Food Patterns Associated with Intakes of Fat, Carbohydrate and Dietary Fibre
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European Journal of Clinical Nutrition (1997) 51, 354±361 ß 1997 Stockton Press. All rights reserved 0954±3007/97 $12.00 Food patterns associated with intakes of fat, carbohydrate and dietary ®bre in a cohort of Danish adults followed for six years M Osler1,3 and BL Heitmann2,3 1Department of Social Medicine and Psycosocial Health, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark; 2Danish Epidemiology Science Center at the Institute of Preventive Medicine, Copenhagen Hospital Corporation, Copenhagen Municipal Hospital, 1399 Copenhagen K. Denmark; and 3The Copenhagen County Centre of Preventive Medicine, Department of Medicine C, Glostrup University Hospital, 2600 Glostrup, Denmark Objective: To examine associations between food consumption patterns, measured by a short food frequency questionnaire (FFQ), and the intakes of fat, carbohydrates and ®bre over time, and in relation to recommended guidelines. Design: The same 329 individuals had their diet intake measured by a short FFQ and a thorough diet history interview, ®rst in 1987/88, and again six years later in 1993/94. Setting: The County of Copenhagen, Denmark. Subjects: Three hundred and twenty-nine men and women, aged 35±65 y selected randomly from a large population sample. Results: At both examinations fat energy displayed the strongest positive associations with the intake of animal fats and negative correlations with the vegetables. These food items explained most of the total explained variation in fat intake. In general the associations between food items and intakes of carbohydrates and ®bre were similar but inverse, to those found for fat. During the study period median fat energy decreased from 41±38%. A less frequent intake of animal fats over time predicted an increase in fat energy both among men and women, while a more frequent intake of fruit and pasta, and a less frequent intake of cakes was associated with an increase in dietary ®bre. Conclusions: Food items like animal fats, vegetables and certain high starch foods can predict compliance to dietary guidelines for fat and carbohydrates. The study also shows that the food pattern of this Danish cohort has changed in the direction of a more healthy diet during the six years of follow-up. Sponsorship: This study was granted by the Danish Agricultural and Veterinary and Danish Medical Councils and the Danish Health Insurance foundation. Descriptors: diet; epidemiology; methods; longitudinal study Introduction and an increase in the intake of vegetables (PraÈttaÈla et al, 1992; Osler & Schroll, 1995). The high mortality from coronary heart disease and cancer From a public health point of view it is important to in most Western countries has, in part, been attributed to a know if food consumption measured by a short FFQ follow high fat, low ®bre diet (James et al, 1988), and in the last the recommended dietary guidelines. Indeed, ®ndings from two decades health authorities in these countries have earlier studies have suggested associations between certain strongly recommended that the adult populations reduce food patterns and dietary fat intake. For instance, high fat fat intake to between 30 and 35% of daily energy. Also intakes in the general population in US, Australia, UK and an increase in the consumption of carbohydrates to more Finland have been found to be associated with the use of than 55% of energy, and in dietary ®bre intake to more than full-fat milk, pastry or desserts, table fat, pork, and pro- 3 g/MJ, has been emphasized (National Research cessed meats, while low-fat intakes were characterized by a Council, 1989; The Scienti®c Committee for Food, 1992; frequent intake of high-®bre breads, cereals, ®sh, chicken, National Food Agency, 1993). fruit and vegetables (RaÈsaÈnen & Pietinen, 1982; Ursin et al, Today it is generally accepted that attrition to dietary 1993; Barghurst et al, 1994; Subar et al, 1994; Pryer et al, recommendations may be better, and compliance more easy 1995). However, only in a few studies have food consump- to monitor, if recommendations are formulated in terms of tion patterns associated with other nutrients, such as car- foods rather than nutrients (The Scienti®c Committee for bohydrates and dietary ®bre, been investigated. An exception Food, 1992; National Food Agency, 1993). Several studies to this is the study by Randall et al (1991) who, in the control have used short food frequency questionnaires (FFQ) to population of 2255 subjects from a case-control study of diet monitor intake and changes, in food patterns of popula- and cancer in USA, found that dietary ®bre density was tions, and studies from Denmark and Finland have, for positively associated with intake of salads, whole grain food instance, shown a decreasing trend in the intake of butter, and fruits; associations with intake of high-fat foods and snacks were negative. Furthermore, to our knowledge, there arenostudiesdescribinghowchangesinfoodintakemeasured Correspondence: Dr M Osler Received 1 August 1996; revised 30 January 1997; accepted 14 by a short FFQ associate with changes in nutrient intake in the February 1997 general population. Food patterns and associated nutrients M Osler and BL Heitmann 355 Therefore, the present study aims at examining how measured by the diet history interview increased with food intake, estimated from a short FFQ, associate with the increasing frequency category of the FFQ, indicating that intakes of fat, carbohydrates and ®bre, estimated from a the FFQ was able to identify levels of food intake correctly. thorough diet history interview over time, and in relation to Furthermore, those who reported a less frequent intake by the recommended guidelines. the FFQ in 1993/94 compared with 1987/88 also had lower mean daily intakes according to the diet history informa- tion. Thus the short FFQ may be used to monitor changes in Materials and methods food patterns at a group level. Subjects The study included 552 Danish citizens aged 35, 45, 55 and Diet history interview 65 y randomly selected from the general population. All In 1987/88, and six years later in 1993/94, the same trained subjects were invited to a general health examination. Of dietician interviewed all the subjects about their habitual the 552 subjects invited, and (435) 79% agreed to partici- diet using the diet history method. The diet was assessed, pate, and to give a diet history interview. Non participation based on information for the previous month, and average has been described earlier (Heitmann, 1993). daily intakes were calculated from this information. Meal The study was a part of the Danish MONICA project (an patterns, dishes and foods were explored by interview using international study conducted under the auspices of the a detailed pre-coded interview form. Quantities were World Health Organization to monitor trends and determi- explored by the use of food models, photo series, cups nants of mortality from cardiovascular disease) and was and measures. This instrument has been validated earlier carried out in collaboration with the Copenhagen Country (Heitmann, 1993). Nutrient calculations were carried out Centre of Preventive Medicine. The study was approved by with the DANKOST programme, which is derived from the the Ethical Comity of the County of Copenhagen and all Danish Food Composition Tables. This database included participants had provided informed consent. The examina- 835 food items in 1988, but in 1991 it was extended and tion (GEN-MONICA) was carried out from December now comprises 1250 food items. The nutrient values were 1987 to November 1988. After six years, 511 of the 552 not up-dated at this occasion. subjects originally sampled were alive, and could be invited The intake of nutrients was estimated from the diet to a follow-up examination, and 365 (71%) attended. Of history reports. As nutrient intakes are strongly associated these, 329 had also participated in the GEN-MONICA with energy intake, density-based measures were calcu- study. The 106 and 36 subjects who did not participate in lated, for example percent of energy from fat and carbohy- the follow-up or base-line examination, respectively, had drates, and amounts of dietary ®bres (g) per MJ consumed. the same distribution on sex, age, body mass and energy Table 1 gives the distribution of the nutrients at both intake as the 329 subjects who attended both examinations examinations. (all P > 0.20). The present analysis include these 329 subjects, only. This sample was considered to be represen- Statistical methods tative of the total sample. The 163 men and the 166 women The intake of nutrients were approximately normally dis- of the sample, were equally distributed on the four age tributed. Differences in mean values were examined using a groups, and had a mean BMI of 25.2 and 24.6 kg/m2 t-test. The associations between intake of each nutrient, as respectively. assessed from the diet history, and the intake of each food group, as obtained from the FFQ, were evaluated using Questionnaire data Pearsons correlation analyses. Stepwise multiple regression The method of data collection was exactly the same at the was used to select the foods in the FFQ that best predicted two examinations. An extensive questionnaire on socio- intakes of each of the nutrients. The dependent variables demographic variables, lifestyle, and health was completed were the relative intakes of fat, carbohydrates and ®bre, before the general health examination, and the dietary calculated from the diet history interview. The 24 foods history interview. This self-administered questionnaire listed in Table 2 were entered into the equations. The included questions about how often 26 food items were criterion applied for adding new variables to the equation consumed: The alternatives used in the frequency scale was that each new variable had to improve the variance were as follows: never, once a month or less, twice a explained by the model with at least 1.5%.