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NUTRIENT INTAKE

12 EVA ROOS AND RITVA

12 EVA ROOS AND RITVA PRÄTTÄLÄ 1989): breakfast should provide you 1/4 of the daily energy intake, lunch and dinner both about 1/3, and the remainder should come from 1–2 snacks. Such recommendations are not based on scientific evidence, but on practical experience and the assumption that a regular pattern of warm meals guarantees a varied diet (Bruce, 1987; 1991; Standing Nordic Committee on Food, 1989). Although nutritional scientists have been worried about snacking patterns, especially among children and teenagers (Thomas & Call, 1973; Gillespie, 1983; McCoy et al., 1986; Dugdale, Townsend & Rigsby, 1988; Anderson, Macintyre and West, 1993; Cross, Babicz & Cushman, 1994) and obese (Birckbeck, 1981; Basdevant, Craplet and Guy-Grand, 1993), meal patterns have received little attention in studies. A complication in meal pattern studies is that definitions of meals and snacks are not universal. In medical research, meals have been defined as any eating occasion (e.g. Franceschi, La Vecchia, Bidoli, Negri & Talamini, 1992; Fabry & Tepperman, 1970) while in sociological studies a meal is regarded as a social event (see Mäkelä, 1991, for review). In nutritional studies meals are usually defined by time, e.g. breakfast, lunch and dinner, and snacks as eating occasions between these meals (Pao & Mickle, 1981; Kennedy, Harrell & Frazao, 1982; Haraldsdottir, Holm, Jensen & Møller, 1987; Morgan, Johnson & Stampley, 1988; Virtanen, 1988; Ryan, Craig & Finns, 1992; Anderson et al., 1993; Prätälä et al., 1993; Roos, Quandt & DeWalt, 1993; Summerbell, Moody, Shanks, Stock & Geissler, 1995). Time-based meal definitions can also be found in dietary recommendations (Standing Nordic Committee on Food, 1989). In some nutritional studies, however, meal definitions are based on the food and nutrient composition of eating occasions (Johansson, Callmer & Gustafsson, 1992; Lennernäs, Åkerstedt, Hagman, Bruce & Hambraeus, 1993; Rothenberg, Bosaeus, Steen, 1994). Because food is eaten as meals and snacks, not as single food items or nutrients, investigations of meal patterns have relevance for nutritional educators and food policy planners, as well as for multidisciplinary food research (Prättälä, 1991; Johansson et al., 1992; Holm, 1993). Since meals have social as well as nutritional significance, research on meals, by focusing on overlapping issues in the two fields, could narrow the gap between the social and nutritional sciences. In addition, dietary assessment methods could be improved by incorporating evaluations of meal patterns (Kohlmeier, 1994). The main question in the present study was: is a conventional meal pattern of breakfast, lunch and dinner healthier than other meal patterns including fewer meals? Nutrient contents of meals, snacks and other eating occasions of the study participants were compared, and the differences in dietary intake between those following a conventional three-meal daily pattern and those eating fewer meals were analysed. SUBJECTS AND METHODS Subjects The subjects and their recruitment have been described earlier (Kleemola, Virtanen & Pietinen, 1994; Roos, Ovaskainen & Pietinen, 1995a). Briefly, 1861 adults (991 women and 870 men) who participated in a dietary survey in spring 1992 and had completed a 3-day food record were included in this study. The subjects were aged 25–64 years and from four different regions of Finland; North Karelia (rural),

MEAL PATTERN AND NUTRIENT INTAKE AMONG ADULT FINNS 13 Kuopio (urban+rural), Turku-Loimaa (urban+rural) and Helsinki-Vantaa (urban). The original random sample was stratified by 10-year age groups, regions and sex. The response rate was 66% of the 2822 people contacted. Younger people, men and those who from the metropolitan area of Helsinki-Vantaa had lower response rates than others. Because our definition of a conventional meal pattern was time-based, we excluded 160 shift workers (men 60, women 100) from the meal pattern analyses. We also excluded 12 subjects for missing values in the meal pattern question. Altogether, 1689 subjects (801 men and 888 women) were used in the analyses of meal patterns. Questionnaire and 3-day Food Record All participants completed a mailed questionnaire before their study visit to a local health centre, where all answers were checked. In addition to several questions on socioeconomic status, health, smoking, alcohol intake and food habits (not reported here), the questionnaire included one question on meal pattern. During their examination on a weekday at the health centre, the participants were also asked to keep records of all the foods and beverages they consumed over the following three days. They were personally instructed on how to keep a food record starting the following morning. All days of the week were included in the results, with weekend days slightly over-represented. Amounts of food were estimated using a 63-page picture booklet or household measures. The record was open-ended and the subjects were asked to note the time, place (pre-coded) and company (precoded) of every eating occasion, and also to define each one as either a meal or a snack. Meal Patterns, Meals and Snacks The conventional meal pattern was defined by criteria outside this study. The definition was based on national dietary guidelines and recommendations for special population groups such as children, the elderly, sportsmen, and for hospital catering (National Board of Health, 1989; 1990; Ministry of Social Affairs and Health, 1992; 1994). All these guidelines assume a meal pattern of 3 meals and 2–3 snacks during the day. A warm lunch and dinner are not recommended in every case, but a warm meal is considered more nutritious than a cold one. In our study the conventional meal pattern meant 3 meals during the day: breakfast, warm lunch, and warm dinner. The other meal pattern types were ‘‘2 meals per day’’ or ‘‘one meal or less per day’’. Subjects who had a conventional meal pattern were identified with the help of the mailed questionnaire. The question on meal pattern included in the questionnaire was structured into six time-based options: breakfast, snack in the morning, lunch, snack in the afternoon, dinner, and snack in the evening. For every eating occasion the subjects could choose between three pre-coded alternatives: 1. Do not eat, 2. Eat warm prepared food (including porridge) or 3. Eat something else—what? This question identified those who usually ate breakfast, warm lunch and warm dinner. Lunch and dinner was considered as a meal if the food eaten was warm. They were not defined by the type of food eaten at the eating occasion. This definition was used because of the structure of the meal pattern question. Breakfast was considered as a meal if 1. it was warm (e.g. porridge) or 2. the subject had something to eat (not just liquids) before 10 o’clock in the morning according to his/her food

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