Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

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Snelle meettechnieken voor nutriëntenbenutting bij landbouwhuisdieren
Vrolijk, M. ; Goselink, R.M.A. ; Veldkamp, T. - \ 2015
Wageningen : Wageningen UR Livestock Research (Livestock Research rapport 902) - 43
vee - veevoeding - nutriëntengebruiksefficiëntie - voedingsstoffenopname (mens en dier) - meettechnieken - voedingsfysiologie - livestock - livestock feeding - nutrient use efficiency - nutrient intake - measurement techniques - nutrition physiology
Efficient feeding of animals in livestock production deserves constant attention. Feed is input for milk, meat and egg production. It is a challenge to use nutrients as efficiently as possible, and produce ‘more with less’. Feeding the animals at their requirements can be improved if the effects of nutrient intake can be measured within a short time. This project made an overview of possible ‘rapid measuring techniques’ to be used in the near future. Each technique was scored for relevance, technical feasibility, practical application and the investment needed for development (time and money). From an expert workshop, measuring by means of sensor boluses or fluorescent markers as well as manure analysis, were defined as most promising for future research and practice.
Micronutrient intakes and potential inadequacies of community-dwelling older adults: a systematic review
Borg, S. ter; Verlaan, S. ; Hemsworth, J. ; Mijnarends, D. ; Schols, J.M.G.A. ; Luiking, Y.C. ; Groot, C.P.G.M. de - \ 2015
British Journal of Nutrition 113 (2015)8. - ISSN 0007-1145 - p. 1295 - 1206.
vitamin-d status - elderly-people - cognitive function - dietary assessment - nutritional-status - nutrient intake - food-consumption - intake adequacy - united-states - energy-intake
Micronutrient deficiencies and low dietary intakes among community-dwelling older adults are associated with functional decline, frailty and difficulties with independent living. As such, studies that seek to understand the types and magnitude of potential dietary inadequacies might be beneficial for guiding future interventions. We carried out a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Observational cohort and longitudinal studies presenting the habitual dietary intakes of older adults ( = 65 years) were included. Sex-specific mean (and standard deviation) habitual micronutrient intakes were extracted from each article to calculate the percentage of older people who were at risk for inadequate micronutrient intakes using the estimated average requirement (EAR) cut-point method. The percentage at risk for inadequate micronutrient intakes from habitual dietary intakes was calculated for twenty micronutrients. A total of thirty-seven articles were included in the pooled systematic analysis. Of the twenty nutrients analysed, six were considered a possible public health concern: vitamin D, thiamin, riboflavin, Ca, Mg and Se. The extent to which these apparent inadequacies are relevant depends on dynamic factors, including absorption and utilisation, vitamin and mineral supplement use, dietary assessment methods and the selection of the reference value. In light of these considerations, the present review provides insight into the type and magnitude of vitamin and mineral inadequacies.
A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: The need for action
Ngo, J. ; Roman-Vinas, B. ; Ribas-Barba, L. ; Golsorkhi, M. ; Wharthon Medina, M. ; Bekkering, G.E. ; Cavelaars, A.J.E.M. ; Groot, C.P.G.M. de - \ 2014
Journal of Immigrant and Minority Health 16 (2014)5. - ISSN 1557-1912 - p. 941 - 950.
food-frequency questionnaires - vitamin-d deficiency - ethnic-groups - immigrant population - nutrient intake - african origin - dietary-intake - south-asians - risk-factors - east london
This systematic review evaluated micronutrient intake inadequacy of ten micronutrients for adult ethnic minority populations residing in Europe. Pubmed was searched for studies, related references were checked and experts consulted. Ten studies were identified and six were included in the final analysis representing Albanian, Roma, Sub-Saharan African, South Asian and African-Caribbean minority groups. The Estimated Average Requirement cut point was applied to estimate inadequate intake. With the exception of a sub-Saharan African study, of seven micronutrients analysed, inadequate intakes were markedly elevated (>50 % of the population in most cases) in both genders for folate, vitamin B12, calcium and iron (the latter in females only). A pressing need exists for intake adequacy studies with sound methodologies addressing ethnic minority groups in Europe. These populations constitute a vulnerable population for inadequate intakes and results substantiate the need for further investigation, interventions and policy measures to reduce their nutritional risk
Stability of dietary patterns assessed with reduced rank regression; the Zutphen Elderly Study
Jankovic, N. ; Streppel, M.T. ; Kampman, E. ; Groot, C.P.G.M. de; Boshuizen, H.C. ; Soedamah-Muthu, S.S. ; Kromhout, D. ; Feskens, E.J.M. - \ 2014
Nutrition Journal 13 (2014)30. - ISSN 1475-2891 - p. 1 - 9.
coronary-heart-disease - nutrient intake - swedish women - risk-factors - food - mortality - cancer - reproducibility - index - men
Background Reduced rank regression (RRR) combines exploratory analysis with a-priori knowledge by including risk factors in the model. Dietary patterns, derived from RRR analysis, can be interpreted by the chosen risk factor profile and give an indication of positive or adverse health effects for a specific disease. Our aim was to assess the stability of dietary patterns derived by RRR over time. Methods We used data from 467 men, aged 64–85 years, participating in the 1985 and 1990 examination rounds of the Zutphen Elderly Study. Backwards regression on risk factors and food groups was applied prior to the RRR analysis to exclude food groups with low predictability (from 36 to 19 food groups) for the chosen risk factor profile. For the final RRR analysis, dietary intake data from 19 food groups as predictor variables and 6 established risk factors for cardiovascular diseases (body mass index, systolic and diastolic blood pressure, high density lipoprotein and total cholesterol levels, and uric acid) were used. Results Three RRR dietary patterns were derived for both examination years: a “(low in) cereal fibre pattern”, an “alcohol pattern” and an “inconsistent pattern”. The “(low in) cereal fibre pattern” was most stable over time, with a correlation coefficient of 0.47 (95% CI: 0.38-0.53) between 1985 and 1990 measurements. Conclusion Dietary patterns as measured by RRR, after backwards regression, are reasonably stable over a period of five years. Thus, RRR appears to be an attractive method to measure long-term dietary exposure for nutritional epidemiological studies, with one dietary measurement at baseline.
Socio-economic determinants of micronutrient intake and status in Europe: a systematic review
Novakovic, R.N. ; Cavelaars, A.J.E.M. ; Geelen, A. ; Nikolic, M. ; Altaba, I.I. ; Vinas, B.R. ; Ngo, J. ; Golsorkhi, M. ; Medina, M. ; Brzozowska, A. ; Szczecinkska, A. ; Cock, D. de; Vansant, G. ; Renkema, J.M.S. ; Serra Majem, L. ; Moreno, L.A. ; Glibetic, M. ; Gurinovic, M. ; Veer, P. van 't; Groot, C.P.G.M. de - \ 2014
Public Health Nutrition 17 (2014)5. - ISSN 1368-9800 - p. 1031 - 1045.
life-style factors - food-habits - dietary-intake - maternal education - nutrient intake - population - nutrition - quality - adults - consumption
OBJECTIVE: To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake. DESIGN: MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability. SETTING: Europe. SUBJECTS: Children, adults and elderly. RESULTS: Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5-47 %) and for vitamin D in total of four studies (4-31 %). CONCLUSIONS: The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases
Socioeconomic differences in micronutrient intake and status in Europe
Novakovic, R.N. - \ 2013
University. Promotor(en): Pieter van 't Veer; Lisette de Groot, co-promotor(en): Anouk Geelen; M. Gurinovic. - [S.l. : S.n. - ISBN 9789461735775 - 154
sporenelementen - voedingsstoffenopname (mens en dier) - voedingstoestand - sociale economie - sociaal-economische positie - europa - vitaminen - trace elements - nutrient intake - nutritional state - socioeconomics - socioeconomic status - europe - vitamins

The aim of this thesis was to evaluate micronutrient intake and status of socioeconomic disadvantaged populations, such as from Central and Eastern European (CEE) as compared to other European populations, and low socioeconomic status (SES) groups as compared to high SES groups within European countries. We addressed the micronutrients that have been prioritized because of their relevance for nutritional health by the EC-funded EURRECA Network of Excellence. Moreover, we assessed the association between folate intake and status which can be used in the process of setting folate DRVs.

Micronutrient intake and status of CEE countries versus other European countries

CEE countries have recently experienced rising income inequalities over a period of economic transition. There is some evidence that these reforms have been accompanied by health inequalities. Inadequacy in micronutrient intake and status may contribute to these inequalities. Because in more affluent Western European countries wide ranges in micronutrient intake and status are observed, we studied if low micronutrient intake and status levels are prevailing in CEE. The findings from this thesis signal no differences in micronutrient intake and status between CEE populations in comparison to those of other European regions with the exception of calcium intake in adults and iodine status in children that were lower in CEE than in other European regions. Since data from Western Europe indicate that inadequacies do exist among SES strata, more insight in the nutritional situation of lower SES populations in CEE and an understanding of both its determinants and consequences is needed. It is important to mention that evidence from grey literature added to that from open access sources. Fundamental to further studying of nutritional health in CEE, is suitable data. We underline the necessity for conducting nutritional surveillances on micronutrient intake and status in CEE as we have identified significant knowledge gaps for many life-stage groups.

Differences in micronutrient intake between SES groups

Considering that not enough studies have addressed the relationship between SES and micronutrient intake and status in their analyses of nutritional health, we performed a systematic review on this topic and we used data from the large European EPIC cohort to address that issue.

To be able to conclude on socioeconomic, i.e. educational, occupational and income, inequalities associated with intake and status of prioritized micronutrients for all life stages in Europe, substantial knowledge gaps should be filled. Currently, data are mostly available for the intake of calcium, vitamin C and iron as collected from adults in Western European countries. When either of the above mentioned SES indicators was applied to estimate relative differences in micronutrient intake and status between the lowest and the highest SES category within one study, the results often, but not consistently, indicated a lower intake and/or status in low versus high SES groups. For example, in eight out of ten studies a lower intake for calcium intake was found with relative differences ranging from -2 to -14%. Similar patterns were found for vitamin C and iron: in eleven out of twelve studies relative differences ranged from -5 to -48% for vitamin C, whereas in nine of ten studies on iron relative differences went up to -14%. Studies on intake and/or status of folate, vitamin B12, zinc, iodine, and intake of vitamin D, selenium and copper were limited. Still, when differences were observed, it appeared that lower intake in low than in high SES groups was found except for vitamin B12 and zinc for which the findings were inconsistent.

Furthermore, using education as a proxy for SES, we assessed differences in micronutrient intake between educational levels using the individual-participant data on European adults and elderly from the EPIC cohort. Based on data from 10 Western European countries it appeared that intake of calcium (except in France and a distinctive ‘health-conscious’ group in the UK), folate (except in Greece), and vitamin C was lower in the lowest than in the highest education groups: relative differences ranged up to 12, 13 and 23%, respectively. The intake of iron differed marginally, whereas the variation in intake of vitamins D and B12 was inconsistent. The observed association between educational level and intake of micronutrients was the same for men and women. Furthermore, differences in micronutrient intake were found to be larger between countries than between SES groups.

With respect to SES differences in micronutrient intake and status, there are significant gaps in the open source literature for many life-stage groups in Europe, but particularly in CEE countries. There is a clear need for cross-country and within country comparative research and for the monitoring of trends in dietary intake across different SES groups and European countries.

Relationship between folate intake and status to add complementary evidence for deriving folate dietary reference values (DRVs)

DRVs are under continuous review and periodic revision as the cumulative evidence base and body of knowledge evolve. Folate is considered a public health priority micronutrient for which re-evaluation of DRVs is needed. For this micronutrient, a systematic review of observational studies on the relationship between intake and status was done followed by meta-analysis. The intake of folate was significantly associated with markers of folate status. The results of our meta-analysis showed that an average person with a folate intake of 100 µg/day has a serum/plasma folate status concentration that is 26% higher and a red blood cell folate status that is 21% higher than a person who has a folate intake of 50 µg/day; plasma homocysteine was found to be 16% lower. The difference between natural food folate and that from supplements and fortified foods (folic acid) significantly influenced the estimated relationship between folate intake and serum/plasma status. Associations were stronger when assessed as folate from the diet than as folate from diet and supplements. Dietary assessment method did not significantly influence the association, although pooled estimates were somewhat higher when FFQs were used as compared to 24-hour recalls combined with food records. To focus on the impact of poor intakes on related health outcomes, data modelling can be conducted to produce estimates for Average Nutrient Requirements. For this analysis datasets and statistical models developed within the EURRECA NoE are available and can be used.

Overall, further research would benefit from methodologically comparable data on food intake in all age ranges, especially on so far understudied CEE populations. Both intakes obtained through diet and from supplements and fortified foods should be assessed. Monitoring of trends across SES strata should be done with standardized SES measurements that would also facilitate cross-country comparative research. The findings on the level and distribution of micronutrient intake and status could be used for development of food based dietary guidelines. To make them effective in meeting populations’ micronutrient needs, they should be created accounting for the country specific dietary patterns giving consideration to the socioeconomic context.

Nutrition of grazing cattle in the Mid Rift Valley of Ethiopia: use of an improved n-alkane method to estimate nutrient intake
Derseh, M.B. - \ 2013
University. Promotor(en): Wouter Hendriks, co-promotor(en): Wilbert Pellikaan; A. Tolera. - S.l. : s.n. - ISBN 9789461734686 - 160
rundvee - begrazing - weiden - merkers - voedingsstoffenopname (mens en dier) - voedselsamenstelling - voedingswaarde - verteerbaarheid - ruwvoer (roughage) - diervoeding - ethiopië - cattle - grazing - pastures - markers - nutrient intake - food composition - nutritive value - digestibility - roughage - animal nutrition - ethiopia

Nutrient intake is an important factor that determines the performance of production animals. In free ranging animals, direct measurement of nutrient intake is difficult to conduct, and it is frequently estimated indirectly by the aid of markers. The aim of this thesis was to investigate the potential of using cuticular n-alkanes and their carbon isotope enrichments (δ13C) as markers to study the nutritional ecology of grazing animals under tropical conditions. In addition, this improved method was used to determine the seasonal patterns of nutrient intake and diet composition of grazing cattle in the Mid Rift Valley grasslands of Ethiopia. The first focus of the thesis was to quantify the interspecies variability in the n-alkane profile and δ13C values of alkanes among commonly available pasture species in the Mid Rift Valley of Ethiopia. The analysis showed that the variability is sufficiently large to allow n-alkane and their δ13C values to be used as diet composition markers, with a combined use of the two increasing the discriminatory power. Faecal recovery of dosed and natural alkanes in cattle consuming low-quality tropical roughages was investigated in an indoor balance study. The recovery of synthetic alkanes dosed in the form of molasses boluses was considerably higher than adjacent natural odd-chain alkanes, and correction appears necessary when intake is estimated with the double n-alkane method. The next focus of the thesis was to generate information on the nutritive value of pasture species and nutritional status of grazing cattle in the region. Large variability was observed in the nutritive value and methane production potential of pasture species as evaluated in vitro, with scope for selection of genotypes with high nutritive value and low methane production potential for a sustainable pastureland management. The nutritional status of grazing cattle measured using a combination of n-alkanes, their δ13C values and visual observations showed that diet composition and nutrient intake of the animals is highly dependent on rainfall patterns, with a cyclic positive (wet period) and negative (dry period) energy and nutrient balance observed over the grazing seasons. Energy intake was more limiting than crude protein for body weight gain in most of the grazing seasons. While mature and non-producing animals appeared to tolerate nutritional restriction in the dry period and regain lost body condition in the following wet periods, young animals before the age of puberty may need supplementary feeding. Furthermore, concentrate supplementation of finishing animals needs to coincide with the onset of the wet season to take advantage of compensatory growth. In conclusion, the n-alkanes method coupled with isotope enrichment in n-alkanes and visual observations as used in the present study can provide realistic nutritional data for free-ranging cattle which correlates well with changes in body conditions.

Nort-South gradients in plasma concentrations of B-vitamins and other components of one-carbon metabolism in Western Europe: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study
Eussen, S.J.P.M. ; Nilsen, R.M. ; Midttun, O. ; Hustad, S. ; IJssenagger, N. ; Meyer, K. ; Fredriksen, A. ; Ulvik, A. ; Ueland, P.M. ; Brennan, P. ; Johansson, M. ; Bueno-de-Mesquita, B. ; Vineis, P. ; Chuang, S.C. ; Boutron-Ruault, M.C. ; Dossus, L. ; Perquier, F. ; Overvad, K. ; Teucher, B. ; Grote, V.A. ; Trichopoulou, A. ; Adarakis, G. ; Plada, M. ; Sieri, S. ; Tumino, R. ; Santucci de Magistris, M. ; Ros, M.M. ; Peeters, P.H.M. ; Redondo, M.L. ; Zamora-Ros, R. ; Chirlaque, M.D. ; Ardanaz, E. ; Sonestedt, E. ; Ericson, U. ; Schneede, J. ; Guelpen, B. ; Wark, P.A. ; Gallo, V. ; Norat, T. ; Riboli, E. ; Vollset, S.E. - \ 2013
British Journal of Nutrition 110 (2013)2. - ISSN 0007-1145 - p. 363 - 374.
tandem mass-spectrometry - 24-hour dietary recalls - colorectal-cancer - homocysteine metabolism - microbiological assay - alcohol-consumption - nutrient intake - dairy-products - folate intake - 10 countries
Different lifestyle patterns across Europe may influence plasma concentrations of B-vitamins and one-carbon metabolites and their relation to chronic disease. Comparison of published data on one-carbon metabolites in Western European regions is difficult due to differences in sampling procedures and analytical methods between studies. The present study aimed, to compare plasma concentrations of one-carbon metabolites in Western European regions with one laboratory performing all biochemical analyses. We performed the present study in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort among 5446 presumptively healthy individuals. Quantile regression was used to compare sex-specific median concentrations between Northern (Denmark and Sweden), Central (France, Germany, The Netherlands and United Kingdom) and Southern (Greece, Spain and Italy) European regions. The lowest folate concentrations were observed in Northern Europe (men, 10·4 nmol/l; women, 10·7 nmol/l) and highest concentrations in Central Europe. Cobalamin concentrations were slightly higher in Northern Europe (men, 330 pmol/l; women, 352 pmol/l) compared with Central and Southern Europe, but did not show a clear north–south gradient. Vitamin B2 concentrations were highest in Northern Europe (men, 22·2 nmol/l; women, 26·0 nmol/l) and decreased towards Southern Europe (P trend <0·001). Vitamin B6 concentrations were highest in Central Europe in men (77·3 nmol/l) and highest in the North among women (70·4 nmol/l), with decreasing concentrations towards Southern Europe in women (P trend <0·001). In men, concentrations of serine, glycine and sarcosine increased from the north to south. In women, sarcosine increased from Northern to Southern Europe. These findings may provide relevant information for the study of regional differences of chronic disease incidence in association with lifestyle.
The role and requirements of digestible dietary carbohydrates in infants and toddlers
Stephen, A. ; Alles, M. ; Graaf, C. de; Fleith, M. ; Hadjilucas, E. ; Isaacs, A. ; Maffeis, C. ; Zeinstra, G.G. ; Gil, A. - \ 2012
European Journal of Clinical Nutrition 66 (2012). - ISSN 0954-3007 - p. 765 - 779.
food-frequency questionnaire - one-year-old - fao/who scientific update - fructose corn syrup - preschool-children - nutrient intake - young-children - nutrition survey - dental-caries - national diet
Digestible carbohydrates are one of the main sources of dietary energy in infancy and childhood and are essential for growth and development. The aim of this narrative review is to outline the intakes of digestible carbohydrates and their role in health and disease, including the development of food preferences, as well the consequences of excess carbohydrate. Key experts in these fields provided up-to-date reviews of the literature. A search of available information on dietary intakes of children below the age of 4 years was conducted from 1985 up to 2010. Articles and reports including information about sugars and/or starch intakes were selected. A number of factors limit the ability to obtain an overall picture of carbohydrate intakes and food sources in this age group. These include small numbers of intake studies, differing approaches to analysing carbohydrate, a variety of terms used to describe sugars intakes and a dearth of information about starch intakes. Data suggest that sweet taste is preferred in infancy and later food choices. There are few established adverse consequences of high intakes of digestible carbohydrate for young children. The greatest evidence is for dental caries, although this is influenced by high intake frequency and poor oral hygiene. Evidence for detrimental effects on nutrient dilution, obesity, diabetes or cognition is limited. In infants, minimum carbohydrate (mainly lactose) intake should be 40% of total energy, gradually increasing to 55% energy by the age of 2 years.
Potential and requirements for a standarized pan-European food consumption survey using the EPIC-Soft software
Ocke, M.C. ; Slimani, N. ; Brants, H.A.M. ; Buurma-Rethans, E. ; Casagrande, C. ; Nicolas, G. ; Dofkova, M. ; Donne, C. le; Freisling, H. ; Geelen, A. ; Huybrechts, I. ; Keyzer, W. de; Laan, J.D. van der; Lafay, L. ; Lillegaard, I.T.L. ; Niekerk, E.M. ; Vries, J.H.M. de; Wilson-van den Hooven, E.C. ; Boer, E.J. de - \ 2011
European Journal of Clinical Nutrition 65 (2011). - ISSN 0954-3007 - p. S48 - S57.
24-hour diet recall - plasma carotenoids - level correlations - nutrient intake - nutrition - cancer - recommendations - questionnaires - calibration - validation
Background/Objectives: To describe the strengths, limitations and requirements of using EPIC-Soft software (the software developed to conduct 24-h dietary recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) in pan-European food consumption surveys, and to discuss potentials and barriers for a harmonized pan-European food consumption survey. Subjects/Methods: The paper is based on the experiences in the ‘European Food Consumption and Validation’ Project, which included updating six existing and preparing one new country-specific EPIC-Soft version, applying EPIC-Soft in validation and feasibility studies, and estimating the intake of nutrients and flavoring substances. The experiences were discussed in the September 2009 workshop ‘Pan-European Food Consumption Surveys—for Standardized and Comparable Transnational Data Collection’. Results: EPIC-Soft is suitable for detailed and standardized food consumption data collection in pan-European food consumption surveys. A thorough preparation of all aspects of the food consumption survey is important for the quality and efficiency during data collection and processing. The preparation and data-handling phase of working with EPIC-Soft is labor intensive and requires trained, motivated and qualified personnel. Conclusions: Given the suitability of EPIC-Soft as standardized dietary assessment tool in European dietary monitoring, the proposed strategy toward a pan-European food consumption survey is to prepare well, to allow flexibility in national extensions and to start with a limited number of countries that are interested
Estimation of micronutrient intake distributions: development of methods to support food and nutrition policy making
Verkaik-Kloosterman, J. - \ 2011
University. Promotor(en): Pieter van 't Veer, co-promotor(en): M.C. Ocké. - [S.l.] : S.n. - ISBN 9789085859451 - 192
sporenelementen - vitaminen - voedingsstoffenopname (mens en dier) - dieet - beleid inzake voedsel - volksgezondheid - fortificatie - voedselsupplementen - trace elements - vitamins - nutrient intake - diet - food policy - public health - fortification - food supplements

Adequate and safe micronutrient intake is important. Both insufficient and excessive intakes should be prevented as these can be associated with negative health effects. Therefore, the population intake distribution will ideally lay between insufficient and excessive intakes. For the development and evaluation of nutrition and food policy a good estimation of dietary micronutrient intake is of great importance.

Three challenges were addressed to improve the estimation of population micronutrient intake distributions: 1) how to estimate current habitual micronutrient intake when (detailed) data are lacking or data from different sources should be combined, 2) how to predict future intakes in order to support policy making, and 3) how to estimate a maximum safe fortification level per food item. The aim of this PhD-thesis is to further develop and apply statistical models which can cope with these challenges.

Methods & Results
Data from the Dutch National Food Consumption Surveys (DNFCSs) were used to develop and apply statistical models which can cope with the defined challenges. In addition, data from the Dutch food composition database (NEVO) and the Dutch dietary supplement database (NES) were used.

Three main methodological improvements have been made. First, the combination of a deterministic approach with probabilistic approaches to be able to take into account uncertainty and variability were needed. This method was applied to estimate habitual iodine and salt intake distributions. From DNFCSs no detailed information was available on the discretionary use of (iodized) salt and no up to date information was available on the use of iodized salt in industrially processed foods. Estimates of the proportion of the population discretionarily using (iodized) salt and the proportion of industrially processed foods applying iodized salt were obtained from other data sources. The model accurately estimates habitual iodine and salt intake distributions when compared with studies measuring urinary iodine and sodium excretion. Additionally a framework was developed to simulate the habitual intake distribution for potential scenarios of future fortification strategies. Within this framework, deterministic and probabilistic approaches were combined when uncertainty or variability had to be taken into account. This framework was illustrated by the estimation of habitual folate-equivalent intake for different scenarios of mandatory or voluntary fortification with folic acid. Further this framework was applied to estimate the habitual iodine intake for several potential changes in the Dutch iodine policy and also for several scenarios of salt reduction strategies.

A second methodological improvement was the development of a new statistical model to estimate habitual total micronutrient intake aggregated from food and dietary supplements. Within this 3-part model, habitual intake is estimated separately for a) intake from food for non-users of dietary supplements, b) intake from food for users of dietary supplements, and c) intake from dietary supplements for users only. Habitual total intake for the whole population was obtained by combination of the three separate habitual intake distributions (‘first shrink then add’). This 3-part model was illustrated by vitamin D intake for young children. With a more simple ‘first add then shrink’ approach the estimation of habitual total vitamin D intake distribution may give inconsistent results for the distribution of intake from foods and dietary supplements combined as compared to the intake from food only. In addition, this more simple approach may not be able to cope with multi modal distributions. With the newly developed model this inconsistency problem was solved and the multi-modal shape of the distribution as observed in the ‘raw’ data was preserved.

Third, a model calculating the maximum safe fortification level per 100 kcal of a food was developed for the Dutch situation. By considering the tolerable upper intake level and reasonable high micronutrient intakes from food and dietary supplements, the ‘free space’ for voluntary fortification was calculated. This amount was divided over the amount of energy intake that can and may be fortified. The model was applied to derive safe maximum fortification levels for vitamin A, D, and folic acid. Based on these results the risk manager decided to legally allow voluntary fortification with vitamin D and folic acid up to a maximum level of 4.5 and 100 μg/100 kcal respectively.

The methodological improvements have resulted in higher accuracy for estimations of habitual intake distributions, which are essential for nutritional and food policy making. Furthermore, scenario analyses provide (under specific conditions) quantitative insight into proposed changes or areas such as maximum safe fortification levels. Several results and methods described are currently being used in research to assist Dutch and European food and nutrition policy making, which shows these methodologies are of immediate value to the practice of policy development and support.

Multivitamin supplement use and risk of invasive breast cancer
Meulepas, J.M. ; Newcomb, P.A. ; Burnett-Hartman, A.N. ; Hampton, J.M. ; Trentham-Dietz, A. - \ 2010
Public Health Nutrition 13 (2010)10. - ISSN 1368-9800 - p. 1540 - 1545.
multimineral supplements - nutrient intake - national-health - united-states - folate intake - vitamin - fortification - determinants - population - prostate
Objective: Multivitamin supplements are used by nearly half of middle-aged women in the USA. Despite this high prevalence of multivitamin use, little is known about the effects of multivitamins on health outcomes, including cancer risk. Our main objective was to determine the association between multivitamin use and the risk of breast cancer in women. Design: We conducted a population-based case-control study among 2968 incident breast cancer cases (aged 20-69 years), diagnosed between 2004 and 2007, and 2982 control women from Wisconsin, USA. All participants completed a structured telephone interview which ascertained supplement use prior to diagnosis, demographics and risk factor information. Odds ratios and 95% confidence intervals were calculated using multivariable logistic regression. Results: Compared with never users of multivitamins, the OR for breast cancer was 1.02 (95% CI 0.87, 1.19) for current users and 0.99 (95% CI 0.74, 1.33) for former users. Further, neither duration of use (for >= 10 years: OR = 1.13, 95% CI 0.93, 1.38, P for trend 0.25) nor frequency (> 7 times/week: OR = 1.00, 95% CI 0.77, 1.28, P for trend 0.97) was related to risk in current users. Stratification by menopausal status, family history of breast cancer, age, alcohol, tumour staging and postmenopausal hormone use did not significantly modify the association between multivitamin use and breast cancer. Conclusions: The current study found no association between multivitamin supplement use and breast cancer risk in women.
Simple Food Group Diversity Indicators Predict Micronutrient Adequacy of Women's Diets in 5 Diverse, Resource-Poor Settings
Arimond, M. ; Wiesmann, D. ; Becquey, E. ; Carriquiry, A. ; Daniels, M.C. ; Deitchler, M. ; Fanou-Fogny, N.M.L. ; Joseph, M.L. ; Kennedy, G.L. ; Martin-Prevel, Y. ; Torheim, L.E. - \ 2010
The Journal of Nutrition 140 (2010)11. - ISSN 0022-3166 - p. 2059S - 2069S.
nutrient intake - variety - quality - determinants - perspective - cutoff - adults - mali
Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.
Dietary assessment methods for micronutrient intake in elderly people: a systematic review
Ortiz-Andrellucchi, A. ; Sanzech-Villegas, A. ; Doreste-Alonso, J. ; Vries, J.H.M. de; Groot, C.P.G.M. de; Serra-Majem, L. - \ 2009
British Journal of Nutrition 102 (2009)Suppl. 1. - ISSN 0007-1145 - p. s118 - s149.
food-frequency questionnaire - picture-sort - nutrient intake - relative validity - calcium intake - older adults - vitamin-c - validation - women - reproducibility
The European micronutrient recommendations aligned (EURRECA) Network of Excellence seeks to establish clear guidelines for assessing the validity of reported micronutrient intakes among vulnerable population groups. A systematic literature review identified studies validating the methodology used in elderly people for measuring usual dietary micronutrient intake. The quality of each validation study selected was assessed using a EURRECA-developed scoring system. The validation studies were categorised according to whether the reference method applied reflected short-term intake ( <7 d), long-term intake ( = 7 d) or used biomarkers (BM). A correlation coefficient for each micronutrient was calculated from the mean of the correlation coefficients from each study weighted by the quality of the study. Thirty-three papers were selected, which included the validation of twenty-five different FFQ, six diet histories (DH), one 24-h recall (24HR) and a videotaped dietary assessment method. A total of five publications analysed BM, which were used to validate four FFQ, and one 24HR, presenting very good correlations only for vitamin E. The analysis of weighted correlation coefficients classified by FFQ or DH showed that most of the micronutrients had higher correlations when the DH was used as the dietary method. Comparing only FFQ results showed very good correlations for measuring short-term intakes of riboflavin and thiamin and long-term intakes of P and Mg. When frequency methods are used for assessing micronutrient intake, the inclusion of dietary supplements improves their reliability for most micronutrients.
Evaluation of dietary diversity scores for assessment of micronutrient intake and food security in developing countries
Kennedy, G.L. - \ 2009
University. Promotor(en): Frans Kok, co-promotor(en): Inge Brouwer. - [S.l. : S.n. - ISBN 9789085855255 - 157
sporenelementen - sporenelementtekorten - mineraaltekorten - voedselzekerheid - voedingsstoffenopname (mens en dier) - dieet - ontwikkelingslanden - trace elements - trace element deficiencies - mineral deficiencies - food security - nutrient intake - diet - developing countries
Micronutrient malnutrition and food insecurity are widespread global public health problems. Micronutrient deficiencies affect one-third of the global population. Household food insecurity, often results in monotonous diets, a contributing factor to malnutrition. Consuming a varied diet comprised of diversity across food groups is a recommended approach to achieving nutritional requirements. Many organizations promote the collection of information on dietary diversity to inform food security and nutritional assessments, but there is not an agreed upon set of indicators used for this purpose. Simple, standardized diet-based indicators are needed to assess, monitor and evaluate individual micronutrient intake and household food security. This thesis has a two-fold aim i) to examine relationships between dietary diversity and adequate intake of micronutrients and ii) to consider outstanding methodological questions. These include, determining an appropriate cut-point for (in)adequate intake of micronutrients from the diet and the effect of length of recall period on characterizing dietary patterns.

The association between probability of adequate micronutrient intake and individual dietary scores was determined by secondary analysis of data sets of non-breastfed Filipino children (n=2805, 2-5.9y), South African children (n=2200, 1-8y), and urban Malian women (n=102, 15-49y). Dietary diversity scores were positively and significantly correlated with intake of micronutrients, with correlation coefficients of 0.36, 0.63, and 0.33 in the Philippines, South Africa, and Mali respectively. Using a minimum quantity for a food group to count in the score improved the correlations to 0.44 in the Philippines and 0.48 in Mali. The best score cut-offs for a dichotomous indicator of inadequate intake of micronutrients were four and six food groups in South Africa and six in the Philippines. In Mali, five or more food groups was the best cut-off point for increased mean probability of micronutrient adequacy. In Mali dietary diversity scores using six and nine food groups had slightly higher correlations and indicator performance than scores based on thirteen or twenty-one food groups. Differences in household-level dietary patterns over one and seven day recall periods were tested through secondary analysis in Somalia (n=430 hh), Burkina Faso (n=3640 hh), Lao PDR (n=3913 hh) and Northern Uganda (n=1956 ). In Somalia, the median dietary diversity score was four for both a one day and seven day recall period. The main food groups consumed by fifty percent or more of households in the lowest dietary diversity tertile were cereals, sugar and oil for both recall periods. The dietary patterns based on food group consumption using score tertiles in Burkina Faso, Lao PDR and Northern Uganda were similar for one or seven days.

This thesis shows that dietary diversity scores are acceptable indicators of micronutrient intake from the diet. Requiring a minimum quantity of consumption for a food group to count in the score is better, but jeopardizes simplicity. The best cut-off for a dichotomous indicator differed across studies, but fell within the range of four to six food groups for predicting poor intake in children and five or more food groups to predict higher probability of adequate intake in women of reproductive age. Cost implications of misclassification and social unacceptability of false results are low for this indicator. For the purposes of characterizing dietary patterns of households at population level a one day recall period is sufficient. The simplicity of data collection and analysis of indicators of dietary diversity should enable more widespread and repeated collection of information on dietary intake in resource constrained, food insecure environments. Areas for further research include, the added value of assigning weights to food groups and studies in populations with higher average micronutrient intakes to better define an appropriate cut-point for a dichotomous indicator. It is recommended that dietary diversity scores be incorporated as monitoring and evaluation tools in food security and nutrition assessments at national level and below.

Satisfying giant appetites : mechanisms of small scale foraging by large African herbivores
Pretorius, Y. - \ 2009
University. Promotor(en): Herbert Prins; R. Slotow, co-promotor(en): Fred de Boer. - [S.l. : S.n. - ISBN 9789085854784 - 141 p.
herbivoren - afrika - ruwvoer (forage) - foerageren - zoekgedrag - morfologie - monddelen - voedingsstoffenopname (mens en dier) - lichaamssamenstelling - lichaamsgewicht - lineair programmeren - allometrie - grote grazers - herbivores - africa - forage - foraging - searching behaviour - morphology - mouthparts - nutrient intake - body composition - body weight - linear programming - allometry - large herbivores
Variation in body mass allows for resource partitioning and co-existence of different species. Body mass is also seen as the main factor governing nutrient requirements in herbivores as metabolic rate and requirements have often been found to scale to ¾ power of body mass. Although the consequences of body mass on foraging behaviour of herbivores has been extensively studied, the mechanism behind how body mass differences determines the small scale foraging patterns of especially larger herbivores, has up to now been unclear. In this study, I looked at how body mass and small scale vegetation characteristics shaped the mouth morphology of herbivores and how body mass of a herbivore affects the scale at which intake is maximized. The results indicate that the dilution of plant mass and more specifically leaf mass in space requires that mega-herbivores such as elephant have enlarged soft mouth parts to compensate for this dilution. Finally, I demonstrate, using linear programming techniques with multiple nutrients as constraints, how a mega-herbivore’s daily diet choice is determined by forage abundance whereas a small herbivore is more constrained by fibre.
Oranje cassave tegen ondervoeding
Brouwer, I.D. - \ 2008
Kennis Online 5 (2008)dec. - p. 11 - 11.
ondervoeding - voedingsstoffenopname (mens en dier) - vitaminetekorten - cassave - undernutrition - nutrient intake - vitamin deficiencies - cassava
De halve wereldbevolking krijgt te weinig vitaminen en mineralen binnen. Internationaal proberen wetenschappers in basisgewassen als rijst, maïs en cassave het niveau van vitamine A, zink en ijzer te verhogen. Wageningse onderzoekers kijken naar de opname van de stofjes
Dietary folate intake: is there a need for folic acid fortification in the Netherlands?
Winkels, R.M. - \ 2008
University. Promotor(en): M.B. Katan, co-promotor(en): P. Verhoef; Ingeborg Brouwer. - S.l. : S.n. - ISBN 9789085852001 - 133 p.
foliumzuur - foliumzuurtekort - fortificatie - dieet - voedingsstoffenopname (mens en dier) - vitamine b12 - biologische beschikbaarheid - dieetrichtlijnen - nederland - geslacht (gender) - folic acid - folic acid deficiency - fortification - diet - nutrient intake - vitamin b12 - bioavailability - dietary guidelines - netherlands - gender
Design Characteristics of Food Frequency Questionnaires in Relation to Their Validity
Molag, M.L. ; Vries, J.H.M. de; Ocke, M.C. ; Dagnelie, P.C. ; Brandt, P.A. van den; Jansen, S.C. ; Staveren, W.A. van; Veer, P. van 't - \ 2007
American Journal of Epidemiology 166 (2007)12. - ISSN 0002-9262 - p. 1468 - 1478.
dietary assessment methods - doubly-labeled water - energy-intake - nutrient intake - assessment instruments - history questionnaire - biochemical markers - urinary nitrogen - weighed records - womens health
The authors investigated the role of food frequency questionnaire (FFQ) design, including length, use of portion-size questions, and FFQ origin, in ranking subjects according to their nutrient intake. They also studied the ability of the FFQ to detect differences in energy intake between subgroups and to assess energy and protein intake. In a meta-analysis of 40 validation studies, FFQs with longer food lists (200 items) were better than shorter FFQs at ranking subjects for most nutrients; results were statistically significant for protein, energy-adjusted total fat, and energy-adjusted vitamin C. The authors found that FFQs that included standard portions had higher correlation coefficients for energy-adjusted vitamin C (0.80 vs. 0.60, p <0.0001) and protein (0.69 vs. 0.61, p = 0.03) than FFQs with portion-size questions. However, it remained difficult from this review to analyze the effects of using portion-size questions. FFQs slightly underestimated gender differences in energy intake, although level of energy intake was underreported by 23% and level of protein intake by 17%. The authors concluded that FFQs with more items are better able to rank people according to their intake and that they are able to distinguish between subpopulations, even though they underestimated the magnitude of these differences.
Invloed stikstofbemesting grasland op voorziening mineralen en spoorelementen rundvee
Remmelink, G.J. ; Holshof, G. ; Ouweltjes, W. - \ 2005
Lelystad : Animal Sciences Group (PraktijkRapport / Animal Sciences Group, Praktijkonderzoek : Rundvee ) - 70
stikstofmeststoffen - melkvee - graslanden - voedingsmineralen - sporenelementen - rundveevoeding - voedingsstoffenopname (mens en dier) - melkveehouderij - nederland - nitrogen fertilizers - dairy cattle - grasslands - dietary minerals - trace elements - cattle feeding - nutrient intake - dairy farming - netherlands
Het rantsoen op Nederlandse melkveebedrijven verandert. Boeren bemesten minder, gebruiken vaker klaver en het areaal beheers- en natuurland neemt toe. Bij een ruim ruwvoeraanbod neemt het aandeel krachtvoer af. Dit heeft consequenties voor de mineralen- en spoorelementenvoorziening van het rundvee. Tegen welke risico's lopen veehouders aan en welke mineralen en spoorelementen moet je zeker in de gaten houden? Het Praktijkonderzoek van de Animal Sciences Group heeft onderzoek op proefveld- en praktijkschaal uitgevoerd
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