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20 EVA ROOS AND RITVA PRÄTTÄLÄ TABLE 5 Daily intake of foods by meal pattern of 888 women and 801 men Food items g/10 MJ Conventional Other meal Δ 3M–2M, p-value meal pattern pattern adjusted for adjusted for (3M), (2M), age and age and unadjusted unadjusted region region Men (N=371) (N=430) Milk 359 345 1 0·96 Cereals 95 68 26 0·001 Bread 167 151 10 0·05 Cheese 28 31 −2 0·42 Cooked dishes 387 366 24 0·05 Potatoes, pasta and rice 154 142 17 0·02 Cooked vegetables 22 23 0 0·90 Fresh vegetables 71 65 9 0·10 Desserts and cakes 160 145 9 0·28 Fruit & berries 155 174 −13 0·25 Juices 135 125 5 0·71 Coffee and tea 543 627 −83 0·0005 Sweet and salty snacks 37 43 −6 0·13 Women (N=377) (N=511) Milk 373 303 57 0·002 Cereals 123 81 33 0·0002 Bread 144 138 3 0·50 Cheese 37 47 −7 0·005 Cooked dishes 383 364 14 0·22 Potatoes, pasta and rice 135 117 21 0·002 Cooked vegetables 34 34 1 0·83 Fresh vegetables 104 114 −2 0·75 Desserts and cakes 207 189 8 0·40 Fruit & berries 241 288 −45 0·0006 Juices 147 147 −5 0·69 Coffee and tea 639 733 −86 0·002 Sweet and salty snacks 43 54 −11 0·005 or snacks were not coded at all. It may have been difficult for subjects to code eating occasions as only meals or snacks; perhaps more pre-coded alternatives in the good record, e.g. drinks, would have decreased the frequency of uncoded eating occasions. Meals contributed to more than half of the daily energy and therefore retained their importance over snacks or other eating occasions during the day. However, the proportion of energy intake derived from meals (55%) was lower than that found in British and North American studies (Kennedy et al., 1982; Summerbell et al., 1995) and what was recommended in the Swedish nutrition and food recommendations (Standing Nordic Committee on Food, 1989). Uncoded eating occasions were quite commonly reported in our study, and probably some of the energy involved was actually derived from uncoded meals. Another possible reason why meals in Finland provided less of the daily energy intake than in the U.K. and U.S.A. is cultural differences in meal pattern or in defining eating occasions. The meaning of the words meal and snack might be different in Finland compared to their everyday use in the English language. For example, what is in this study meant by ‘‘meal’’ might be

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS 21 better translated into English as a ‘‘proper meal’’ (Prättälä et al., 1993) and what is in this study meant by ‘‘snack’’ might be better translated into ‘‘sandwich meal’’. Also lay people and nutritional educators seemed to define eating occasions, especially breakfast, differently. Moreover, the studies themselves applied different methodologies and meal definitions. Meals contribute to protein and fat intake and snacks to sugar and alcohol intake. The macronutrient density (alcohol excluded) in the present study compares favourably with data from Virtanen (1988), who looked at the nutrient density in meals and snacks of Finnish adolescents. The only exception was the higher content of sugar among the young people’s snacks. Previous researchers have also found snacks to be higher in carbohydrate and sugar densities, and lower in protein and fat compared with meals (Pao & Mickle, 1981; Kennedy et al., 1982; McCoy et al., 1986; Summerbell et al., 1995). Differences in nutrient densities of meals and snacks can be explained in terms of food densities. In Finland cooked dishes are a primary source of fat (Roos, Kleemola & Pietinen, 1995b), so the high density of cooked dishes explains partly the high fat contribution of meals. The high consumption of vegetables during meals explains the high intake of carotenoids, and the high consumption of fruits, berries, desserts and cakes during snacks the high intake of sugars and vitamin C. Fruits, berries and fruit juices consumed as snacks seem to be more common in Finland than in the U.S.A. because we found a higher vitamin C density in snacks than meals, in contrast to the U.S.A. (Thomas & Call, 1973; Kennedy et al., 1982; McCoy et al., 1986). Findings of earlier studies in young people that snacks contribute far more than just ‘‘empty calories’’ (Thomas & Call, 1973; McCoy et al., 1986) are confirmed among adults by our findings. In fact, the fat density of snacks in our study was closer to the national recommendations (National Nutrition Council, 1989) than that of the meals. On the other hand, the sugar and fibre densities of meals were closer to the recommendations than those of snacks. Nutrient densities of snacks and meals are different and we find favourable and less favourable ‘‘components’’ in both meals and snacks. The results of this study suggest, that meal pattern had only a small effect on diet and that meal pattern did not influence the healthfulness of the diet. Meal pattern had no effect on nutrient intake in men, but some effect in women; alcohol and vitamin C intakes were lower and cholesterol intake higher among women following the conventional meal pattern. Even though the differences between the meal pattern groups in women were significant, they were not large, and it is impossible to state that one meal pattern group had a more healthy diet than the others. The response rate in this study was 66% and those who answered the questionnaire had probably a healthier lifestyle than those who did not. It is possible that an association between meal pattern and the quality of diet existed in the entire population, but was not observed in this study due to selection bias. It is also possible that only a very irregular meal pattern (no warm meals daily) lowers the nutrient quality of diet. Finns eating very irregularly, i.e., less than two meals per day were too few for statistical analysis. A larger number of respondents would probably have permitted significant differences to emerge between this group and the others. Although meal pattern had no effect, or only a minor one, on nutrient intake, it had more influence on food intake. The intakes of cereals (porridge), potatoes, rice and pasta, and cooked dishes were higher and those of cheese, fruits and berries,

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