrom about 0middot5 to 1 mgd Mean daily intakes were in therange of 0middot6ndash0middot8 mg Intakes in 4- to 6-year-olds rangedfrom about 0middot7 to 1middot4 mgd and most reported intakes werein the range of 0middot8ndash1middot2 mgd For girls and boys aged 7ndash10 years daily intakes ranged from 0middot9 to 2middot7 mg andmost reported intakes were in the range of 1middot0ndash1middot4 mg

Intakes in 11- to 14-year-old boys varied from 0middot9 mgdin Hungary to 2middot1 mgd in Norway and Spain Greecereported intakes of about 2middot9 mgd for 9- to 12-year-oldboys Most intakes in boys aged 11ndash14 years were between1middot2 and 1middot5 mgd In 15- to 18-year-old boys the lowestintakes were reported for Bulgaria (1middot2 mgd) The highestintakes of about 2middot4ndash2middot5 mgd were observed in Greece andPoland Most intakes in this age group were between 1middot4and 1middot8 mgd

Intakes among 11- to 14-year-old girls varied from 0middot8 to2middot1 mgd Most intakes in this age group were between 1middot1and 1middot4 mgd In girls aged 15ndash18 years intakes rangedfrom 0middot9 to 2middot5 mgd and most intakes were between 1middot2and 1middot5 mgd

Status data from four countries (Austria France TheNetherlands UK) for thiamin were available Most statusdata were about 1middot1 erythrocyte transketolase activationcoefficient

Vitamin B12 Data for male and female children andadolescents were obtained from twenty-nine surveys ofwhich three represented data for both genders combinedThe highest vitamin B12 intakes were observed in AustriaSpain and Sweden whereas the lowest intakes werereported for Hungary The Netherlands and by some UKreports In general vitamin B12 intake increased with agebut was consistent within an age group and each surveyconsidered There was no evidence for any geographicaltrend

Intakes in 2- and 3-year-old girls and boys ranged fromabout 2middot4mgd in the UK (Payne amp Belton 1992b Crawley1993) to 5middot6mgd in France Intakes in 4- to 6-year-oldsranged from about 2middot5mgd in the UK to 7middot5mgd inFrance Most intakes ranged between 3middot0 and 4middot3mgdFor 7- to 10-year-old girls and boys the lowest intakesof about 2middot6mgd were observed in the UK Most intakeswere reported were in the range of 3middot5ndash5mgd The highestintakes of 6middot1mgd (females) and 9mgd (males) werereported in a French survey (Hercberg et al 1991b1994)

Intakes in 11- to 14-year-old boys varied from 2middot8 to11mgd Most intakes in this age group ranged between 3middot5and 5middot3mgd For 15- to 18-year-old boys the lowest intakeswere reported for Hungary (3middot2mgd) Intakes of about8middot7mgd were observed in the UK but the greatest intakewas 11mgd by 16- to 29-year-olds in Norway Most intakesin this age group were in the range of 5ndash7mgd

Intakes in 11- to 14-year-old girls varied from 2middot6mgdin a UK survey (McNulty et al 1996) to 9middot6mgd in



Spain (Vazquez et al 1996) but most intakes werebetween 3middot3 and 5middot5mgd The lowest intakes in 15- to18-year-old girls were reported for the UK and Hungary(2middot5mgd) The highest intake of about 7middot1mgd wasobserved in Norway (16- to 29-year-olds) but most intakesin this age group were between 3middot4 and 5mgd

Status data for vitamin B12 were available from threecountries (Austria The Netherlands UK) Most statusdata were in the range of 400ndash560 pg serum cobalaminml (Austria) and 290ndash410 pmoll (The Netherlands)Status data from the UK also averaged about 400 pmoll

Vitamin B6 Data for male and female children andadolescents were obtained from thirty-six surveys ofwhich four surveys presented combined data No particularpattern of intake of vitamin B6 was apparent The highestintakes were observed in France Ireland and Polandwhereas Germany reported the lowest intakes In generalthe vitamin B6 intake increased with age

Intakes in 2- and 3-year-old girls and boys ranged from0middot6 mgd in Germany to 1middot1 mgd in the UK andFrance Among 4- to 6-year-olds intakes ranged from0middot7 mgd in the Czech Republic and Germany to1middot7 mgd in the UK (Gregory et al 1995) Most intakeswere between 1middot0 and 1middot4 mgd

In 7- to 10-year-old girls and boys the lowest intakes ofabout 0middot8 mgd were observed in the Czech Republic Mostintakes were between 1middot1 and 1middot4 mgd and the highestintake of about 2middot4 mgd was reported in a Yugoslavianstudy (Pavlovic 2000)

Intakes in 11- to 14-year-old boys ranged from 1middot1 mgdin Germany to 2middot2 mgd in Ireland and the UK Mostintakes by this age group were in the range of 1middot3ndash1middot9 mgd For 15- to 18-year-old boys the lowest intakeswere reported in Germany (1middot4 mgd) and the highest inthe UK Ireland and Poland (2middot6 mgd) Most intakes bythe older group were between 1middot6 and 2middot2 mgd

Intakes among 11- to 14-year-old girls ranged from1middot0 mgd in Germany to 1middot9 mgd in the UK but mostintakes were between 1middot3 and 1middot4 mgd For 15- to 18-year-olds the lowest intakes were reported in Germany(1middot3 mgd) and the highest intake of 2 mgd was observedin the UK (McNulty et al 1996) Most intakes in this agegroup were between 1middot4 and 1middot6 mgd

Status data were available from four countries (AustriaFrance The Netherlands UK) for vitamin B6 and were inthe range of 1middot3ndash2middot0 for erythrocyte aspartate aminotrans-ferase activation coefficient

Vitamin C Data were obtained from fifty-six surveysfor males and fifty-three surveys for females of whichseven included data for males and females combined Ingeneral vitamin C intake increased with age No geo-graphical trends were apparent and intakes among childrenand adolescents appear to be very heterogeneous withinEurope

For 2- and 3-year-old girls and boys intakes rangedfrom 35 mgd in Russia and one UK survey (Payne ampBelton 1992b) to 95 mgd in France and Spain (Aguileraet al 1994) Most reported intakes were between 50 and70 mgd

Intakes among 4- to 6-year-olds ranged from about30 mgd in the Czech Republic to 115 mgd in Austria

and Finland and most intakes were between 50 and90 mgd For 7- to 10-year-old girls and boys the lowestintakes of about 50 mgd were observed in Russia Thehighest intakes of about 125 mgd were reported for Yugo-slavia (Pavlovic 2000) Most reported intakes werebetween 60 and 100 mg vitamin Cd Intakes among girlsand boys aged 11ndash14 years ranged from 30 to 185 mgdand most were in the range of 60ndash90 mgd

Among 15- to 18-year-old male and female adolescentsthe lowest intakes were reported for Estonia (50 mgd) andthe highest were observed for Switzerland (males 163 mgd females 146 mgd) Most intakes in this age group werebetween 70 and 100 mgd

Status data for vitamin C were available from fourcountries (Austria France The Netherlands UK) Valueswere 15ndash17 mg ascorbatel plasma (Austria) 1ndash18mgascorbic acidml serum (France) 50mmol vitamin Cl(The Netherlands) and 56mmol vitamin Cl plasma forboys and 5mmol vitamin Cl plasma for girls (UK)

Fat-soluble vitamins

Vitamin A Surveys presented data on vitamin A intakeretinol b-carotene or retinol equivalents (RE) Themajority (fifty-four for girls forty-seven for boys and onefor both sexes combined) reported RE In nine surveysb-carotene and retinol intakes were presented from whichRE were calculated Data on RE and b-carotene only arereported in this review

Mean daily RE ranged from 0middot39 mg in Yugoslavia(Pavlovic 2000) to 2middot00 mg Low intakes were foundin Belgium The Netherlands Austria Germany (12years) the UK and Yugoslavia and high intakes inNorway Sweden and Denmark (early childhood and7ndash12 years) The lowest intakes tended to be in the Wes-tern European countries and the highest in Northern Euro-pean countries There were wide variations in intakesreported from different surveys within Germany andPoland Differences in intake between the age groups inthe surveys were slight Intakes tended to be higher inboys but the differences between the two sexes were notgreat

Intakes in 4- to 6-year-old boys ranged from about0middot5 mg REd in Germany to about 1middot4 mg REd in PolandIn 7- to 10-year-old boys the lowest intakes of about0middot39 mg REd were observed in Yugoslavia The greatestintakes of 1middot4 mg REd were reported for DenmarkAmong boys aged 11ndash14 years mean daily RE variedfrom 0middot4 mg in the UK to 1middot6 mg in Denmark In 15- to18-year-olds the lowest intakes were reported in Germanyand the UK (0middot6 mg REd) and the greatest of 1middot8 mg REd (median) was reported in Norway

Intakes in 4- to 6-year-old girls ranged from about0middot4 mg REd in Germany to 1 mg REd in Denmark In7- to 10-year-old girls lowest intakes of about 0middot5 mgREd were reported in Yugoslavia Germany and the UKThe greatest intakes of 1middot3 mg REd were reported forDenmark Intakes in girls aged 11ndash14 years varied from0middot48 mg REd in Germany to 1middot25 mg REd (median) inNorway Among 15- to 18-year-olds the lowest intakeswere reported for the UK and Germany (0middot5 mg REd)

J Lambert et alS156


The highest intake of 1middot32 mg REd (median) was observedin Norway

Status data from four countries were available Thevalues were 280ndash360mg retinoll serum (Austria)0middot75ndash1middot16mmol retinoll serum (France) 0middot84mmolretinoll serum (The Netherlands) and 1middot0ndash1middot29mmollplasma (UK)

b-Carotene intake of boys was recorded in nineteen sur-veys of girls in fourteen surveys and of both sexes com-bined in five surveys Mean reported daily b-caroteneintake ranged from 0middot35 mg in one UK survey (Ruxtonet al 1996) to 8middot4 mg in one Yugoslavian survey (Pavlovic2000) A very high intake of b-carotene was found inYugoslavia in comparison with other countries Lowintakes were reported in Belgium Some large differenceswere noted between surveys in Germany (Ergebisse dernationalen Verzehrsstudie 1995 Deutsche Gesellschaftfur Ernahrung eV 2000) France (Hercberg et al 1991b1994 Volatier 2000) and the UK (Ruxton et al 1996 Gre-gory amp Lowe 2000) Relatively high intakes were found inDenmark and relatively low intakes in France There didnot appear to be any geographical trend

Within each survey intakes were similar in all agegroups indicating that the younger smaller children hadgreater intakes relative to their body weight No largedifferences in b-carotene intake between sexes wereobserved with three exceptions one Danish surveywhere intakes were greater in females aged 7ndash10 yearsand 15ndash18 years (Andersen et al 1996) one Frenchsurvey where intakes were greater in males aged 15ndash18years (Hercberg et al 1991b 1994) and one Greeksurvey where intakes were greater in females aged11ndash14 years (Hassapidou amp Fotiadou 2001)

b-Carotene intakes in 4- to 6-year-old boys ranged fromabout 1middot1 mgd in the UK to 2middot9 mgd in Denmark In 7- to10-year-old boys the lowest intakes of about 0middot35 mgdwere reported for the UK and the greatest intakes ofabout 2middot9 mgd were reported for Denmark For boysaged 11ndash14 years intakes varied from 0middot85 mgd inFrance to 3middot2 mgd in Denmark In 15- to 18-year-oldsthe lowest intakes were reported in Belgium (0middot9 mgd)and the highest in Poland (2middot5 mgd)

Intakes of b-carotene among 4- to 6-year-old girlsranged from about 1middot1 mgd in the UK to 2middot6 mgd in Den-mark In 7- to 10-year-old girls the lowest intakes of about0middot1 mg b-carotened were observed in France The highestintakes of about 4middot1 mgd were reported for Denmark Forgirls aged 11ndash14 years intakes varied from 0middot9 mgd inFrance to 2middot9 mgd in Denmark In 15- to 18-year-oldsthe lowest intakes were reported from Belgium (0middot8 mgd)and the highest intakes from Denmark (3middot6 mgd)

Status data for b-carotene were available from fourcountries (Austria France The Netherlands UK) Thevalues were about 22ndash40mmoll serum in Austriaand France total carotenoids of 1middot53 (SD 0middot69)mmolLplasma in The Netherlands and 0middot312ndash0middot626mmollplasma in the UK

Vitamin D Vitamin D intake was recorded in twenty-two surveys for boys and girls separately and in fivefor both sexes combined Mean vitamin D intakeranged from 0middot7mgd in Spain (boys) to 6middot5mgd in

Sweden (Bergstrom et al 1993) The highest intakeswere found in Northern European countries (Sweden age12 years) Estonia and The Netherlands The lowestintakes were recorded in Spain (age 8 years) Austria(age 12 years) Ireland and the UK Intakes increasedwith age and in most surveys were higher in boys thanin girls

Boys aged 2ndash3 years were investigated in only two sur-veys and these reported intakes of 1middot7 and 2middot0mgd Intakesin 4- to 6-year-old boys ranged from 0middot7mgd in Austriato 3mgd in Germany In 7- to 10-year-old boys thelowest intakes of about 1middot7mgd were observed in AustriaThe highest intakes of about 3middot5mgd were reported forGermany For boys aged 11ndash14 years intakes rangedfrom 1middot7mgd in Spain to 5middot8mgd in Sweden Spanishboys aged 13ndash14 years had similarly high intakesAmong 15- to 18-year-old boys the lowest intakes werereported for Germany and Austria (1middot8mgd) and thehighest intakes for Sweden (6middot5mgd)

Intakes in 2- and 3-year-old girls were reported in twoNorthern European surveys only and were 1middot8ndash2middot2mgdIntakes of 4- to 6-year-old girls ranged from about1middot2mgd in Austria to 2middot9mgd in Germany The lowestintakes among girls aged 7ndash10 years were about 1middot3mgd reported by Austria and one UK survey Howeveranother UK survey reported the highest intake of 5middot9mgd Intakes of 11- to 14-year-old girls ranged from 1middot2mgd in the UK to 4middot4mgd in Sweden For girls aged 15ndash18years the lowest intakes were reported by Austria(1middot4mgd) and highest intakes by Sweden (4middot6mgd)

Vitamin E Vitamin E intake was recorded in twenty-five surveys for boys twenty-one surveys for girls andsix surveys for both sexes combined These provideddata for fourteen countries Most of the studies expressedthe data as tocopherol equivalents and only three surveysused a-tocopherol (Deheeger et al 1994 1996 Kafatoset al 2000 Moschandreas amp Kafatos 2002) The meana-tocopherol equivalent intake ranged from 3middot2 mgd(Kersting et al 1998 ab 2000) to 32middot4 mgd (Smigielet al 1994) The greatest intakes were found in Bulgariaa Polish survey (Szponar amp Rychlik 1996a) andYugoslavia and the lowest in the Czech RepublicFrance Sweden the UK and Denmark Girls tended toconsume less than boys and intakes increased with age

Vitamin EPUFA (mgg) was calculated where data forboth values were available The lowest ratios were foundin Hungary (0middot41) and the highest in Yugoslavia andBulgaria (2middot06) In most of the countries the ratios did notchange with age except in Bulgaria where ratios increasedwith age The ratios were also very similar in both sexes

Vitamin K Data were provided only by Yugoslaviawhich recorded vitamin K intake in both sexes combinedfor children aged 9ndash10 years

Minerals

Calcium Data were obtained from forty-five surveys formales fifty for females and eight surveys for males andfemales together In general Ca intake increased with age

In boys and girls aged 2ndash3 years mean daily Ca intakeranged from about 500ndash600 mg in Bulgaria Italy and



Russia to about 1000 mg in France and Spain The UKaverage intake was about 650 mgd whereas intakesbetween 700 and 1000 mgd were observed in DenmarkFinland Greece and The Netherlands There were noobvious geographical trends across Europe Intakes of chil-dren aged 4ndash6 years hardly differed from those of youngerchildren In this age category data were also available forthe Czech Republic and Germany where mean intakeswere in the range of 600ndash700 mgd

Among children aged 7 years and over and among ado-lescents the daily Ca intake of males was often about100ndash200 mg higher than that of females In boys aged7ndash10 and 11ndash14 years Ca intake ranged from 500 mgd (Russia) to 1200 mgd (Denmark Finland France Ire-land Sweden Yugoslavia) or more (Norway 1624 mgd)Intakes of between 800 and 1000 mgd were reported inAustria Germany Greece The Netherlands and the UKAmong girls aged 11ndash14 years intakes below 600 mgdwere mostly found in Central and Eastern Europeancountries whereas the greatest intakes (1000 mgd andhigher) were recorded in Ireland Northern Europeancountries Greece and one French study Although the Caintakes of males aged 15ndash18 years were mostly slightlyhigher than of those aged 11ndash14 years the general pictureregarding lower and higher ranges was roughly the sameIntakes in 15- to 18-year-old female adolescents weremore or less comparable with intakes of the younger agegroup

Only Austria provided information on Ca excretion inurine as a status parameter The mean values varied from0middot9 (SD 0middot85) mmolg creatinine (boys 13ndash14 years) to2middot01 (SD 1middot23) mmolg creatinine (girls aged 6 years)and all mean values were within the normal range(0middot5ndash6middot6 mmolg creatinine)

Magnesium Data were collected from thirty surveysfor males twenty-nine for females and four for malesand females combined Across Europe there were noobvious geographical trends In general Mg intakeincreased with age

For boys aged 2ndash3 years mean daily Mg intake rangedfrom 123 mg (Bulgaria) to about 320 mg (Russia) Inmost surveys the mean intake figures for children aged2ndash6 years and 7ndash10 years were between 175 and275 mgd and 225 and 300 mgd respectively Older boysgenerally had higher intakes than did older girls Formales mean intakes were mostly in the range of 300ndash325 mgd (11ndash14 years) and 350ndash375 mgd (15ndash17years) For females intakes were mostly in the range of250ndash275 mgd In five studies from Norway (Johanssonet al 1997) Yugoslavia (Pavlovic 2000) Estonia (Grun-berg et al 1997) Poland (Smigiel et al 1994) andRussia (B Popkin unpublished results) values exceeded400 mgd in some male groups some of which had alarge standard deviation

Data on Mg as a status parameter was available forAustria Excretion in urine ranged from 6middot26 (SD 2middot8) mggcreatinine (boys aged 15ndash18 years) to 10middot8 (SD 16middot1) mggcreatinine (girls aged 10ndash12 years) normal range is4ndash11 mgg creatinine

Phosphorus Data were obtained from twenty-four andtwenty surveys for males and females respectively and

from four surveys where no distinction was made betweengenders

For children aged 2ndash6 years mean intake of P rangedfrom about 700 to 1200 mgd in the youngest and from700 to 1400 mgd in those aged 4ndash6 years Most valuesfell between 700 and 1000 mgd Similar intakes werereported for children aged 7ndash10 years but in this groupthe overall range was broader The highest intakes werefound in Denmark and Yugoslavia In 11- to 14-year-oldboys average intakes were mostly between 1400 and1600 mgd Among girls most values fell in the range of1200ndash1400 mgd In male adolescents mean intakesabove 1800 mgd were not exceptional whereas infemale adolescents the highest intakes were between 700and 1200 mgd The highest values were often observedin Northern European countries

Potassium Data were obtained from fifteen surveys formales thirteen for females and three for males and femalescombined In most countries the intake of K by males wasslightly higher than by females and intakes increased withage No obvious geographical trends were seen acrossEurope

In boys and girls aged 2ndash6 years most mean values fellin the range of 2200ndash2400 mgd and 2000ndash2200 mgdrespectively The range of intakes among 7- to 10-year-olds was broader but still most values were in the samerange as for the younger children Studies in Yugoslaviarecorded the highest figures (3000 mgd) In boys aged11ndash14 years mean intakes were mostly between 2400and 2600 mgd although in several studies values between2600 and 3200 mgd were found whereas intake figures for15- to 17-year-old boys were mostly between 3200 and3800 mgd For females mean intakes were mostly in therange of 2000ndash2800 mgd (11ndash14 years) and 2200ndash3000 mgd (15ndash17 years) Highest intakes were observedin Denmark Sweden and The Netherlands

Information on K status was available only for AustriaThe excretion in urine ranged from 45middot9 (SD 36middot9) mmolgcreatinine (boys aged 15ndash18 years) to 80middot6 (SD 40middot2) mmolg creatinine (boys aged 6 years) Mean values were withinthe normal range of 30ndash84 mmolg creatinine

Sodium Data were provided for males by nine surveysfor females by nine surveys and for males and femalescombined by three surveys Among young children datafor average intakes ranged from about 1400 mgd tonearly 2600 mgd and increased with age In adolescentsthe intake ranged from about 1800 to 4800 mgd In mostsurveys Na intake was higher among males than amongfemales Generally the lowest intake figures were observedin the UK and the highest in Russia and Yugoslavia Nogeneral geographical trend was obvious

Chloride Two surveys in the UK and one survey inGermany presented intakes of chloride Mean intakesranged from 2000 to 3150 mgd for young children from3600 to nearly 5500 mgd for males aged 7ndash18 yearsand from 3200 to 4130 mgd for females aged 7ndash18 years

In Austrian boys the excretion in urine varied from 245(SD 153) mmolg creatinine (boys aged 7ndash9 years) to 497(SD 429) mmolg creatinine (boys aged 10ndash12 years) Inall age groups mean values exceeded the upper value ofthe normal range (135ndash150 mmolg creatinine)

J Lambert et alS158


Fluoride In only two countries were intake figures forfluoride reported In Finland young children had a meanintake of 255mgd (2- to 3-year-olds) and 313mgd (4- to6-year-olds) In Germany mean values varied amongmales from 434mgd (4- to 10-year-olds) to 642mgd(15- to 18-year-olds) and among females from 369mgd(4- to 6-year-olds) to 548mgd (15- to 18-year-olds)

Iron Data were available from forty-seven surveys formales forty-six for females and four for males and femalescombined Intakes were highest among boys in Finlandurban regions of Estonia and Sweden Among adolescentsthe Fe intake of males was often much higher than that offemales and adolescent girls had lower intakes than didtheir younger compatriots There was a clear trend ofincreasing intake with age in males There were no cleardifferences in intakes between Southern and NorthernEuropean countries

Intakes in 2- to 3-year-olds ranged from about 5 to10 mgd and those of 4- to 6-year-old boys and girls fromabout 6 to 13 mgd Among boys aged 7ndash10 years thelowest intake of about 8middot7 mgd was observed in FranceThe greatest intake of Fe by girls aged 7ndash14 years wasreported in Russia and the greatest intake by 15- to 18-year-old girls (15middot2 mgd) was reported in Sweden

Status data for Fe were available from five countries(Austria France The Netherlands Sweden UK) In AustriaFe in serum varied from 651 (SD 420)mgl (boys aged 6years) to 1078 (SD 400)mgl (boys aged 15ndash18 years) andfrom 700 (SD 420)mgl (girls aged 6 years) to 972 (SD

449)mgl (girls aged 15ndash18 years) In France and the UKFe status data were available as Hb mean corpuscularvolume serum Fe transferrin saturation erythrocyte proto-porphyrin and serum ferritin For The Netherlands andSweden status data were also described differently (meancorpuscular volume serum ferritin haematocrit )

Zinc Data were obtained from twenty-eight surveysfor males and twenty-seven surveys for females Threesurveys combined the data for girls and boys Zn intakeincreased with age The Zn intakes across Europeappear very inconsistent There are no clear differencesin intakes between the South West East or North Thehighest intakes were recorded for boys (19 mgd) andgirls (15 mgd) in Finland (age 11ndash17 years) Thelowest intakes for both sexes within this age category(11ndash18 years) were reported for The Netherlands andthe UK

Zn intakes for 2- and 3-year-old boys and girls werereported only for The Netherlands (5middot8 mgd males5middot5 mgd females) Intakes in girls and boys aged 4ndash6years ranged from about 5middot6 to 8middot5 mgd

Status data for Zn were available for Austria and theUK This was in the range of 0middot97ndash1middot13 mg Znl serum(normal range 0middot8ndash1middot6 mgl) for Austria and about54mmol Zn protoporphyrinmol haem for the UK TheUK also described the status data as mmol Znl plasma

Copper Data were available from eleven surveys formales twelve for females and two for males and femalescombined but these represented only six countries Cuintakes increased with age in males and females The Cuintake of the children and young people appeared to bequite uniform within a country and was about 1ndash2 mgd

Status data for Cu were available only for Austria andthe value was in the range of 0middot94ndash1middot28 mg Cul serum(normal range 0middot8ndash1middot2 mgl)

Iodine Data were available for males and femalesfrom five countries These was obtained from nine surveysfor boys and girls separately and from three surveys forboth genders combined Intakes varied within thecountries Recorded intakes were the highest (330ndash470mgd) in Finland (Rankinen et al 1995) and thelowest in German male and female children and adoles-cents (62ndash92mgd)

Status data for I were only available for Austria where therange was from 206 to 85mgg creatinine (I excretionurine)

Chromium Data for males and females were availableonly for two countries Data for boys and girls wereobtained from two surveys and two surveys showed resultsfor both genders combined Cr intake increased with ageIn Yugoslavia the daily Cr intake was very low (1ndash2mg)and in Finland the mean daily intake ranged from about17 to 40mg

No status data for Cr were availableSelenium Data for Se intakes were obtained from seven

countries from fifteen surveys for boys thirteen surveys forgirls and two surveys for both genders combined Se intakeof children and adolescents varied from country to countryand seemed generally low The lowest intakes were found inEastern European countries eg Yugoslavia Withincountries intake increased with age The highest intakeswere 90 (SD 20)mgd by Finish children (12-year-old ath-letes) and 80 (SD 20)mgd among British adolescent boys

Status data for Se were available only from Austriavalues were in the range of 55ndash89mg Sel serum (normalrange 50ndash130mg Sel serum)

Molybdenum No data for Mo intake or status wereavailable

Manganese No data for Mn intake or status wereavailable

Discussion

Availability of the data

The aim of this project was to obtain information on diet-ary intakes of children and adolescents across the whole ofEurope Our particular interest was to have data fromdifferent regions of Europe to make some comparisonsbetween countries and regions The geographical regionswere chosen for their likely similarity in eating patternsThey are large and not all parts of each country willnecessarily fit the region However with so much variationin nutrient intakes recorded for children and adolescentsbetween and within countries the use of regions is a help-ful tool for examining trends in nutrient consumption

We tried to find publications through literature searchesbut many publications did not appear in databases such asMedline Most publications were harvested through con-tacts with local experts in each country Each author wasresponsible for selecting the surveys from his or herallotted countries and the use of the pre-set criteria inTable 1 limited selection bias by authors However wedid include some exceptions where selection was moresubjective if it was felt the survey would make a useful



contribution to our review We looked for published sur-veys but in the case of Russia (B Popkin unpublishedresults) we included recent good-quality data that shouldbe published soon One pre-1987 survey from The Nether-lands was included as it contained data on nutritionalstatus Many surveys were published in local languagesbut were still assessed according to the set quality criteria

Our aim was to obtain information not only on energyand macronutrient intakes which was available in mostof the surveys but also on micronutrient intakes some ofwhich was included only in selected publications Thiswas one reason for including some small surveys Wewould have preferred to include nationally representativestudies only but chose to widen the net to regional andlocal studies in order to obtain a good spread acrossEurope Despite our efforts some of the smaller localstudies may be of lower quality Ideally we would haveonly included surveys for which there were anthropometricdata so that we had something against which to checkreliability of reporting However children were weighedin an insufficient number of studies for us to insist onthis criterion for inclusion

By literature search and personal contacts of the authorswe believe all suitable surveys have been included in thispaper Finding the surveys involved a considerableamount of effort especially for Central and Eastern Euro-pean countries and for countries in which none of theauthors resided but we acknowledge that some usefulones could have been missed Nevertheless we have man-aged to survey the breadth of Europe so there are fewcountries for which we have no data

We are aware that there are limitations to all surveyshowever good the methodology appears to be We haveattempted to reduce these as much as possible by our selec-tion process but have not been so restrictive as to end upwith no surveys at all

A particular problem was the comparison of data fromdifferent studies according to age categories as thesevaried from survey to survey and rarely matched the agegroup classification of the EU

In the end we collected a large number of surveys whichenabled us to analyse dietary intakes of almost all nutrientsand attempt to make comparisons between countries andEuropean regions For most of the macronutrients weobtained a large volume of data which added to theirvalue We also found a relatively large number of surveyson vitamin intake although for some individual vitaminsthere were few studies (vitamin K biotin pantothenicacid) There were other micronutrients that were reportedin only a few surveys (Cu Se fluoride Cr chloride)which did not allow many conclusions to be drawnAnother problem was the comparison of nutrient intakewith status as hardly any studies included status dataThese were selected surveys from Austria FranceGreece The Netherlands Sweden and the UK whichdescribed the micronutrient status together with micronu-trient intake (we did not include studies on status alone)

Quality of data

As demonstrated in Table 3 there is large diversity in themethodologies used to assess the individual dietary intakes

of children and adolescents Overall these fall intofour main classes 24 h recalls (retrospective) foodfrequency questionnaires (retrospective) dietary history(retrospective) and dietary records of 1 2 3 4 and 7days (prospective) Because the different methods applyto different time frames this inevitably resulted in variancein both the quality and the quantity of available data andhampered comparisons within and between countries

Moreover evaluation of the data sets is necessarilycomplicated by another phenomenon In all studies foodcomposition tables were used for the conversion of foodintake data to the estimated nutrient intakes Most Euro-pean countries have their own national food compositiondatabases which are compiled using country-specific pro-cedures and traditions Recent comparisons and evaluationsof national food composition tables have shown that nutri-ents differ in definition analytical methods units and modeof expression all of which could potentially result indifferent nutrient values between tables (Deharveng et al1999) In turn these differences may have an impact onthe precision of nutrient estimations and make between-country comparisons difficult and inaccurate (Ireland et al2002) In studying the comparability of food compositiontables Deharveng et al (1999) distinguished three groupsof nutrients The first group is those that can legitimatelybe compared even though the definition and analyticalmethod may be slightly different This group includes Nlactose alcohol water cholesterol fat fatty acids retinolvitamin D tocopherols tocotrienols thiamin riboflavinvitamin B6 vitamin B12 Ca Fe and K The secondgroup is those that are not readily comparable due to dis-crepancies in the calculation or mode of expression andcomprise protein carbohydrates starch sugars energycarotenes vitamin A and vitamin E Finally there arenutrients that are not comparable at all due to the analyticalmethod or definition used namely folate and fibre

In addition dietary studies tend to overestimate trueintakes of Na primarily due to the inability to account pre-cisely for added salt and the fact that much salt is discardedwith the cooking water Salt may also be lost when manu-factured foods are cooked Therefore to assess the intakeof Na it is recommended that measurements of Naexcretion are made (Ovesen amp Boeing 2002) Howevernone of the surveys reporting Na intake included Naexcretion as a status parameter

Consequently in the present paper these issues weretaken on board in the evaluation of the information onnutrient intake For instance in the reviewed papers themodes of expression for vitamin A vitamin E and folatewere not always made explicit in the source documentsTherefore for vitamins A and E only data that specificallyreferred to RE and a-tocopherol were used For Austriaand Germany dietary folate was converted to free folicacid However despite these precautions differencessuch as the conversion factors used to assess the intakesof protein carbohydrates and energy and the analyticalquality of the data (possible use of outdated analyticalmethods) cannot be excluded and prudence is called forin the interpretation of the figures given

In general the present findings are in line withearlier observations that there is a lack of internationally

J Lambert et alS160


comparable food consumption data (Lowik amp Brussaard2002) and support the need for better data for the evalu-ation of dietary intake on a European level

Most dietary intake studies of children and adolescentshave at least until recently tacitly assumed that the dataare representative and valid measures of habitual food con-sumption Unfortunately epidemiological studies of foodhabits and dietary intake in children and adolescents facea number of difficulties that are more-or-less specific tothese age groups and which are highly likely to bias theoutcome measurements (Livingstone amp Robson 2000Livingstone amp Black 2003 Livingstone 2004) On thebasis of recent validation studies it is now widely acceptedthat misreporting is a major problem in dietary surveys ofchildren and adolescents Consequently the dietary datapresented in this review need to be interpreted and evalu-ated with caution

TrendsDespite the concerns mentioned above over the infor-mation obtained from the surveys included in this reviewsome observations on trends can be made Data onenergy-related intake (percentage of energy) were similaracross the European countries Reported energy intakesincreased with age and when data were expressed inrelation to body weight the opposite trend was true Inchildren up to 10ndash12 years the energy intakes for both gen-ders were quite similar In adolescent males the increase inabsolute energy intake continued up until the age of 18years In girls however reported energy intakes began tolevel off in early adolescence and decline in late adoles-cence suggesting that under-reporting and dietary restric-tion in this age group probably occurs across EuropeWithin each age group there was a large range in reportedintakes for all nutrients which partly reflected differencesin body weight but also reporting errors that are knownto be a common problem in all dietary surveys No surveyshad attempted to exclude under-reporters

The percentage of energy from carbohydrate totalsugars and sucrose tended to decrease and the percentageof energy from starch to increase with age Boys atemore carbohydrate and fibre than did girls in terms ofabsolute amount (g) however their intakes were verysimilar in relation to energy intake Within surveysthroughout Europe there were large differences betweenindividuals in absolute carbohydrate intakes but much ofthis can be explained by variations in energy intake Theintake of carbohydrate total sugars and sucrose tended tobe lowest in Southern European countries Apart fromsome Southern European surveys with increasing agethere was a clear trend of declining intake of sugars andsucrose and increased intake of starch

Children and adolescents in Southern Europeancountries tended to report the highest intakes of total fatand MUFA (sometimes with cholesterol too as in thecase of Spain) Central and Eastern countries reported thegreatest intakes of PUFA and lowest intakes of SFA Thelowest fat intakes were recorded in Northern Europeexcept Finland where SFA intakes were greatest Asthere is no information on food these differences cannotbe explained from our data although it is generally

known that the consumption of olive oil a major sourceof MUFA is highest in Mediterranean countries Itshould be noted that these are only general trends asthere were large variations in reported intakes withincountries and between countries of the same region

Within countries the protein intake (as a percentage ofenergy) was usually quite similar There were some differ-ences between the European regions Intakes in somecountries in the South and North of Europe reachedabout 17ndash19 of energy respectively The Western Euro-pean countries like Austria Germany The Netherlandsand the UK reached more moderate protein intakes ofabout 11ndash15 of energy

Alcohol intakes were highly variable both within andbetween studies Children up to the age of 11 years con-sumed hardly any alcohol There was a clear trend ofincreasing alcohol intakes from 11 years of age onwardswith males consuming more alcohol than females

Reported intakes of vitamins by children and adolescentswere inconsistent across Europe No clear regional trendscould be described In general it can be said that intakesof most vitamins increase with age in both males andfemales in parallel with energy intake For some vitaminssuch as folic acid the intake is higher in some countries(UK and Ireland) than in others Higher intakes of vita-mins especially within one country andor within an inves-tigation may be explained by seasonal food patterns byspecific food-technological achievements such as micronu-trient enrichment of cereal foods or by the use ofsupplements

Some geographical trends were noted for vitamin Aintake Vitamin D intake was greatest in Northern countriesand low in some Western countries This may be related toa higher consumption of milk and milk products by chil-dren living in Northern regions vitamin D fortification offood or the use of supplements Vitamin E intake was high-est in some Central and Eastern European countries whichmay have reflected the higher consumption of PUFA

Intake of minerals is also very variable across EuropeNo clear regional trends were distinguishable Like vita-mins the intake of minerals increases with age which isrelated to increased food consumption In the case of Cathe variation in intake within the studied populationgroups differed considerably Roughly the coefficient ofvariation varied from 10 to about 60 Also therewas a considerable variation in Fe intake This might bedue to inaccurate reporting andor different eating patternsof children and adolescents within Europe Adolescent girlstherefore do not appear to consume more vitamins or min-erals than their younger counterparts and in the case of Femay consume less Some countries of the North reportedhigher intakes of Fe than Western countries which couldbe due to food fortification or higher meat intakes

Nutritional status

The literature has shown that the correlations betweenblood analytes and dietary intakes are generally weakand if a relationship between the analyte and intake datais found it may not necessarily be causal Some factorsin particular the young personrsquos health at the time of



investigation may affect the degree of correlation Statusvalues and normal ranges are dependent on assaymethod which makes it difficult to compare values directlybetween different surveys conducted within Europe Inaddition the number of investigations and surveys pub-lished is too small to be able to describe andor comparethe nutritional status of children and adolescents withinEurope

The differences in information on measured status mayhave an impact on the precision of nutrient estimationsand make comparisons imprecise In the case of vitaminD not only diet but also endogenous synthesis under theinfluence of sunlight can influence status Studies showthat status during the winter is therefore lower than thatduring the summer (Lehtonen-Veromaa et al 1999)

Moreover it is also important to take into account thatdifferent technical equipment and statistical softwarepackages were used to run the data analyses (status andintake) Not all data were expressed as mean (SD) Insome cases medians or ranges (minimum and maximum)were used making it difficult to compare status data

Conclusions

Many surveys of food and nutrient intake in children andadolescents have been undertaken over the past ten totwenty years Of those published the data from manyhave no meaningful use due to small andor unrepresenta-tive samples poor methodology and failure to provide suf-ficient details on subjects and methods The studies thathave been included in this review provide some usefulinformation on energy and nutrient intakes of childrenand adolescents across Europe and suggest some interest-ing trends However their value for discovering averageintakes of European children and adolescents or makingcomparisons between countries or regions is severely lim-ited The reported values for many nutrients varied widelyboth within and between surveys so it was impossible toknow how much of this was real and how much due torecording error Apart from the inherent problems foundin even the most carefully conducted dietary surveysthere were several other reasons why surveys could noteasily be compared These included different methodsfor measuring intake different age cut-off points use ofa variety of food composition tables based on different ana-lytical techniques for measuring food composition failureto exclude under-reporters and few truly nationally repre-sentative samples

The value of the surveys for assessing the nutritionaladequacy of the diets of European children and adolescentswas limited due to the lack of measurements of nutritionalstatus although this has been rectified in some more recentsurveys Comparisons with sets of country-specific Rec-ommended Daily Amounts are of little value since themethods used to establish many of these have beencalled into question (Prentice et al 2004)

A European Nutrient Database would be a useful firststep towards being able to compare food intake data(Charrondiere et al 2002) This would also help in defininganalytical methodology and in the harmonisation of unitsfor specific nutrients such as dietary fibre folic acid and

vitamins A and E The routine collection of status data atthe same time as food intake is assessed would help incomparisons of the status situation in different countriesAligned methodologies for nutrient status would make acomparison at an international level more precise

Acknowledgements

This work was supported by a grant from the NutritionalNeeds of Children Task Force of the European branch ofthe International Life Sciences Institute (ILSI Europe)Industry members of this task force are Barilla Coca-Cola Danone Vitapole Friesland Coberco MasterfoodsNestle and Numico Further information about ILSIEurope can be obtained from thorn 32 (0)2 771 00 14 orinfoilsieuropebe The opinions expressed herein arethose of the authors and do not necessarily represent theviews of ILSI and ILSI Europe

The authors of the paper would like to thank Dr BrigitteWasserbacher Ms Valerie Rolland and Ms AriannaBonazzi for their contribution to this publication

References

Adamson A Rugg-Gunn AJ Butler T Appleton D amp Hackett A(1992) Nutritional intake height and weight of 11ndash12-year-oldNorthumbrian children in 1990 compared with informationobtained in 1980 Br J Nutr 68 543ndash563

Adolf T et al (1995) In Ergebnisse der nationalen Verzehrsstudie1985ndash1988 VERA-Studie Band XI [W Kubler HJ Anders andW Heeschen editors]

Agostoni C Garofalo R Galluzzo C Scaglioni S Ortisi MT RivaE Bellu R amp Giovannini M (1998) Studio delle abitudini ali-mentari in una popolazione scolastica di un comune della pro-vincia di Milano Riv Pediatr Prev Soc 38 59ndash65

Aguilera F Lupianez L Magana D Planells E Mataix FJ ampLlopis F (1994) Iron status in a population of Spanish school-children Nahrung 38 192ndash198

Amorim Cruz JA (2000) Dietary habits and nutritional status inadolescents over Europe ndash Southern Europe Eur J Clin Nutr54 Suppl 1 S29ndashS37

Andersen NL Fagt S Groth MV Hartkopp HB Moslashller AOvesen NL amp Warming DL (1996) Dietary Intakes for theDanish Population 1995 Publication no 235 Soslashboslashrg TheNational Food Agency of Denmark

Aranceta J amp Perez C (1996) Consumo de Alimentos y EstadoNutricional de la Poblacion Escolar de Bilbao Guıas Alimen-tarias para la Poblacion Escolar Bilbao Area de Salud yConsumo del Ayuntamiento de Bilbao

Bellu R Riva E Ortisi MT De Notaris R Bonacina M Luotti Damp Giovannini M (1996) Preliminary results of a nutritionalsurvey in a sample of 35000 Italian schoolchildren J Int MedRes 24 169ndash184

Bergstrom E Hernell O amp Persson LA (1993) Dietary changes inSwedish adolescents Acta Paediatr 82 472ndash480

Biro G Hulshof KFAM Ovesen L amp Amorim Cruz JA for theEFCOSUM Group (2002) Selection of methodology to assessfood intake Eur J Clin Nutr 56 Suppl 2 S25ndashS32

Brazdova Z Fiala J amp Klimova A (1992) Dietary intake of aselected child population in Brno Cesk Hyg 197ndash300

Brazdova Z Matejova H amp Fiala J (2000) Intake of selected nutri-ents by children in the Czech Republic Hygiena 45 10ndash15

Brussaard JH Brants HAM van Erp-Baart AMJ Hulshof KFAMamp Kistemaker C (1999) De voeding van allochtone

J Lambert et alS162


bevolkingsgroepen Deel 3 Voedselconsumptie en voedingstoe-stand bij Marokkaanse Turkse en Nederlandse 8-jarigen enhun moeders Report no V99855 Zeist TNO Nutrition andFood Research

Charrondiere UR Vignat J Moller A et al (2002) The EuropeanNutrient Database (ENDB) for nutritional epidemiology JFood Compost Anal 15 435ndash451

Charzewska J Chwojnowska Z Rogalska-Niedzwiedz M ampChabros E (1992) Changes in the nutrition of adolescents inWarsaw in the years 1985ndash1990 Zywienie czlowieka i metab-olism 17ndash25

Couet C Rigaud D Volatier JL Borys JM Giachetti I CassutoD-A amp Reiser P (2000) Enquete francaise de consommationalimentaire (II) La consommation des glucides aspects quan-titatifs et qualitatifs Cah Nutr Diet 35 257ndash268

Crawley HF (1993) The energy nutrient and food intakes of teen-agers aged 16ndash17 years in Britain Br J Nutr 70 15ndash26

Crawley HF amp White D (1995) The diet and body weight of Brit-ish teenage smokers at 16ndash17 years Eur J Clin Nutr 49904ndash914

Czeczelewski J Huk E Jusiak R amp Raczynski G (1995) Nutritionmode and status and physical fitness of children in a schooltaken as an example in Biala Podlaska Zywienie czlowieka imetabolism 174ndash183

Davies PSW Coward WA Gregory J White A amp Mills A (1994)Total energy expenditure and energy intake in the pre-schoolchild a comparison Br J Nutr 72 13ndash20

De Henauw S amp Matthys C (1998) Voedingsgewoonten bij jonge-ren van 14ndash18 jaar Report Ghent Universiy of Ghent

De Henauw S Wilms L Mertens J Standaert B amp De Backer G(1997) Overall and meal-specific macronutrient intakein Belgian primary school children Ann Nutr Metab 41 89ndash97

De Henauw S Matthys C amp De Backer G (2001) Differences inoverall food and nutrient intake profile between breakfast usersand breakfast skippers in a representative sample of 14ndash18years old Belgian adolescents (extended abstract) PublicHealth Nutr 4 419

Deharveng G Charrondiere UR Slimani N Southgate DAT ampRiboli E (1999) Comparison of nutrients in the food compo-sition tables available in the nine European countries participat-ing in EPIC Eur J Clin Nutr 53 69ndash79

Deheeger M Rolland-Cachera MF Labadie M-D amp Rossignol C(1994) Etude longitudinale de la croissance et de lrsquoalimentationdrsquoenfants examines de lrsquoage de 10 mois a 8 ans Cah Nutr Diet29 16ndash23

Deheeger M Akrout M Bellisle F Rossignol C amp Rolland-Cachera MF (1996) Individual patterns of food intake develop-ment in children a 10 months to 8 years of age follow-up studyof nutrition and growth Physiol Behav 59 403ndash409

Deutsche Gesellschaft fur Ernahrung eV (2000) Ernahrungsber-icht 2000 Frankfurt am Main Deutsche Gesellschaft furErnahrung eV

Elmadfa I amp Wasserbacher B (2002) Expertengutachten zurErnahrung von Vorschulkindern in Osterreich ndash Feldstudieuber die Verzehrsgewohnheiten und Lebensmittelpraferenzenvon Vorschulkindern (3ndash6 Jahre) in Osterreich ndash EndberichtReport no GZ 3531179-IX901 Bundesministerum furGesundheit Vienna

Ergebnisse der nationalen Verzehrsstudie 1985ndash1988 (1995)VERA Studio Band XL Bayerisches Staats Ministerium furUnwelt Gesundheit und Verbraucherschutz Vienna

Frost Anderson L Nes M Sandstad B Bjoslashrneboe G-EA ampDrevon CA (1995) Dietary intake among Norwegian adoles-cents Eur J Clin Nutr 49 555ndash564

Frost Anderson L Nes M Bjoslashrneboe G-EA amp Drevon CA (1997)Food habits among 13-year-old Norwegian adolescents ScandJ Nutr 41 150ndash154

Gabor Z (1998) Iskolas gyermekek taplalkozasa (Nutrition ofschool children) In Az iskola-egeszsegugy kezikonyve (Hand-book of School Health) pp 373ndash381 Budapest Kiado

Gonzalez E Alonso JLD Sanchez PH amp Lopez AS (1994) Habi-tos alimentarios de la poblacion infantil de un distrito en la islade Gran Canaria Atencion Primaria 14 1141ndash1147

Gregory J amp Lowe S (2000) National Diet and Nutrition SurveyYoung People aged 4 to 18 years Vol 1 Report of the Dietand Nutrition Survey London HMSO

Gregory JR Collins DL Davies PSW Hughes JM amp Clarke PC(1995) National Diet and Nutrition Survey Children aged 1middot5to 4middot5 years Vol 1 Report of the Diet and Nutrition SurveyLondon HMSO

Grunberg H Mitt K amp Thetloff M (1997) Food habits and dietaryintake of schoolchildren in Estonia Scand J Nutr 41 18ndash22

Guillaume M Lapidus L amp Lambert A (1998) Obesity and nutri-tion in children The Belgian Luxembourg Child Study IV EurJ Clin Nutr 52 323ndash328

Hamułka J amp Gronowska-Senger A (1999) Monitoring sposobuzywienia i stanu odzywienia dzieci w wieku szkolnym z terenuPolski poludniowo-wschodniej Rocznik NaukowyInstytutWychowania Fizycznego i Sportu w Bialej Podlaskiej 301ndash311

Hamułka J amp Gronowska-Senger A (2000) Ocena sposobuZywienia uczniow Zywienie czlowieka i metabolism 176ndash181

Hamułka J Kosiorek K amp Gronowska-Senger A (1998) Dailyintake of salt and cholesterol in primary schoolchildren Pol JFood Nutr Sci 549ndash585

Hamułka J Gronowska-Senger A amp Witkowska K (2000) Energyvalue and frequency breakfast intake in Warsaw primaryschools Rocznik PZH 279ndash290

Hassapidou MN amp Fotiadou E (2001) Dietary intakes and foodhabits of adolescents in Northern Greece Int J Food Sci Nutr52 109ndash116

Hassapidou M Kafatos A amp Manoukas G (1996) Dietary vitaminE intake and plasma tocopherol levels of a group of adolescentsfrom Spili Crete Int J Food Sci Nutr 47 365ndash368

Hercberg S Preziosi P Galan P Deheeger M amp Dupin H (1991a)Apports nutritionnels drsquoun echantillon representatif de la popu-lation du Val-de-Marne II Les apports en macronutrimentsRev Epidemiol Sante Publique 39 233ndash244

Hercberg S Preziosi P Galan P Deheeger M Papoz L amp DupinH (1991b) Apports nutritionnnels drsquoun echantillon representatifde la population du Val-de-Marne III Les apports en minerauxet vitamines Rev Epidemiol Sante Publique 39 245ndash261

Hercberg S Preziosi P Galan P Devanlay M Keller HBourgeois C Potier de Courcy G amp Cherouvrier F (1994)Vitamin status of a healthy French population dietaryintakes and biochemical markers Int J Vitam Nutr Res 64220ndash232

Hulshof KFAM Kistemaker C amp Bouman M (1998) De innamevan energie en voedingsstoffen door Nederlandse bevolkings-groepen ndash Voedselconsumptiepeiling 1997ndash1998 Report noV98805 Zeist TNO Nutrition and Food Research

Ilow R Regulska-Ilow B amp Szymczak J (1999) Assessment offood intake of secondary-school girls from Glogow andLublin Part I Dietary habits Bromat Chem Toksykol 35ndash42

Ireland J van Erp-Baart AMJ Charrondiere UR Moslashller ASmithers G amp Trichopoulou A (2002) Selection of a foodclassification system and a food composition database forfuture food consumption surveys Eur J Clin Nutr 56 Suppl2 S33ndashS45

Johansson L Solvoll K Bjoslashrneboe G-EA amp Drevon CA (1997)Dietary habits among Norwegian men and women Scand JNutr 41 63ndash70

Kafatos A Verhagen H Moschandreas J Apostolaki I amp VanWesteropp JJ (2000) Mediterranean diet of Crete foods andnutrient content J Am Diet Assoc 100 1487ndash1493



Kersting M Sichert-Hellert W Lausen B Alexy U Manz F ampSchoch G (1998a) Energy intake of 1 to 18 year old Germanchildren and adolescents Z Ernahrungswiss 37 47ndash55

Kersting M Sichert-Hellert W Alexy U Manz F amp Schoch G(1998b) Macronutrient intake of 1 to 18 year old German chil-dren and adolescents Z Ernahrungswiss 37 252ndash259

Kersting M Alexy U amp Sichert-Hellert W (2000) Vitamin intakeof 1 to 18 year old German children and adolescents in the lightof various recommendations Int J Vitam Nutr Res 70 48ndash53

Leclercq C amp Ferro-Luzzi A (1991) Total and domestic consump-tion of salt and their determinants in three regions of Italy EurJ Clin Nutr 45 151ndash159

Lee P amp Cunningham K (1990) Irish National Nutrition SurveyDublin Irish Nutrition and Dietetic Institute

Lehtonen-Veromaa M Mottonen T Irjala K Karkkainen MLamberg-Allardt C Hakola P amp Viikari J (1999) Vitamin Dintake is low and hypovitaminosis D common in healthy 9- to15-year-old Finnish girls Eur J Clin Nutr 53 746ndash751

Livingstone MBE (2004) Issues in dietary assessment in childrenand adolescents Br J Nutr 92 Suppl 2 S213ndashS222

Livingstone MBE amp Black AE (2003) Markers of the validity ofreported energy intake J Nutr 133 17Sndash42S

Livingstone MBE amp Robson PJ (2000) Measurement of dietaryintake in children Proc Nutr Soc 59 279ndash293

Lowik MRH amp Brussaard JH (editors) (2002) EFCOSUM Euro-pean Food Consumption Survey Method Eur J Clin Nutr 56Suppl 2 S1ndashS96

Lyhne AN (1998) Dietary habits and physical activity of Danishadolescents Scand J Nutr 42 13ndash16

McNeill G Davidson L Morrison DC Crombie IK Keighran J ampTodman J (1991) Nutrient intake in schoolchildren some prac-tical considerations Proc Nutr Soc 50 37ndash43

McNulty H Eaton-Evans J Cran G Woulahan G Boreham CSavage JM Fletcher R amp Strain JJ (1996) Nutrient intakesand impact of fortified breakfast cereals in schoolchildrenArch Dis Child 75 474ndash481

Meulmeester JF (1989) Voedingsonderzoek bij Turkse enMarokkaanse kinderen in Nederland KIT Dissertation Amster-dam

Moschandreas JA amp Kafatos A (2002) Calcium intake in relationto diet and health indicators in Cretan primary and high schoolpupils Greece Int J Vitam Nutr Res 72 264ndash277

Nelson M Naismith DJ Burley V Gatenby S amp Geddes N (1990)Nutrient intakes vitaminndashmineral supplementation and intelli-gence in British schoolchildren Br J Nutr 64 13ndash22

Ovesen L Boeing H EFCOSUM Group (2002) The use of bio-markers in multicentric studies with particular considerationof iodine sodium iron folate and vitamin D Eur J ClinNutr 56 S12ndashS17

Paulus D Saint-Remy A amp Jeanjean M (2001) Dietary habitsduring adolescence ndash results of the Belgian Adolux StudyEur J Clin Nutr 55 130ndash136

Pavlovic M (1999) Characteristic of population nutrition InHealth Care of Population in North Balkan Region in 1998with Comparative Review of Health Conditions from 1994pp 151ndash171 [M Pavlovic editor] Subotica YugoslaviaPublic Health Institute

Pavlovic M (2000) Yugoslav Study of Arteriosclerosis Risk Fac-tors in School-children (JUSAD) pp 206ndash217 SuboticaRegional Center for Population Nutrition Improvement

Pavlovic M Bolits Z Rapic D amp Kadvan A (1999) Nutrient intakeand precursors of atherosclerosis in 10 year old schoolchildren inSubotica In Current Trends of the Prevention of Athersosclero-sis in Childhood Proceedings of the 2nd Conference of the Inter-national Group for Prevention of Atherosclerosis in Childhoodvol 3 pp 146ndash149 [T Szamosi editor] Budapest ConventionBudapest Ltd

Pavlovic M Majkic SN Bolits Z Bjeloglav D amp Kadvan A(2001) Nutrition as a potential nutritive risk factor of athero-sclerosis Jugoslav Med Biohem 20 107ndash115

Payne JA amp Belton NR (1992a) Nutrient intake and growthin pre-school children I Comparison of energy intakeand sources of energy with growth J Hum Nutr Diet 5 287ndash298

Payne JA amp Belton NR (1992b) Nutrient intake and growth inpre-school children II Intake of minerals and vitamins J HumNutr Diet 5 299ndash304

Petrova S Angelova K Ivanova L et al (2000) National dietaryand nutritional status survey of the population in BulgariaHygiene and Public Health XLIII 4ndash67

Prentice A Branca F Decsi T Michaelsen KM Fletcher RJGuesry P Manz F Vidailhet M Pannemans D amp Samartın S(2004) Energy and nutrient dietary reference values for chil-dren in Europe methodological approaches and current nutri-tional recommendations ILSI Europe Nutritional Needs ofChildren Task Force ndash Expert Group 1 Br J Nutr 92 Suppl2 S83ndashS145

Preziosi P Hercberg S Galan P Devanlay M Cherouvrier F ampDupin H (1994) Iron status of a healthy French population fac-tors determining biochemical markers Ann Nutr Metab 38192ndash202

Societe Swisse de la Nutrition (1998) Quatrieme rapport sur lanutrition en Suisse Berne Office Federale de la Sante Publi-que

Rankinen T Fogelholm M Kujala U Rauramaa R amp Uusitupa M(1995) Dietary intake and nutritional status of athletic andnonathletic children in early puberty Int J Sports Med 5136ndash150

Rasanen L Laitinen S Stirkkinen R Kimppa S Viikari J UhariM Pesonen E Salo M amp Akerblom HK (1991) Composition ofthe diet of young Finns in 1986 Ann Med 2 73ndash80

Ratsch IM Catassi C Verrina E et al (1992) Energy and nutrientintake of patients with mild-to-moderate renal failure comparedwith healthy children an Italian multicentre study Eur JPediatr 151 701ndash705

Scientific Committee on Food (1993) Reports of the ScientificCommittee on Food Thirty-first Series Brussels Commissionof the European Communities

Rigaud D Giachetti I Deheeger M Borys JM Volatier JLLemoine A amp Cassuto D-A (1997) Enquete francaise de con-sommation alimentaire I Energie et macronutrients Cah NutrDiet 32 379ndash389

Rogalska-Niedzwiedz M Charzewska J Chwojnowska Z ampChabros E (1992) Calcium content in diets of adolescentsZywienie czlowieka i metabolism 244ndash249

Roma-Giannikou E Adamidis D Gianniou M Nikolara R ampMatsaniotis N (1997) Nutritional survey in Greek childrennutrient intake Eur J Clin Nutr 51 273ndash285

Ruxton CHS Kirk TR amp Belton NR (1996) Energy and nutrientintakes in a sample of 136 Edinburgh 7ndash8 year olds a com-parison with UK dietary reference values Br J Nutr 75151ndash160

Samuelson G Bratteby L-E Enghardt H amp Hedgren M (1996a)Food habits and energy and nutrient intake in Swedish adoles-cents approaching the year 2000 Acta Paediatr Suppl 415 1ndash20

Samuelson G Bratteby L-E Berggren K Elverby JE amp Kempe B(1996b) Dietary iron intake and iron status in adolescents ActaPaediatr 85 1033ndash1038

Samuelson G Bratteby L-E Mohsen R amp Vessby B (2001) Diet-ary fat intake in healthy adolescents inverse relationshipsbetween the estimated intake of saturated fatty acids andserum cholesterol Br J Nutr 85 333ndash341

Smigiel D Bliwert K amp Chorazy W (1994) Calcium and phos-phorus in daily foods rations of children two districts of thesouthern part of Poland Rocznik PZH 55ndash60

J Lambert et alS164


Stopnicka B Szamrej IK amp Jerulank I (1998) Assessment of indi-vidual dietary habits of children in elementary schools in theProvince of Bialystok Food Nutr Health 392ndash400

Strain JJ Robson PJ Livingstone MBE Primrose ED SavageJM Cran GW amp Boreham CAG (1994) Estimates of foodand macronutrient intake in a random sample of Northern Ire-land adolescents Br J Nutr 72 343ndash352

Szponar L amp Rychlik E (1996a) Nutrition mode and nutritionalstatus of boys and men in Poland Pol J Hum Nutr Metab 3ndash37

Szponar L amp Rychlik E (1996b) Nutrition mode and nutritionalstatus of girls and women in Poland Pol J Hum Nutr Metab38ndash70

Vazquez C de Cos AI Martinez P et al (1996) Consumo de

alimentos y nutrientes por edades y sexo en escolares de lacomunidad de Madrid (CAENPE) Rev Clin Esp 196501ndash508

Volatier J-L (2000) Enquete INCA individuelle et nationale surles consommations alimentaires Credoc Agence Francaisede Securite Sanitaire des Aliments Ministere de lrsquoAgricultureet de la Peche Paris Editions Tec amp Doc

Werker H (2000) Evaluation of the nutritional status and feedingpatterns of pre-school children on the basis of a questionnairestudy Dev Period Med 41ndash52

Ylonen K Virtanen SM Ala-Venna E amp Rasanen L (1996) Com-position of diet in relation to fat intake of children aged 1ndash7years J Hum Nutr Diet 9 207ndash218



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accepted that many published surveys do not accuratelyreflect true intakes For this report as part of an exerciseto review data available in Europe that could be used tohelp develop dietary guidelines information on nutrientintake and status across Europe was collected and evalu-ated to ascertain whether any trends could be identified

Methodology

To gain insight into the dietary intake and nutritional statusof children and adolescents the first step was to collectdata and to highlight the measurement tools used and bio-logical parameters investigated for each data set individu-ally before a final selection of the most relevant surveysfor further analysis was made For this purpose the infor-mation listed below was collected for each survey

Quality of the document and whether published

Dietary assessment method used

Range of intakes (mean values standard deviations orother distribution characteristics)

Food composition databases used for the conversion offood intakes to estimated nutrient intakes (national foodcomposition databases other country databases andormanufacturerrsquos database duplicate portion techniquewith chemical analysis data nutrient calculationsinclusive or exclusive of the contribution of food sup-plements)

Year and type of the survey eg longitudinal or cross-sectional

Age ranges and cut-off ages sex and sample size

Assessment of status anthropometric data (measured orself-reported) and biochemical parameters

Geographical distribution national regional or localstudy rural or urban

Next each member of the Working Group looked for theabove-defined survey information and data on the energyand nutrients listed in Table 1 from their specifiedcountries Surveys to be assessed were collected betweenApril and December 2001 by literature search andor bycontacting experts in this field Once the available surveyswere collected and related information was incorporatedinto the template by country a selection of relevant sur-veys was made according to the criteria listed in Table 2

Originally we aimed to focus also on fluid intake (egwater other fluids juices soda) and meal pattern How-ever only a few studies provided information about the

intake of water and other fluids Sometimes these figureswere related to total water (including water from food)whereas in other studies figures seemed to refer only todrinks including or excluding tap water Furthermorealthough some information on meal pattern was availablethe kind of information was difficult to compare Since theinformation on fluids and meal pattern could not be inter-preted unequivocally we decided not to include this typeof data

In a final stage the results of the selected surveys wereincorporated in tables by nutrient using units accordingto the SI system and each nutrient was reviewed

The age group classification of the EU was used as gui-dance 1ndash3 years 4ndash6 years 7ndash10 years 11ndash14 years and15ndash17 years (Reports of the Scientific Committee on Food1993) Data were collapsed if relevant (weighted meanswhen only a small amount of data was available) Whenage categories were combined this was clearly indicatedData of specific groups within countries eg urbanruralwere collapsed in the case of minor differences

For describing regional trends in dietary intake of chil-dren and adolescents Europe was divided into fourregions Northern countries (Denmark Finland NorwaySweden) Western countries (Austria Belgium FranceGermany Ireland The Netherlands Switzerland theUK) Central and Eastern countries (Bulgaria CzechRepublic Estonia Hungary Poland Russia Yugoslavia)and Southern countries (Greece Italy Portugal Spain)

Results

Eighty surveys from twenty-three countries which satisfiedthe selection criteria were selected for inclusion in thereview These are listed by country in Table 3 Only sur-veys from the UK used 7 d weighed records Most surveysgave data for males and females separately for all ages

Table 2 Inclusion and exclusion criteria

Unpublished surveys were included only if relevant(eg no published documents were available)

Control groups from studies of children with medical conditionswere not used even for rare nutrients or for nutrients for whichno other data were available in the country

To assess nutrient intake only surveys based on theindividual level were included Therefore only dataobtained with a record method (weighed or estimated)24 h recall food frequency questionnaire andor dietaryhistory method were included

Surveys before 1987 were excluded unless specific information onfood status was available

If too much information was missing in a document the survey wasexcluded except if there was only a small number of surveysavailable for a specific country or a specific nutrient

Nutritional status data were included only if they could be linked todietary intake data in the same or a similar study In thisparticular case a randomised selection of children shouldbe ensured

Surveys with too broad age categories (eg 2ndash24 years) wereexcluded

Data were excluded when genders were mixed in children above12 years of age

Surveys with a very small sample size (n frac14 10ndash25) were excluded

Table 1 Nutrients included in the inventory

EnergyCarbohydrates (total sugars sucrose starches total available

carbohydrates) and NSPfibreLipids (total fat saturated fatty acids MUFA PUFA trans fatty

acids polyunsaturated fatssaturated fats cholesterol)ProteinAlcoholVitamins (biotin folic acid niacin pantothenic acid retinol

equivalents riboflavin thiamin vitamin B12 vitamin B6vitamin C vitamin D vitamin E vitamin K)

Minerals and trace elements (Ca Mg P K Na chloride iron CrCu fluoride I Mn Mo Se Zn)

J Lambert et alS148


Tab

le3

Surv

eys

inclu

ded

inth

edie

tary

inta

ke

and

sta

tus

revie

w

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)S

am

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

Austr

iaA

12002

Elm

adfa

ampW

ass

erb

uch

er

(2002)

7d

record

1pound

24

hre

call

mthorn

f4

ndash18

4ndash

6

7ndash

9

10

ndash12

13

ndash15

15

ndash18

2234

national

Belg

ium

B1

1992

Guill

aum

eet

al

(1998)

3d

record

mthorn

f6

ndash12

8

10

1028

regio

nal

B2

1991

De

Henauw

et

al

(1997)

FF

Qm

thornf

6ndash

12

ndash1321

local

B3

1995

Paulu

set

al

(2001)

1d

record

mthorn

f12

ndash17

ndash1526

regio

nal

B4

1997

De

Henauw

ampM

att

hys

(1998)

De

Henauw

et

al

(2001)

7d

record

mthorn

f13

ndash18

ndash341

local

urb

anr

ura

lB

ulg

aria

BG

11998

Petr

ova

et

al

(2000)

1pound

24

hre

call

mix

1

ndash10

mthorn

f11thorn

1ndash

18

3

6

10

14

362

national

Czech

Republic

CZ

11998

Bra

zdova

et

al

(2000)

1pound

24

hre

call

FF

Qf

6ndash

9

11

ndash15

ndash1564

national

CZ

2N

AB

razdova

et

al

(1992)

1pound

24

hre

call

mix

3ndash

6

9ndash

11

ndash100

local

Denm

ark

DK

11995

Anders

en

et

al

(1996)

7d

record

mthorn

f1

ndash18

3

6

10

14

1413

national

DK

21995

Lyhne

(1998)

7d

record

mthorn

f14

ndash19

ndash245

national

Est

onia

EE

11993

ndash95

Gru

nberg

et

al

(1997)

1pound

24

hre

call

FF

Q

OC

Dm

thornf

11

ndash12

14

ndash15

ndash341

regio

nal

Fin

land

SF

11996

Rasanen

et

al

(1991)

2pound

24

hre

call

mthorn

f9

ndash24

12

15

18

902

regio

nal

SF

2N

AR

ankin

en

et

al

(1995)

4d

record

mthorn

f9

ndash12

ndash170

local

SF

31989

Ylo

nen

et

al

(1996)

3d

record

mix

1ndash

73

77

regio

nal

SF

419969

7Lehto

nen-V

ero

maa

et

al

(1999)

4d

record

f9

ndash15

ndash191

national

Fra

nce

F1

1988

Herc

berg

et

al

(1991a)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F2

1988

Herc

berg

et

al

(1991b)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F3

1988

Herc

berg

et

al

(1994)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F4

1988

Pre

zio

siet

al

(1994)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F5

19939

4R

igaud

et

al

(1997)

1d

WR

mthorn

f2

ndash20

6

12

17

271

national

F6

19939

4C

ouet

et

al

(2000)

1d

WR

mthorn

f2

ndash20

6

12

17

271

national

F7

19899

0V

ola

tier

(2000)

1d

WR

mthorn

f3

ndash14

6

8

11

1018

national

F8

1985

ndash93

Deheeger

et

al

(1994)

DH

mthorn

f2

ndash20

4

6

82781

12

local

F9

1985

ndash93

Deheeger

et

al

(1996)

DH

mthorn

f2

ndash20

4

6

82781

12

local

Germ

any

D1

1998

Deuts

che

Gesells

chaft

fur

Ern

ahru

ng

eV

(2000)

1d

WR

D

Hm

thornf

4ndash

19

7

10

13

15

38

924

national

D2

1985

ndash88

Adolf

et

al

(1995)

7d

record

mthorn

f4

ndash18

6

9

12

14

24

632

national

D3

1985

ndash95

Kers

ting

et

al

(2000)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

D4

1985

Kers

ting

et

al

(1998a)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

D5

1985

Kers

ting

et

al

(1998b)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

Gre

ece

GR

119939

4R

om

a-G

iannik

ou

et

al

(1997)

1d

WR

O

CD

mthorn

f2

ndash14

3

5

7

9

11

1936

national

GR

21994

Kafa

tos

et

al

(2000)

1pound

24

hre

call

OC

Dm

12

ndash98

regio

nal

GR

31999

Moschandre

as

ampK

afa

tos

(2002)

1pound

24

hre

call

mthorn

f9

ndash16

9ndash

12

14

ndash16

10547

99

regio

nal

GR

41997

Hassapid

ou

et

al

(2001)

3d

WR

1pound

24

hre

call

OC

D

FF

Qm

thornf

11

ndash14

ndash582

regio

nal

GR

51987

ndash88

Hassapid

ou

et

al

(1996)

3d

WR

mthorn

f13

ndash14

ndash20

local

Hungary

H1

1995

Gabor

(1998)

3pound

24

hre

call

mthorn

f13

ndash14

13

ndash14

414

regio

nal

Irela

nd

IRL1

1988

Lee

ampC

unnin

gham

(1990)

DH

O

CD

mthorn

f8

ndash25

12

15

18

643

national



Tab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

Italy

IT1

1996

Bellu

et

al

(1996)

FF

Qm

thornf

7

mix

10

7

10

ndash35

072

national

IT2

1992

Rats

ch

et

al

(1992)

4d

record

mix

3

7

10

ndash93

national

IT3

1991

Lecle

rcq

ampF

err

o-L

uzzi(1

991)

1pound

24

hre

call

mix

10

ndash11

ndash178

national

IT4

1988

Agosto

niet

al

(1998)

1pound

24

hre

call

mthorn

f11

mix

15

11

15

ndash120

local

The

Neth

er-

lands

NL1

19979

8H

uls

hof

et

al

(1998)

2d

record

mthorn

f2

ndash19

3

6

9

12

15

1538

national

NL2

1984

Meulm

eeste

r(1

989)

1pound

24

hre

call

mthorn

f8

ndash135

local

NL3

1999

Bru

ssaard

et

al

(1999)

1pound

24

hre

call

mthorn

f7

ndash9

ndash202

local

Norw

ay

N1

NA

Fro

st

Anders

on

et

al

(1995)

1d

WR

F

FQ

mthorn

f18

ndash1564

national

N2

NA

Fro

st

Anders

on

et

al

(1997)

FF

Qm

thornf

13

ndash1705

national

N3

NA

Johanss

on

et

al

(1997)

1d

WR

mthorn

f16

ndash29

ndash845

national

Pola

nd

PL1

1991

ndash94

Szponar

ampR

ychlik

(1996a)

1pound

24

hre

call

m11

ndash14

11

12

13

14

401

national

PL2

1991

ndash94

Szponar

ampR

ychlik

(1996b)

1pound

24

hre

call

f11

ndash14

11

12

13

14

725

national

PL3

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(2000)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL4

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(1999)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL5

19969

7H

am

ułk

aet

al

(1998)

1pound

24

hre

call

FF

Qm

thornf

13

ndash15

13

15

104

urb

an

rura

lP

L6

NA

Ham

ułk

aet

al

(2000)

1pound

24

hre

call

m17

ndash18

17

18

215

local

PL7

NA

Sm

igie

let

al

(1994)

1pound

24

hre

call

m17

ndash18

17

18

236

local

PL8

19909

1R

ogals

ka-N

iedzw

iedz

et

al

(1992)

1pound

24

hre

call

mthorn

f11

ndash15

11

15

7562

local

PL9

NA

Czeczele

wskiet

al

(1995)

1pound

24

hre

call

mthorn

f13

ndash15

13

15

76

local

PL10

NA

Ilow

et

al

(1999)

1pound

24

hre

call

mix

3ndash

73

7822

national

PL11

NA

Werk

er

(2000)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL12

NA

Sto

pnic

ka

et

al

(1998)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL13

NA

Charz

ew

ska

et

al

(1992)

FF

Qm

thornf

9ndash

14

9

14

672

regio

nal

Port

ugal

P1

1995

Am

orim

Cru

z(2

000)

1pound

24

hre

call

mthorn

f13

ndash18

ndash78

local

Russia

Rus1

2000

BP

opki

n(u

npublis

hed

results

)1pound

24

hre

call

mthorn

f1

ndash20

2

3

4

etc

2779

national

Spain

E1

19899

2A

guile

raet

al

(1994)

FF

Qm

ix2

ndash7

3

6264

local

E2

NA

Gonzale

zet

al

(1994)

1pound

24

hre

call

OC

Dm

thornf

6ndash

14

7

8

9

etc

2608

local

E3

1988

Vazquez

et

al

(1996)

1pound

24

hre

call

mthorn

f6

ndash16

7

12

164

local

E9

Ara

nce

taamp

Pere

z(1

996)

Sw

eden

S1

19899

0B

erg

stro

met

al

(1993)

7d

record

mthorn

f14

ndash17

17

731

regio

nal

S2

19939

4S

am

uels

on

et

al

(1996a)

7d

record

mthorn

f15

ndash398

regio

nal

S3

19939

4S

am

uels

on

et

al

(1996b)

7d

record

mthorn

f15

ndash398

regio

nal

S4

NA

Sam

uels

on

et

al

(2001)

7d

record

mthorn

f15

ndash93

regio

nal

Sw

itzerland

CH

119949

5S

ocie

teS

uis

se

de

laN

utr

itio

n(1

998)

7d

record

mthorn

f13

ndash21

15

19

1862

regio

nal

UK

UK

11988

Nels

on

et

al

(1990)

7d

WR

mthorn

f7

ndash12

11

227

local

UK

21989

McN

eil

et

al

(1991)

7d

WR

mthorn

f12

ndash61

local

UK

31990

Adam

son

et

al

(1992)

2pound

3d

record

mthorn

f11

ndash12

ndash379

local

UK

419889

0P

ayne

ampB

elto

n(1

992a)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

519889

0P

ayne

ampB

elto

n(1

992b)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

619868

7C

raw

ley

(1993)

4d

record

mthorn

f16

ndash17

ndash4760

national

J Lambert et alS150





Energy




ab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

UK

71989

Davie

set

al

(1994)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

81

local

UK

81990

Str

ain

et

al

(1994)

DH

mthorn

f12

15

ndash1015

regio

nal

UK

919868

7C

raw

ley

ampW

hite

(1995)

4d

record

mthorn

f16

ndash17

ndash3288

national

UK

10

19929

3G

regory

et

al

(1995)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

1675

national

UK

11

1990

McN

ulty

et

al

(1996)

DH

mthorn

f12

ndash15

ndash1015

regio

nal

UK

12

19919

2R

uxto

net

al

(1996)

7d

WR

mthorn

f7

ndash8

ndash136

local

UK

13

1997

Gre

gory

ampLow

e(2

000)

7d

WR

mthorn

f4

ndash18

6

10

14

1701

national

Yugosla

via

YU

11998

Pavlo

vic

et

al

(2001)

1d

record

mix

10

9

11

5834

national

YU

21998

Pavlo

vic

et

al

(1999)

1d

record

mix

9ndash

10

9

11

492

local

YU

319949

5P

avlo

vic

(1999)

1d

record

mix

4ndash

64

6123

local

YU

4

YU

4b

1998

Pavlo

vic

(2000)

1d

record

mix

9ndash

10

9

11

375

local

NA

not

availa

ble

F

FQ

fo

od

frequency

questionnaire

OC

D

oth

er

countr

yfo

od

com

positio

ndata

base

DH

die

this

tory

W

R

weig

hed

food

record

m

m

ale

f

fem

ale

m

ix

genders

not

separa

ted
















J Lambert et alS152




Fat









Protein







Alcohol















J Lambert et alS154









































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210




Tab

le3

Surv

eys

inclu

ded

inth

edie

tary

inta

ke

and

sta

tus

revie

w

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)S

am

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

Austr

iaA

12002

Elm

adfa

ampW

ass

erb

uch

er

(2002)

7d

record

1pound

24

hre

call

mthorn

f4

ndash18

4ndash

6

7ndash

9

10

ndash12

13

ndash15

15

ndash18

2234

national

Belg

ium

B1

1992

Guill

aum

eet

al

(1998)

3d

record

mthorn

f6

ndash12

8

10

1028

regio

nal

B2

1991

De

Henauw

et

al

(1997)

FF

Qm

thornf

6ndash

12

ndash1321

local

B3

1995

Paulu

set

al

(2001)

1d

record

mthorn

f12

ndash17

ndash1526

regio

nal

B4

1997

De

Henauw

ampM

att

hys

(1998)

De

Henauw

et

al

(2001)

7d

record

mthorn

f13

ndash18

ndash341

local

urb

anr

ura

lB

ulg

aria

BG

11998

Petr

ova

et

al

(2000)

1pound

24

hre

call

mix

1

ndash10

mthorn

f11thorn

1ndash

18

3

6

10

14

362

national

Czech

Republic

CZ

11998

Bra

zdova

et

al

(2000)

1pound

24

hre

call

FF

Qf

6ndash

9

11

ndash15

ndash1564

national

CZ

2N

AB

razdova

et

al

(1992)

1pound

24

hre

call

mix

3ndash

6

9ndash

11

ndash100

local

Denm

ark

DK

11995

Anders

en

et

al

(1996)

7d

record

mthorn

f1

ndash18

3

6

10

14

1413

national

DK

21995

Lyhne

(1998)

7d

record

mthorn

f14

ndash19

ndash245

national

Est

onia

EE

11993

ndash95

Gru

nberg

et

al

(1997)

1pound

24

hre

call

FF

Q

OC

Dm

thornf

11

ndash12

14

ndash15

ndash341

regio

nal

Fin

land

SF

11996

Rasanen

et

al

(1991)

2pound

24

hre

call

mthorn

f9

ndash24

12

15

18

902

regio

nal

SF

2N

AR

ankin

en

et

al

(1995)

4d

record

mthorn

f9

ndash12

ndash170

local

SF

31989

Ylo

nen

et

al

(1996)

3d

record

mix

1ndash

73

77

regio

nal

SF

419969

7Lehto

nen-V

ero

maa

et

al

(1999)

4d

record

f9

ndash15

ndash191

national

Fra

nce

F1

1988

Herc

berg

et

al

(1991a)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F2

1988

Herc

berg

et

al

(1991b)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F3

1988

Herc

berg

et

al

(1994)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F4

1988

Pre

zio

siet

al

(1994)

DH

mthorn

f2

ndash20

6

10

14

18

207

local

F5

19939

4R

igaud

et

al

(1997)

1d

WR

mthorn

f2

ndash20

6

12

17

271

national

F6

19939

4C

ouet

et

al

(2000)

1d

WR

mthorn

f2

ndash20

6

12

17

271

national

F7

19899

0V

ola

tier

(2000)

1d

WR

mthorn

f3

ndash14

6

8

11

1018

national

F8

1985

ndash93

Deheeger

et

al

(1994)

DH

mthorn

f2

ndash20

4

6

82781

12

local

F9

1985

ndash93

Deheeger

et

al

(1996)

DH

mthorn

f2

ndash20

4

6

82781

12

local

Germ

any

D1

1998

Deuts

che

Gesells

chaft

fur

Ern

ahru

ng

eV

(2000)

1d

WR

D

Hm

thornf

4ndash

19

7

10

13

15

38

924

national

D2

1985

ndash88

Adolf

et

al

(1995)

7d

record

mthorn

f4

ndash18

6

9

12

14

24

632

national

D3

1985

ndash95

Kers

ting

et

al

(2000)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

D4

1985

Kers

ting

et

al

(1998a)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

D5

1985

Kers

ting

et

al

(1998b)

3d

record

mthorn

f1

ndash18

3

6

9

12

14

627

local

Gre

ece

GR

119939

4R

om

a-G

iannik

ou

et

al

(1997)

1d

WR

O

CD

mthorn

f2

ndash14

3

5

7

9

11

1936

national

GR

21994

Kafa

tos

et

al

(2000)

1pound

24

hre

call

OC

Dm

12

ndash98

regio

nal

GR

31999

Moschandre

as

ampK

afa

tos

(2002)

1pound

24

hre

call

mthorn

f9

ndash16

9ndash

12

14

ndash16

10547

99

regio

nal

GR

41997

Hassapid

ou

et

al

(2001)

3d

WR

1pound

24

hre

call

OC

D

FF

Qm

thornf

11

ndash14

ndash582

regio

nal

GR

51987

ndash88

Hassapid

ou

et

al

(1996)

3d

WR

mthorn

f13

ndash14

ndash20

local

Hungary

H1

1995

Gabor

(1998)

3pound

24

hre

call

mthorn

f13

ndash14

13

ndash14

414

regio

nal

Irela

nd

IRL1

1988

Lee

ampC

unnin

gham

(1990)

DH

O

CD

mthorn

f8

ndash25

12

15

18

643

national



Tab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

Italy

IT1

1996

Bellu

et

al

(1996)

FF

Qm

thornf

7

mix

10

7

10

ndash35

072

national

IT2

1992

Rats

ch

et

al

(1992)

4d

record

mix

3

7

10

ndash93

national

IT3

1991

Lecle

rcq

ampF

err

o-L

uzzi(1

991)

1pound

24

hre

call

mix

10

ndash11

ndash178

national

IT4

1988

Agosto

niet

al

(1998)

1pound

24

hre

call

mthorn

f11

mix

15

11

15

ndash120

local

The

Neth

er-

lands

NL1

19979

8H

uls

hof

et

al

(1998)

2d

record

mthorn

f2

ndash19

3

6

9

12

15

1538

national

NL2

1984

Meulm

eeste

r(1

989)

1pound

24

hre

call

mthorn

f8

ndash135

local

NL3

1999

Bru

ssaard

et

al

(1999)

1pound

24

hre

call

mthorn

f7

ndash9

ndash202

local

Norw

ay

N1

NA

Fro

st

Anders

on

et

al

(1995)

1d

WR

F

FQ

mthorn

f18

ndash1564

national

N2

NA

Fro

st

Anders

on

et

al

(1997)

FF

Qm

thornf

13

ndash1705

national

N3

NA

Johanss

on

et

al

(1997)

1d

WR

mthorn

f16

ndash29

ndash845

national

Pola

nd

PL1

1991

ndash94

Szponar

ampR

ychlik

(1996a)

1pound

24

hre

call

m11

ndash14

11

12

13

14

401

national

PL2

1991

ndash94

Szponar

ampR

ychlik

(1996b)

1pound

24

hre

call

f11

ndash14

11

12

13

14

725

national

PL3

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(2000)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL4

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(1999)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL5

19969

7H

am

ułk

aet

al

(1998)

1pound

24

hre

call

FF

Qm

thornf

13

ndash15

13

15

104

urb

an

rura

lP

L6

NA

Ham

ułk

aet

al

(2000)

1pound

24

hre

call

m17

ndash18

17

18

215

local

PL7

NA

Sm

igie

let

al

(1994)

1pound

24

hre

call

m17

ndash18

17

18

236

local

PL8

19909

1R

ogals

ka-N

iedzw

iedz

et

al

(1992)

1pound

24

hre

call

mthorn

f11

ndash15

11

15

7562

local

PL9

NA

Czeczele

wskiet

al

(1995)

1pound

24

hre

call

mthorn

f13

ndash15

13

15

76

local

PL10

NA

Ilow

et

al

(1999)

1pound

24

hre

call

mix

3ndash

73

7822

national

PL11

NA

Werk

er

(2000)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL12

NA

Sto

pnic

ka

et

al

(1998)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL13

NA

Charz

ew

ska

et

al

(1992)

FF

Qm

thornf

9ndash

14

9

14

672

regio

nal

Port

ugal

P1

1995

Am

orim

Cru

z(2

000)

1pound

24

hre

call

mthorn

f13

ndash18

ndash78

local

Russia

Rus1

2000

BP

opki

n(u

npublis

hed

results

)1pound

24

hre

call

mthorn

f1

ndash20

2

3

4

etc

2779

national

Spain

E1

19899

2A

guile

raet

al

(1994)

FF

Qm

ix2

ndash7

3

6264

local

E2

NA

Gonzale

zet

al

(1994)

1pound

24

hre

call

OC

Dm

thornf

6ndash

14

7

8

9

etc

2608

local

E3

1988

Vazquez

et

al

(1996)

1pound

24

hre

call

mthorn

f6

ndash16

7

12

164

local

E9

Ara

nce

taamp

Pere

z(1

996)

Sw

eden

S1

19899

0B

erg

stro

met

al

(1993)

7d

record

mthorn

f14

ndash17

17

731

regio

nal

S2

19939

4S

am

uels

on

et

al

(1996a)

7d

record

mthorn

f15

ndash398

regio

nal

S3

19939

4S

am

uels

on

et

al

(1996b)

7d

record

mthorn

f15

ndash398

regio

nal

S4

NA

Sam

uels

on

et

al

(2001)

7d

record

mthorn

f15

ndash93

regio

nal

Sw

itzerland

CH

119949

5S

ocie

teS

uis

se

de

laN

utr

itio

n(1

998)

7d

record

mthorn

f13

ndash21

15

19

1862

regio

nal

UK

UK

11988

Nels

on

et

al

(1990)

7d

WR

mthorn

f7

ndash12

11

227

local

UK

21989

McN

eil

et

al

(1991)

7d

WR

mthorn

f12

ndash61

local

UK

31990

Adam

son

et

al

(1992)

2pound

3d

record

mthorn

f11

ndash12

ndash379

local

UK

419889

0P

ayne

ampB

elto

n(1

992a)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

519889

0P

ayne

ampB

elto

n(1

992b)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

619868

7C

raw

ley

(1993)

4d

record

mthorn

f16

ndash17

ndash4760

national

J Lambert et alS150





Energy




ab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

UK

71989

Davie

set

al

(1994)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

81

local

UK

81990

Str

ain

et

al

(1994)

DH

mthorn

f12

15

ndash1015

regio

nal

UK

919868

7C

raw

ley

ampW

hite

(1995)

4d

record

mthorn

f16

ndash17

ndash3288

national

UK

10

19929

3G

regory

et

al

(1995)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

1675

national

UK

11

1990

McN

ulty

et

al

(1996)

DH

mthorn

f12

ndash15

ndash1015

regio

nal

UK

12

19919

2R

uxto

net

al

(1996)

7d

WR

mthorn

f7

ndash8

ndash136

local

UK

13

1997

Gre

gory

ampLow

e(2

000)

7d

WR

mthorn

f4

ndash18

6

10

14

1701

national

Yugosla

via

YU

11998

Pavlo

vic

et

al

(2001)

1d

record

mix

10

9

11

5834

national

YU

21998

Pavlo

vic

et

al

(1999)

1d

record

mix

9ndash

10

9

11

492

local

YU

319949

5P

avlo

vic

(1999)

1d

record

mix

4ndash

64

6123

local

YU

4

YU

4b

1998

Pavlo

vic

(2000)

1d

record

mix

9ndash

10

9

11

375

local

NA

not

availa

ble

F

FQ

fo

od

frequency

questionnaire

OC

D

oth

er

countr

yfo

od

com

positio

ndata

base

DH

die

this

tory

W

R

weig

hed

food

record

m

m

ale

f

fem

ale

m

ix

genders

not

separa

ted
















J Lambert et alS152




Fat









Protein







Alcohol















J Lambert et alS154









































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210




Tab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

Italy

IT1

1996

Bellu

et

al

(1996)

FF

Qm

thornf

7

mix

10

7

10

ndash35

072

national

IT2

1992

Rats

ch

et

al

(1992)

4d

record

mix

3

7

10

ndash93

national

IT3

1991

Lecle

rcq

ampF

err

o-L

uzzi(1

991)

1pound

24

hre

call

mix

10

ndash11

ndash178

national

IT4

1988

Agosto

niet

al

(1998)

1pound

24

hre

call

mthorn

f11

mix

15

11

15

ndash120

local

The

Neth

er-

lands

NL1

19979

8H

uls

hof

et

al

(1998)

2d

record

mthorn

f2

ndash19

3

6

9

12

15

1538

national

NL2

1984

Meulm

eeste

r(1

989)

1pound

24

hre

call

mthorn

f8

ndash135

local

NL3

1999

Bru

ssaard

et

al

(1999)

1pound

24

hre

call

mthorn

f7

ndash9

ndash202

local

Norw

ay

N1

NA

Fro

st

Anders

on

et

al

(1995)

1d

WR

F

FQ

mthorn

f18

ndash1564

national

N2

NA

Fro

st

Anders

on

et

al

(1997)

FF

Qm

thornf

13

ndash1705

national

N3

NA

Johanss

on

et

al

(1997)

1d

WR

mthorn

f16

ndash29

ndash845

national

Pola

nd

PL1

1991

ndash94

Szponar

ampR

ychlik

(1996a)

1pound

24

hre

call

m11

ndash14

11

12

13

14

401

national

PL2

1991

ndash94

Szponar

ampR

ychlik

(1996b)

1pound

24

hre

call

f11

ndash14

11

12

13

14

725

national

PL3

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(2000)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL4

1996

ndash98

Ham

ułk

aamp

Gro

now

ska-S

enger

(1999)

1pound

24

hre

call

FF

Qm

thornf

9ndash

11

9

11

224

regio

nal

PL5

19969

7H

am

ułk

aet

al

(1998)

1pound

24

hre

call

FF

Qm

thornf

13

ndash15

13

15

104

urb

an

rura

lP

L6

NA

Ham

ułk

aet

al

(2000)

1pound

24

hre

call

m17

ndash18

17

18

215

local

PL7

NA

Sm

igie

let

al

(1994)

1pound

24

hre

call

m17

ndash18

17

18

236

local

PL8

19909

1R

ogals

ka-N

iedzw

iedz

et

al

(1992)

1pound

24

hre

call

mthorn

f11

ndash15

11

15

7562

local

PL9

NA

Czeczele

wskiet

al

(1995)

1pound

24

hre

call

mthorn

f13

ndash15

13

15

76

local

PL10

NA

Ilow

et

al

(1999)

1pound

24

hre

call

mix

3ndash

73

7822

national

PL11

NA

Werk

er

(2000)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL12

NA

Sto

pnic

ka

et

al

(1998)

1pound

24

hre

call

mthorn

f15

ndash18

15

18

600

regio

nal

PL13

NA

Charz

ew

ska

et

al

(1992)

FF

Qm

thornf

9ndash

14

9

14

672

regio

nal

Port

ugal

P1

1995

Am

orim

Cru

z(2

000)

1pound

24

hre

call

mthorn

f13

ndash18

ndash78

local

Russia

Rus1

2000

BP

opki

n(u

npublis

hed

results

)1pound

24

hre

call

mthorn

f1

ndash20

2

3

4

etc

2779

national

Spain

E1

19899

2A

guile

raet

al

(1994)

FF

Qm

ix2

ndash7

3

6264

local

E2

NA

Gonzale

zet

al

(1994)

1pound

24

hre

call

OC

Dm

thornf

6ndash

14

7

8

9

etc

2608

local

E3

1988

Vazquez

et

al

(1996)

1pound

24

hre

call

mthorn

f6

ndash16

7

12

164

local

E9

Ara

nce

taamp

Pere

z(1

996)

Sw

eden

S1

19899

0B

erg

stro

met

al

(1993)

7d

record

mthorn

f14

ndash17

17

731

regio

nal

S2

19939

4S

am

uels

on

et

al

(1996a)

7d

record

mthorn

f15

ndash398

regio

nal

S3

19939

4S

am

uels

on

et

al

(1996b)

7d

record

mthorn

f15

ndash398

regio

nal

S4

NA

Sam

uels

on

et

al

(2001)

7d

record

mthorn

f15

ndash93

regio

nal

Sw

itzerland

CH

119949

5S

ocie

teS

uis

se

de

laN

utr

itio

n(1

998)

7d

record

mthorn

f13

ndash21

15

19

1862

regio

nal

UK

UK

11988

Nels

on

et

al

(1990)

7d

WR

mthorn

f7

ndash12

11

227

local

UK

21989

McN

eil

et

al

(1991)

7d

WR

mthorn

f12

ndash61

local

UK

31990

Adam

son

et

al

(1992)

2pound

3d

record

mthorn

f11

ndash12

ndash379

local

UK

419889

0P

ayne

ampB

elto

n(1

992a)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

519889

0P

ayne

ampB

elto

n(1

992b)

7d

WR

mthorn

f2

ndash5

3

5153

local

UK

619868

7C

raw

ley

(1993)

4d

record

mthorn

f16

ndash17

ndash4760

national

J Lambert et alS150





Energy




ab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

UK

71989

Davie

set

al

(1994)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

81

local

UK

81990

Str

ain

et

al

(1994)

DH

mthorn

f12

15

ndash1015

regio

nal

UK

919868

7C

raw

ley

ampW

hite

(1995)

4d

record

mthorn

f16

ndash17

ndash3288

national

UK

10

19929

3G

regory

et

al

(1995)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

1675

national

UK

11

1990

McN

ulty

et

al

(1996)

DH

mthorn

f12

ndash15

ndash1015

regio

nal

UK

12

19919

2R

uxto

net

al

(1996)

7d

WR

mthorn

f7

ndash8

ndash136

local

UK

13

1997

Gre

gory

ampLow

e(2

000)

7d

WR

mthorn

f4

ndash18

6

10

14

1701

national

Yugosla

via

YU

11998

Pavlo

vic

et

al

(2001)

1d

record

mix

10

9

11

5834

national

YU

21998

Pavlo

vic

et

al

(1999)

1d

record

mix

9ndash

10

9

11

492

local

YU

319949

5P

avlo

vic

(1999)

1d

record

mix

4ndash

64

6123

local

YU

4

YU

4b

1998

Pavlo

vic

(2000)

1d

record

mix

9ndash

10

9

11

375

local

NA

not

availa

ble

F

FQ

fo

od

frequency

questionnaire

OC

D

oth

er

countr

yfo

od

com

positio

ndata

base

DH

die

this

tory

W

R

weig

hed

food

record

m

m

ale

f

fem

ale

m

ix

genders

not

separa

ted
















J Lambert et alS152




Fat









Protein







Alcohol















J Lambert et alS154









































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210







Energy




ab

le3

Continued

Countr

yS

urv

ey

no

Year

of

surv

ey

Age

(years

)

Sam

ple

siz

eG

eogra

phic

dis

trib

utio

nR

efe

rence

Die

tary

meth

odolo

gy

Gender

Range

Cut-

off

poin

ts

UK

71989

Davie

set

al

(1994)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

81

local

UK

81990

Str

ain

et

al

(1994)

DH

mthorn

f12

15

ndash1015

regio

nal

UK

919868

7C

raw

ley

ampW

hite

(1995)

4d

record

mthorn

f16

ndash17

ndash3288

national

UK

10

19929

3G

regory

et

al

(1995)

4d

WR

mthorn

f1middot5

ndash4middot5

2middot5

3middot5

1675

national

UK

11

1990

McN

ulty

et

al

(1996)

DH

mthorn

f12

ndash15

ndash1015

regio

nal

UK

12

19919

2R

uxto

net

al

(1996)

7d

WR

mthorn

f7

ndash8

ndash136

local

UK

13

1997

Gre

gory

ampLow

e(2

000)

7d

WR

mthorn

f4

ndash18

6

10

14

1701

national

Yugosla

via

YU

11998

Pavlo

vic

et

al

(2001)

1d

record

mix

10

9

11

5834

national

YU

21998

Pavlo

vic

et

al

(1999)

1d

record

mix

9ndash

10

9

11

492

local

YU

319949

5P

avlo

vic

(1999)

1d

record

mix

4ndash

64

6123

local

YU

4

YU

4b

1998

Pavlo

vic

(2000)

1d

record

mix

9ndash

10

9

11

375

local

NA

not

availa

ble

F

FQ

fo

od

frequency

questionnaire

OC

D

oth

er

countr

yfo

od

com

positio

ndata

base

DH

die

this

tory

W

R

weig

hed

food

record

m

m

ale

f

fem

ale

m

ix

genders

not

separa

ted
















J Lambert et alS152




Fat









Protein







Alcohol















J Lambert et alS154









































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210

















J Lambert et alS152




Fat









Protein







Alcohol















J Lambert et alS154









































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






Fat









Protein







Alcohol















J Lambert et alS154









































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210





Alcohol















J Lambert et alS154









































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210











































J Lambert et alS156
















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210


















Minerals




















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210



















J Lambert et alS158




















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






















Discussion












Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210










Quality of data







J Lambert et alS160













Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210















Nutritional status







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210







Conclusions





Acknowledgements



References














J Lambert et alS162



















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210





















































































J Lambert et alS164













J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210















J Lambert et alS166




J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS168




J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS170




J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS172




J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS174




J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS176




J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS178




J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS180




J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS182




J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS184




J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS186




J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS188




J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS190




J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS192




J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS194




J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS196




J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS198




J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS200




J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS202




J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS204




J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS206




J Lambert et alS208




J Lambert et alS210






J Lambert et alS208




J Lambert et alS210






J Lambert et alS210




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